1 June 2023
During an inspection looking at part of the service
Tender-Hearted Care Limited is a domiciliary care agency and provides personal care to adults living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. 13 people were receiving personal care at the time we inspected.
People’s experience of using this service and what we found
We found not enough improvements had been made, the service continued to be in breach of regulations and people had been placed at risk of significant harm.
Medicines were not always managed safely. When people had missed medicines, the service had not always reported this to the local safeguarding team and had not instructed staff to monitor the person for any signs or symptoms they may be unwell. Audits had identified that medicines were not always signed as administered. Actions had not been taken to investigate why there was no signature, and if the person had taken their medicine.
The recording of accident and incidents had been improved; however, the provider/registered manager told us accident and incidents were still not reviewed on a regularly basis to identify themes and trends and ensure the correct actions had been taken. This had resulted in reportable incidents not being notified to the local safeguarding team and to CQC.
Governance systems were either not in place, or robust enough to identify and improve the quality of the service. Audits had not always been completed or, when they had, no actions had been taken to improve the areas of concern found. Governance systems had not always identified when people’s health, safety and well-being were at risk and people had been placed at risk of significant harm.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
At our last inspection we identified people did not always have the paperwork in place to demonstrate their capacity to make specific decisions had been assessed and that the least restrictive decision had been made in their best interest. We found no improvements to the provider/registered managers understanding of the Mental Capacity Act 2005 (MCA) and no improvements to the systems and processes had been made placing people at risk of significant infringements to their rights and/or welfare.
The provider had relocated to a new address and had failed to notify CQC. The registered manager had not taken action since our last inspection to improve their competence, skills and experience required to manage the carrying on of the regulated activity and people had been placed at risk of significant harm.
Feedback had been sought from people using the service and from the staff, results had not yet been reviewed. Since our last inspection improvements had been to ensure staff were recruited safely into the service.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
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 requires improvement and there were breaches of regulation (published 22 February 2023). At this inspection we found not enough improvements had been made and the provider was still in breach of regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and Regulations 15 and 18 of the Registration Regulations 2009 Notifications of other incidents.
Enough improvement had been made and the service was no longer in breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Why we inspected
We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to follow up on the breaches we identified at our last inspection due to the concerns we found. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.
We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
Enforcement and Recommendations
We have identified breaches in relation to the requirements of registered managers, safe care and treatment, good governance and notifying CQC of reportable incidents and reportable notice of changes.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.