We carried out a review of the data available to us about Tendercare Home Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Tendercare Home Ltd, you can give feedback on this service.
Tendercare Care home is a residential care home providing personal care and accommodation for up to 43 people some of whom may live with dementia. The service was supporting 27 people at the time of the inspection.
People’s experience of using this service and what we found
Improvements had been made to the service and systems were in place to ensure people were supported safely and protected from the risk of harm. People were supported by skilled and competent staff and received their medicines when they needed them. Systems were in place to reduce the risk of infection, and to review any incident and accidents to see if there were any lessons to learn from these.
There has been a change of management since our last inspection and action has been taken to drive improvements to the service provided to people. The registered manager was described as approachable, supportive, open and transparent in the way they managed the service.
People, relatives and staff have been consulted about the service and their feedback was gathered. Improvements have been made to the systems in place to monitor the delivery of the service and to address any shortfalls. Although improvements have been made these now needed to be sustained to ensure standards of care were maintained.
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 (Report published 16 February 2021) and there were breaches of regulations identified. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
This service has been in special measures since February 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 carried out an unannounced inspection of this service in November 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safe care and treatment and governance of 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 and well led which contain those requirements.
The ratings from the previous comprehensive inspection undertaken in March 2020 for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Tendercare Home Ltd is a residential care home providing personal care and accommodation for up to 43 older people some of whom may live with Dementia. The service was supporting 30 people at the time of the inspection.
People’s experience of using this service and what we found
People were not supported in a safe way. People were not protected from potential harm and abuse. Abuse or improper treatment was not always reported and investigated. Medicines were not managed safely.
The provider’s systems failed to identify that care and support was not provided in a safe way. Audits did not identify concerns with risks to people, safeguarding, medicines, and care plans.
Staff concerns were not always acted on. Staff practice was not effectively monitored, and new staff did not receive the training they needed for their role.
The provider did take immediate action when information of concern was shared with them to protect people from further harm.
Rating at last inspection. The last rating for this service was Good (published 14 March 2020).
Why we inspected
We received whistle blowing concerns in relation to safeguarding, medicines management, moving and handling, and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We received further whistle blowing concerns on the 17 November 2020 which were also reviewed as part of this inspection process.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvement. Please see the Safe and Well Led sections of this full report. The provider took immediate action to mitigate the risks of people receiving unsafe care.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tendercare Home Ltd 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 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, safeguarding, staffing, and governance. Please see the action we have told the provider to take at the end of this report.
Follow up
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.
Special Measures:
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 6 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 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.
Tendercare Home Limited is a residential care home providing accommodation and personal care to 33 people aged 65 and over living with dementia at the time of the inspection. The service can support up to 43 people.
People’s experience of using this service and what we found
Staff knew how to keep people safe and people told us they felt safe. The provider had recruitment systems in place to ensure staff could support people safely and staff were appropriately trained to support people with their medicines as they were prescribed. There were sufficient staff to support people and risks to people were identified and reviewed. Staff received infection control training, so they understood how to reduce the risk of infection while supporting people. When an accident or incident took place, trends were monitored.
People were supported to have maximum choice and control of their lives and care 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 had support, so they had the appropriate skills and knowledge to meet people’s needs. People made choices as what they had to eat and drink and accessed health care when needed.
People received support from staff who were kind and compassionate. People’s privacy, dignity and independence were promoted.
People received support that was responsive to their needs. Communication was delivered in line with the Accessible Information Standard, so people could understand. Assessments and care plans were in place and reviews took place. Activities were available in line with people’s interest and hobbies. The provider had a complaints process in so people could raise concerns.
People received support that was well led. The provider ensured appropriate governance was now in place to monitor the quality of the service. Spot checks and audits were now taking place regularly. The registered manager ensured people were engaged with by using questionnaires, resident and relative meetings and a regular newsletter.
Rating at last inspection
The last rating for this service was Requires Improvement (Report published 2 October 2019) and there was a breach of regulation 11 and 17. 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 improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
• People did not always receive safe care. Staff were not always available when people needed them. The provider had a recruitment process to ensure the appropriate checks were carried out when recruiting staff to support people safely. People received their medicines as it was prescribed. Staff had access to personal protective equipment. Accidents and incidents were noted and trends monitored to reduce the amount of accidents.
• People did not always receive effective care. The provider and registered manager ensured the principles of the Mental Capacity Act 2005(MCA) were being adhered to so people’s liberty were restricted following the law. They did not however ensure staff had sufficient knowledge and understanding of the MCA. The provider did not ensure people had sufficient meal choices as to what they had to eat and drink. People accessed health care when needed.
