We carried out a review of the data available to us about Dynamic Support on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Dynamic Support, you can give feedback on this service.
Dynamic Support is a domiciliary care and supported living agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. 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. In addition, this service provides support to 14 people living in 2 'supported living' settings, so that they can live in their own home as independently as possible.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
People’s experience of using this service and what we found
Right Support:
Staff helped people access health and social care support in the community. They assisted people to enable them to maintain their own health and wellbeing where possible. Staff communicated with people in ways that met their needs. The service gave people care and support in a safe environment.
People were supported to have maximum choice and control of their lives and staff provided them with care in the least restrictive way possible. The policies and systems in the service promoted this practice.
Right Care:
People's needs were appropriately assessed before they moved to the service. The service worked together with healthcare professionals and relatives to ensure people's needs could be met. People were supported with nutrition and hydration. Care was person-centred and promoted people's dignity, privacy, and human rights. Staff understood how to protect people from poor care and abuse. Staff were appropriately trained on how to recognise and report abuse and they knew how to report safeguarding concerns. Relatives of people told us their loved ones were safe living at the service. Care records contained risk assessments with clear guidance for staff to follow. Medicines were managed safely. Staff were recruited safely. The premises were clean and well maintained.
Right Culture:
The registered manager promoted a person-centred environment and people experienced good outcomes. Relatives spoke positively about the management team and staff. People received good quality care and support because staff were trained to meet peoples needs and wishes
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: The last rating for this service was good (published 2 October 2019).
Why we inspected
The inspection was prompted in part by notification of an incident in which a person using the service was potentially subjected to serious abuse. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the risk of unsafe care and treatment. This inspection examined those risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dynamic Support on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Dynamic Support is a domiciliary care and supported living agency. It provides personal care to any adults who require care and support in their own houses and flats in the community. In addition, this service provides support to six people living in two 'supported living' settings, so that they can live in their own home as independently as possible.
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. At the time of inspection, the service supported 12 people who were receiving personal care in their own homes. The service provides support to older people, people with learning and physical disabilities, sensory impairment and people living with dementia.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used positive behaviour support principles to support people in the least restrictive way. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
People’s experience of using this service and what we found
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
Positive outcomes for people were evidenced and feedback about the service described it as exceptional. A relative commented, “We just feel so fortunate. We never thought we’d have this level of care for [person]. You can tell they [staff] want to be with [person]. They are the answer to our prayers.” The service had excellent links and worked effectively in partnership with other health and social care organisations. Where people had complex or continued health needs, staff always sought to improve their care. There was a holistic approach to assessing, planning and delivering care and support. New evidence-based techniques were used to support the delivery of high-quality care and support. Staff training was developed and delivered around individual needs. There was a proactive support and appraisal system for staff, which recognised that continuing development of skills, competence and knowledge was integral to ensuring high-quality care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The service was consistently well-managed and led. The leadership and culture promoted the delivery of high-quality, person-centred care. It had clear, person-centred vision and values that included compassion, dignity and respect, independence and equality. The registered manager was available, consistent, and led by example. Staff felt respected, valued and supported. Management systems identified and managed risks to the quality of the service. This information was used to drive improvement within the service. The service involved people, their family, friends and other supporters in a meaningful way. Support and resources were available to enable the staff team to develop and be heard. All staff understood the fundamental need to provide a quality service. As we saw in the Effective domain of this report, there was a strong focus on continuous learning by all employees. The service worked in partnership with key organisations to support care provision, service development and joined-up care.
The service ensured that people were always treated with kindness and this was reflected in the feedback from people’s families, representatives and external professionals. People were treated with dignity, respect and kindness during all interactions with staff.
People were involved in developing their care plans. These care plans reflected their individual care needs and preferences. Staff were well-supported to understand and meet these needs through learning and development. The service enabled people to carry out person-centred activities and encouraged them to develop new skills and maintain their interests. People’s families felt confident that if they needed to complain, this would be explored thoroughly and responded to. People were supported to make decisions about their preferences for end of life care.
