Tender Loving Care South West

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

We identified a breach of regulation relating to safe recruitment.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Accident and incident records showed investigations had been completed, however opportunities to identify areas of learning and improvement were not always identified.

There was evidence of learning and improvement in relation to the management of medicines. Where audits had identified issues with staff documentation, additional support and training was provided to staff and subsequent audits identified improvements in accuracy.

Staff said they could talk to the registered manager at any time and were confident any concerns raised would be listened to and acted on promptly.

Staff received informal training and support from external professionals to meet people’s specific needs. Professionals told us, “Staff have been willing to be trained up on things which they may be required to be part of, such as PEG (Percutaneous Endoscopic Gastrostomy) feeding”.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service ensured people’s needs were assessed and identified before support was provided. The registered manager normally visited people at home or in hospital as part of the assessment process to gain a full understanding of the person’s needs and expectations. Information gathered during the assessment process was used as the basis from which people’s care plans were developed.

The service worked collaboratively with health service partners to ensure people needs were consistently met when care was transferred. The service worked effectively with community services and the registered manager told us, “I have a good rapport with the district nurse and am able to help people get home”.

The provider worked with people to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. However, where decisions had been taken in people’s best interests these had not been consistently recorded.

Most people had capacity to make decisions for themselves and controlled how their support was provided. Where people’s capacity to make decisions fluctuated the service had consistently acted in the person’s best interests. However, these decisions and associated assessments of people’s capacity to make specific decisions had not always been recorded. This meant we were unable to assess if the decisions were proportionate and in the person’s best interest. Following feedback, the registered manager reviewed these decisions to ensure they were in people’s best interests and updated care records.

People told us they felt safe using the service. Their comments included, "I feel very safe”, “They make sure that I have all that I need” and “They are the best carers I have ever had”. The registered manager had systems to support staff to identify and report safeguarding concerns. Care staff had received safeguarding adults training. They were able to demonstrate they would recognise possible signs of abuse and understood it was their responsibility to report any concerns. Staff were confident any safety concerns they reported would be acted upon. They told us, “People are safe” and “Concerns are dealt with very well”. Staff promptly reported any safety concerns, and the registered manager was willing to challenge others to ensure people's safety. Records showed the registered manager had previously made prompt and appropriate safeguarding alerts in response to concerns identified by staff.

People were given information packs, when they joined the service, which included information on how to report any safety concerns.

Care records showed all planned visits had been provided and no one we spoke with reported having experienced a missed care visit. People told us, “They always turn up and they let you know when they are coming” and “No missed visits, sometimes in an emergency they are late but they always come”. Staff were confident care visits were not missed. They told us, “I have never, never known a missed visit” and “No missed visits. I do the Padstow / coast run. We never miss any calls”.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s care plans included guidance for staff on how to manage and mitigate identified risk in relation to the environment of people’s home and their support needs.

Staff supported people to mobilise safely during our observed visits and used equipment appropriately when required. Care plans included guidance for staff on how they should support people to manage identified risk. People sometimes made decisions which put them at increased risk. When this occurred, staff reminded people of the risks they were taking, to ensure people understood the possible consequences of their choices and actions.

Where staff identified concerns in relation to people’s health needs, they encouraged and supported people to promptly request assistance from health professionals. Relatives told us, “They have picked up potential bed sores on [my relative] and organised for the district nurse to visit. They have been brilliant”. Where professionals had provided guidance on the management of specific risks, staff had acted on the guidance provided and this information was available in the person’s care records.

Staff ensured people had access to drinks and snacks between visits and encouraged people to remain well hydrated. At the end of each care visit staff ensured people had access to any life-line devices to enable people to call for emergency support if required.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The service had systems to ensure all lifting equipment in people’s homes was regularly tested and serviced. As part of the service’s emergency and adverse weather planning the prioritisation of each person’s support needs had been identified based on their level of needs and access to other support networks.

During care visits staff ensured risks in people’s environment were mitigated and that where available, people had access to their lifelines for use in the event of an emergency between care visits.

The provider did not make sure staff were recruited safely. There were enough skilled and experienced staff. However, they had not always received effective support, supervision and development.

Staff were not recruited safely. Necessary pre-employment checks, designed to ensure people were protected from potentially abusive staff, had not been completed before new staff were permitted to work independently. Full employment histories had not been recorded and references from previous employers in the care sector had not been requested prior to staff being appointed. This meant people using the service were unnecessarily exposed to significant risk of harm and was a breach of the regulations in relation to fit and proper persons employed.

Staff new to the care sector had received an induction to the service but had not promptly completed the care certificate. This training is designed to ensure all staff new to care gain an understanding of current best practice. When new staff were recruited, they were supported by a peer who acted as their mentor, providing advice, guidance and support and supported during their first weeks of employment. Recently recruited staff told us they were not expected to provide support independently until they felt confident to do so.

Care staff received regular supervision, probation review meetings when first employed and staff meetings occurred regularly. However, senior carers and the deputy manager had not received regular supervision. Records showed staff training had been recently updated to ensure staff had the skills necessary to meet people’s needs. Staff told us they felt well supported and their comments included, “I have got all my online training, I have a couple to do this month”.

Rotas were well organised and included time for staff to travel between consecutive care visits. The service had enough staff to meet people’s support needs and bank staff were employed to ensure sufficient staff were available to cover for holidays and unexpected staff absences.

Call monitoring records showed staff normally arrived on time and stayed with people for the allocated time. People told us staff did not rush and we observed staff providing support at a relaxed pace with kindness and compassion. People said, “They have enough time”, “I can have a chat with them” and “They always come within 15 mins of when the visit is due”.

Relatives were also complimentary of the staff team and told us, “On the whole they are very good”, “They are very caring, very supportive, and they support me as well” and “The staff are very good”. Staff said they had enough time to support people and commented, “I’m normally on time, sometimes early, in summer there is a lot more traffic but most of the time I’m on time. I am not rushed at all”.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had received training in the management of infection control risks and had access to good stocks of Personal Protective Equipment (PPE) when required. We observed that staff washed their hands between different care tasks and used PPE correctly when needed. Team meeting minutes showed infection control best practice was regularly discussed.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Most people managed their own medicine with help from family members. In these situations, staff checked during visits that people had taken their medicines. Where staff supported people to manage their medicines this was detailed in the person’s care plans and staff documented the support they provided on a paper Medicines Administration Record (MAR).

Staff had received medicines training and their competence to support people with medicines had been assessed. Medicines audits had been completed regularly and where issues were identified these had been addressed with staff. Recent audits showed improvements in the accuracy of MAR recording and that action had been take in response to issues identified in earlier audits.

Body maps were available detailing where creams should be applied but details within MAR charts did not always clearly record when support had been provided to apply creams