What life is like for people using this service:

• 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.

Tendercare home Ltd is registered to provide accommodation and personal care to a maximum of 25 older people who may have a diagnosis of Dementia. At the time of the inspection, there were 21 people living at the home.

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.

There were 19 people living at the home on the day of our inspection. No one knew we would be visiting. We spoke with eight people who lived at the home, seven relatives and six staff.

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 reviewed all the information we hold about this provider, carried out a visit on 12 January 2012, observed how people were being cared for, looked at records of people who use services, talked to staff, reviewed information from stakeholders and talked to people who use services.

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.