Linkage Community Trust's Community Support Services deteriorated from Good to Requires Improvement overall, with weaknesses in mental capacity documentation, inconsistent care plan quality, intermittent governance oversight, and staffing gaps exacerbated by the COVID-19 pandemic. Caring and responsive practice remained Good, with staff demonstrating warmth, person-centred support and effective communication with people with learning disabilities and autism.
Concerns (9)
moderateConsent / capacity: “staff did not always demonstrate best practice around documentation of assessment of mental capacity to show the least restrictive options had been undertaken”
moderateRecord keeping: “we saw care plans for people being supported in one location had contradictory information and had not been reviewed on a regular basis”
moderateCare planning: “The information in people's care plans varied at different locations. Some information was contradictory and had not been reviewed to ensure it was still relevant to people's needs.”
moderateGovernance: “The quality monitoring processes were not always robust...oversight of quality audits in areas such as medicines and care plans being intermittent.”
moderateStaffing levels: “The service did not always have enough appropriately skilled staff to meet people's needs.”
minorMedication management: “We found one person's medicine record had not been completed accurately or checked.”
minorSupervision / appraisal: “there were some staff in some areas of the service who had not had regular supervision recently.”
minorCommunication with families: “one relative said, 'Lately I feel uncomfortable, more communication would be nice...managers don't. No one answers the phone.'”
minorStaff training: “The training matrix showed some staff training was not up to date, the provider had a plan in place to address this.”
Strengths
· People felt safe with staff and interactions observed were warm and positive.
· Staff understood and implemented STOMP principles to prevent over-medication.
· Provider proactively recruited and increased staff wages, appointing a full-time recruitment manager.
· Staff supported people's equality, diversity and cultural needs, including religious beliefs.
· People were supported to pursue interests, gain independence and participate in community activities.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Continuous learning and improving careGood
Community Support Services, a domiciliary care agency supporting adults with learning disabilities and autism, was rated Good overall at its April 2021 inspection, having deteriorated from Outstanding in 2019. Key weaknesses included insufficient oversight of medicines management in community settings and an incomplete disciplinary policy, both of which the provider addressed promptly following the inspection.
Concerns (3)
criticalSafeguarding: “The inspection was prompted in part due to Safeguarding concerns and staff culture.”
moderateMedication management: “The tools in place were not robust enough to give assurance of clear oversight of processes. This increased the risk of medicine error not being identified promptly.”
moderateGovernance: “their disciplinary policy did not give managers clear guidance on how to proceed with disciplinary processes if a member of staff left the service before they had completed their investigations.”
Strengths
· Staff were passionate and knowledgeable about person-centred care, promoting independence and dignity for people with learning disabilities and autism.
· Robust safeguarding investigation processes were in place and management responded proactively to concerns raised.
· Strong COVID-19 management including shielding arrangements, PPE use, and creative social activities to maintain wellbeing.
· People and relatives were highly involved in care decisions, including participation in staff recruitment interviews.
· Open and transparent leadership with clear duty of candour approach; regular CQC notifications maintained.
Community Support Services received a Good rating across all five key questions at its July 2016 KLOE inspection, demonstrating safe staffing, effective personalised care planning, and strong leadership. No regulatory breaches or failure themes were identified; the service showed consistent strengths in safeguarding, staff training, person-centred practice, and quality governance.
Strengths
· Staff understood safeguarding procedures and people felt safe with consistent, known carers
· Safe recruitment practices including DBS checks and references completed before staff commenced work
· Medication administration competency regularly assessed with accurate records and regular audits
· Staff received structured induction including Care Certificate, regular supervision (minimum six per year), appraisals, and role-specific training
· Mental Capacity Act 2005 followed with capacity assessments recorded and best-interest decisions documented
Community Support Services, a domiciliary care agency supporting 19 adults with learning disabilities or autism, was rated Outstanding overall at its February 2019 inspection, improving from Good in 2016. The service demonstrated exceptional person-centred care, innovative safeguarding practices, and outstanding leadership with no failure themes identified.
Strengths
· Innovative safeguarding approach including safeguarding ambassadors, anonymous reporting, and person-centred safeguarding processes involving the individuals themselves.
· Exceptional person-centred care with support plans tailored to each individual's physical, emotional, social and spiritual needs.
· Strong community inclusion focus, actively supporting people to engage with community groups, employment, and social activities.
· Outstanding leadership with a transparent, supportive management culture including daily well-being calls to staff.
· Robust quality assurance systems aligned with CQC KLOEs, with thorough audits and action plans for continuous improvement.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementOutstanding
safe: Systems and processes to safeguard people from the risk of abuseOutstanding
safe: Using medicines safelyOutstanding
safe: Staffing and recruitmentOutstanding
safe: Learning lessons when things go wrongOutstanding
safe: Preventing and controlling infectionOutstanding
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Good
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
caring: Ensuring people are well treated and supported; equality and diversityOutstanding
caring: Supporting people to express their views and be involved in making decisions about their careOutstanding
caring: Respecting and promoting people's privacy, dignity and independenceOutstanding
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: End of life care and supportGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Planning and promoting person-centred, high-quality care and support; duty of candourOutstanding
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsOutstanding
well-led: Engaging and involving people using the service, the public and staff; continuous learning and improving careOutstanding
well-led: Working in partnership with othersOutstanding