Link Community Care (Tottenham)

Updated 23 December 2023

The inspection

We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.

Unlike our standard approach to assessing performance, we did not physically visit the office of the location. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing, video and phone calls to engage with people using the service and staff.

Inspection team

The inspection was completed by 1 inspector and 2 Experts by Experiences. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

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

We gave the service 24 hours’ notice of the inspection to enable the registered manager and provider to arrange for us to speak with people and staff. The inspection activity started on 19 October and ended on 9 November 2023.

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 spoke with the quality assurance lead for the local authority to gain their views and the outcomes of their assessments of the service.

During the inspection

This inspection was carried out without a visit to the location’s office. We used technology such as video calls to speak with the registered manager and provider and telephoned people, their relatives and staff. We were given remote access to the services records and documents. We spoke with 22 people over the phone. We spoke with 11 people’s relatives and 6 members of staff. We reviewed 8 people’s risk assessments, care plans, reviews in full. Daily notes for 4 people and 3 people’s consent to care documents. Staff recruitment checks were completed for 2 members of staff. Staff rotas and spot checks, emergency plans, and quality monitoring audits were also reviewed.

Updated 23 December 2023

About the service

Link Community Care is a domiciliary care service providing personal care in people’s own homes. At the time of our inspection there were 58 people using the service. The service was supporting older people and adults with physical disabilities.

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

We found the management of the service did not have effective and tested systems to respond to safeguarding concerns and when people had accidents and incidents such as falls. There was also a practice of staff being removed from individuals’ rotas when people complained rather than investigate and take actions such as revisit staff training. This meant other people could be at risk and lessons were not being learnt.

The registered manager and provider were not effectively assessing the quality of care to spot problems and act to fix them. Audits did not effectively look into people’s actual care experience. The management and provider did not have a culture to effectively investigate concerns.

When issues were raised to the office these issues were not processed and dealt with appropriately. There were missed opportunities to advocate for people, assess the quality of staff practice, and learn lessons.

New staff, who did not speak English well, they needed more support to understand their role and the people they were supporting. People were sympathetic to this issue, but the management although aware of this issue, had not effectively revised how they were supporting this element of their work force. Some people told us this undermined their care experience.

We had a mixed response with how people found their care. Some spoke well of the regular staff who supported them. The staff knew what these people’s needs were and how they wanted to be supported. These people had got to know the staff and felt comfortable in their company. One person said, “My main carer is excellent, [carer] treats me with respect.” Another person said, “We [person and carer] have a good natter.”

Others found staff did not understand their needs and what their care plan was asking of them. One person told us, “They [management] need to support those carers who have recently arrived from overseas.”

Most people said they saw staff at regular times which they were happy with. Some people told us they had experienced late and missed care visits. The providers electronic system which logged when staff visited people, did not support this view, but some people were very clear about this.

People were generally 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; but there were issues with policies, systems, and management knowledge in relation to people’s consent to care and being involved in decisions relating to their care.

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 this service was good (published 21 January 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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 based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to protecting people from potential harm and abuse. We found issues with how management promoted people’s safety and how well the service was managed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.