Linwood House

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

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question as good. At this assessment the rating remained the same. This meant people were safe and protected from avoidable harm. The service was well furnished, well maintained and fit for purpose. Staff provided care and treatment in a way which made clients feel supported and listened to. Clients felt they were respected and treated with kindness, and compassion. Clients were treated as individuals and encouraged to be involved in their care and treatment planning. There were sufficient staff, processes, and equipment in place to maintain the safety of the clients and to meet their needs. Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. Information regarding the client’s care, treatment, and external resources available were displayed throughout the service.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 3. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

All staff knew what incidents to report, how to report them and did so accordingly. Staff understood the duty of candour. They were open and transparent and gave clients and families a full explanation if and when things went wrong. Staff received feedback from investigation of incidents, both internal and external to the service. Staff told us that when they reported incidents, they received feedback in several ways including via team meetings, care group meetings, email and during supervision.

There was 1 serious incident during the previous 12 months. This related to the death of a client, and this was still under investigation at the time of our assessment.

There was evidence of changes being made as a result of feedback from incidents such as the implementation of the Linwood House site improvement plan and a complaints action log which identified any trends and any actions and improvements that have been made.

We scored the service as 3. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the client such as GP summaries were received to determine if their needs could safely be met. Staff completed a full assessment for each client prior to admission with a thorough risk assessment carried out to determine if they were suitable for the service. There was an admissions criteria policy in place. Clients deemed to be higher risk (mainly for physical health reasons) would not be admitted to Linwood House but another unit under the same provider that had nursing care on site. Staff involved all the necessary healthcare and social care services to ensure clients had continuity of safe care, both within the service and post-discharge.

We scored the service as 3. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were provided mandatory training in safeguarding adults and safeguarding children and at the time of our inspection the compliance rates were 100% for both. Staff knew how to make a safeguarding alert and did so when appropriate. Staff could give examples of how to protect clients from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies.

In the last 12 months, staff had made 10 safeguarding referrals to the local authority.

Staff followed safe procedures for children visiting the service. Clients did not typically have visitors whilst going through detox. However, if clients had young children, use of face time was used to keep in contact, and as a last resort, children could be brought to the unit to see clients under the supervision of staff.

Staff did not use restraint at the service. There were some blanket restrictions in place, such as a prohibited and restricted items list. Clients were not allowed to bring their own food into the unit, and there were set times when mobile phones could be accessed. Patients did not go out in the community unescorted whilst completing their initial detox. Clients agreed to the rules of the unit prior to admission and were given a behaviour contract and group rules on arrival.

Mental Capacity Act

100% of staff had received training in the Mental Capacity Act.

Staff we spoke with had a good understanding of the Mental Capacity Act, particularly the five statutory principles.

There was a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff we spoke with were aware of the policy and told us they had access to it.

Care records showed clients were supported to make decisions for themselves wherever possible.

At the time of our assessment, there were no clients in which best interests meetings needed to be facilitated.

We scored the service as 3. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to clients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed 8 sets of care records during the assessment and found that each client had an up-to-date risk assessment in place.

Staff involved clients in care planning and risk assessments, and this started prior to admission on pre-admission assessment calls.

We saw that clients had an exit plan if they decided to or were asked to leave treatment unexpectedly. This set out who to contact and what action to take, as well as signposting the client to other support agencies.

Staff communicated effectively with clients so that they understood their care and treatment, including finding effective ways to communicate with clients with communication difficulties.

Staff enabled clients to give feedback on the service. There were weekly community meetings in place. Meeting minutes showed that these were well attended by clients as well as support staff, therapy staff, kitchen staff, cleaners and the maintenance team. Client feedback was discussed and actioned following each community meeting. Clients could also give feedback via Doctify reviews. Doctify allows healthcare providers to collect and publish verified client feedback and provides surveys allowing clients to find healthcare services that best suit their needs.

We found the admission criteria ensured that the service only admitted patients whose needs could safely be managed. The service did not admit patients at risk of suicide and self-harm or any medical needs that required medical and nursing care.

We scored the service as 2. The evidence showed some shortfalls. The service 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.

Staff completed regular risk assessments of the care environment. There were some blind spots within the care environment, but staff mitigated these by observations, environmental checks, and regular checks of CCTV. Staff utilised regular checks of clients alongside CCTV in all communal areas of the facility. There was a large bank of monitors in the main office with live feeds of CCTV allowing staff to observe clients within communal areas.

