The inspection took place on 16, 17 and 18 January and was announced. We gave 48 hours notice of the inspection, as this is our methodology for inspecting domiciliary care agencies.

Tender Loving Carers provides personal care and support to people in their own homes in Whitstable, Herne Bay and surrounding areas. At the time of the inspection the service was providing care for 120 people. This included older people, people living with dementia and people with a learning or physical disability.

The service has a registered manager who was available and supported us during the inspection. 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.

People trusted staff and therefore felt safe whilst being supported by them. Staff had received training in how to safeguard people. They knew what signs to look out for which would cause concern and how to report them so the appropriate action could be taken to help keep them safe.

Comprehensive checks were carried out on all potential staff at the service, to ensure that they were suitable for their role. People had their needs met by regular staff that were available in sufficient numbers.

Assessments of potential risks had been undertaken in relation to the environment that people lived and worked in and in relation to people’s personal care needs. This included potential risks involved in moving and handling people, supporting people with their personal care needs and with managing medicines. Guidance was in place for staff to follow to make sure that any risks were minimised.

A medicines policy was in place to guide staff. Staff had received in-house training in the administration and storage of medicines and a system was in place to regularly check they had the knowledge and competence to manage people’s medicines safely.

New staff received an induction which ensured that they had the skills they required, before they started to support people in their own homes. Staff undertook face to face training in essential areas, shadowed senior staff and feedback was sought from people who used the service to ensure they were competent. People said that staff had the specialist skills and knowledge they needed to support them.

Staff had undertaken training in The Mental Capacity Act (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant.

People’s health care and nutrition needs had been comprehensively assessed and clear guidance was in place for staff to follow, to ensure that their specific health care needs were met. Staff were knowledgeable about people’s health care needs and liaised with health professionals and family members when appropriate.

Staff were consistently kind, caring and compassionate, and treated people with the upmost dignity and respect. The service had gone the ‘extra mile’ by considering the needs of people’s carers, staff undertaking additional tasks and by fundraising to provide a Christmas party for people each year. Staff had positive relationships with people and their family members who they knew well.

People’s care, treatment and support needs were assessed and a plan of care was developed jointly with the person which included their individual choses and preferences. Guidance was in place for staff to follow to meet people’s needs. Staff knew people well which enabled them to support people in a personalised way.

The service was extremely flexible and responsive to meet people’s needs. In agreement, some peopl

We visited the office and spoke with the Registered Manager, senior staff and six members of care staff. We later spoke with nine people using the service and seven relatives. All of the people spoken with were satisfied with the service.

We found that people had given their consent to the care and treatment to be provided. People said they were able to make day to day decisions about their care and support. They told us that staff consulted with them about how they wanted to be supported and were satisfied with the care being provided.

People’s needs were assessed before a service was provided and people were involved in planning their care and support. We found that people’s care plans had been regularly reviewed to make sure their current care needs were being met.

There was a policy and process in place for ensuring that staff were trained, supervised and appraised yearly. We found that staff had a good knowledge of people's needs and knew how they liked their care to be provided. People said: “The staff are very respectful, they always ask me how I am, and if there is anything else I need.” The staff are always there for me, and deal with me kindly.”

We saw the service had systems in place to monitor the care provided and manage identified risks. People told us they had been asked for their feedback on the service they received. They said they did not have any complaints and were confident that when issues were raised they would be listened to and acted upon.

People who used the service spoke positively about the staff and felt that they were fully supported with their care needs. People said that all the staff were polite and respected their privacy and dignity. People told us that they were satisfied with the care and support they received. They said that the staff treated them with respect, listened to them and supported them to remain as independent as possible.

We found that people's care was personalised to their needs and they told us that staff always asked what they would like to be called. Some people said they felt safer living at home knowing staff would be calling. They said that overall staff had the skills and knowledge to do their jobs well.

They told us they did not have any formal complaints but would tell the staff or manager if they had any concerns. They said they had information in their care folders on how to complain about the service.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

People told us that someone from the agency had visited them before the service commenced. They said they were treated with dignity and their privacy was respected by staff. People told us that they had the help that they required. People said that the staff were very kind and helpful.