People were protected from avoidable harm and abuse. The service had effective safeguarding systems, policies and procedures in place and managed concerns promptly. The service anticipated and managed risks to people and staff had guidance to support them in their role of protecting people. There were enough competent staff on duty at all times with the right mix of skills. The service was clear about its responsibilities and role in relation to medicines and people received their medicines as prescribed. Lessons were learnt and reflected upon to improve practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 18 September 2018).
Why we inspected
This was a planned inspection based on the previous rating. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Not everyone using Dynamic Support services receives a regulated activity. The Care Quality Commission only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do receive personal care we also take into account any wider social care provided. At the time of inspection, the service supported 12 people who were receiving personal care in their own homes. The service provides support to older people, people with physical disabilities, sensory impairment and people living with dementia.
At the time of inspection there was 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.
The service was last inspected on 21 January 2016 and had an overall rating of Good. At this inspection we found the service to be overall Requires Improvement.
People’s medication records did not always reflect that they were administered safely. We recommend that the provider seeks guidance around the proper and safe management of medicines.
Records did not always contain sufficient detail on how to meet people health conditions. We have made a recommendation that the provider seeks guidance in line with best practice on specific health conditions.
Quality assurance audits had not always taken place in relation to safe management and administration of medicines. We have made a recommendation that the provider seeks guidance in line with best practice on the administration and management of medicines.
Staff understood their responsibilities to keep people safe from abuse.
Staff felt confident to use the whistleblowing policy if required and felt management would act on concerns.
Care plans demonstrated a commitment to person centred care and risks to people were assessed and managed.
Care and risk plans were reviewed and the service worked in partnership with external agencies to meet people's needs.
Staff had a good understanding of people's needs and were kind and caring.
Staff understood the importance of respecting people's dignity and upholding their right to privacy.
People's nutritional needs were catered for and the level of support provided was dependant on people's abilities. Staff told us how they worked alongside people to prepare their own meals where they were able.
The provider had continuity plans in place to ensure that people's support needs would still be met in emergency situations. Infection control policies and procedures were followed to ensure the control of infection.
The registered manager and the management team strived at creating an inclusive environment to strongly encourage staff, people and their relatives to be involved in the service.
Staffing levels were monitored by the registered manager to ensure sufficient staff were on duty to keep people safe.
Staff received the training they required to help them keep people safe, and were supported with regular supervision and annual appraisals.
The overall rating of the service is Requires Improvement. This is the first time the service has been rated Requires Improvement.
A personal budget is a sum of money allocated to a person as a result of an assessment of their needs by the local authority. This money is then used to purchase the services required to meet the person’s needs. The two people using the service were receiving personal budgets and had chosen to use this service.
A registered manager was employed by the service. 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.
People’s needs were assessed and care plans developed to identify the care and support people required. Relatives said they were involved in planning their family member’s care and were happy to express their views or raise concerns.
Relatives spoke positively about the care and support offered by Dynamic Support.
There were systems in place to protect people from the risk of abuse and potential harm. Staff were aware of their responsibility to report any concerns they had about people’s safety and welfare.
The focus of the service was to develop people’s everyday living skills, support them to access their local and wider community and to help people live their lives as independently as they were able. Staff had knowledge of people’s preferences and needs. They received training and supervision to enable them to meet people’s needs.
There were enough staff deployed to fully meet people’s health and social care needs. The registered manager and provider had systems in place to ensure safe recruitment practices were followed.
Whilst the service was not currently supporting people with their medicines there were processes in place to ensure safe medicines management.
Staff working in the service had access to personal protective equipment (PPE) such as gloves and aprons to help prevent cross contamination and promote infection control.
Where required people were supported to access healthcare services to maintain and support good health.
The registered manager had systems in place to monitor the quality of service provided. People and their relatives were encouraged to comment on how they felt about the service provided.