Dunamis Social Care

Dunamis Social Care is a domiciliary care agency. It provides personal care to people in their own homes. The service provides support to people with dementia, people with physical disabilities, sensory impairment and people with a learning disability and autistic people. At the time of our inspection there were 25 people using the service.

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.

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.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

People’s experience of using this service and what we found

Right Support:

People had been recruited into the service without references being verified. Systems were not in place to robustly check the recruitment process. We have made a recommendation about the recruitment of staff.

Staff training did not include topics staff needed to be aware of, such as training in dignity and specific health conditions. We saw no evidence of harm of this lack of training. However, there was a risk staff may not understand and act on people's health needs.

People had their needs assessed before care was delivered. People were supported to have maximum choice and control of their lives, this meant staff were able to support them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice.

The service protected people from the risk of poor nutrition and dehydration. People were supported by staff to prepare meals and drinks to meet their needs.

The service worked with medical professionals. This included working with district nurses to assist a person with pressure area needs. People were confident their healthcare needs were met.

Right Care:

People's care, treatment and support plans had not always been updated and did not show how people had been involved. The registered manager had identified care plans needed improvement and was in the process of updating them.

Staff had training on how to recognise and report abuse and they knew how to apply it. Systems and processes identified and protected people from abuse. People told us they felt safe with staff.

Medicines were managed safely. Electronic medication administration charts (eMAR) had been completed and showed people had their medicines as prescribed. Systems and processes flagged when records were not completed.

Staff had access to personal protective equipment (PPE) and people told us staff wore this appropriately, kept their homes clean and were regularly observed to wash their hands.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity.

Right Culture:

Systems and processes were not always robust to ensure good governance of the service. Audits did not identify the concerns reported on during this inspection. This placed people at risk of not having their care needs met.

People told us the registered manager and staff were kind, caring and their needs were met. One relative told us, "Best care [our relative] has ever had. It has made a huge difference. We can appreciate how good they are.”

The registered manager was open and transparent throughout the inspection. They told us their focus had been working with new staff.

Staff felt supported by the registered manager. Staff told us they were happy to work for Dunamis Social Care and people felt they received good care.

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 8 July 2022).

Why we inspected

We received concerns in relation to staffing. As a result, we undertook a focused inspection to review the key questions of good, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

The registered manager assured inspectors that they were managing their financial commitments and they had recently recruited regular care staff to ensure continuity of care for people.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dunamis Social Care 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.

People’s experience of using this service and what we found

People told us they felt safe receiving care from the staff. Staff we spoke with were trained and knowledgeable in safeguarding procedures.

Risks were assessed. Checks and monitoring processes were in place to keep people safe.

Medicines were administered safely by trained staff.

Prompt action was taken in response to incidents, to ensure lessons were learnt.

There were enough staff working at the service to keep people safe and meet their needs. Staff were recruited safely and trained to provide care safely.

Audits and checks were in place. Records we saw, were being accurately monitored and kept.

Staff were well supported within their roles and felt able to approach management with any concerns or requests for support.

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 which was published on 16th February 2021.

Why we inspected

The inspection was prompted in part due to concerns received about safe recruitment procedures. A decision was made for us to inspect and examine 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Dunamis Social Care 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.

Dunamis Social Care is a domiciliary care service. The service provides personal care to people living in their own homes. At the time of the inspection there were 33 adults using the service. The services provided, include a reablement service to support adults in regaining their independence following an incident or injury. The service also supports people on an ongoing basis, which in some instances included live in support.

People’s experience of using this service and what we found

Staff recruitment procedures had improved. However, we have made a recommendation that any missing information on application forms is explored with the candidate and recorded. People said they were not provided with a rota to inform them which staff would be providing their care, and many told us they had experienced late calls. A majority of people told us they were informed if staff were running late.

Staff training in key safety areas promoted people’s safety, which included staff knowledge and understanding of reporting potential safeguarding concerns, and following infection control procedures. Staff undertook tailored training to meet the specific needs of some people. People’s records provided information about their medication. People’s medication in most instances was managed by themselves or a family member.

Processes were in place to monitor the quality of the service provided. However, the analysis of information gathered through surveys sent to people was not timely. This delayed potential action being taken to improve the service. People’s concerns and complaints were acted upon, however the information recorded regarding the concern, and the action taken was limited. Systems were in place to ensure effective communication and the sharing of information amongst the staff team and partner stakeholders to support the delivery of care.

Rating at last inspection

The last rating for this service was requires improvement (published 17 September 2019) Breaches of legal requirements were found in relation to staff recruitment and ineffective systems to monitor the quality of the service.

Why we inspected

We carried out a focused inspection of this service in August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they do and when to improve, Fit and proper persons employed and Good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to Safe and Well-led.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dunamis Social Care on our website at www.cqc.org.uk.

Follow up

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.

Dunamis Social Care is a domiciliary care service providing personal care to 29 people with dementia, physical disabilities, sensory impairments, a learning disability or autistic spectrum disorder.

People’s experience of using this service and what we found

Recruitment procedures were not always operated effectively. Staff had a good knowledge of risks associated with providing people’s care, including infection control. Their competency was assessed before they gave people their medicines. Staff knew how to identify, and report abuse to keep people safe. Accidents and incidents were reported and reviewed.

Systems and processes to monitor the quality and safety of the service did not always operate effectively. The registered manager did not identify gaps in recruitment files, when people’s right to work in the United Kingdom had expired, or that records to identify when staff needed training, were not up to date.

People did not always receive care at the time they needed it and did not always know who would be attending to provide their care. The registered manager had implemented systems and processes to improve call times. However, implementation was in the early stages and needed to be further developed and embedded in practice to improve people’s care experience.

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 18 September 2018). At this inspection we found areas required improvement and some areas where the provider had breached the regulations.

Why we inspected

We received concerns in relation to recruitment, staff arriving late to provide people’s care and not staying for as long as was needed. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dunamis Social Care on our website at www.cqc.org.uk.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own houses. It provides a service to older adults.

Dunamis Social Care Limited provides care and support to people who wish to remain in their own homes. Services include personal care, meal preparation, hospital discharge, live in carers and medication support. At the time of our inspection there were 29 people receiving personal care.

The service had a registered manager in post. 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 told us they felt safe, and staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by their manager. Risk assessments were in place to manage the risks associated with people’s care. These included assessments to support people with their mobility, eating and drinking and falls. Staffing numbers were appropriate to keep people safe and the registered provider followed thorough recruitment procedures to ensure staff employed were suitable for their role.

People’s medicines were managed safely and in line with best practice guidelines. Systems were in place to ensure that people were protected by the prevention and control of infection. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service

People’s needs and choices were assessed and their care provided in line with best practice that met their diverse needs. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they were able to provide care based on current practice when supporting people.

People received enough to eat and drink and staff gave support when required. People were supported to use and access a wide variety of other services and social care professionals. The staff had a good knowledge of other services available to people and we saw these had been involved with supporting people using the service. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

People's consent was gained before any care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People received care that was person centred and met their needs. They had developed positive relationship with the staff who understood their likes and dislikes. Staff were kind, caring and treated people with dignity and respect.

People were listened to, their views were acknowledged and acted upon and care and support was delivered in the way that people chose and preferred. Records showed that people and their relatives were involved in the care planning process. There was a complaints procedure in place to enable people to raise complaints about the service.

Staff felt supported and valued. There were systems in place to monitor the quality of the care and to ensure on-going improvement were made. The registered manager was aware of their responsibility to report events that occurred within the service to the Care Quality Commission (CQC) and external agencies.