Direct Approach Care Limited

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.

This is the first assessment for this newly registered service. This key question has been rated Inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to governance and leadership and duty of candour at the service.

This service scored 36 (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 have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

The values of the service were clearly defined, however the registered manager had not always been able to ensure these were understood and followed by staff. This meant though we found staff to be committed to providing high-quality care for people, the leadership did not fully embed a shared culture within the home. Lack of detailed and specific guidance for staff and lack of open and transparent leadership meant there was a risk of a closed culture.

The provider did not have inclusive leaders at all levels who understood the context in which they delivered care, treatment and support, or who embodied the culture and values of their workforce and organisation. Leaders did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

The registered manager was passionate and caring about the service they provided. They wanted to provide good life experiences, opportunities and outcomes for people in their care. However, we found they had not effectively understood their role and responsibilities to achieve this and had not always acted with openness or transparency. The registered manager had not always exercised the duty of candour required by CQC and stakeholders. There had been a failure to notify CQC and safeguarding following a serious injury. We received conflicting accounts of safety incidents which meant we could not be confident in the accuracy and reliability of information provided. A relative expressed concern that they had not been informed when their relation went to hospital until a few days later.

People did not feel they could speak up and that their voice would be heard.

Some staff said they were able to speak up or express their views. Some staff told us the registered manager could be difficult to approach and responded to them unprofessionally and felt unable to raise their concerns. We had received similar separate concerns before this assessment. We discussed these concerns with the registered manager who said there had been some challenges in ensuring staff met their responsibilities. People were at risk of potential harm because staff did not feel able to raise their concerns with leaders or that they would be listened to, meaning there was a risk of a closed culture developing.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Incomplete recruitment records meant we could not be confident the provider had captured sufficient data regarding diversity in their workforce. We observed, the staff team was diverse. We received mixed feedback from staff about whether they felt respected. We had received some concerns about the registered manager using discriminatory language to describe some staff. Some comments we heard during this assessment, could be interpreted as discriminatory.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Incomplete recruitment records meant we could not be confident the provider had captured sufficient data regarding diversity in their workforce. We observed, the staff team was diverse. We received mixed feedback from staff about whether they felt respected. We had received some concerns about the registered manager using discriminatory language to describe some staff. Some comments we heard during this assessment, could be interpreted as discriminatory.

Governance, management and sustainability

Score:

1

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.

People were at risk of harm because the providers auditing and governance systems were either not in place or not been followed. The registered manager did not have effective oversight of the service. They had not identified the concerns we noted during this assessment in relation to, medicines, safe transitions between services, inconsistent risk management strategies, risk of inappropriate physical restraint, safeguarding, safety incidents, duty of candour or the premises. The provider had failed to audit recruitment records to ensure staff had been recruited safely and were suitable to work with people. The registered manager accepted they had not followed their own procedures and did not have a clear system in place to ensure they had safe and effective oversight. The registered manager had not ensured records were in good order and stored securely. Feedback from other stakeholders showed they had found access to records difficult and disorganised. Some information and documentation was not readily available during our assessment.

Rotas were well planned to ensure people had the commissioned level of support available. Staff meetings had taken place, minutes we read did not evidence input or engagement with staff.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The provider was aware of their duty to work in partnership with stakeholders and services. However, the registered manager had not been able to establish consistent and effective partnerships to facilitate seamless experiences for people. Feedback from other professionals and relatives hi-lighted the difficulties in accessing information they needed. This included, epilepsy records, documents for legal proceedings and access to care records. We discussed this with the registered manager who acknowledged this needed to improve.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

Opportunities for continuous learning and improvement were missed because the oversight and governance had failed to ensure effective quality assurance systems. Meeting minutes we read did not facilitate effective opportunities for reflection and problem solving. Supervision records were not structured to encourage staff participation and learning.

Staff’s experiences of working at the service were mixed, for some staff learning and improvement was unlikely to be achieved due to the difficulties they had experienced with sharing their views or concerns with leaders.