• People did not always receive care and support that respected their dignity and privacy. People were encouraged to be involve in how decision were made about their support. People were supported by staff who showed them compassion and kindness. People were able to express their views as to how they were supported.
• People did not always receive responsive care. The provider used care plans to identify how people’s support needs would be met, however information on people’s end of life wishes was not being gathered. The provider was unable to show whether people were involved in the reviewing process. People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. We have made a recommendation about the service keeping up to date with current care guidance and legislation. The provider had a complaint process which people were aware of and knew how to access.
• The service was not consistently well led. The environment was welcoming, warm and comfortable, but the provider and registered manager’s quality audits and spot checks systems failed to identify areas for improvement where bedrooms were not being cleaned sufficiently or where there were unexplained gaps in the medicines records. The registered manager was known and made themselves available. The provider used questionnaires to gather views on the service.
More information is in the Detailed Findings below.
Rating at last inspection:
• Rated Good (Report published 25/02/2016).
About the service:
• Tendercare Home Ltd is a care home providing personal care and accommodation for up to 43 people who have a dementia. At this inspection 42 people lived within the service.
Why we inspected:
• This was a planned inspection based on the rating at the last inspection.
Enforcement:
Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.
Follow up:
We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
Our inspection took place on 20 and 21 January and was unannounced. Our last inspection took place in November 2013 and the provider was compliant in all areas looked at.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.
Staff understood the importance of enabling people to make their own decisions in line with the Mental Capacity Act 2005 but did not always have the knowledge of Deprivation of Liberty Safeguards to support them in their role.
We saw that there were a lack of meaningful activities provided for people. The manager had identified this and had taken action to ensure personalised activities were made available.
Staff knew how to identify abuse and the actions to take if they suspected someone was at risk of harm.
Staff were able to recognise risks and took action to minimise this where possible.
There were sufficient numbers of staff available with the skills and knowledge to meet people’s needs. People were supported by staff who had a kind and caring approach.
Medication was well managed and people received their medication as prescribed and in a safe way.
Staff supported people with their dietary needs and people had sufficient amounts to eat and drink.
People were supported to access healthcare professional input to maintain their health and well-being.
People were involved and supported to make decisions about their care. Where people’s needs changed, their relatives were kept informed.
Systems were in place to support people and their relatives to make complaints and raise concerns. Complaints were investigated and resolved.
People felt that the home was well led. The registered manager undertook audits to ensure the quality of the service and acted on feedback received from people.
During our inspection we spoke with three people, one visiting relative, three members of staff, an external healthcare professional and the manager. We looked at three people's care records.
We found that people's consent to care was sought. People told us staff offered choice and respected their wishes. A visitor told us, 'They do get choices'.
People received care which supported their needs. One person said, 'I'm happy here. Everything's alright'.
The home provided a suitable environment for people to live in. We saw that a number of safety audits were carried out to ensure people's safety. We found that some areas of the home would benefit from redecoration.
Staff were supervised in a way which meant they were supported to provide good care. One person told us, 'They look after me very well. The (manager) is really good. She does everything for us'.
Records were accessible to staff and provided them with the information they needed to support people appropriately. Confidential information was kept securely.
All people we spoke with told us positive things about the home. One person told us "I really like it here. We are well looked after and are happy'. Another person said 'I would say that it is excellent". One visitor said 'Because of the home's reputation I would not let my relative be discharged from hospital until there was a bed here. The home has lived up to its reputation I can only give it praise'.
People's needs had been assessed by external health professionals including the dietician and speech and language therapists. This meant that people's health care needs had been monitored and met.
We found that medication systems were safe and that medication had been given to people as it had been prescribed by their doctor.
Recruitment processes ensured that staff employed were suitable to work with the people living at the home which protected them from harm.
Records and staff both confirmed that systems had been used to monitor how the home had been run
We spoke with nine people who used the service and four members of staff.
People told us they were very comfortable and fully involved in planning their care. Care records we looked at confirmed this to be the case. Staff supported people with making choices for what they wished to do during the day.
We spoke with three visitors, one a relative and two visiting professionals. A visitor commented 'It's a long time since I have seen her look that good; her nails are painted, her hair done, she looks very pretty'.
People told us they were able to tell a member of staff if they had any concerns or worries. We saw that staff were aware of the procedures for reporting any suspicions of abuse or if people were at risk of harm.
We saw that staffing levels were sufficient to meet the needs of the people who used the service.
Arrangements were in place for staff to check the quality of the service, and people told us they were regularly asked for their opinion of the standard of the service.