Tender Loving Care Services

Updated 18 January 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Following the last inspection in September 2016 we asked the provider to complete an action plan by January 2017 to show what they would do to improve the key questions, ‘Is this service safe, effective, and well led?’ to at least good. This was because we found quality monitoring systems were not always effective; systems were not in place to ensure safeguarding was responded to, to ensure medicines were safely managed and people’s capacity was assessed where needed.

This was an announced inspection and we gave the service seven days’ notice of the inspection site visit. This was because some of the people using it could not consent to a receiving a telephone call from an inspector, which meant that we had to arrange for a ‘best interests’ decision about this. This inspection was carried out by one inspector and an expert by experience. The expert by experience had knowledge of care services including domiciliary services.

The inspection site visit activity started on 5 December 2017 and ended on 7 December 2017. It included telephoning six people with their relative or friends; we spoke with three staff and the registered manager. We visited the office location on 7 December 2017 to see the registered manager and office staff; and to review care records and policies and procedures.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. Not everyone using this service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection there were 11 people receiving a service.

On this occasion we did not ask the provider to send us a provider information return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. However, we offered the provider the opportunity to share information they felt relevant with us.

We looked at four people’s care records to see if they were accurate and up to date. We also looked at records relating to the management of the service including quality checks. We reviewed statutory notifications the registered manager had sent us and information received from people that used the service. A statutory notification is information about important events which the provider is required to send to us by law.

Updated 18 January 2018

We inspected this service on 5 and 7 December 2017. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults in and around Chesterfield. Not everyone using this service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. There were 11 people receiving a service at the time of our inspection.

This announced inspection was carried out by one inspector and an expert by experience. The expert by experience had knowledge of care services including domiciliary services.

There was a registered manager in the service. 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.

We rated this service as Requires Improvement in September 2016. Following this inspection, we asked the provider to complete an action plan by January 2017 to show what they would do to improve the key questions ‘Is this service safe, effective, and well led?’ to at least good. This was because we found quality monitoring systems were not always effective and systems were not in place medicines were safely administered; to ensure safeguarding was responded to and people’s capacity was assessed where concerns had been identified.

On this inspection we found improvements had been made although further improvements were needed with how quality was reviewed within the service, and checks were needed in the office to ensure it was safe. We have made a recommendation about the management of quality systems.

People felt safe when being supported. The staff knew how to protect people if they suspected they were at risk of abuse or harm and how to report concerns. Recruitment checks were made to confirm staff were of good character to work with people and sufficient staff were available to meet people's support needs.

Risks to people had been identified and staff understood how to support people to reduce risk and protect them from potential harm without restricting their rights. People had support plans which reflected their specific needs and preferences for how they wished to be cared for. We found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about their care and staff knew how to respond if people no longer had capacity to make some specific decisions.

There was a small team of staff who had the skills to meet people’s needs. The support was flexible and responsive to changes. People received their care at a time they wanted it and they knew who would be providing their support. People were happy with how the staff provided care and were positive about the way staff treated them. People’s privacy and dignity were respected and upheld by the staff who supported them.

Risks to people’s health and wellbeing were assessed and plans were in place to monitor and to assist them in a safe manner. People felt comfortable raising any issues or concerns and there were arrangements in place to deal with people's complaints. People felt the staff had the right skills to provide the care they wanted.

People’s health needs were managed and the staff worked with health care professionals and helped people to attend appointments where necessary. When people required assistance to eat and drink, the provider ensured that this was planned to meet their preferences and assessed needs.

People had developed good relationships with staff and the registered manager. Care was planned and reviewed with people and the provider ensured that people’s choices were followed.