The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: Healthlinc House

Overall: Inadequate read more about inspection ratings

Cliff Road, Welton, Lincoln, Lincolnshire, LN2 3JN (01673) 862000

Provided and run by:
Elysium Healthcare (Healthlinc) Limited

All Inspections

5-18 January 2022

During a routine inspection

Healthlinc House is an independent healthcare service providing care and treatment to people with a learning disability and/or autism. Healthlinc House is owned and operated by Elysium Healthcare Limited.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The service did not always support people to have the maximum possible choice, control and independence be independent and they had control over their own lives.

Staff did not always focus on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

People were not always supported by staff to pursue their interests.

Staff did not always support people to achieve their aspirations and goals.

The service did not always effectively work with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Staff did not always do everything they could to avoid restraining people. The service did not always record when staff restrained people, and staff did not always learn from those incidents and how they might be avoided or reduced.

The service did not always give people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.

People were able to personalise their rooms.

People did not always benefit from the interactive and stimulating environment.

The service did not always make reasonable adjustments for people so they could be fully in discussions about how they received support, including support to travel wherever they needed to go.

Staff did not always support people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests.

Staff enabled people to access specialist health and social care support in the community.

Staff did not always support people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Staff did not always support people to play an active role in maintaining their own health and wellbeing.

Right care

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.

People did not always receive kind and compassionate care. Staff did not always protect and respect people’s privacy and dignity. They did not always understand and respond to their individual needs.

Staff did not always understand how to protect people from poor care and abuse. The service worked well with other agencies to do so. However, management were not always informed of every incident that may have happened. Staff had training on how to recognise and report abuse. However, they did not always know how to apply it.

The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People could not always communicate with staff and understand information given to them because staff did not always support them consistently and understand their individual communication needs.

People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols (add to or delete as appropriate) could interact comfortably with staff and others involved in their treatment/care and support because staff had the necessary skills to understand them.

People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

People did not always receive care that supported their needs and aspirations, or was focused on their quality of life, and followed best practice.

People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. However, this could be restricted due to access to transport.

Right culture

People did not always lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

People did not always receive good quality care, support and treatment because although there was trained staff and specialists, they did not always meet people's needs and wishes.

People were not always supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive compassionate and empowering care that was tailored to their needs.

Staff did not always know and understand people well and some staff were responsive, supporting peoples’ aspirations to live a quality life of their choosing.

Staff did not always place people’s wishes, needs and rights at the heart of everything they did.

People and those important to them, including advocates, were not always involved in planning their care.

Staff did not always evaluate the quality of support provided to people, did not always involve the person, their families and other professionals as appropriate.

The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views.

People’s quality of life was not always enhanced by the service’s culture of improvement and inclusivity.

Staff did not always ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

SUMMARY

Our rating of this service stayed the same. We rated it as inadequate because:

  • People’s care and support was not always provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.
  • People were not always protected from abuse and poor care. The service did not always have sufficient, appropriately skilled staff to meet people’s needs and keep them safe.
  • People were not always supported to be independent and did not always have control over their own lives. Their human rights were not always upheld.
  • People did not always receive kind and compassionate care from staff who protected and did not always respect their privacy and dignity and understood each person’s individual needs. People did not always have their communication needs met and information was shared in a way that could be understood.
  • People’s risks were assessed regularly but not managed safely. People were not involved in managing their own risks whenever possible and we saw staff intervene to restrain before the use of any de-escalation.
  • When restrictive practices were used, there was a reporting system in place. However staff failed to use this system to report all incidents of restraint and this limited management attempts to reviews and try to reduce the use of these practices.
  • People made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
  • People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs.
  • Staff had not understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.
  • People were in hospital to receive active, goal oriented treatment. People had clear plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support they went home.
  • Staff supported people through recognised models of care and treatment for people with a learning disability or autistic people. Leadership was good, and governance processes helped the service to keep people safe, protect their human rights and provide good care, support and treatment.

