Link House

About the service

Link House is a residential care home providing personal care care for up to 6 people who were autistic and, or had a learning disability. At the time of the inspection there were 4 people using the service.

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

Right Support: The general condition of the home was good, and the risks to people's safety was minimised because staff knew people well and could anticipate their needs. People were able to understand risk and largely keep themselves safe. There was a plan in place to continue to improve the environment people lived in but we identified some potential risks which had not been identified as part of the provider overall quality and governance. This included uncovered radiators and pipe work and unguarded stairs. The risks associated with possible nocturnal seizure activity had not been fully assessed. Window restrictors had just been put in place but there was no evidence that these were checked to ensure they remained in good working order and could not be opened more than 100 MM in line with health and safety guidance. All of our concerns were addressed immediately following the inspection and risks were therefore mitigated.

The provider was changing over to an electronic recording system which when established should provide clearer governance oversight. Although people’s records were of a high standard, on the medication error forms staff had not recorded if medicine errors had been reported to the local authority or if they had sought medical advice in line with the medicines protocol. The registered manager assured us staff did report correctly and revised the form to ensure staff ticked of all actions completed. Medicine procedures were kept under review and all staff were adequately trained and had their medicine competencies assessed.

The service had the right number of staff in line with people’s assessed needs and the outcome of recent funding reviews were being challenged by the registered manager to ensure people remained appropriately funded. People took part in activities in line with their interests and needs and these were discussed at residents’ meetings and in one-to-one meetings with staff. People’s care plans included outcomes they wished to achieve and what support they needed to achieve their goals.

People were encouraged to make their own decisions and any restrictions on people’s freedoms due to risk were clearly documented and people were supported to remain safe. 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; the policies and systems in the service supported this practice.

Right Care: People’s needs were clearly documented, kept under review and where changing needs were identified these were followed up with relevant professionals. There were close working relationships with family and the community. Continuity of staffing helped ensure people’s needs were known and met consistently. Safeguards were raised as required to ensure people’s safety.

Right Culture: People received good outcomes of care and the service supported people in a range of different ways around their changing needs. There was shared accommodation and single accommodation. Staffing levels varied from intermittent support to 1-1 support in line with needs and people were able to contact staff 24 hours a day. Some people had monitoring/sensor alarms and CCTV was being considered to further enhance people’s security and wellbeing.

A range of audits were completed which included seeking feedback from staff, people using the service, relatives, and visitors. The registered manager acted on feedback to enhance people’s experiences and the manager was proactive in ensuring people had the support they needed.

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

Rating at last inspection

The last rating for the service under this provider was good (published on 13 October 2017.)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Link house on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements in well led .

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

Recommendations

We have made a recommendation about fire safety arrangements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Link House provides residential care to up to six adults with a learning disability.

There was a registered manager in post at the time of our inspection. They were registered for both services. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was extremely well managed and clearly run in the interest of people using the service. The service was generously staffed and all staff were familiar with people’s needs and provided continuity of support. There was minimal turnover of staff and no agency usage. This meant people using the service had built up relationships with staff and had a degree of predictability and established routines. Staff said this was important in terms of reducing people’s anxieties.

There were safe systems in place to ensure people were protected from unnecessary risks and staff knew what actions to take to mitigate risk. The environment was well maintained and equipment checked regularly to ensure it was safe to use.

People received their medicines as intended and checks were carried out by staff to ensure they received their medicines safely.

Staff understood different types of abuse and knew what actions to take should abuse occur or they suspected someone to be at risk of harm or actual abuse.

Staff recruitment procedures were sufficiently stringent to help ensure only suitable staff were employed. Staff were supported in their role and had the necessary competencies. There was a thorough induction, ongoing training and support for staff including regular supervision, observation of practice and appraisal.

Staff were highly motivated and had developed good relationships with the people they were supporting and extended this support to family and friends. Staff supported people to have relationships of their choosing and to make their own decisions about this.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation. Practice related to MCA and DoLS was very good and in line with legal requirements.

People were supported to make appropriate choices about their diet and staff provided opportunities for people to follow a healthy lifestyle and take regular exercise. People were fully involved in menu planning; shopping and preparing meals for themselves and others they lived with.

People were encouraged to live independent, fulfilling lives and had opportunities to participate in a range of different social activities, work placements and day centres. There was opportunity for evening and weekend activities and annual holidays. This helped ensure people were fully engaged and participating within their local communities. Staffing levels were planned around people’s individual needs ensuring people had the chance to do the things they wanted to do.

People had up to date care and support plans which documented how their needs should be met in line with their wishes and aspirations. Plans showed what they had achieved or what they were hoping to achieve. Staff knew people’s needs and work consistently in line with people’s plans.

People received medical attention as required and staff monitored people’s physical and mental well- being to enable them to seek prompt support as required.

The service was very well led and staff worked cohesively in line with the services aims and objectives. They enabled people to have a full life as possible and were skilful in balancing positive risk taking with the right to self-determination and independence.

The service had audits in place to measure the success and effectiveness of the service it provided. It took into account feedback about the service to help them improve the service and provide in a way that met people’s wishes and aspirations.

The service was continuously developing and taking into account current legislation and best practice to help ensure the service was run as professionally and as effectively as possible.