Archived: RNIB Pears Centre for Specialist Learning

Updated 22 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The previous inspection of RNIB Pears, Bungalow 5 took place over three days on 1 and 15 February and 15 April 2018.

Several significant and serious concerns were found as a result of the inspection, and a total of five breaches of regulations were found. In response to these breaches, additional conditions were imposed on the provider’s registration. The registered provider is currently registered to ensure that the regulated activity “Accommodation for persons who require nursing or personal care and treatment for disease disorder and injuries” is managed by an individual who is registered as a manager in respect of that activity at or from RNIB Pears Centre for Specialist Learning. The registered provider must only accommodate a maximum of 6 service users at RNIB Pears Centre for Specialist Learning.,

The conditions that were imposed on the providers original registration in April 2018 are as follows;

1. (The provider must review all service users’ risk assessments including, but not limited to, the use of equipment, and the safe movement of service users. Reviews must be carried out no less than fortnightly and must be carried out by a nurse registered with the Nurse and Midwifery Council (NMC).

2. Equipment checks must be carried out no less frequently than daily, and a record of those checks must be made and kept.

3. A dependency tool must be implemented and utilised to determine adequate and safe staffing levels. Assessments of service user’s needs must be carried out by a registered nurse and these assessments used to help ascertain required staffing levels. If staffing levels fall below levels determined by them as required to provide safe and effective care, the CQC must be notified.

4. A person registered as a nurse with the NMC must be available to advise and/or assist in Bungalow 5 at all times.

5. The CQC must be provided by the provider with weekly written update and which outlines measures they will put in place to meet the imposed conditions.

This inspection, carried out on August 30 and August 31 2018, was to ensure that the provider was acting within their conditions of registration and was making satisfactory progress and improvements to the quality of care being provided to children and young people.

Services in special measures are kept under review. Any service that is in special measures are expected to have made significant improvements within a six-month period. When services are re-inspected and are given a further rating of inadequate for any key question or overall, we may take action in line with our criminal enforcement procedures to begin a process if preventing the provider from operating the service and their registration may be cancelled.

As part of our inspection planning we looked at the information we received from commissioners of services and other regulators, including Ofsted. Commissioners are the professionals who have the authority and responsibility to find and fund suitable placements for children and young people with complex needs.

Prior to our inspection Ofsted conducted a full, comprehensive inspection of RNIB Pears on July 17 July 2018 and 18 July 2018 which included a review of Bungalow 5. We used information and findings from this report to inform the planning of our inspection. The full Ofsted report is published and available on Ofsted’s website. The provider has agreed to close their service on 07 November 2018.

This inspection was unannounced. The interim manager of Bungalow 5 was on annual leave during the inspection. As part of our inspection process we later contact

Updated 22 November 2018

This comprehensive inspection took place on 30 and 31 August 2018. The first day of the inspection was unannounced. The second day of the inspection was announced to the provider.

The inspection was carried out to determine what improvements the service had made since the previous inspection.

The previous inspection visit was conducted on 1 February 2018, 15 February 2018 and on the 5 April 2018. Following this inspection we asked the provider to take action to make improvements in relation to consent, safe care and treatment, safeguarding, good governance and staffing. The service was rated as ‘inadequate’ and placed into special measures as a result. This led to varying the terms of their registration. The provider sent us an action plan to tell us what they were going to do to make improvements, however during this inspection we found that insufficient improvements had been made.

RNIB Pears Centre for Specialist Learning; 5 Pears Court (Bungalow 5) provides specialist accommodation, nursing and personal care for up to six children and young people living with complex health and medical needs who require long term ventilation and/or other complex health requirements.

Bungalow 5 is one of a group of specialist built bungalows at the Pears Centre. The centre provides care for children and young people up to the age of nineteen. At the time of the inspection two children/young people lived in Bungalow 5 at the time of our inspection visit. Both of these children received accommodation and personal care as a single package under one contractual agreement. CQC regulates both premises and the care provided. Therefore the quality of the accommodation and the care provided were looked at during this inspection.

The ethos of RNIB at the Pears Centre is to provide children with and young people with high levels of care in a homely environment, and to support and encourage them to participate in activities which will develop their social and communication skills. The centre also comprises of a specialist school, and children are encouraged to access education. The school and all on site accommodation are registered by Ofsted. Ofsted regulate and inspect services that care for and provide services for children and young people, and services that provide education for learners of all ages.

Only Bungalow 5 is registered with the Care Quality Commission (CQC).

