Direct Approach Care Limited

Updated 29 June 2022

The inspection

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector.

Service and service type

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

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager was also the director for the provider of the service. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the registered manager would be in the office to support the inspection.

Inspection activity started on 16 May 2022 and ended on 25 May 2022. We visited the location’s office on 16 May 2022.

What we did before the inspection

We reviewed information we had received about the service since its registration. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We attended the office and spoke with three members of staff, including the care co-ordinator, a senior carer and the registered manager.

We looked at records in relation to people who used the service including three care plans, staff files and systems for monitoring the quality of the service provided.

After the inspection we continued to seek clarification from the provider to validate evidence found. We looked at staff training and quality assurance records. We also spoke with one person who used the service. Not everyone was able to speak with us due to their health conditions, so we spoke to three relatives on the telephone to help us understand their experience of the care and support their loved ones received.

Updated 29 June 2022

About the service

Direct Approach Care Ltd is a service that provides support with personal care to people living in their own homes. This includes adults living with dementia and mental health conditions.

At the time of our inspection, the service was providing support to seven people.

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.

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

The service was not always safe. Information about people’s risks was not comprehensive enough. There was no evidence that the service looked for safety related themes or trends. We could not be assured that medicines were always managed safely as audit processes were not in place.

Recruitment processes were not robust enough to ensure staff were safe to work with people. Full employment histories were not always recorded or corroborated.

The safeguarding policy did not reflect current guidance meaning staff may not be up to date with safeguarding practice. We have made a recommendation that the provider updates its policies.

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 caring, people and their relatives told us staff treated them well.

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.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Although the service adopted a model of care that maximises people’s choice, control and Independence; people’s care records and governance processes required improvement to better evidence that care was person-centred and promoted people’s dignity, privacy and human rights.

The service was not always responsive. People’s care plans did not contain enough information about their routines and preferences around their care and support, but people and their relatives told us that staff were caring and treated them with respect.

Although the service had not received many complaints, complaints were not recorded and there was little evidence of learning applied to practice within the service. We have made a recommendation about the management of complaints.

The service was not always well-led. Systems for governance and performance management either did not exist or were not reliable or effective.

The registered manager began to address our concerns immediately following the inspection, showing they were responsive and committed to making the required improvements, and that the safety and quality of the service was a priority.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

This service was registered with us on 19 November 2020 and this is the first inspection.

Why we inspected

As the service has been registered with CQC for over one year, we carried out this comprehensive inspection to award a rating for the service.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.