Link House

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We identified 1 breach of regulation in relation to person centred care. People’s care had not always been delivered in a way that met their individual needs or reflected their preferences. Staffing levels were reduced in the evenings and at weekends, this did not allow for people to be supported to go out when they wished. We also found one person had been prevented from going out alone to a place of interest to them without any clear rationale or legal authorisation recorded. People had not been provided with information in an accessible format aligned to their individual needs. We found some people had been supported to access advocacy services, however, plans were not always in place to show how staff could support them in achieving their wishes.

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.

People were supported to attend planned activities, but staff were not available for people to undertake spontaneous or adhoc activities when they wished. People went on group holidays and outgoings, however, we were not able to see any evidence of this being people’s preferences or choice. We found restrictions in place for people that they had not consented too. We found no evidence to support this practice by authorisations from the legal authority Deprivation of Liberty Safeguarding (DoLS).

We asked what arrangements were in place if a person wished to undertake adhoc activities. The registered manager told us that activities within the home had to be planned due to staffing levels. The registered manager told us they had not explored the need for additional commissioned hours from the local authority.

We observed some staff members did not always speak about and interact with people in a caring and compassionate way. We also found care records to contain derogatory comments about people and instructions provided to staff by the registered manager did not always promote people’s social or well being needs.

People spoke positively about their experiences at Link House, 1 person told us they chose what they had to eat, and another person told us, “I know staff well, they know me well.” We found that people’s experience had not always been positive as their needs had not been thoroughly assessed or considered so they had not always received flexible support that met their needs and preferences.

Leaders lacked knowledge on people’s protected characteristics and had not always considered these in planning and assessing the care and support people required. Staff had undertaken training in equality, diversity, and inclusion but we found this training was not consistently put into practice.

External professionals told us they had identified a lack of information in people’s care plans and risk assessments, they had provided advice to the registered manager on this.

We found systems and processes in place did not consider people’s individual’s choice on how they wished for their care and support to be delivered, we found limited information on how people were supported to develop relationships or take part in activities outside of Link House. We found when people had interests and hobbies, people had not always been supported to pursue these.

Care plans and information in the service was not always provided in accessible formats, this limited the choice and control people had in their day to day lives on accessing information about them and that could support them.

Leaders lacked knowledge on people’s protected characteristics and had not always considered these in planning and assessing the care and support people required.

We found information was not always provided to people in a way they preferred, for example information on display in the service was not accessible to people who were unable to read. We also found people’s care plans were not available in a format to suit people’s known needs such as in a picture format.

Positive behaviour plans had not been co-produced and did not include the person’s views and wishes, this therefore did not reflect people’s choices and preferences for when they experienced feelings of distress.

Leaders told us they listened to people using the service and their relatives. Leaders told us they regularly provided opportunities for people to share their experiences, however we found when people had shared their experiences or made requests to go to certain events this had not always been actioned.

The provider held house meetings with the people who lived at Link House, as well as completing surveys. We reviewed people’s feedback and found this to be positive. However, the provider did not have any service development plans to show where any improvements were needed to the service and any progress made.

People were not consistently supported to access support in a way that worked for them. Some people were subjected to restrictions which we found no evidence to suggest they had consented too or was in their best interests. For example, one person had been prevented from accessing their church independently, we did not find any legal authorisations in place to support this.

Leaders did not demonstrate an understanding of people’s protected characteristics or how to support people in line with the Mental Capacity Act, this had led to people been subjected to restrictions on their movements and use of technology.

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.

The providers systems and processes had not identified the restrictions in place at Link House. Whilst people’s care plans identified their needs and wishes we found insufficient guidance available to staff on how to support people to ensure they had equity in access to services and support.

People and their relatives told us they were happy with the service provided at Link House, however we found people had not always been listened too and had experienced in an inequality in their experience due to the restrictions we found in place.

Leaders did not demonstrate a good understanding of promoting and empowering people to understand their rights to equality. Staff told us, they felt confident in responding to potential discrimination, however we found this had not occurred when people had been subject to inequality and restrictive practice.

Although staff had received training equality, diversity and inclusion but we found this training was not consistently put into practice. People had not been supported to ensure their rights were upheld; people had been unlawfully restrained and people's capacity had not been assessed.

People were supported to access advocacy services to support them with information on making decisions about their future. Decisions people had made were recorded and known by staff, however we did find for some people, plans were not always in place to show how staff could support them in achieving their wishes.

Leaders did not always show an understanding of supporting and empowering people to achieve their future wishes. For example, when we asked about if people were supported to access employment, the registered manager told us people were asked but didn’t want to seek employment and then commented, “They are on to a good thing work wise aren’t they?”

We found people’s care plans contained information on their future wishes however we found for some people their care plans did not provide any guidance for staff on how to support people with their wishes. The provider’s systems and processes had not identified this.