Link House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified 1 breach of regulations in relation to people’s consent to care. We found people’s needs had not been assessed prior to them moving into Link House. We assessed all quality statements in the effective key question and found areas of concern. People were subject to blanket restrictions which the provider had not demonstrated were lawful and justified. We found the provider was not working in line with the Mental Capacity Act 2005, by ensuring that where people lacked capacity, decisions had been made in their best interest. The provider failed to ensure that people were not subject to improper treatment and control. We found people’s needs had not always been thoroughly assessed and although people had been supported to attend regular health appointments, referrals to external agencies for additional support had not always been identified as required.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

One person told us they were given choice of where they lived prior to them moving into Link House and they were happy with this decision. We were not able to see any evidence of how these choices were given to this person or any written agreement to this placement.

The registered manager told us they do not do any assessments prior to people moving into the service and the head office place people into the home. We were told that some people may have not been suitably placed at the home.

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’s care plans and risk assessments had not always been reviewed following incidents or accidents to see if any changes were required to people’s planned care and support.

People told us they were happy living at Link House. However, the restrictive practices and control we found in place did not empower people using the service to live their lives in line with the framework right support, right care, right culture. This framework is an expectation for all providers of services for people with a learning disability and/or autistic people.

We found the leadership team lacked knowledge on how people could be supported to live an ordinary life. Staff and leaders had insufficient knowledge on how to support people with consent and known risks which impacted on people’s day to day lives.

The providers processes were not robust in ensuring people received evidence-based care and treatment. We identified multiple instances of restrictive practice and people were not empowered to live their lives in line with their choices and preferences. The provider and registered manager had not identified this.

People told us they were happy living at Link House, however we saw as people’s needs had not been thoroughly assessed we were not assured their experience had always been positive as the support people required had not always been identified and this at times presented as a risk to others.

Staff and leaders told us they referred people to external agencies for support and guidance, however we found this had not consistently happened as we had to prompt a referral for 1 person during our assessment.

External professionals told us they had identified people using the service who had required referrals for support from external agencies, they had raised this with the registered manager who completed referrals as requested.

We found the systems and processes in place to ensure services worked together to improve people’s outcomes were not always effective. For example, the registered manager had not done all that was possible to seek additional support for people to support them in meeting their chosen outcomes. We also found that people’s transitions into the service had not been thoroughly assessed to ensure people’s known risks were considered and mitigated.

People’s care plans did not provide adequate guidance to support one person with their diet and nutrition. We found multiple incidents relating to food intake for one person and their diet had been restricted at times, which had resulted in this person experiencing feelings of distress.

We found the leadership team lacked knowledge on how people could be supported to live healthier lives due to the inconsistent approaches and restrictions found in place. Staff told us about how they supported people to meal plan and how they encouraged people to make their own meals.

People were not always supported to live healthier lives, for instance, we found inconsistent approaches in place to support a person with their diet. The provider and registered manager had not identified this and the person’s care plan lacked guidance for staff to follow. People were supported to attend regular health and social care appointments. For example, learning disability reviews, access to dieticians, GP’s, and dental services. People were offered choice around annual health checks and screenings.

People had shared with staff the outcomes they wished to achieve, and this had been recorded in their care plans. However, we found not all people had been supported to achieve these, for example, 1 person had said they would be interested in volunteering opportunities and attending a disco. We found no plans in place to evidence this had been actioned.

Leaders told us how they ensured people had a monthly key worker meeting to provide people with opportunities to discuss their care and support, however we found not enough action had been taken to fulfil the requests people had made in these meetings. Staff told us how when people had input from external professionals such as the falls team any advice was incorporated into the persons’ care plan.

People regularly met with their keyworker to discuss their care and review what was working well. However, we found people were not always supported and empowered to achieve the outcomes they desired. For example, people had shared in their care plans places they would like to go. For some people we found no actions had been taken to take people’s wishes forward. This had not been identified by the provider or registered manager.

We found people were subject to restrictive practice which limited their choice and control, we could not find any evidence people had consented to the restrictions placed upon them. People's care plans contained no information about their capacity to make decisions. People were identified to have contributed to purchasing furniture for the home. We found no evidence that people’s capacity had been assessed in these areas, or if these large purchases were in the person’s best interest, we reported our concerns to the local authority's safeguarding team.

Staff did not demonstrate best practice knowledge on assessing mental capacity, supporting decision-making and best interest decision-making. Staff were unable to provide any evidence that capacity assessments had been completed for people using the service.

Processes to ensure people were empowered to make decisions about their care and treatment were not effective. The service was not working within the principles of the Mental Capacity Act 2005 (MCA). People were at risk of unlawful restrictions on their liberty. The provider had not ensured that mental capacity assessments and best interest decisions were completed for people who were known to lack capacity to make specific decisions around their care