Tender-Hearted Limited

Tender-Hearted Care Limited is a domiciliary care agency and provides personal care to adults living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. 13 people were receiving personal care at the time we inspected.

People’s experience of using this service and what we found

We found not enough improvements had been made, the service continued to be in breach of regulations and people had been placed at risk of significant harm.

Medicines were not always managed safely. When people had missed medicines, the service had not always reported this to the local safeguarding team and had not instructed staff to monitor the person for any signs or symptoms they may be unwell. Audits had identified that medicines were not always signed as administered. Actions had not been taken to investigate why there was no signature, and if the person had taken their medicine.

The recording of accident and incidents had been improved; however, the provider/registered manager told us accident and incidents were still not reviewed on a regularly basis to identify themes and trends and ensure the correct actions had been taken. This had resulted in reportable incidents not being notified to the local safeguarding team and to CQC.

Governance systems were either not in place, or robust enough to identify and improve the quality of the service. Audits had not always been completed or, when they had, no actions had been taken to improve the areas of concern found. Governance systems had not always identified when people’s health, safety and well-being were at risk and people had been placed at risk of significant harm.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

At our last inspection we identified people did not always have the paperwork in place to demonstrate their capacity to make specific decisions had been assessed and that the least restrictive decision had been made in their best interest. We found no improvements to the provider/registered managers understanding of the Mental Capacity Act 2005 (MCA) and no improvements to the systems and processes had been made placing people at risk of significant infringements to their rights and/or welfare.

The provider had relocated to a new address and had failed to notify CQC. The registered manager had not taken action since our last inspection to improve their competence, skills and experience required to manage the carrying on of the regulated activity and people had been placed at risk of significant harm.

Feedback had been sought from people using the service and from the staff, results had not yet been reviewed. Since our last inspection improvements had been to ensure staff were recruited safely into the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement and there were breaches of regulation (published 22 February 2023). At this inspection we found not enough improvements had been made and the provider was still in breach of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and Regulations 15 and 18 of the Registration Regulations 2009 Notifications of other incidents.

Enough improvement had been made and the service was no longer in breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to follow up on the breaches we identified at our last inspection due to the concerns we found. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Enforcement and Recommendations

We have identified breaches in relation to the requirements of registered managers, safe care and treatment, good governance and notifying CQC of reportable incidents and reportable notice of changes.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Arena Business Centre is also known as Tender-Hearted Care. Tender-Hearted Care is a domiciliary care agency and provides personal care to adults living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. 18 people were receiving personal care at the time we inspected.

People’s experience of using this service and what we found

People told us the registered manager and staff were kind, caring and their needs were met. One person told us, “Best care I have ever had. The staff are so caring, so hands on, they would do anything to help.”

The provider, also the registered manager was open and transparent throughout the inspection. They told us their focus had been providing hands on care to people using the service and working with new staff to Tender-Hearted Care. This meant they were unable to oversee the running of the service. We found the lack of oversight and governance had led to our inspection identifying areas of improvements.

People had been recruited into the service without complete background checks. Systems were not in place to robustly check the recruitment process.

Medicines were not managed safely. Medication administration charts (MAR) had not been completed and showed people did not always get their medicines as prescribed. Systems and processes had failed to identify MAR were not completed.

We found that people who lacked capacity had not always been assessed and reviewed within the principles of the Mental Capacity Act 2005 (MCA). This meant, people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Systems and processes were not robust to ensure good governance of the service. Frameworks were not in place to ensure good quality care could be delivered consistently. Audits were either not in place or not robust to identify any concerns. There was not a robust accident and incident reporting system in place. This meant any areas of improvements were not identified, themes and trends were not identified and placed people at risk of not having their care needs met and safeguarded against.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

People were not supported to have maximum choice and control of their lives, this meant staff were unable to supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care:

People's care, treatment and support plans had not always been updated and did not show how people had been involved. The service had identified care plans were not up to date and were in the process of updating them.

Staff had training on how to recognise and report abuse and they knew how to apply it. Systems and processes needed to be improved to ensure the service identified and protected people from abuse.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity.

Right Culture:

The quality of the care people received had not always been monitored and reviewed to ensure people's needs were met.

People and those important to them, including advocates, were involved in planning their care.

Staff had access to personal protective equipment (PPE) and people told us staff wore this appropriately, kept their homes clean and were regularly observed to wash their hands.

Staff knew how to recognise signs and symptoms of abuse and who to report their concerns to. People told us they felt safe with staff.

Staff felt valued, supported and appreciated by the registered manager. Staff told us they felt proud to work for Tender-Hearted Care and felt people received good care.

