Direct Approach Care Limited

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. This is the first assessment for this newly registered service. This key question has been rated Inadequate. This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulation in relation to people’s safe care and treatment, the way medicines were managed, safeguarding, lack of robust recruitment processes, safe storage of cleaning chemicals and infection prevention and control practices and duty of candour.

This service scored 34 (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 have a proactive and positive culture of safety based on openness and honesty. The provider did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Though systems were in place to facilitate learning from safety events and incidents the provider had not consistently followed their own policy. Incidents where staff had used physical interventions or where people and staff had been assaulted by other people accessing the service had not been recorded with sufficient detail to enable lessons to be learned. We were assured there had been some verbal communication with staff, but the lack of recording meant overall patterns and themes could not be analysed to minimise the risk of it happening again.

Seizure records for one person with epilepsy had not been completed in enough detail to allow for analysis and learning.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Systems in place to support people when transitioning to and from hospital were unsafe. The provider had failed to review and assess the needs of a person who returned from hospital following a serious injury. The person was at risk of harm because their changing needs had not been accurately identified.

Systems to reconcile medicines had not been followed. The person experienced harm because they received the wrong doses of some medicines for a prolonged period, upon their return from hospital. We raised a safeguarding with the local authority about this matter.

Systems were in place to support people transitioning into the service when they first began to access respite care. We had positive feedback from a person’s school about the efforts made to support the person to settle into this service.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

The provider had safeguarding procedures and processes in place. We could not be confident people accessing the service were protected from the risk of harm and abuse because the provider had not followed their own safeguarding policies. Safety incidents had not been properly recorded. We asked to see the safeguarding log, but this was not available during the assessment. Not all safeguarding incidents had been reported to the CQC or the local authority, though we did see some safeguarding outcome letters.

People were at risk of avoidable harm and abuse if they were distressed. Positive behavioural support plans had not included enough detail to guide staff how to safely support people if they needed physical interventions to minimise risks to themselves or others.

Staff had received safeguarding training and were able to tell us what a safeguarding concern might be. Not all staff were aware who to contact if they needed to raise concerns outside of the service. People were at risk of harm because of the possibility some concerns might not be raised.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that where people needed the protection of DoLS authorisations applications had been made to the appropriate authority. However, we received feedback about significant delays in the provider ensuring the documentation needed to progress an application, was provided to the Court of Protection.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

The provider had safeguarding procedures and processes in place. We could not be confident people accessing the service were protected from the risk of harm and abuse because the provider had not followed their own safeguarding policies. Safety incidents had not been properly recorded. We asked to see the safeguarding log, but this was not available during the assessment. Not all safeguarding incidents had been reported to the CQC or the local authority, though we did see some safeguarding outcome letters.

People were at risk of avoidable harm and abuse if they were distressed. Positive behavioural support plans had not included enough detail to guide staff how to safely support people if they needed physical interventions to minimise risks to themselves or others.

Staff had received safeguarding training and were able to tell us what a safeguarding concern might be. Not all staff were aware who to contact if they needed to raise concerns outside of the service. People were at risk of harm because of the possibility some concerns might not be raised.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that where people needed the protection of DoLS authorisations applications had been made to the appropriate authority. However, we received feedback about significant delays in the provider ensuring the documentation needed to progress an application, was provided to the Court of Protection.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider had failed to follow their own policies in relation to the safety of the environment.

Regular checks had not been consistently completed. The checks that had been done did not identify what we found during our assessment, meaning people were at risk of avoidable harm.

Not all downstairs windows had restrictors on. There was a risk people might climb out and come to harm.

Radiator covers were missing from 3 radiators. These were bought during our assessment.

A bedroom door was missing from one bedroom; the hinges were protruding and posed a risk to people. This was also a fire risk.

Some requirements from the most recent fire safety risk assessment had not been met.

One bedroom did not have a door on it. Not all bedroom doors were fire doors, and not all bedroom doors had intumescent strips in place. Though the fire risk assessment identified they may not be needed if the area on the floor below was clear of combustible materials, a hot tub had recently been installed without a risk assessment being completed in relation to fire. We sought assurance about fire doors and intumescent strips but did not receive confirmation of this.

Records relating to fire drills did not show who was present and fire safety equipment checks had not been completed regularly.

Cleaning chemicals were not securely stored, there was a risk people might come to harm because they may access them without staff knowledge or support.

The paperwork to demonstrate, Legionella safety checks were done was not available. The last one we saw was dated December 2024.

Some bedrooms did not have any blinds or curtains at the window, there was some privacy from screens, however we could see inside bedroom windows from the street. The mattresses we looked at in 2 bedrooms were plastic and did not have a cover for peoples’ comfort and safety. One mattress we looked at was old and lacked support.

The registered manager began to address these concerns during the assessment.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

The provider had not followed their own recruitment policy and procedures. Recruitment records were incomplete and lacked the necessary documentation to demonstrate they met the requirements detailed in the regulations.

We reviewed 4 recruitment files, 3 did not have application forms, this meant the provider could not be assured of people’s employment history or ask them to account for any gaps. One person had no references, 2 people had references from the provider only. One staff member was found to be working contrary to their visa/sponsorship.

Not all staff had received a proper induction; induction records we saw were not sufficient. One staff member told us they did not get an induction but shadowed another carer on shift. Another staff member told us they did not get an induction but shadowed another staff member for 3 shifts.

Staff had received training to support them in their roles. Staff told us they felt they had enough knowledge to support people. However, we found some staff did not have effective knowledge of risk management plans and did not know how to access them.

Staff had not received regular recorded supervision; records we saw did not include all the staff and were not robust. None of the 4 staff we asked told us they had received a supervision or an appraisal.

Feedback from staff was mixed. Some staff said they felt well supported but others said they did not.

During the assessment there were enough staff on duty, as identified in people’s care records. Rotas we saw for the previous month, also confirmed this.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

When assessing a person’s continence support needs, we saw 3 staff did not use personal protective equipment (PPE) or wash their hands before or after on 3 occasions. This meant there was a risk of infection. Supplies of PPE were not easily accessible for staff; we raised this with the registered manager who ensured this was addressed during the assessment.

The home appeared to be clean, though would benefit from some refurbishment. There were cleaning schedules in place which were completed by staff.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People’s medicines were not managed safely. We were not assured people received their medicines as prescribed. Medicine administration records (MAR) lacked detail and did not always contain clear information about dosage. Some doses of medicines were incorrect on the MAR. Medicine stock records were not maintained which meant the registered manager could not be assured how much of some medicines people may have had.

One person’s liquid medicine bottles did not have any labels on to identify whose it was, what dose was prescribed and how and when to administer it.

Protocols to guide staff when and how to use rescue medicines for people at risk from epileptic seizures were unclear and inconsistent. People were at risk of harm because staff did not have clear information to guide them.

The registered manager failed to ensure the temperature medicines were stored was checked and recorded each day. There was a risk medicines might not be effective.

The registered manager had failed to follow their own controlled drugs policy. Controlled drugs are drugs which are subject to stricter management and recording. Stocks of one controlled drug were excessively high, and the registered manager did not know how much there was or how much there should have been.

The registered manager had failed to follow their own safe disposal of medication policy. No records had been kept of medicines taken back to the pharmacist.