Background to this inspection
Updated
7 July 2023
Healthlinc House is an independent healthcare service providing care and treatment to people with a learning disability and/or autism. Healthlinc House is owned and operated by Elysium Healthcare Limited.
This was a planned comprehensive inspection timed to review the services progress against the enforcement action we had taken and placed the service in special measures. The inspection was unannounced to the provider.
This previous inspection was a focused inspection in November 2021 and triggered by receipt of concerns from staff about the safety of the service and that people who use the service were subject to unreasonable restrictions. The CQC issued enforcement action, a requirement notice for Regulation 10 Dignity and Respect and warning notices for Regulation 13, Safeguarding service users from abuse and improper treatment and Regulation 15, Premises and equipment.
Our previous comprehensive inspection of this service in April 2021 rated the service inadequate overall. The key questions were rated as good for effective, requires improvement in caring and responsive whilst safe and well led were rated as inadequate. The service was placed in special measures when the report was published in July 2021. Conditions on the registration of the service were applied. These included presenting regular weekly reports on staffing levels and incidents to the CQC and that the registered provider must not admit any service user to Healthlinc House without the prior written agreement of the Care Quality Commission.
Healthlinc House can accommodate a maximum of 25 male and female people in self-contained apartments or ensuite bedrooms.
We expect Health and Social Care providers to guarantee people with autism and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability or autistic people. Throughout the report and in respect of this statement we refer to “people” or “people using the service” rather than the term patients.
This was a comprehensive, unannounced re-inspection of the service in line with the CQCs special measures guidance. We looked at all of the five key lines of enquiry.
Due to the seriousness of the concerns CQC found during this inspection, we sent a letter to the provider detailing our concerns and giving them opportunity to provide documentary evidence that risks were managed, and patients were safe. The provider responded to the challenges around the safety of the site by providing some immediate mitigation of risk as requested by the CQC. They also decided that the site should close and, in the months following the visit in January 2022 the provider worked closely with commissioners, NHS England, the local authority and CQC to ensure the safe discharge of all patients. The hospital closed on 31 March 2022.
What people who use the service say
One person told us they understood what medication they were on and why they were on it.
Another person told us they could only go out in the community when the minibus was free.
One person told us things haven't improved since we most recently inspected in November and that they feel their physical health care isn't being looked after.
One person told us they felt things were alright.
A relatives told us that communication between the hospital and them was not great. Care plans were not always being shared with family members.
A relatives told us there was a lack of clarity about staff changes and the change of management.
One relative told us they were concerned about how the hospital were caring for their loved ones physical health.
Our inspection team included an inspection manager, three inspectors, an assistant inspector and a Mental Health Act Reviewer.
Before the inspection visit, we reviewed information that we held about the location, reviewed the feedback from staff and received feedback about the service from other organisations.
During the inspection visit, the inspection team:
- visited the communal and accommodation areas of the hospital, looked at the quality of the environment, and saw how staff were caring for people;
- spoke with three people who were using the service;
- spoke with one relative who had family members using the service;
- spoke with the manager of the service, and members of the senior management team from the providers regional team;
- spoke with the consultant psychiatrist and six healthcare support workers;
- reviewed four independent care, education and treatment review records of people using the service and two sets of care plans and risk assessments in more detail;
- reviewed incidents in the previous six months recorded on IRIS (the providers incident reporting system);
- reviewed closed circuit television (closed circuit television) of reported incidents of restraint;
- reviewed prescribing records for two people using the service;
- looked at a range of policies, procedures, records and other documents relating to the running of the service.
Updated
7 July 2023
Healthlinc House is an independent healthcare service providing care and treatment to people with a learning disability and/or autism. Healthlinc House is owned and operated by Elysium Healthcare Limited.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support
The service did not always support people to have the maximum possible choice, control and independence be independent and they had control over their own lives.
Staff did not always focus on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.
People were not always supported by staff to pursue their interests.
Staff did not always support people to achieve their aspirations and goals.
The service did not always effectively work with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.
Staff did not always do everything they could to avoid restraining people. The service did not always record when staff restrained people, and staff did not always learn from those incidents and how they might be avoided or reduced.
The service did not always give people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs.
People were able to personalise their rooms.
People did not always benefit from the interactive and stimulating environment.
The service did not always make reasonable adjustments for people so they could be fully in discussions about how they received support, including support to travel wherever they needed to go.
Staff did not always support people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests.
Staff enabled people to access specialist health and social care support in the community.
Staff did not always support people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.
Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
Staff did not always support people to play an active role in maintaining their own health and wellbeing.
Right care
Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.
People did not always receive kind and compassionate care. Staff did not always protect and respect people’s privacy and dignity. They did not always understand and respond to their individual needs.
Staff did not always understand how to protect people from poor care and abuse. The service worked well with other agencies to do so. However, management were not always informed of every incident that may have happened. Staff had training on how to recognise and report abuse. However, they did not always know how to apply it.
The service had enough appropriately skilled staff to meet people’s needs and keep them safe.
People could not always communicate with staff and understand information given to them because staff did not always support them consistently and understand their individual communication needs.
People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols (add to or delete as appropriate) could interact comfortably with staff and others involved in their treatment/care and support because staff had the necessary skills to understand them.
People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.
People did not always receive care that supported their needs and aspirations, or was focused on their quality of life, and followed best practice.
People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. However, this could be restricted due to access to transport.
Right culture
People did not always lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.
People did not always receive good quality care, support and treatment because although there was trained staff and specialists, they did not always meet people's needs and wishes.
People were not always supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people did not always receive compassionate and empowering care that was tailored to their needs.
Staff did not always know and understand people well and some staff were responsive, supporting peoples’ aspirations to live a quality life of their choosing.
Staff did not always place people’s wishes, needs and rights at the heart of everything they did.
People and those important to them, including advocates, were not always involved in planning their care.
Staff did not always evaluate the quality of support provided to people, did not always involve the person, their families and other professionals as appropriate.
The service enabled people and those important to them to worked with staff to develop the service. Staff valued and acted upon people’s views.
People’s quality of life was not always enhanced by the service’s culture of improvement and inclusivity.
Staff did not always ensure risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.
SUMMARY
Our rating of this service stayed the same. We rated it as inadequate because:
- People’s care and support was not always provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.
- People were not always protected from abuse and poor care. The service did not always have sufficient, appropriately skilled staff to meet people’s needs and keep them safe.
- People were not always supported to be independent and did not always have control over their own lives. Their human rights were not always upheld.
- People did not always receive kind and compassionate care from staff who protected and did not always respect their privacy and dignity and understood each person’s individual needs. People did not always have their communication needs met and information was shared in a way that could be understood.
- People’s risks were assessed regularly but not managed safely. People were not involved in managing their own risks whenever possible and we saw staff intervene to restrain before the use of any de-escalation.
- When restrictive practices were used, there was a reporting system in place. However staff failed to use this system to report all incidents of restraint and this limited management attempts to reviews and try to reduce the use of these practices.
- People made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
- People’s care, treatment and support plans, reflected their sensory, cognitive and functioning needs.
- Staff had not understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.
- People were in hospital to receive active, goal oriented treatment. People had clear plans in place to support them to return home or move to a community setting. Staff worked well with services that provide aftercare to ensure people received the right care and support they went home.
- Staff supported people through recognised models of care and treatment for people with a learning disability or autistic people. Leadership was good, and governance processes helped the service to keep people safe, protect their human rights and provide good care, support and treatment.