10, 15, 16 November 2021

During an inspection looking at part of the service

• The service failed to provide safe care. Some ward environments were unsafe and dirty. Potential infection risks had been left unaddressed and we found food hygiene issues in two kitchens.
• Maintenance of the hospital environment remained a concern. Work needed to ensure persons safety, wellbeing and privacy had not been addressed. The maintenance log was not fit for purpose and urgent work had not been prioritised.
• The level of restriction imposed on some people using the service had not been fully recognised. The scope of the restrictive practice review was too limited and omitted consideration of some of the physical and psychological restraints placed upon people.
• Staff had not understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. An internal review of a person’s care regime minimised the degree of restraint used in managing behaviours that challenge. Risks to others, assessed by the clinical team, were not considered when considering if the person was segregated.

However:
• Staffing levels overall met the providers planned levels of safety staffing. However, there were three occasions we could identify were staff allocations went against the care plans to maintain the safety of two people using the service.
• Managers were able to demonstrate that they had responded to learning around closed cultures of care. Training around closed cultures had been delivered to staff and additional visits to the service and oversight from the regional management team had been put in place. However, there had been delays in providing CCTV coverage to social areas of the hospital.

12 April 2021, 13 April 2021

During an inspection looking at part of the service

The Health and Social Care Act 2008 allows CQC to add, vary or remove existing conditions of registration for a registered provider or registered manager. Using these powers to address the issues we found at our inspection of Healthlinc House in April 2021, we issued a Notice of Proposal to add conditions on 11 May 2021. The provider made representations against the conditions to be imposed, and having independently reviewed the representations CQC decided to uphold some of the conditions and withdraw others. A Notice of Decision to add the upheld conditions to the providers registration was issued on 25 August 2021. The provider did not challenge the revised conditions which became active on 23 September 2021. The provider started to comply with the additional conditions as soon as they came into effect.

The additional conditions placed on the providers registration included:

  • The provider cannot accept any new admissions without written approval from CQC.
  • The provider must send to CQC a weekly review of all incidents of restraint.
  • The provider must carry out a review of staff qualifications and submit a plan of action showing how they will ensure all staff have the right skills to work with patients safely.
  • Demonstrate how they will ensure that all staff including agency staff have received specialist training to enable them to work effectively with people who have learning disability and autism.
  • The provider must ensure that there are sufficient numbers of suitably qualified, skilled, competent and experienced registered nurses and healthcare support workers to meet the needs of all patients on every shift.
  • The provider must submit weekly reviews of its staffing levels.
  • The provider must submit a weekly report or copies of any analysis or audits they have undertaken to monitor completion and / or implementation of the systems set out in the above conditions.

In addition to the enforcement we have taken, the Chief Inspector of Hospitals, Ted Baker, has placed Healthlinc House into special measures. Services placed in special measures will be inspected again within six months of publication of the original report dated 23 July 2021. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question, we will take further enforcement procedures. The service will be kept under review and, if needed, could be escalated to urgent enforcement action.

We found:

