We undertook an announced inspection of Dynasty Care Limited on 25 September 2018.

Dynasty Care Limited is a small service which provides personal care and support services to people living in their own homes, including older people with dementia. At the time of our inspection the service provided support to 10 people.

At the previous inspection on 31 July 2017 we found that the service was not meeting all the quality standards and was rated "Requires Improvement” in the key areas of safety, effectiveness, being responsive to people’s needs and in the management and leadership of the service. The inspection rated the service overall as “Requires Improvement”.

We asked the service to provide us with an action plan for improvement and we monitored improvement during this inspection. At this inspection we found that the provider and registered manager had made the necessary improvements to their service.

At the previous inspection we found that the provider did not have suitable arrangements to protect people against the risks associated with the management of medicines. The registered manager had not ensured that staff follow National Institute for Health and Care Excellence (NICE) guidelines for the recording of medicines taken or refused which meant that the registered manager could not be sure that medicines were administered safely.

At this inspection we found that records of medicines were accurately maintained and that staff were confident in administering medicines because they had had adequate training in medicines administration. People and relatives confirmed that medicines records were kept and that they received their medicines as prescribed.

At the previous inspection we found that the registered manager did not have systems in place to ensure care staff received appropriate or regular training and support to effectively meet people’s needs.

At this inspection we found that improvements had been made to the planning and recording of staff supervision and training. Records indicated that regular supervision was held and was carried out both in the form of individual conversations and in the carrying out of spot checks. There were records of up to date mandatory training and refresher training for staff.

At the previous inspection we found that the provider did not always follow the service’s complaints policy and procedure correctly, which had led to some people’s complaints not being appropriately responded to.

At this inspection we found that there were records of any issues or concerns and recorded details of how people were responded to, together with checks that people were satisfied with the outcome. People and their relatives expressed satisfaction with the way they could raise any issues with the registered manager or provider.

At the previous inspection we found that the service did not have good governance arrangements in place to assess, monitor and improve the quality and safety of the services provided. Audits and checks by the registered manager had not always been carried out, such as regular supervision, spot checks to monitor quality or developing quality assurance systems to receive and act on the feedback of people who used the service.

At this inspection we found that the registered manager had improved their good governance arrangements. These included regular telephone contact with people, spot checks, surveys and recorded audits of the service.

At the time of the inspection, the service had 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.

People were encouraged to make their own choices and maintain their independence. They were included in risk assessments to ensure that care

We undertook an announced inspection of Dynasty Care Limited on 31 July 2017.

Dynasty Care Limited is a small service which provides personal care and support services to people living in their own homes, including older people with dementia. At the time of our inspection the service provided support to 10 people.

At the previous inspection on 21 July 2015 we found that the service was meeting all the quality standards and was rated "Good". At this inspection (2017) we found the service to require improvement in several areas.

At the time of the inspection, the service had 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 provider did not have suitable arrangements to protect people against the risks associated with the management of medicines. We found that the registered manager did not ensure that staff followed National Institute for Health and Care Excellence (NICE) guidelines for the recording of medicines taken or refused which meant that the registered manager could not be sure that medicines were administered safely.

The registered manager did not have systems in place to ensure care staff received appropriate training and support to effectively meet people’s needs. Although there was some evidence of supervision this did not happen regularly enough to enable the registered manager to properly develop staff. There was some basic training when a new employee started but little in the way of further development and no proper procedure to identify when staff required refresher training.

People told us they would feel comfortable raising any issues they had about the provider in an informal manner. However we found that there was at least one formal complaint which had not been appropriately dealt with by the registered manager and had not correctly followed the service’s complaints policy.

The service did not have good governance arrangements in place to assess, monitor and improve the quality and safety of the services provided. Audits and checks by the registered manager were not always carried out, such as regular supervision, spot checks to monitor quality or developing quality assurance systems to receive and act on the feedback of people who used the service.

People and their relatives were satisfied with their service. Feedback from people was positive throughout. People felt that they were with a care provider they could trust and they liked their care workers who were described as kind, caring and respectful. They told us their needs were met and the way in which they were cared for reflected their preferences. People were involved in planning and reviewing their own care.

People were encouraged to make their own choices and maintain their independence.

People received personalised care in accordance with care plans which included risk assessments and instructions on how people preferred their care to be given. Staff had received basic training in and were aware of, policies and procedures designed to keep people safe, including safeguarding people from abuse and the management of medicines.

There were systems in place to guide staff in reporting any concerns. The registered manager and care staff were aware of the Mental Capacity Act 2005 (MCA) code of practice.

