Link House

Updated 16 February 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was conducted by one inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats and in a number of ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a manager currently registered with the CQC. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection. Inspection activity started on 16 December 2021 and ended on 12 January 2022. We visited the office location on 16 December 2021 and 12 January 2022. We visited two supported living services on 06 and 12 January 2022.

What we did before the inspection

We reviewed information we had received about the service since it had registered with us. We used this information to plan our inspection.

We did not ask the provider to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with three people using the service, three relatives, the registered manager, two team leaders and two support workers.

We reviewed a range of records. This included four care records, two staff recruitment files and a variety of records relating to the management of the service, including complaints, incident forms, policies and procedures were reviewed.

After the inspection

We received feedback from four healthcare professionals. We continued to seek clarification from the provider to validate evidence found.

Updated 16 February 2022

About the service

Link House is a domiciliary care provider delivering personal care to people living in their homes. Some people lived in their own homes, others lived in supported living schemes with separate tenancy agreements which were typically shared homes set in residential areas.

At the time of the inspection, there were 15 people using the service. Not everyone who used the service received personal care and there were 7 people receiving personal care at the time of the inspection. The Care Quality Commission (CQC) inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People receiving support from the provider were not kept as safe as they could be. Risk assessments for people were either incomplete, did not sufficiently identify all the areas of risk or were not reviewed regularly. In addition, medicines management was not safe. Medicines records were not accurately maintained and staff did not receive refresher training in medicines management.

The service was not always effective. Staff did not receive up to date training and were not always given the opportunity to reflect on their working practices through regular supervisions.

Care or support plans for people were not always reviewed and key worker meetings did not take place regularly.

The service was not managed consistently managed. This was because although quality assurance checks had identified the issues we found during this inspection, the provider had failed to take appropriate action to address these.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. We found the model of care and setting maximised people’s choice, control and independence and people using services led confident, inclusive empowered lives. However care was not always person-centred.

People felt safe living in their individual homes and relatives were also happy that their family members were safe from harm and abuse. People received continuity of care from a team of support workers who were familiar with their personal needs and wishes and daily routines. There were enough staff employed by the service and there were safer recruitment checks in place. Staff followed current best practice guidelines regarding the prevention and control of infection, including those associated with COVID-19.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not support this practice. The staff supported people with their nutrition and ongoing health support needs.

The provider completed pre-assessments of people’s support needs before they started to support them. The provider met people’s dietary needs and they were supported to access the appropriate community health and social services if required.

People’s communication needs were met and they were supported to access the community and local amenities to avoid social isolation.

We have made some recommendations to the provider to clearly record discussions related to best interests decisions for restrictive practices and ensuring records are current.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection.

This was the first inspection of the service since it registered with the CQC on 21 June 2021.

Why we inspected

The inspection was prompted in part due to concerns received about the way the service was being managed. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the key questions Safe, Effective, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection. Please see the action we have told the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.