  • Staff did not manage peoples distress effectively and further incidents, soon after the initial incident occurred, resulted in harm and injury to staff and other people. We could not be assured that the provider always checked the qualifications, skills and experience of all agency staff before they worked with people. Although specialist training was available, the provider considered this as optional for staff. The provider did not have robust systems in place to show what specialist training staff had completed. The acuity and presentation of some new admissions was such that staff felt they did not always have the skills, qualifications and knowledge to work effectively with people’s distress in a rehabilitation setting.
  • People were not always protected from poor care because the service did not have enough permanent staff. The service relied heavily on agency staff, who didn’t always know the people they were caring for. The impact was delay in staff response times to safely manage restraint procedures. Staff were often not able to take their full break entitlement or breaks from observation duties during a shift because there was no cover for them. People using the service said they often had to wait for the required number of staff to become available to escort them on leave or into the grounds.
  • The service did not have a full multidisciplinary team to deliver the range of care and treatment necessary to meet the needs of people with learning disability and autism in a rehabilitation setting. There had not been any meaningful occupational therapy input since September 2020 as there had not been an occupational therapist in post. This meant some people had not had a full occupational therapy assessment and evaluation to support their rehabilitation programs.
  • Registered nurses did not have any ongoing mandatory training or competency assessments for administering medications.
  • Only 30% of registered nurses had received regular supervision. Supervision rates for healthcare support workers was 72%. Only very recently, and after close scrutiny visits and a requirement of the clinical commissioning group, had registered nurses started to be visible on the apartments to give support to the healthcare support workers who delivered the majority of the patients care.
  • There were eight delayed discharges. The longest length of stay for one person was nine and half years. The other seven delayed discharges ranged from six to three years.
  • People’s care and support was not always provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs. This had been reported following our previous inspection. The decoration in the accommodation was tired, some integral window blinds were broken, the communal lounge areas of the apartments and some bedrooms were not clean. Paintwork was chipped and not clean the environment in the apartments was not homely or conducive to good mental wellbeing for people living there. Furniture was dated, sparse and not comfortable. The provider did not have adequate oversight for maintaining the quality and control of cleanliness in the apartments.
  • Leaders did not articulate a clear vision for the service and so were unable to ensure a cohesive, good quality service was provided. Although the service described itself as an enhanced rehabilitation service, many staff believed they were working with people towards containment of distress and behaviour modification. While other staff believed they were offering activity programs to promote wellbeing and daily routine. Staff told us they used to understand the providers vision and values but thought they had moved away from this. Senior managers did not have effective oversight of the gap in service provision vacancies in the multidisciplinary team had created.

However

  • Staff understood how to protect people from abuse and the service worked well with other agencies to do so. The provider reported and investigated all incidents of alleged abuse to the local authority and CQC.
  • People were involved in managing their own risks whenever possible. There was clear evidence in personal behaviour support plans of people identifying what helped them to feel safe.
  • Restrictive practices were only used as a last resort, for the shortest time and in situations where people were a risk to themselves or others. Staff did not use seclusion, although the provider had a policy which outlined how seclusion would be used if required. The service monitored and reported the use of restrictive practices. They reviewed all incidences of restraint and used the examples as learning within their restrictive intervention’s reduction programme.
  • Risk assessments, positive behaviour support plans and care plans were of high quality. They were comprehensive, personalised, holistic and updated as required. They showed evidence of co-production with people using the service and reflected people’s needs and aspirations. They were easily accessible to staff.
  • Staff used the principles of stopping over-medication of people with a learning disability, autism or both (STOMP) to only administer medicines that benefitted people’s recovery or as part of ongoing treatment.

02 and 03 July 2019

During a routine inspection

We rated Healthlinc House as Good because:’

  • The service had enough nursing and medical staff, who were able to keep patients safe from avoidable harm and abuse. Staff assessed and managed risks to patients and themselves well and achieved the right balance between maintaining safety and providing the least restrictive environment possible to facilitate patients’ recovery. The service was a strong advocate of the STOMP program (stopping over medication of people with learning disability). Staff carried out thorough physical and mental health assessments of all patients on admission. Staff reviewed care plans regularly with the patient and their family or carers, care plans reflected the assessed needs, were personalised, holistic and recovery-orientated. Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice.
  • The staff team included or had access to the full range of specialists required to meet the needs of patients. Managers made sure staff had the range of skills needed to provide high quality care. Staff worked well together and understood their roles and responsibilities under the Mental Health Act 1983, and Mental Capacity Act 2005. Staff treated patients with compassion and kindness. Patients had a core care team to ensure that on every shift there was always at least one member of staff that they knew working with them. Staff understood the individual needs of patients and supported patients to understand and manage their care, treatment and condition. Staff and managers had gone the extra mile to ensure that patients could maintain links with their families who lived some distance away. Most carers we spoke with said staff kept them informed of their relatives care and treatment and involved them appropriately.
  • Staff planned and managed patient discharge well, as a result, staff rarely delayed discharge for other than a clinical reason. Each patient had their own en suite bedroom, within an apartment, and could keep their personal belongings safe. The service treated concerns and complaints seriously, investigated them and learned lessons from the results.
  • Managers had created two new key posts to address specific issues. A physical care co-ordinator to work closely with the consultant psychiatrist and visiting general practitioner. An employee engagement lead to buddy new healthcare assistants during the first few months of working at the hospital. The provider had made significant progress towards addressing the concerns raised in our previous inspection report. The provider had produced a quality assurance action plan and had engaged well with CQC to bring about positive changes to their service. There was a culture of mutual respect between managers and staff and patients.

