This was an announced inspection which took place on the 26th January 2017. Tendercare provides personal care to people living in their own homes in Gloucestershire. It has been operating for 19 years. At the time of our inspection there were ten people receiving personal care from the service. The registered manager provided most of the personal care and support herself and was helped by three members of staff when needed.

There was a registered manager in post. 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. The registered manager was also the owner of Tendercare.

At our last inspection on 24 November 2015 this service was rated as requires improvement overall. We asked the provider to take action to make improvements to:

• recording decisions made in people’s best interests where they lacked the capacity to make decisions about their care

• submitting notifications to CQC about incidents which must be notified

and we found these actions had been met.

People enjoyed the benefits of receiving a service from a small agency. They liked the fact that they knew all the staff and had continuity of care. Staff understood them well and recognised when there were changes to their health or well-being. They were able to respond quickly and immediately to any requested changes to the service being provided. The registered manager had agreed to be the first contact point for a person’s life line overnight. People were involved in planning their care and support. Their preferences, routines and needs were clearly identified in their care records, which were reviewed and kept up to date. People’s lifestyle choices were respected and the personal care and support delivered reflected people’s wishes.

People felt safe with the care provided and with the staff supporting them. They knew how to raise concerns and make a complaint. Their relatives and health care professionals were happy with the service they received and were kept informed. When people were unable to make decisions about their care, they had the appropriate assessments in place and decisions were made in the best interests. Any hazards people faced in their day to day lives had been assessed and action had been taken to reduce these keeping them as safe as possible. Staff had received training and knew how to use any equipment provided to people, how to administer medicines safely and how to move and position people. Staff were supported in their roles with individual meetings and annual appraisals to reflect on their roles and review their training needs.

The service was well managed. Communication was open and transparent between people, staff and their relatives. Information had been provided to people which was accessible and easy to read. People’s views were sought to ensure the quality of the service was being maintained. Positive feedback had been received which included, “You are little treasures, I would be lost without you”, “Brightens my week” and “Over the moon with the visits, thank you.”

The provider had displayed their rating in the office and on their website.

This inspection took place on 24 and 26 November 2015 and was announced. Tendercare provides personal care to people in their own homes. It had been operating for 17 years. At the time of our inspection there were eight people receiving personal care from the service. The registered manager provided most of the personal care and support herself and was helped by three members of staff when needed.

Tendercare 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.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

When people were unable to make decisions and choices about their care or had fluctuating ability to make decisions, the principles of the Mental Capacity Act 2005 were not being followed. The appropriate assessments had not been completed and there was no written evidence when decisions had been taken in their best interests. When people were affected by events which impacted on them, the registered manager had not submitted notifications to the Care Quality Commission (CQC). CQC monitors events affecting the welfare, health and safety of people living in the home through the notifications sent to us by providers.

People’s needs had been assessed and their care plans reflected their personal wishes and preferences for the way in which their personal care was delivered. People said they had been involved in this process and continued to be consulted about all aspects of their care and support. People told us, “We discuss what needs to be done” and “Everything is very straight forward and we have our routines”. People said they liked the consistency and continuity offered by a small agency. Visits were agreed with them to reflect the times they preferred and they said they were usually on time and staff stayed for the correct duration. If staff were going to be late they let people know but this rarely happened.

People were confident with the skills and knowledge of staff. The registered manager was a qualified trainer and delivered some training to staff. Staff were completing the care certificate to make sure their knowledge and skills were up to date. Staff were supported by individual meetings and annual appraisals giving them the opportunity to discuss their roles, people’s needs and any training they would like to complete. Staff were allocated to work alongside the registered manager when people needed two members of staff to help with their moving and handling. The registered manager had contingency plans in place to cover her when not working and in the case of emergencies.

People said they were very happy with the service they received. One person said they had recommended Tendercare to other people. The registered manager gauged the quality of service provided through compliments received from people and the lack of complaints. People commented, “We couldn’t have coped without you, you have been our rock” and “I admire all you do – it’s lovely to know that mum is being well looked after”.

During our inspection we visited two people in their own homes and spoke with two relatives on the telephone. People we spoke with told us they were happy with the service provided by Tendercare. People told us they had regular staff visiting them and they knew the time staff were going to arrive. Comments from people and relatives included; “very happy with the service”, “no complaints” and “it’s been a life saver”.

Staff we spoke with told us they always asked people for their consent before providing any care. This was confirmed by the people we visited and by observing staff interaction with people during these visits. Care plans were personalised to the individual and gave detailed information about how the person wanted their care and support to be provided. Appropriate arrangements were in place to support people to take their medication.

There were enough qualified, skilled and experienced staff to meet people’s needs. We found staff were competent in their role and understood the needs of the people they cared for. People told us about staff, “staff are very sensitive to my mother’s needs” and “staff are very kind to me”.

People told us that the registered manager/owner regularly visited them to ask about the service provided and if they ever had any concerns they would feel confident raising them.

During this inspection to check improvement we did not receive any information from people who use the service or their representatives.

We looked at the care files for all nine people that the service provided personal care to. We found that every record had been reviewed and updated and there was a plan in place to review the care records again for each person in January 2013. Each care plan gave clear instructions for how staff should enter and leave the property and any other information required about the premises. Care plans described in step-by-step detail how staff should carry out personal care with people. Records detailed what staff needed to do to assist the person and what the person could to for themselves. As well as when staff would need to encourage people to do tasks for themselves to ensure that they could remain as independent as possible.

This level of detail and the personalisation of people's care records meant that their needs were more likely to met.

During our visit we spoke with one person who uses the service and three relatives of people who use the service.

Everyone we spoke with told us that Tendercare provides an excellent service to the people they cared for. They also told us that if they had any concerns they knew how to contact the service and felt confident that the owner/manager would listen and act swiftly to rectify any problems.

One relative told us, "We chose to use Tendercare because we knew that they are a small agency and we didn't want lots of different care staff. They have provided a good, reliable and flexible service. Another relative told us, "We couldn't do without them".