Clients admitted to the unit were risk assessed around their mental health prior to admission and staff explained that if someone was an active self-harm risk or had a recent significant history, they may go to another unit that could manage this higher level of need. Staff were however conscious of the possibility of new risks emerging during the detox process and ensured risk assessments were regularly reviewed, and that environmental risks were managed accordingly with the use of observations, CCTV and staff knowledge of individual presentations. Staff had access to alarms and radios and clients had access to nurse call systems. Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

There were ligature cutters available. However, staff were unable to locate these and when we asked managers about a specific ligature policy, ligature risk assessment or location and any processes relating to the usage and maintenance of the ligature cutters, they were unable to provide this information. We immediately notified managers of this and were informed that this would be actioned.

The service managed risk and client safety where there was mixed sex accommodation. Most clients had their own rooms with en-suite facilities, but there were no separate bedroom corridors for men and women and no women only day spaces. There were 5 rooms that were not en-suite, and those occupants had access to a toilet and shower on the same corridor. The provider had a risk assessment and policy in place to manage sexual safety, and they monitored any sexual safety incidents. Where they identified concerns, we saw they took appropriate action, including issuing warnings and implementing behaviour contracts with clients.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

There were 2 vacancies at the time of assessment, and 4 members of staff had recently been recruited who were in the onboarding process and had not commenced work yet.

Sickness was 16% at the time of our on-site visit, and we saw robust plans in place to support staff back to work. The average staff turnover for the previous 12 months was 5%.

Managers had calculated the number of support workers and therapists required. The number of support workers and therapists matched this number on most shifts. The manager could adjust staffing levels to meet specific demands on the service.

Where necessary, managers deployed agency and bank staff to maintain safe staffing levels. Agency and bank staff employed, received the same mandatory training package as regular staff. They were given a tour of the facility and familiarised with emergency procedures and shown where emergency equipment was stored. Managers told us they would always attempt to cover shifts with regular bank and agency staff wherever possible.

Staffing levels allowed clients to spend regular 1:1 time with their assigned therapists and to attend scheduled group therapy sessions.

Staffing levels rarely resulted in the cancellation of therapy sessions. However, all 14 clients we spoke with told us that the advertised walking groups rarely take place due to staff availability. One of the clients told us they had been at Linwood House for 28 days and that a walking group had not taken place during that time. We Informed managers of this feedback and a walking group was arranged for the next day.

The service provided medical cover to meet the clients needs. This was via a small team who routinely reviewed clients remotely via video calls. Clients were temporarily registered with a local GP for any routine appointments. Staff called the emergency services where clients needed urgent help with a medical need. In the 12-month period preceding our assessment, there were 49 occasions where a client was referred to the local emergency department, 20 of these occasions via ambulance.

Staff had received and were up to date with appropriate mandatory training. This included first aid training, manual handling, medicines management, legionella, and safeguarding adults and children and Autism and learning disability training. All training was above 75%.

The mandatory training programme was appropriate for the client group using the service.

We scored the service as 3. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. All areas were clean, had good furnishings and were well-maintained. Cleaning records were up to date and demonstrated that the environment was cleaned regularly. Staff adhered to infection control principles, including handwashing.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Care records and observations showed that staff followed systems and processes to prescribe and administer medicines safely. Staff reviewed each client's medicines regularly and provided advice to clients about their medicines. Clients were prescribed medicines for short periods of time while they completed their detoxification programme. The doctors could review medicines administration remotely.

Staff completed medicines records accurately and kept them up to date. Staff stored and managed all medicines and prescribing documents safely. They followed national practice to check clients had the correct medicines when they were admitted or they moved between services. Where clients gave permission, staff checked with the client’s GP what medicines they were prescribed. Medicines that clients brought in with them was checked in, and any repeat prescriptions had to be ordered through the client’s own GP.

We found that local policy was not always followed when checking and monitoring controlled drugs. We found that it was common practice for one, rather than two members of staff to carry out checks on controlled drugs. In addition, staff checked controlled drugs when clients were initially prescribed these, but did not complete the required weekly follow up checks.

We raised this with managers during the assessment who took immediate action to resolve the issue.

Staff reviewed the effects of medication on client’s physical health regularly and in line with National Institute for Care and Excellence (NICE) guidance. We found evidence of client’s physical observations being taken and recorded. Staff were also trained in the recognition of normal parameters.