Link House

Updated 5 January 2024

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector over 2 days.

Service and service type

Link house is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Link House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 28 September 2023 when we visited the service. We visited the service again on the 4 October 2023 as on our first visit no one using the service was at home.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We reviewed information we held about the service. We used all this information to plan our inspection.

During the inspection

We reviewed records including care plans, medicines, toured the environment and spoke with the registered manager and a senior member of staff. On our second visit we spent time with the 4 people living at the service and joined them for a meal at their request. Following the inspection we spoke with 2 relatives, 3 staff via email, a member of the quality assurance team from the local authority. We continued to clarify evidence collated.

Updated 5 January 2024

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.

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.