Tender Loving Care South West

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 61 (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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

People and their relatives were complimentary of their kind and caring staff. Their comments included, “We put the world to rights. We do have a laugh and a joke”, “The staff seem in good spirits” and “On the whole they are very good indeed, friendly and take an interest in my relative”.

Staff told us the provider issued them with a handbook when they joined the service which included their mission statement, “The main purpose of Tender Loving Care is to provide quality care for our clients”.

Staff took pride in their work and showed commitment to supporting people to continue living as independently as possible. Staff comments included, “It is about the care and safety of the person, first and foremost” , “I like to go home and feel I have made a difference to someone”, “It is a lovely job, I really enjoy it” and “I would be happy for a friend or relative to work here”. During our observed visits one person needed additional support as they were not feeling well. Staff were patient and took the additional time necessary to ensure the person’s needs were met with compassion.

Not all leaders understood the context in which the provider delivered care, treatment and support. Leaders did not always have the knowledge and skills necessary to ensure the service consistently met the requirements of the regulation. The leadership was open and honest about recent challenges and took action in response to feedback provided.

Senior staff had not received regular supervision from the registered manager, this meant opportunities to discuss their development, review performance and provide support were missed.

However, the registered manager regularly worked alongside staff providing care and support. People told us the registered manager visited them regularly and commented, “The registered manager is very good for talking with you, if I’m not well or I have a problem they always have time to listen”. However, some relatives raised concerns about the registered manager’s communication style commenting that they could be, “a bit blunt”.

Staff spoke positively of the registered manager and the support and guidance they provided. They told us, “[The registered manager] is really supportive and kind. Always has time for us”, “If you have a problem [registered manager] and [training manger] are always there for you”

and “I don’t have a problem at all, [The registered manager] is a good boss”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

People knew how to contact the registered manager if they had any concerns and told us, “If I had a complaint I would be happy to phone or email”. Everyone received an information pack when they joined the service which included contact details for the registered manager and details of the service’s complaints procedure. All complaints received had been investigated and where possible action taken to prevent similar events reoccurring.

Staff were confident the registered manager would listen to and act upon any issues or concern they reported.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The registered manager valued the staff team. They told us, “The way I see it I have a good team, they live locally, and I want to keep [the business] small and personal”. Staff were treated fairly and requests for reasonable adjustments to staff working practices were met where possible. One recently recruited staff member experienced challenges accessing the service’s digital training system. As a result, the provider’s training manager had sat with the new staff member and supported them to access these systems.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The service was led by a registered manager, who was supported by a deputy manager and a training and health and safety manager. The roles and responsibilities of the registered manager and deputy manager were not clearly defined or understood by staff.

The service’s governance systems were ineffective and had failed to ensure compliance with the requirements of all the regulations. Processes had not ensured staff were recruited safely. In addition, new staff had not received appropriate induction training and best interest decision making had not been appropriately documented.

Prior to the inspection, issues were identified with the effectiveness of the service’s governance arrangements by the local authority quality assurance team. The registered manager was engaging positively with the local authority and a local care provider to improve service performance. All care plans had been reviewed and updated prior to the inspection and accurately reflected people’s current needs. The registered manager reported audits of daily record keeping were completed, however these checks had not been documented. The lack of effective quality assurance systems meant the provider was in breach of the regulation relating to governance.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The service worked in partnership with others to ensure they provided a quality service and the people they supported were safe. One person regularly attended a day centre and the service adjusted the timings of visits to accommodate this.

Managers and senior care staff understood what partners and stakeholders were available to the service and how best to access their support. Senior care staff engaged effectively with district nurses, occupational therapists, GPs and community matrons to ensure people’s needs were met. Health professionals were complimentary of the service’s performance and told us, “They have always been very responsive to calls or messages and it is rare that I have not been able to contact them, They are willing to help if they can and they will contact me or the surgery if they are concerned about a patient. They call ambulances when required”.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

The provider did not ensure learning was identified and acted upon following incidents, accidents or complaints. Although these events had been recorded, opportunities for learning and improvement had been missed. Managers had not documented their reviews of these incidents. Where information on the management of risk had been informally shared with staff, people’s care plans had not been consistently updated with guidance for staff.