Direct Link Care Ltd - Oxfordshire

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People told us their needs were assessed before they began receiving care and support from the service. One relative told us, “The assessment of care needs involved both myself and my mother. Staff took time to understand the situation, ask relevant questions and ensure that the support plan reflected her real needs.”

Staff had confidence in the information they had available to them. Staff told us “Care plans and risk assessments for each service user are available on the[electronic] system. They provide clear guidance on mobility, personal care, and medication. I feel I have sufficient information to manage risks safely and confidently”, “Care plans and risk assessments are essentially your road map for keeping someone safe while still supporting their independence. They take what could be vague concerns and turn them into clear, practical guidance you can act on with confidence.”

Staff told us they knew what to do when a person’s condition changed. Comments included, “If l identify any signs of deterioration such as changes in mobility, behaviour, appetite or mood l accurately document these observations and report the to my senior staff” and “If there is any deterioration, I immediately document thoroughly any observations report to any health professional or supervisor also seeking emergency assistance.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider did not routinely ensure they followed best practice guidance for administering and recording of prescribed medicines and care plans did not always provide best practice guidance on skin integrity. For instance, although care plans referred to the importance of repositioning for people at risk of a deterioration in skin health, the documents failed to ensure mitigating factors were clearly documented. For instance, what type of equipment was needed to reduce pressure damage.

However, staff told us they received training in key areas such as diabetes and modified diets as examples. One member of staff told us “Having completed trainings on diabetes awareness and Level 2 diet, nutrition, and hydration, I have the knowledge to support individuals with specific dietary needs. I recognize the unique challenges faced by those with swallowing difficulties and diabetes.”
 

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff spoke about how they worked together to build respectful, supportive relationships with the people they cared for. They said they had access to personal histories, preferences and goals, which helped them to provide more personalised care. One member of staff told us, “Support is tailored to individual life histories, values, and preferences, ensuring service users feel heard, respected, and involved in their care.”

Staff described a culture of dignity, inclusion and mutual respect. Staff said they were appreciated and supported by both colleagues and managers. One member of staff told us “The exchange of information within Direct Link Care Ltd- Oxfordshire is effective and coordination and collaboration with all other relative organisations is quite remarkable. The service demonstrates that staff are valued by promoting open communication providing regular supervision and offering opportunities for training. I feel respected and supported by management and colleagues.”

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People and their relatives told us how staff have encouraged them to maintain their health. People’s relatives told us “The care planning process involved myself, my relative, and relevant family members. The service also consulted healthcare professionals where appropriate to ensure all needs were fully understood and catered for” and “Staff offer gentle encouragement and positive reinforcement. They provide helpful reminders, explain the benefits of healthy choices, and always respect personal preferences while promoting wellbeing.”

Staff told us they were keen to support people make healthier choices. Comments from staff included, “I understand people’s health concerns through their care plans, regular reviews, and daily observation. If I notice deterioration like increased confusion, reduced mobility, or not eating. I follow our agreed ways of working which includes recording, inform the manager and if the client is at risk I call 999 immediately or 111 to seek medical advice, and monitor as directed.”
 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We found care plans guided staff on how to manage people’s conditions; however, this was not routinely evidenced in daily notes recorded by staff. For instance, one person’s care plan stated they required to have daily support with monitoring blood sugar levels, food intake and care staff should, “Take blood sugar reading [name of person] will check [their] blood sugar. Staff will record the readings.” However, we found this was not routinely recorded. We have provided this feedback to the provider to take action.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. The provider did not always work within the guidance of The Mental Capacity Act 2005 (MCA).

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty.

We found mental capacity assessment were not completed in line with the code of practice of the MCA. We found the provider had completed mental capacity assessments when the person did not have a disturbance or impairment of the mind or brain, this was not in line with the two stage capacity test under the MCA. In addition, when mental capacity assessment had been completed these were not routinely decision specific. However, we found the registered manager and provider were aware of the code of practice and how to support staff to uphold people’s human rights under the MCA.

Staff understood the principles of gaining valid consent and how it applied in day-to-day practice. They told us gaining consent from people before providing care and support was embedded within their working practices.