Link 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

We identified 2 breaches of regulation in relation to people's safe care and treatment and how people are protected from abuse and improper treatment. We assessed all quality statements in the safe key question and found areas of concern. However, we found people were protected from the risk of infection, the service was clean, staff had completed infection prevention and control training and we saw they were following safe infection prevention and control practices throughout our assessment. Accidents and incidents had not been effectively reported or actioned to improve care at the service. There were no records in place to demonstrate the provider had done all that was reasonably practicable to reduce the risk of potential distress to people or reoccurrence of incidents. This had placed people at risk of harm. The provider had not done all that was reasonably practicable to provide care and treatment to people in a safe way. We identified that people had been subject to unnecessary, and disproportionate restrictive practice. People’s care plans did not contain adequate guidance for staff to mitigate risks associated to people when they showed feelings of distress. The provider failed to identify, record, and monitor incidents of a safeguarding nature and the use of restrictive interventions. Staff had not always followed safe medicines management procedures; this placed people at risk of not receiving their medicines as prescribed.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us they are informed about any incidents which occurred at the service. One relative told us there had not been any incidents to notify them of. We found from the evidence we gathered on site there were some incidents which related to this person’s family member. We could therefore not be assured duty of candour was consistently applied and the provider was open and honest when things had gone wrong, this meant people and their relatives were not always provided with an apology or an account and follow up of notifiable safety events.

Staff told us they understood their responsibilities in relation to incident reporting. However, we found not all incidents had been documented in line with the provider’s policy. For example, we found multiple incidents which had not been reported and not enough action had been taken to safeguard people, and the incidents re-occurred.

Robust systems were not in place to ensure that incidents were used as an opportunity for the provider and staff to learn and improve. The provider did not take action to prevent harm to people from further accidents and incidents. Analysis of incidents was minimal and did not identify themes and trends. Learning did not take place and the risk of harm to people was not reduced. This placed people at risk of avoidable harm as there was a lack of oversight of incidents from the provider.

We found people had not always received a joined up and collaborative approach to the planning of their care with people who were important to them. One person’s care plan said they had been given choice of their placement. However, we could not see how these options had been presented to this person and how the person agreed with this. People had received regular reviews of their care and ongoing wishes, however we found when some people had made requests about their support this had not always been actioned by staff or identified by the provider or registered manager.

The registered manager told us they were not involved in the assessment process for when new people moved into the service, and this was done by the providers head office. We found people’s needs had not always been thoroughly assessed and considered to ensure a smooth transition into the service, as known risks had not been mitigated.

External professionals told us they had identified short falls in people’s care, which they had addressed with the registered manager, they had also identified when the registered manager needed to make referrals to external agencies for additional support and had prompted the registered manager to do this.

The providers process on ensuring people received an assessment of their needs was not robust. We found people's needs had not been thoroughly assessed prior to them using the service, this meant known risks were not considered as part of their transition to Link House. People already using the service had not been considered or consulted with about a new person joining their home. However, we found people had been supported to transition by visiting the service several times before they moved in.

People and their relatives all told us they felt Link House was safe. However, we found people had not always been protected from abuse and not enough action had been taken to mitigate the risk of ongoing harm. We raised our concerns with the local authority’s safeguarding team at the time of assessment.

Although staff we spoke with told us they had a good understanding of safeguarding, we found staff did not always raise concerns when incidents of abuse occurred. Staff were involved in numerous incidents of concern and abuse; however, these were not raised externally by contacting the local authority safeguarding team. The registered manager did not demonstrate a good knowledge of how to report incidents of a safeguarding nature appropriately to keep people safe.

People were not kept safe from avoidable harm because staff did not understand or have guidance on how to fully protect them from abuse. We saw the home had safeguarding information displayed around the home. However, we found staff were not always working in line with the providers policy.

People had not always been protected from the risk of harm. Safeguarding systems were not robust, when incidents had happened. Investigation and follow up actions had not always been taken and we found some incidents reoccurred. Practices and systems did not protect people from the risk of abuse. The provider had not consistently identified safeguarding concerns or raised alerts with the local authority to ensure an investigation was carried out and to protect people from potential harm

The provider did not do all that was reasonably practicable to mitigate risks associated with people when they had feelings of distress and people did not always receive appropriate support. People were exposed to their known triggers of escalation and staff did not always support people in the least restrictive way.

From speaking with the registered manager, we were not satisfied that physical interventions were used as a last resort. We were told that physical interventions were not used at the service “until [person] moved in”. When we asked further questions, we were told physical intervention were not used, “unless they needed to be”. Staff did not demonstrate that other de-escalation techniques should be attempted before when required medicines (PRN) for anxiety and agitation were administered. This meant people were at risk of receiving medicines as a form of restriction and control.