People had their needs assessed before care was delivered. The service had good working relationships with social workers and arranged healthcare professionals as required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 December 2021). The service remains rated requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 17 November 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe recruitment of staff into the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arena Business Centre on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the management of medicines, good governance of the service, safe recruitment of staff into the service and the making of appropriate statutory notifications to CQC.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Arena Business Centre is also known as Tender-Hearted Care. Tender-Hearted Care is a domiciliary care agency and provides personal care to adults living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. 10 people were receiving personal care at the time we inspected.

People’s experience of using this service and what we found

Staff had not always been recruited safely as records showed recruitment checks had not been completed to ensure suitable staff had been recruited to work with older people. The registered manager had employed a person responsible for the recruitment of staff. Following our inspection, they told us they would review and update all current staff recruitment files and going forward would oversee the recruitment of all new staff.

Tender-Hearted Care had implemented systems and processes, since the last inspection, which had led to improvements throughout the service. We received positive feedback from people who used the service and their relatives. People and their relatives told us they felt safe with the support and care from staff. People had been assessed to ensure any risks were mitigated. Medicines were managed safely, and infection prevention and control procedures were adhered to. There were enough staff and recruitment was ongoing.

The service sought healthcare professional support for people where required in a timely manner. We received positive feedback from healthcare professionals telling us how well the service worked with them to improve the lives of people using the service. Staff felt supported and had received an induction and subsequent training to ensure they had the skills to provide care to people using the service. Where people required support to eat and drink people told us staff gave them a choice and assisted appropriately as needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were kind and caring. The service provided person centred care and the registered manager spoke passionately about the people who used the service and the ways in which the service works to ensure people’s rights and wishes were upheld.

People said they felt listened to and told us the service was responsive to their changing needs. Care plans were detailed and reviewed regularly or when peoples care needs changed. People knew how to make a complaint or raise a concern and were confident it would be addressed promptly by the management of the service.

Systems to assess the quality of the service meant it was continually learning and developing. Accidents and incidents within the service were used to make improvements. There were checks at provider level with a focus on compliance to ensure the service operated safely.

People, relatives, staff and healthcare professionals provided positive feedback about the registered manager and felt the service was well-led. Staff knew and understood their job roles and responsibilities. Staff felt empowered and proud to work for Tender-Hearted Care and felt involved in the running of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update: The last rating for this service was inadequate (published 22 July 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found improvements had been made and the provider was no longer in breach of Regulation 9 (Person-centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service has been in Special Measures since 8 April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arena Business Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe recruitment of staff into the service. Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Arena Business Centre known as Tender-Hearted Care, is a is a domiciliary care agency. Tender-Hearted Care provides personal care to adults living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. Around 21 people were receiving personal care at the time we inspected.

People’s experience of using this service and what we found

People told us they felt safe. However, the service had failed to assess people for risks that would put them at harm. This meant people’s needs were not always identified and care needs not met. Some risks that had been identified did not have clear instructions for staff on how to support people with that risk. This placed people at risk of not having safe care and treatment.

Staff had not always been recruited safely into the service. Recruitment files had missing information to show the service had sought assurances staff were suitable to work with people who might be vulnerable as a result of their circumstances.

Medicines were not always managed safely. The service could not provide assurances that people had been given their medicines as prescribed. The service did not have robust processes to ensure medicines were administered safely. This was due to the registered manager having no audits in place. The registered manager told us “I haven’t got any audits to show you as I haven’t done any.” The service failed to ensure staff were trained and competent to administer medicines.

There was no robust system or process to assess, monitor and review people’s care needs. We have made a recommendation that every person has an initial assessment of their needs prior to receiving support from the service. Some care plans were missing, some omitted important information and some had not been reviewed. There were no governance frameworks to monitor the quality and safe delivery of care and treatment. We have made a recommendation the provider implements a system for recording complaints to provide oversight of an ongoing concerns.

Staff had not all been provided with core training. This put people at risk of receiving unsafe or ineffective care and treatment.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff told us they felt supported. However, formal supervisions were not taking place and interactions with staff where support was offered were often not recorded. Feedback we received about staff was that they were kind and caring.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

This service was registered with us on 23 October 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staff training, supervisions, and overall governance of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Since our inspection the registered manager has ceased delivering care to focus on governance frameworks and provide oversight of the service. The registered manager has started working on the assessment, monitoring and reviewing of care and staff have been placed on appropriate core training courses.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, person centred care, need for consent, staffing, recruitment, and good governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is inadequate and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.