3 October 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
The inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care and supported living agency. It provides personal care to people living in their own houses, flats and in residential care so that they can live as independently as possible. In supported living, people’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection because we needed to be sure the provider was available to support the inspection. Inspection activity started on 14 August 2019 and ended on 20 August 2019. We visited the office location on 14 August 2019.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We visited the office location to review the management of the service. We later visited two people at their homes, but they were unable to verbally give their views. We therefore used some informal observation to help gain feedback about people’s experience of being supported by the service.
We spoke with the provider (who was also the registered manager) two care co-ordinators and a new member of staff who was applying to become the registered manager and had been in post for the past two weeks. We spoke with three members of staff during our visits to people’s homes.
We reviewed a range of records. This included two people’s care records. We looked at two staff files in relation to recruitment and staff supervision. We reviewed a variety of records relating to the management and governance of the service.
After the inspection
Not all people supported by Dynamic Support were able to verbally give us their views. Therefore, we sought views from relatives or representatives that knew people well to help understand their experiences. We contacted three relatives after the inspection to gain their views. We had feedback from four members of care staff about their experience of working in the service. We sought feedback from six health and social care professionals who have knowledge of the service to request feedback. We continued to seek clarification from the provider to validate evidence found.
3 October 2019
About the 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. 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.