We observed staff to not always support people in line with their care plan. For example, we observed one staff member carrying out an action which was known to trigger a change in one person’s behaviour. We observed people having their belongings restricted without lawful documentation being in place to justify these restrictions. We were not able to see any evidence to show that people had consented to these restrictions.

People were at risk of inconsistent and unsafe physical intervention. Evidence we reviewed during this assessment found the providers processes were not always being followed. People were not always supported in the least restrictive way and techniques were used which were not in line with the providers mission statement. For example, 1 person had physical intervention applied by a staff member, this was not in line with the providers training or recorded within the persons care records as an appropriate intervention. People’s positive behavioural support (PBS) plans were not co-produced with people and did not contain enough personalised information or guidance to staff on people’s triggers and how best to support them when experienced feelings of distress. These did not identify de-escalation techniques to keep the person and others safe. PBS plans were not updated following key incidents. People were not always supported to manage their known risks safely, we found insufficient guidance available for staff to support people with their health conditions and people’s care plans lacked detail on the actions staff could take to mitigate risks such as falls.

Relatives told us they felt the home was welcoming and the provider had accommodated their family members changing needs well. However, we did find that not enough had been done to mitigate the risk of harm to people in the environment. We raised this with the provider who told us of the immediate actions they would take to keep people safe.

Staff told us they felt the home was safe and appropriate for the people who lived there. We were told the provider is responsive to maintenance requests and works are undertaken promptly when needed. However, staff and leaders did not always consider people’s safety and actions were not always taken to mitigate risks to people until this was raised by the inspectors on site.

We found a fire door to the office was wedged open. This meant the door would not automatically close in the event of a fire. Fire equipment was in place and had been serviced in line with manufacturers guidelines. We observed a fire evacuation plan on the notice board which was available in easy read format. The providers contingency plan did not contain contact details for people’s emergency contacts. This was later completed when prompted by the inspectors.

Water temperatures were not consistently monitored in line with the providers policy and procedures. We found 1 bedroom sink had not been monitored for over a month. We identified where temperatures exceeded recommended temperatures; action had not been taken to address this. The providers systems and processes failed to identify this and put measures in place to reduce the risk of scalding to people. The provider had a health and safety policy which gave guidance for staff to keep people safe. From evidence inspectors gathered on-site, the provider did not always work in line with these processes and systems.

Relatives told us they felt staffing levels were adequate and staff were appropriately trained to care for their family member. We found that people’s experience had not always been positive in respect of staffing levels, as people were limited to going out only when it was planned in advance.

The registered manager told us the home was fully staffed and there was no agency use at the service. We were told that the home does not have a dependency tool in place to assess safe staffing levels at the service, and this is calculated by the registered manager. We were told that people did not currently have any one-to-one funded hours, and this had not been explored with the local authority.

We observed people were not able to go out when they requested this and were told this needed to be planned in advance. During our assessment, people went out as a group but did not have the support to go out ad hoc when they wished.

Staff were not up to date with training appropriate to their role. For example, we found the majority of staff were not up to date with Safeguarding training. We found there was not always sufficient staffing levels in place to support people to go out. We found staffing levels were reduced in the evening and at weekends, this meant if people wished to go out this had to be planned in advance which limited people’s ability to go out on an ad hoc basis.

People and relatives, we spoke with told us the home were clean and raised no concerns to us.

Staff aware of their responsibilities in regard to infection prevention control. For example, wearing appropriate personal protective equipment (PPE) and ensuring cleanliness of the home. The registered manager told us the home has cleaning schedules in place where night staff undertake most of the deeper cleaning of the home.

We observed the service to be clean and odour free and PPE was readily available to staff.

A recent external infection prevention control (IPC) audit was completed at the service which showed compliance, with few minor actions. The provider had systems in place to monitor IPC, this was covered in the registered manager’s monthly audit. All staff had received training.

People were prescribed medicines to help reduce anxieties. One person’s care plan highlighted this should be administered as a last resort, following other de-escalation techniques. We found this person was administered their medicines and found no evidence to show that other methods of de-escalation had been attempted. The staff member responsible for administering this medicine failed to record this on the provider's monitoring charts and whether this medicine had been effective.

Staff told us they would recognise when PRN medicines for anxieties were required through a change in the person’s presentation. Staff did not assure us that they would follow the person’s care plan and only use this as a last resort.

People were prescribed medicines to help reduce anxieties. One person’s care plan highlighted this should be administered as a last resort, following other de-escalation techniques. We found this person had been administered their medicine, and there was no evidence to show that other methods of de-escalation had been attempted. The staff member responsible for administering this medicine failed to record this on the providers monitoring charts and whether this medicine had been effective and the systems in place had failed to identify this issue.