This assessment took place between 22 April and 30 April 2025. Link House provides care and support to people living in their homes, so that they can live as independently as possible. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. Not everyone who used the service received personal care. At the time of this assessment, 2 people who used the service were receiving personal care. We assessed the service against ‘right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. The service had made improvements and was no longer in breach of regulations. Risks to people were now managed well. Risks to people’s safety and wellbeing were assessed and reviewed at regular intervals. This meant staff had access to up to date information about how to manage these risks and keep people safe from injury or harm. Medicines were managed more safely. Record keeping had improved and staff received appropriate support to help them administer medicines safely. Information about people had improved. People’s needs were assessed and reviewed at regular intervals and staff now had up to date information to help them provide the care and support people required. Staff were now provided with regular and relevant training and supervision to help them meet the range of people’s needs and to continuously improve and develop in their role. Governance systems were used more effectively by managers to help them identify any shortfalls in the service. Staff understood how to protect people from the risk of abuse. There were enough staff to support people and meet their needs. Recruitment practice was safe. Infection risks were managed well. People were involved in assessments of their needs. They received care centred on them and their individual needs, including those related to their protected equality characteristics. People were supported to stay healthy and well. People were given information which met their needs. Staff made sure people understood their care, to give informed consent. People were treated equally, fairly, and supported to access the care and support they needed. Staff understood people’s rights and how these should be met. The service was led by experienced managers. Staff were valued and supported with their wellbeing. People and staff were encouraged to raise concerns and these were listened to. There was a culture of learning, improvement, inclusivity and partnership working, focused on supporting people to achieve positive outcomes.
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Link House was rated Requires Improvement overall at its first inspection, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) due to incomplete risk assessments, unsafe medicines management and ineffective oversight. Caring was rated Good, with people reporting they felt safe and well-supported by familiar staff, but training records, supervisions, care plan reviews and CQC notifications required improvement.
Concerns (13)
criticalMedication management: “Medicines records were not accurately maintained and staff did not receive refresher training in medicines management.”
criticalMedication management: “the main and the witness MAR charts did not correlate and there were discrepancies between the two.”
criticalCare planning: “Risk assessments for people were either incomplete, did not sufficiently identify all the areas of risk or were not reviewed regularly.”
criticalGovernance: “The provider did have an action plan in place, however this was not effective in addressing the issues that were identified in the provider's internal audits.”
criticalGovernance: “The provider had failed to notify CQC of some incidents where the police had been called.”
moderateCare planning: “Some care records had not been reviewed in line with the provider's own policy. For example, some support plans had not been reviewed since November 2019.”
moderateStaff training: “the dates shown on the staff training matrix did not correlate with the dates on the individual training certificates seen.”
moderateSupervision / appraisal: “formal supervision sessions were not consistently completed... she acknowledged they were not always meeting these targets.”
moderateConsent / capacity: “There was no mental capacity assessment in place in relation to this person's living arrangements.”
moderateConsent / capacity: “restrictions... amounted to a deprivation of their liberty. Although it was evident that these restrictions had been put in place by the social workers and were in their best interests, there was no community DoLS in place.”
moderatePerson-centred care: “However care was not always person-centred.”
moderateRecord keeping: “records were not completed appropriately and we could not be assured they were effective in always capturing areas of support that people needed.”
minorCommunication with families: “I would like more contact [from the registered manager] but she is contactable... We get very little feedback from [registered manager]”
Strengths
· People felt safe and relatives had no concerns about safety from harm or abuse.
· Continuity of care from familiar teams of support workers.
· Sufficient staffing levels and robust safer recruitment checks including DBS.
· Good infection prevention and control practices including COVID-19 measures.
· Caring, kind and respectful staff who promoted independence and dignity.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Supporting people to live healthier lives, access healthcare services and supportNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Supporting people to develop and maintain relationships to avoid social isolationNot rated
responsive: End of Life CareNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Working in partnership with othersNot rated