About the service:

Tendacare is a domiciliary care agency that was providing personal care to 115 people aged 65 or over and 15 people aged under 65 at the time of the inspection.

People’s experience of using this service:

People who received care from Tendacare told us they felt safe and supported by staff who visited them. Staff were punctual and consistent at carrying out visits with people in a person-centred manner. One person told us, “I’m very happy with the service. They are friendly, efficient and on time.” People were supported to continue living at home in a way that enabled them to be as independent as possible.

Although there was evidence the service had provided good end of life care, there was no information in care plans about people’s preferences for their end of life care. Following the inspection the service arranged for people’s preferences to be recorded in their care plans.

The service was not always well managed as some records and documents had not been completed. The provider had also failed to notify CQC of safeguarding incidents. However, staff and people we spoke to all agreed that the service was well led. People, staff and relatives were involved in helping the service improve.

Care plans were created with people and relatives to ensure they were person centred and tailored to peoples’ needs and routines. Staff were trained and supported to be effective carers in a collaborative team. Where needed, staff were quick to support people to have access to health care professionals such as occupational therapists or, when necessary, emergency services. One relative told us, “I chose them because they are good at concentrated care and they feel like a very personal agency.”

People and relatives described staff as caring and kind towards them. Staff were approachable and friendly with people they cared for and knew them well.

More information can be seen in the main body of the report for each Key Question below.

Rating at last inspection:

Good (15 June 2016)

Why we inspected:

This was a scheduled comprehensive inspection. We inspect all services rated as 'Good' every 30 months to ensure that we regularly monitor and review the quality and safety of the service people receive.

Follow up:

Following the inspection the registered manager sent us evidence to demonstrate compliance with the Mental Capacity Act, up to date reviews of end of life care and notifications that should have be sent to CQC.

This was an announced inspection that took place on 22 April 2016.

The agency provides domiciliary care to people living in their own homes. It is located in the Ashtead, Surrey area.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At the previous inspection in February 2014, the agency was compliant with regulations. At this inspection the regulations were met.

People told us they were happy with the service provided and were notified of changes to staff and the timing of care provided. The designated tasks were carried out to their satisfaction and the staff team really cared. They thought the service provided was safe, effective, caring, responsive and well led.

The records were kept up to date and covered all aspects of the care and support people received, their choices and identified and met their needs. They contained clearly recorded, fully completed, and regularly reviewed information that enabled staff to perform their duties.

Staff where knowledgeable about the people they gave support to and the way people liked to be supported. They also worked well as a team when it was required, such as calls that may require two staff members. Staff provided care and support in a professional, friendly and supportive way that was focussed on the individual and they had appropriate skills to do so. They were well trained, knowledgeable and accessible to people using the service and their relatives. Staff said the organisation was a good one to work for and they enjoyed their work. They had access to good training, support and there were opportunities for career advancement.

People and their relatives were encouraged to discuss health and other needs with staff and had agreed information passed on to GP’s and other community based health professionals, as appropriate. Staff protected people from nutrition and hydration associated risks by giving advice about healthy food options and balanced diets whilst still making sure people’s meal likes, dislikes and preferences were met.

The agency staff knew about the Mental Capacity Act and their responsibilities regarding it.

People told us the office, management team and organisation were approachable, responsive, encouraged feedback and frequently monitored and assessed the quality of the service provided.

We spoke with eleven people or their representatives who use the service. One person told us, “they were very happy with the service, the staff were very professional and well trained”. Another person told us “they were really satisfied with the service and would recommend it to anyone”.

We noted that people's consent was obtained where possible before care was undertaken. One person told us “the carer always asked what they wanted and ensured they had choice”.

We found that the care given was safe and appropriate and based on effective care planning and risk assessments. We sampled fourteen care records and noted the risk assessments and care plans were person focussed and preferences taken into account. One person told us “the carers were so good at picking up on changes and there was good communication between the provider and themselves”.

People were protected from the risks associated with poor medication management. We noted medicines were properly handled and administered in line with the provider's policy.

Appropriate checks were undertaken before staff began work and there were effective recruitment and selection processes in place. We sampled five staff records and spoke with five staff. One person told us they were “always provided with very good experienced staff”.

The provider regularly monitored and reviewed the quality of its service. One person told us about "good communication and they could make changes at any time or raise any issues".

The agency had policies and procedures in place that ensured people’s needs and wishes were assessed and recorded prior to them receiving care. A relative told us “We work as a team together and there is regular communication with the staff”.

People’s needs and wishes were recorded in a plan of care and these incorporated an assessment of risks to people’s safety. We saw evidence that these were reviewed regularly.

In order to protect the people using the service, there was a robust recruitment policy in place and all new staff received safeguarding training during induction. Regular refreshers were in place for all staff.

Staff received ongoing training and support, which provided them with the skills and knowledge to meet the needs of the people they were supporting. Observational techniques and mentoring were used, to ensure staff carried out their roles appropriately.

People that we spoke with were very positive about the staff team and comments included, “they provide a good quality of care”, “we are happy with the service” and “we have used them for years and never found fault with them”.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires and spot checks. People we spoke to said that changes were made when any issues had been raised with the agency.

People who use the service and their relatives told us they were involved in making decisions about the care and support they or their relative received, and felt they were well supported by the agency. They told us that they were happy with the personal care that staff provided and felt their privacy and dignity was respected. People using the service said they felt safe and secure with their carers. They knew most of them very well and had found them to be both professional and experienced in meeting their needs. Relatives and advocates said they had developed good working relationships with the manager and other senior agency staff, which clearly benefited them and the people using the service. Two people mentioned that the manager and her deputy still continue to work ‘hands on’ when possible, which gave them the opportunity to regularly assess and monitor the quality of the service they offer to people. One person using services told us, “The agency provides complete care and total satisfaction.”