Direct Link Care Ltd - Oxfordshire

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of 2 legal regulations in relation to governance at the service, in the way records were managed and a lack of effective auditing. In addition, the provider failed to notify The Commission of events it was legally required to do so.

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 shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff consistently demonstrated a clear understanding of the service’s vision and values. The provider’s mission statement was readily available to staff, and they told us, “ Direct Link Ltd - Oxfordshire vision, values and mission statement are clear and well understood as they focus on being a leading provider of person centred care, empowering individuals to maximize their independence and live fulfilling lives by setting high standards for quality, dignity and respect to meet and exceed people’s expectations by holistic approach” and “Core values include providing care with compassion, integrity and respect, which are all included in our mission statement. These guides and inspires me to provide quality and safe care to our client on a daily basis to improve our organisations image and promote client’s satisfaction.”
 

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty. However, the registered manager and provider had failed to identify the concerns we found.

We found the registered manager and provider very open, honest and transparent throughout the assessment. Staff were very complimentary regarding the registered manager and management team.

Leaders were visible, approachable and led by example. Staff gave multiple examples of managers being supportive, participating in care delivery, and taking quick, appropriate action when issues arose. Comments from staff included, “Leaders are visible and lead by example, are seen on the ground and attend team meetings”, “Direct Link Ltd – Oxfordshire management team leads by example through, respectful communication, calm decision-making, and ensuring accurate recording and escalation. For example, management responds quickly to urgent concerns, providing clear direction and reassurance” and “Leaders regularly attend team meetings, huddles, and 1-1 sessions, making themselves available for support and guidance.”
 

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff were aware of the term ‘freedom to speak up’ and told us the service encouraged them to do this if they had any concerns.

Staff told us, “To me, it means having a fundamental right and responsibility to raise any concern about safety, quality, or wrongdoing without fear of reprisal, in the interest of those we support and the integrity of the service”, “Freedom is the ability to speak freely about your concerns without any fear of anyone” and “I am aware of the term. To me, it means staff, people we support, and their families can raise concerns, suggestions, or worries about any aspect of the service without fear of negative consequences. It includes speaking up about things like potential risks to care quality, staff well-being, or discrimination.”
 

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us there was a code of conduct which outlined expected behaviour, to promote a culture of dignity and respect at work. They said they were treated fairly at the service and managers were flexible if they needed to take time off for appointments or swap shifts.

Staff told us “When I first started working at our organisation, I was verbally explained the company’s policies and procedures, and code of conduct along with the contract. I was then given trainings to complete to ensure that I am competent to provide person centred care to various service users”, “Our organisation also stipulates that equality under Equality Act 2010 must be observed in our policies and procedures and the organisational code of conduct. Discrimination based on race, religion sex or any other element that falls under protected characteristics is taught to be reported” and “I am treated fairly and equally. The service values diversity, respects staff, and applies policies consistently.”
 

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. We found risk assessments were either not in place or did not routinely and consistently contain enough information to mitigate harm to people.

People’s records were not always representative of the individual. For instance, we found inconsistencies in people’s care plans. Care plans contained contradictions which could have led to harm. For instance, one person’s care plan stated [person] can stand and sit up with the help of a zimmer frame and support of one” in another part of the care plan it stated “During hoisting ensure that the catheter is not caught up in the sling, ask [person] to hold the leg bag while [person] is being hoisted.” It was not clear from the care plan if the person needed support from a hoist to move position or could stand.

The providers auditing systems, did not highlight the concerns we found, we found audits carried out on care plans, and recruitment records did not contain any action plans or follow up. The provider used spreadsheets to monitor comments, complaints, safeguarding and incidents; however, these spreadsheets did not contain all of the information that we had noted from the review of evidence. The nominated individual and registered manager confirmed all safeguarding concerns had not been entered onto the safeguarding spreadsheet. This meant the system was not effective in driving improvements.

We found medicine administration records (MAR), did not routinely follow best practice guidance from National Institute for Health and Care Excellence (NICE).

Systems were not effective to ensure we were notified of all relevant incidents, and this was done “without delay”. The local authority had investigated safeguarding concerns under The Care Act 2014, and the provider was aware of safeguarding concerns, however, we had not been notified of all these allegations of abuse. We provided feedback to the provider and registered manager, who responded quickly to our feedback. However, the provider had not identified the concerns we found through their own quality assurance systems.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The provider worked with external health and social care professionals to ensure people’s needs were met. The provider told us, “Our service maintains regular communication with a wide range of professionals including GPs, district nurses, community therapy services, hospital discharge teams, social workers and pharmacists”. We could see this had occurred and had had a positive impact on people.
 

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.