Linksway

Improvements were needed to the management of risk. Documentation and recording did not consistently reflect the care being provided, and staff did not always have the knowledge and skills to support people to change position in line with their individual needs.

People were at risk because care plans did not provide the detailed information staff needed to meet their needs in line with their preferences. For example, there was no care plan to advise staff how best to support a person experiencing frequent periods of distress. There was no specific information in care plans about people's communication needs and care plans were not available in different formats, for example large print.

The majority of these issues had not been identified by the providers governance systems which meant they were not fully effective. Action previously taken to address concerns about staff practice had not always led to improvements, for example related to the recording of care provision.

The registered manager promoted a culture of openness and honesty. They were open and transparent during the inspection and took immediate action in response to concerns raised. This included seeking advice from external health professionals, addressing concerns with the staff team and improving policies, processes and monitoring systems.

Overall, people and relatives spoke highly of the quality and safety of the service. Comments included, "Staff take marvellous care of me. I am very happy here" and, "Oh, yes he's very safe, it's all fine, I can't fault them". People's outcomes demonstrated risks were well managed overall, with improvements in physical health conditions.

Staff told us they felt valued and happy working at the service. They felt well supported and were passionate about their role. There had been a successful overseas recruitment programme. The Provider Information Return (PIR) stated, "This has provided our staff with an opportunity to learn about different backgrounds, religions, and experiences of our new staff members." Some staff did not have English as a first language, so

received individual support to ensure their induction and training was meaningful and accessible to them.

A newly recruited enabler was in post. They were in the process of developing a person-centred activities programme, incorporating group activities and individual time with people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Regular health and safety checks were undertaken at the service. Some improvement was required to the infection prevention processes, and this was made immediately. A programme of refurbishment was in progress. A robust risk assessment ensured measures were in place to minimise potential risks to people, visitors and staff. People were protected from the risk of abuse through the provision of policies, procedures and staff training, and an effective recruitment process.

Staff had a clear understanding of the process for managing and reporting accidents and incidents and were using it effectively. Information was reviewed and analysed by the registered manager and provider, and action taken where required, to prevent re-occurrence.

Staff made prompt referrals to relevant healthcare services when changes to health or well-being had been identified. The service worked closely with health and social care professionals to ensure people's health needs were met. We spoke to visiting health professionals during the inspection who spoke positively about the responsiveness and effectiveness of the service.

The service worked closely with health and social care professionals to support people at the end of their lives. This ensured people's needs and preferences were understood and met, and they and their families were supported.

People, relatives and staff were invited to express their views of the service through quality assurance surveys. The information from the quality assurance processes was used to drive improvements at the service. Complaints were managed in line with the providers complaints policy.