Tender Loving Carers

Tender Loving Carers is a domiciliary care service. At the time of the inspection the service was supporting 100 people with the regulated activity personal care. People receiving support from the service were adults or older people. Some people were living with dementia. Not everyone who used the service received personal care. The Care Quality Commission (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.

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

People and their relatives said the service was excellent. People looked forward to the carers visiting and enjoyed their company. Staff spoke with compassion and genuine warmth when referring to the people they cared for. The caring ethos of person-centred, expressed to us by the provider and registered manager, was echoed in the comments made by the staff. This was reflected in the care people told us they received. People appreciated the continuity of care from the same care staff who were consistent and always attended. People and their relatives confirmed that they received a weekly rota which was adhered to, with changes only occurring in unforeseen circumstances.

People and their relatives had trust and confidence in the staff and management.

People were provided with a person-centred service which was responsive to their needs, wishes and preferences. The providers values were implemented and embedded into the ethos of the service to provide excellent outcomes for people.

Management and staff had a positive impact on people's lives responded to people's needs and preferences. They supported people's ability to express themselves and included their wishes and aspirations in support planning and activities. The service had taken a key role in the local community. Staff were actively involved in making contact with community resources and support networks to ensure people had access to a broad range of meaningful activities which improved their quality of life, developed their self-confidence and their self-esteem.

The service was well led by a committed and skilled management team who led by example. They used effective checks and audits of care to provide high-quality, person-centred care. There was an ongoing plan of development for the service. The staff team were well trained and supported, and communication was good.

The provider followed their recruitment procedure which ensured all staff were safely employed. Induction training was thorough and the training for staff was kept up to date which meant they could provide effective care.

People and their relatives were confident that if they had concerns they would be dealt with appropriately.

Effective systems were in place to monitor the delivery of care through feedback from people and relatives, audits, spot checks, staff observational supervision and quality assurance questionnaires. Lessons learned were documented and shared in staff meetings. Medicines administration records showed that medicines were taken as prescribed. People confirmed that staff followed infection control procedures and wore gloves and aprons appropriately to prevent the spread of infection.

People's needs had been assessed and their support plans included input from families and community-based professionals. People's health needs were identified, and they were supported to maintain regular appointments and screening. People were supported to eat and drink. Specialists were involved when required for people who were nutritionally at risk.

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

Rating at last inspection

The last rating for this service was Outstanding (published 15 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Tender Loving Carers provides personal care and support to people in their own homes in Whitstable, Herne Bay and surrounding areas. At the time of the inspection the service was providing care for 120 people. This included older people, people living with dementia and people with a learning or physical disability.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People trusted staff and therefore felt safe whilst being supported by them. Staff had received training in how to safeguard people. They knew what signs to look out for which would cause concern and how to report them so the appropriate action could be taken to help keep them safe.

Comprehensive checks were carried out on all potential staff at the service, to ensure that they were suitable for their role. People had their needs met by regular staff that were available in sufficient numbers.

Assessments of potential risks had been undertaken in relation to the environment that people lived and worked in and in relation to people’s personal care needs. This included potential risks involved in moving and handling people, supporting people with their personal care needs and with managing medicines. Guidance was in place for staff to follow to make sure that any risks were minimised.

A medicines policy was in place to guide staff. Staff had received in-house training in the administration and storage of medicines and a system was in place to regularly check they had the knowledge and competence to manage people’s medicines safely.

New staff received an induction which ensured that they had the skills they required, before they started to support people in their own homes. Staff undertook face to face training in essential areas, shadowed senior staff and feedback was sought from people who used the service to ensure they were competent. People said that staff had the specialist skills and knowledge they needed to support them.

Staff had undertaken training in The Mental Capacity Act (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.

People’s health care and nutrition needs had been comprehensively assessed and clear guidance was in place for staff to follow, to ensure that their specific health care needs were met. Staff were knowledgeable about people’s health care needs and liaised with health professionals and family members when appropriate.

Staff were consistently kind, caring and compassionate, and treated people with the upmost dignity and respect. The service had gone the ‘extra mile’ by considering the needs of people’s carers, staff undertaking additional tasks and by fundraising to provide a Christmas party for people each year. Staff had positive relationships with people and their family members who they knew well.

People’s care, treatment and support needs were assessed and a plan of care was developed jointly with the person which included their individual choses and preferences. Guidance was in place for staff to follow to meet people’s needs. Staff knew people well which enabled them to support people in a personalised way.

The service was extremely flexible and responsive to meet people’s needs. In agreement, some people were able to change their support hours to ensure they led as full a life as possible. A wheelchair accessible van had been purchased to enable people to attend health care and social activities. People who were cared for in bed were offered a service so they could receive a bath in their own homes.

People were informed of their right to raise any concerns about the service and felt confident to do so. When people had raised issues, they said the service had been committed to resolving them quickly and to their satisfaction.

There were effective systems in place to assess and monitor the quality of the service, which included asking people about their experiences. There was an open and positive culture and the registered manager was passionate about providing care which enabled people to remain in their own homes. Staff knew how to put the aims and values of the service into practice so people received personalised care. People said that they had or would recommend the service to others.

We found that people had given their consent to the care and treatment to be provided. People said they were able to make day to day decisions about their care and support. They told us that staff consulted with them about how they wanted to be supported and were satisfied with the care being provided.

People's needs were assessed before a service was provided and people were involved in planning their care and support. We found that people's care plans had been regularly reviewed to make sure their current care needs were being met.

There was a policy and process in place for ensuring that staff were trained, supervised and appraised yearly. We found that staff had a good knowledge of people's needs and knew how they liked their care to be provided. People said: 'The staff are very respectful, they always ask me how I am, and if there is anything else I need.' The staff are always there for me, and deal with me kindly.'

We saw the service had systems in place to monitor the care provided and manage identified risks. People told us they had been asked for their feedback on the service they received. They said they did not have any complaints and were confident that when issues were raised they would be listened to and acted upon.

We found that people's care was personalised to their needs and they told us that staff always asked what they would like to be called. Some people said they felt safer living at home knowing staff would be calling. They said that overall staff had the skills and knowledge to do their jobs well.

They told us they did not have any formal complaints but would tell the staff or manager if they had any concerns. They said they had information in their care folders on how to complain about the service.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.