Link Community Care (Tottenham) was rated Requires Improvement overall following an October–November 2023 inspection, with breaches of Regulations 12, 13, and 17 identified covering safe care, safeguarding, and governance. Key failures included a mishandled safeguarding referral, absent incident investigation processes, ineffective auditing, and insufficient support for overseas staff, resulting in a warning notice for good governance.
Concerns (14)
criticalSafeguarding: “A significant safeguarding concern was not handled in a safe way. A referral to the local authority should have been made...but this did not happen.”
criticalGovernance: “Regulation 17 HSCA RA Regulations 2014 Good governance...We issued a warning notice to the provider giving them a timescale to be compliant.”
criticalIncident learning: “When people and relatives raised issues about staff practices, staff were just removed from that person's rota with no investigation to learn lessons.”
moderateCare planning: “People did not have up to date risk assessments. When health needs changed people did not have revised risk assessments and care plans.”
moderateInfection control: “People told us staff did not always use PPE when they should have. They gave examples of staff not wearing aprons when they supported people to have a wash.”
moderateMissed or late visits: “Some people told us they had experienced late and missed care visits. The providers electronic system...did not support this view, but some people were very clear about this.”
moderateStaff training: “The registered manager and management had not received training for some years relevant to key aspects of their work. Such as safeguarding, writing good risk assessments and...MCA.”
moderateStaff competency: “New staff who did not speak English well, they needed more support to understand their role and the people they were supporting.”
moderateConsent / capacity: “The registered manager and management...had not understood the principles of the MCA when people had appointed a relative to make decisions on their behalf.”
moderateComplaints handling: “Relatives told us they did not hear back from the office when they raised issues. Nor were they given the opportunity to make a formal complaint.”
minorEnd-of-life care: “The registered manager and management were not considering this aspect of people's lives unless they were actively at the end stage of their lives.”
minorPerson-centred care: “Information about people's lives, interests and what was important to them was limited and not explored.”
minorCommunication with families: “There was a lack of effective engagement with people and their relatives to seek their views.”
minorCultural competency: “There were missed opportunities to make some people's care plans accessible to them if they did not speak English.”
Strengths
· Staff had a good understanding of what potential abuse could look like and knew to report concerns to the office and registered manager.
· Relevant employment checks including DBS were completed to promote people's safety with staff.
· People said they received their medicines safely with completed electronic medicines administration records in place.
· Some people spoke well of regular carers, noting they felt safe and were treated with respect.
· Established staff spoke well of the manager, supervisions, and team meetings, and felt listened to.
Quality-Statement breakdown (15)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Supporting people to develop and maintain relationships to avoid social isolationRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersRequires improvement