Direct Link Care Ltd - Oxfordshire

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment in respect of the management of risk and records relating to medicines.

This service scored 62 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Providers are required to comply with the duty of candour statutory requirement. The intention of this regulation is to ensure that providers are open and transparent with people who use services and other 'relevant persons' (people acting lawfully on their behalf) in relation to care and treatment. It also sets out some specific requirements that providers must follow when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, providing truthful information and an apology when things go wrong. The regulation applies to registered persons when they are carrying on a regulated activity. The manager was familiar with this requirement and was able to explain their legal obligations in the duty of candour process.

Systems were in place to report incidents and accidents. Lessons learnt were cascaded to staff.

Staff told us they recorded incidents on the computer system and knew to contact the office to report them. Comments included, [we learn] “With debrief, usually a meeting or report is shared with findings and lessons learned. You might get feedback on actions taken” and “We do speak about incidents that have happened in 1-1 meetings, in our huddles which are small groups where all of us can contribute and discuss any lessons learnt. I find these very helpful as we can all learn from what has happened and also support each other with different ideas on how we move forward positively.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider worked with partner organisations to ensure people were discharged from hospital in a timely manner, they provided support for people to regain their independence and not rely on ongoing support in the future. This is in line with nationally recognised strategies and pathways.

The registered manager told us, “The effectiveness of partnership working is monitored through audit outcomes, incident reviews, feedback from professionals and successful care transitions.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems were in place to ensure staff could escalate safeguarding concerns within the organisation. Staff had received training on how to recognise, report and record potential abuse.

Staff were able to demonstrate how they apply the training they had received. Comments from staff included, “I feel confident about raising abuse concerns because we have clear procedures and I know I would be supported”, “I feel confident to raise abuse concerns”, “I complete safeguarding training annually… this ensures I remain confident in recognising safeguarding concerns and know how to report them correctly” and “We are trained to spot the indicators and signs of abuse… I feel confident about raising abuse concerns.”

People and their relatives told us they had confidence in the staff. Comments included, “I feel safe from any risks with the carers present and they give me reassurance” and “I don’t think my relative is put at any risk with the carers.”

The provider did not work well with people to understand and manage risks. Risk assessments were either not always in place or did not provide clear instruction to staff on how to support people to mitigate harm.

Systems were in place to assess and monitor risk to mitigate harm, however, these were not always robust.

People were not always supported by staff to manage and reduce the risks posed to them as a result of their medical condition. This was because staff were not always aware of people’s medical conditions or guidance was lacking or contradictory. For instance, people who were prescribed paraffin based cream which were known to be flammable did not have a risk assessment in place to mitigate the potential harm to them.

People who had been diagnosed with diabetes, had care plans in place, however they did not always contain enough information about the individual and their usual blood sugar levels. We found other people had either equipment or conditions which presented risks to them. The risk assessments completed were not adequate to mitigate potential harm to people. For instance, people who were at risk of a deterioration in their skin integrity did not always have risk assessment in place which assessed the level of possible harm. We found records reflected situations or circumstances other risk assessments should have been completed, but we found this was not always the case. For instance, the use of hot water bottles and use of neck braces.

Staff told us care plans provided them with sufficient information about how to manage risks to people's safety. For example, we were told, “Care plans and risk assessments provide clear, personalised guidance on known risks (e.g. falls and choking) and the agreed strategies to mitigate them, which are developed with the individual. They outline signs to watch for and specific steps to take” and “[Risk assessments] They state how to prevent the risk around and how to respond in case something happens. Yes, the information is enough and well detailed.”

People were supported by a service which assessed potential risk posed by their home environment. At the service commencement an assessment of needs was carried out. This included an assessment of the person’s home. The assessment included areas such as any repair of the home required and potential risks. For example, frayed carpets and poor lighting.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

During the inspection, we found that staffing levels were sufficient and met the needs of the people.

Staff were appropriately qualified, experienced and deployed to ensure effective care. Staff had completed The Care Certificate which is the nationally-recognised standards all care staff need to meet. The standards include communication, privacy and dignity, equality and diversity and working in a person-centred way.

Recruitment processes were robust, with all staff having up to date Disclosure and Barring Service checks. These provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

We found references and employment history were verified before staff starting work. Mandatory training was up to date and staff had access to additional specialist training tailored to the needs of the people, including people with diabetes and people with breathing difficulties.

Staff received 1:1 meetings with their line manager and an annual review of their performance, however, the records shared with us did not fully demonstrate these were carried out in line with the providers policy. However, staff told us they felt supported and had opportunities to meet with their line manager.

Feedback from people and relatives confirmed staff visited them at a time they wanted and stayed for the duration of the care visit. People’s comments included, “I think they try and be on time. They are reasonably punctual and I realise the pressure they are under and I make allowances for that”, “They are usually very punctual”, “We usually get a good idea what time they will arrive on the four visits a day”, “The carers do all my duties and if I want anything else done, I just ask them” and “The carers will ask me if I require anything more and ask if it’s ok to leave.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Systems were in place to ensure staff received training in infection control and food hygiene. People and their relatives told us staff observed good infection control, comments included,
“The hygiene standards are good”, “I have no problem with them wearing PPE and being well presented”. “I definitely think they are well trained and look confident”, “The carers are well turned out and have high standards of hygiene with all the PPE” and “They all wear the PPE and do everything they should be doing”.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. We found staff supported people with medicines and failed to ensure they followed national guidance to ensure risk of administering medicines were minimised. We found care plans referred to people’s prescribed medicines, but these were not always recorded on a medicine administration record (MAR). For instance, one person’s care plan stated they were prescribed Medi derma cream, however, this was not listed on the MAR.

In addition, we found staff were applying prescribed and over the counter creams without any record of what the cream was prescribed or bought for and how it should be administered. In addition, risks associated with those creams were not always clearly recorded. It was not always clear from people’s care plans and records, what level of support they required from staff with their prescribed medicines. This placed people at risk of potential harm, due to lack of information about what the cream was used for and any possible contraindications.

Systems were in place to monitor and audit medicine management; however, they did not identify the issues we found.

However, people were supported by staff who had received training in the safe administration of medicines. People and their relatives told us they had no concerns with how people received their medicines. We found people who were prescribed time sensitive medicines were allocated care calls in a way that ensured they were supported with taking their medicines as prescribed.