People were supported to eat healthily where this was part of the agreed plan of care. In addition, care staff brought any concerns regarding nutrition or fluid intake to the attention of the manager so that they could be raised with relatives if necessary. People received the support they needed to stay healthy and to access healthcare services.

We found four breaches of regulations during this inspection, in relation to safe ca

We carried out an inspection of Dynasty Care Limited on 3 August 2015. This was an announced inspection where we gave the provider 48 hours’ notice because the location provides a domiciliary care service and we needed to ensure someone would be available to speak with us.

Dynasty Care Ltd. provides a range of services to people in their own home including personal care, companionship and shopping in Whitton and the surrounding areas. At the time of inspection there were nine people receiving personal care.

A registered manager was in place. 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 who used the service told us they felt safe. Staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice.

There were sufficient staff employed to provide consistent and safe care to people, with people receiving care from the same small team of staff.

People received their medicines in a safe way and staff had received training in the types of medicines people received. Staff recorded medicines taken by people in an appropriate medicines record sheet.

Staff had received training and were aware of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves. They also received other training to meet people’s care needs.

Staff helped ensure people who used the service had food and drink to meet their needs. Some people were assisted by staff to cook their own food and other people received meals that had been cooked by staff.

Staff knew people’s care and support needs. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. There were regular visits and spot checks carried out by the service to monitor the quality of service and the care practice carried out by staff.

People told us that staff were kind, caring and efficient.

People who received care remained independent and in control of their decision making and choices. People had access to health care professionals to make sure they received appropriate care and treatment. The service maintained accurate and up to date records of people’s healthcare and GP contacts in case they needed to contact them.

A complaints procedure was available and people we spoke with said they knew how to complain, although most people said they had not needed to. Where complaints had been received they had been satisfactorily resolved. The service maintained records of compliments and complaints and recorded how these were resolved.

People had the opportunity to give their views about the service. There was regular consultation with staff, people and/or family members and their views were used to improve the service. Regular audits were completed to monitor service provision and to ensure the safety of people who used the service.

During our announced inspection we spoke with two staff members and we rang four people or their relatives who used the service. We also looked at care plans of people who used the service, management policies, the results of recent surveys and staff files and training records.

Comments we received from people who used the services or their relatives included, “we are very satisfied, staff are polite and prompt” and “they (care workers) are very good, they write daily notes so I know what my relative has been doing” and “management are fantastic”.

Our inspection on the 9th May 2013 found that some procedures for the recruitment of staff were not being fully addressed and there was a lack of audit across the organisation. The provider wrote to us and told us they would review their recruitment procedures and quality audit processes.

During our unannounced visit on the 3rd October 2013 we saw improvements had been made to the recruitment procedures and quality audit processes. We looked at two care plans and audit assessments for daily care records and medication charts. We also looked at the recruitment processes and provider policies.

Our inspection of 9th November 2012 found that some procedures for the recruitment of staff were not being fully addressed and that there were inconsistencies in these procedures. There was a lack of audit across the organisation and records were not being maintained or stored securely. The provider wrote to us and told us they would review their recruitment procedures, quality audit processes and record management systems within three months. We found some improvements to the recruitment procedures and record management systems, although improvements were still required in how the organisation monitored and quality assured some of its processes.

We spoke with six staff members and asked about recent recruitment procedures and care work. Newly recruited staff told us that they found the recruitment process thorough. One staff told us "I was given time to ask questions". They went on to describe questions they were asked at their interview.

Records were stored in separate individual hanging files within a filing cabinet. Each file had been tagged so that information within records could be easily traced. We spoke with the provider and the registered manager about the changes they had made with audit. Staff told us "we recently sent two types of questionnaires to people who use our service and their relatives".

We asked to see daily care records and medication charts but found these had not been audited. We were told this had not yet started.

We spoke with three relatives of people using the service, one person receiving a service, one community representative of a person using the service and five members of staff during our inspection.

People we spoke with told us that the staff and service that they received from Dynasty Care was receptive and friendly. People referred to the service as 'small yet personalised'. Another person explained that staff were reliable and competent, adding “my carer is a natural, and I’ve recommended the service to others”.

We asked people about the service and the care that they received and one person said “I’m very satisfied with the service and I feel in safe hands”. Another person told us “Our care workers have similar interests to my family member; they seem to be ideally suited”. One person remarked “I was nervous at first about having someone in my home and it took time to build my trust, but I’m really pleased with the care worker”. They went on to say “the staff in the office are always helpful, responsive and willing to sort most things out”.