Direct Approach Care Limited

On this page

• 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.

This is the first assessment for this newly registered service. This key question has been rated Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 58 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Assessments had been completed prior to people accessing the service for respite care. We received feedback from people’s relatives and a person’s school which indicated they had been involved and were pleased with the efforts made to understand people’s needs.

Reassessments and reviews had not always been completed regularly or recorded in enough detail. There was a risk some care records, risk assessments and support plans were out of date.

We found risks assessments in relation to physical interventions did not provide enough detail to guide staff which meant people were at risk of unauthorised or inappropriate restraint.

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

Though assessments and care records included information and guidance from a broad range of other professionals and families, the provider did not always ensure best practice guidance was included or followed.

Clinical assessment tools had not been used when needed, in relation to the recording and monitoring of epileptic seizures, and skin integrity.

People’s nutrition and hydration intake was recorded. However, we found some records needed more detail. We had received concerns about a lack of food, however we saw there was plenty of food available. Staff confirmed there was a broad range of food and drink. There were menus and some pictures of food to support people to choose what to eat and drink.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

People were not always supported effectively between different agencies and services. Feedback from relatives and other professionals identified difficulties accessing appropriate information to inform their decision making and input. There had been occasions where other professionals had visited and been unable to review documentation either because it was not clear where it was or it was secured in the office, and staff did not have access to the records. Some staff we spoke with could not find where information might be on the electronic records app on their phones.

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

People who accessed the service for respite were mainly supported by their families, however where the provider had more responsibility, they supported people to live healthier lives. People had access to health screening, routine appointments, including opticians and dental services. People had been provided with effective support to tolerate and accept treatment.

Menus were varied and provided balanced nutrition.

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.

The registered manager had not reviewed or reassessed the needs of a person on their return from hospital. Health professionals’ advice following surgery had not been recorded. There was a risk the person might be harmed because clinical outcomes had not been identified or monitored.

People’s routine health outcomes had been assessed and effective plans developed to promote good outcomes.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People were supported to understand their care and support. We saw people were offered choices in a way they could respond to. This included a variety of visual aids and the use of story boards. Story boards provide visual clues to the order things are planned in the day and support decision making for people who are non-verbal. Obstacles to decision making had been recorded in care records, which included what might trigger distress for a person.