However:

  • The decoration and furnishings were dated and tired, and there was some outstanding maintenance work in two apartments that had potential risk for patient safety. Signage around the hospital was poor. We found a disused telephone in the communal corridor with a cord wrapped around it, this had not been removed and staff had not included this on the ligature audit.
  • We could not substantiate the providers data showing compliance with supervision was 78%. We could not access enough supervision records to confirm the data. The processes for recording and storage of supervision records were not clear, many staff we spoke with told us supervision was inconsistent, and only two staff knew of the providers new supervision passport. Supervision had been the subject of a requirement notice following our last inspection.
  • Staff had not updated two of the seven patient risk assessments we reviewed following a recent incident. Though we saw evidence in the shift handover notes and multidisciplinary team meeting minutes, that the associated risks had been discussed. The providers allocation systems caused delays with new staff getting password access to the electronic patient data system.
  • Two carers told us staff had not returned their telephone calls or e mails when requested, nor had they given them minutes of their relatives care planning meetings.

8 - 10 May 2017

During a routine inspection

We rated Heathlinc House as good because:

  • Managers discussed staffing levels daily in the morning management meeting and deployed staff to take into account individual patient need and risk. We saw that a qualified nurse was often in the communal areas of the service, although a support worker was present in the communal areas at all times.
  • Medicines were stored securely and in accordance with the provider policy and manufacturers’ guidelines. We reviewed eight prescription charts which were completed correctly. Each chart had a “use of as required medication protocol” form which gave direction on when to administer as required medication as well as guidance to staff for reporting issues to the prescriber.
  • Staff treated patients with kindness, compassion and respect. We observed interactions between staff and patients and saw that staff were responsive to patient's needs. We observed support given to patients at meal times. Staff treated patients with dignity and were caring. Staff interacted with patients at a level that was appropriate to individual needs.
  • Doctors followed National Institute for Health and Clinical Excellence (NICE) guidelines when prescribing medication. We reviewed eight medication charts which showed that antipsychotic prescribing met with NICE guidelines. Patients had access to psychological therapies recommended by NICE. These included the use of functional assessments to identify behaviours that challenge, dialectical behaviour therapy and the use of positive behavioural support plans.
  • Patients knew how to complain. The hospital displayed pictorial information on how to make complaints. We spoke with eight patients, all of which said they knew how to complain.
  • Staff were aware of how to manage complaints. Staff we spoke to knew the complaints process and was able to respond appropriately and support patients to make a complaint if required.

However:

  • Staff did not record room temperatures of all clinic rooms. We found several gaps in the recordings for clinic room two. This could have affected the efficacy of the medication stored in the room.
  • Managers had not ensured that polices were kept up to date. We reviewed 10 hospital policies, all of which had expired; the date for review was February 2014. We brought this to the attention of the managers who assured us policies were adhered. The manager provided an action plan which highlighted that all polices would be updated by August 2017.

06 and 15 January 2016

During a routine inspection

Overall we rated Healthlinc House as requires improvement because:

  • there were 58 instances of missed signatures against some prescribed medications, meaning we could not be assured patients had been given their medication as prescribed
  • the use of agency staff was high and staff and patients said agency staff did not always understand the specific needs of the patients
  • cleaning fluids were not securely stored in line with the Control of Substances Hazardous to Health Regulations 2002
  • the automated external defibrillator and suction machine were not serviced on a regular basis
  • in the seven care records reviewed, one patient’s record did not contain a completed risk assessment
  • only two records seen showed that patients had a physical healthcare check completed by the doctor on admission
  • support staff told us that outcomes from multidisciplinary team meetings and contents of patients’ risk assessments were not communicated to them
  • 23% of staff had not received supervision within the past three months
  • 33% of staff had not received an annual appraisal within the past twelve months

However:

  • the environment was clean and tidy, in a good state of repair, suitable for care and treatment, and risk assessed
  • robust systems enabled staff to report incidents
  • patients’ needs were assessed and care and treatment was planned to meet identified needs
  • patients received regular one to one time with their named nurse and there was evidence of this in the care records
  • staff appeared kind with caring and compassionate attitudes, and engaged with patients in a kind and respectful manner
  • activities were available for patients’ specific needs, including arts and crafts, cooking, big breakfast club and trips out

18 July 2013

During an inspection looking at part of the service

During our previous visit in April 2013 we said the provider must improve the way they gained patient's consent to care and treatment, and how they assessed people's capacity to consent. This was in relation to those patients who were not subject to any restrictions under sections of the Mental Health Act, 1983.

We visited again in July 2013 to review the actions the provider had told us they would take.

We saw there were clear systems in place to assess patients' capacity to consent to their care and treatment. The systems included information about advanced decisions, arrangements for acting in patients' best interests and any input from advocates.

16 April 2013

During a routine inspection

When we visited 35 patients were receiving care and treatment within the hospital. 28 of the patients were detained under various sections of the Mental Health Act, 1983.

During our visit we spoke with two patients, five members of staff, a clinical manager and the registered manager for the hospital.

We looked at five patient's care records in detail and other records kept within the hospital such as staff recruitment and training records. We also spent time observing how patient's were supported to receive their care and treatment.

Patient's had individualised care plans and received the care and treatment set out in those plans. For some patient's there was no documentation about their capacity to consent to care and treatment, or records to show they had been asked for their consent. This meant the provider could not be sure they were acting in accordance with patient's wishes or in their best interests. We said the provider must take action to address this issue.

Staff were recruited to work within the hospital in a way which promoted patient's safety. They had received training in subjects which helped them to meet patient's needs.

Patients we spoke with told us they were generally happy living at the home. One patient told us staff helped them to join in with activities they enjoyed and another patient told us staff listened to what they had to say. Patients also said they felt safe living within the hospital.

28 November 2012

During an inspection looking at part of the service

During this visit we followed up on three areas of non-compliance identified in a previous inspection. We reviewed evidence that demonstrated the provider's compliance in these outcome areas.

We spoke to one person who lived at the hospital and they told us about how staff helped them to manage the risks involved with their care.

13 August 2012

During a routine inspection

We spoke with a number of patients within the hospital, and we also used a range of different ways to help us understand their experiences. This was because some patients had complex needs which meant that they were not able to tell us about their care and support experiences. For example, we looked at records, including personal care plans, we spoke to the managers and staff who were supporting patients, and we observed how they provided that support.

We saw patients were supported to make choices and decisions about their lifestyles, and they were treated with dignity and respect. The quality assurance systems that were in place encouraged patients to express their views about the services they received, and be involved in improving the services where necessary.

In general we saw that patients were supported by a knowledgeable care team, and they received the care and support they wanted and needed. Staff demonstrated a good understanding of their roles within the hospital.

Patients told us things like, 'My key worker is nice, she helps me a lot', 'Yes I feel very safe, the staff are nice here' and 'I would speak with the manager if I was worried about anything.'

However we saw that there were areas where the provider needed to make improvements to the service that patients received. For example, we identified issues with medicines management, management of moving and handling needs, and the general hospital environment.

10 November 2011

During a themed inspection looking at Learning Disability Services

There were 41 patients at Healthlinc House when we visited. We met most of the patients and spoke to five of them in more depth to get their views of the service.

The patients we spoke with were positive in their views. They told us they were involved in planning and reviewing the care and support they needed. Patients said that staff were 'kind and polite' and had helped them to move on. They told us about the range of activities they enjoyed. Patients told us they felt safe at Healthlinc House.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.