One child in Bungalow 5 was due to be removed from the home and transferred to another placement. We had been made aware that alternative suitable accommodation is currently being sought by commissioners for the young person who is still placed in Bungalow 5. The RNIB have applied to cancel their registration with the CQC and Ofsted and are therefore working closely with commissioners to find alternative suitable placements for children accommodated at the RNIB Pears Centre for Specialist Leaning. Information and findings of the latest Ofsted report can be found on the Ofsted website.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. An interim manager operated the day to day running of the home who was on annual leave during the time of the inspection. This provided the inspection team with a good opportunity to determine how effectively the home was being managed in the absence of the interim manager.

Not all staff in Bungalow 5 had received the appropriate level of safeguarding training to ensure the safety of children and young people in their care. The provider had stated that staff would receive the appropriate level of safeguarding training for staff at the service, following our previous inspection visit on 1 and15 February and 5 April 2018. However, we found that the provider had not met their own agreed action plan to provide all staff with level three safeguarding training. We found evidence that highlighted a lack of staff knowledge in safeguarding which meant that not all incidents were being appropriately identified, reported and investigated as safeguarding concerns.

Following our inspection visit on 1 and 15 February and 5 April 2018 we spoke with the interim manager. The interim manager was responsible for the management and clinical leadership of Bungalow 5. However, following our visit they confirmed they were also responsible for the overview of the whole of the Pears Centre, which included providing clinical managerial support across the Pears site. This meant they were not always located in Bungalow 5 to oversee the management of the Bungalow. We were concerned that this meant there was a lack of focussed leadership to continue to make the required improvements within Bungalow 5.

There was a lack of leadership for staff at the home during weekends and bank holidays as during these periods the home was managed by various agency nurses. Whilst attempts were made to use the same agency nurses to provide familiarity and continuity of care, there were occasions when agency staff did not have a good understanding of the care and support needs of children and young people in Bungalow 5. Agency nurses managed the home in the absence of the registered manager and which led to inconsistent management and leadership of the home.

We identified a lack of robust analysis and overview of incidents, complaints, feedback and safeguarding concerns. We saw little evidence of trends and patterns being identified to ensure that future risks could be effectively mitigated, which placed the children and young people at the risk of harm.

There was some evidence of the provider actively seeking feedback from parents, carers and children through the use of questionnaires, however there was no evidence of improvements to service provision having been made in response to the feedback provided.

On the first day of our inspection the provider had failed to display a poster in the reception area of the site, showing the most recent CQC rating. The provider had failed to display a copy of the CQC ratings on their website, in a accessible format.

Ensuring that inspection ratings are clearly visible and accessible to children and young people, parents, commissioners is important so that people who may use or commission the service are aware of how the service is currently performing. The provider had been advised about this prior to this inspection, but failed to take action to ensure they were compliant with CQC regulations.

Both of the care records that we viewed were incomplete. One care record did not contain any information relating to the child’s most recent hospital stay and staff in the home were unable to locate this information when asked to provide it.

Children and young people were not always supported in a way that respected their privacy and dignity. We observed a medical procedure being performed in a communal area and no consideration was given to ensure the young person was comfortable with the procedure being performed in full view of members of the public, unqualified administrative staff and the CQC inspection team.

Although there were sufficient qualified and trained staff on duty to care for children and young people in the home safely, we found evidence of nursing staff being called away to other bungalows on the site to provide nursing care and support. This practice means that staffing levels were reduced in Bungalow 5.

Providing treatment of disease, disorder and injuries (TDDI) in locations other than Bungalow 5 is a breach of the providers current CQC registration. The inspection team found evidence of nurses from Bungalow 5 visiting other Bungalows on a frequent basis to support a children who have complex health needs. For example, on the first day of inspection, a registered nurse from Bungalow 5 was called to Bungalow 1 to assist a member of care staff who was administering an injection to a child. Nursing care and treatment should not be provided in any other Bungalow on the site, as they are not registered to provide nursing care.

Some risk assessments were in place and were regularly reviewed to assist staff in mitigating the risks of harm to children and young people. However, we found that some risk assessments did not contain essential information to mitigate the risk of harm to children and young people.

The home was clean and well maintained. Bedrooms were bright, colourful and personalised.

The children accommodated in Bungalow 5 had been taken on a number of trips and outings since the previous inspection visit. This had been made possible due to increased and sustained staffing levels. There was evidence of trips being tailored to accommodate the likes and preferences of the child/young person. However, despite the hydrotherapy pool being re-opened, neither resident of Bungalow 5 had been given the opportunity to use this facility.

Medicines were administered to children and young people by staff that are trained and competent. A weekly audit of medicines is undertaken. However, when we asked to see some Medicines Administrations Records (MARs) they were unavailable. The current system in place to archive records including MARs does not facilitate the retrieval of documents and information when required. Not being able to access and cross reference information prevents learning from incidents and robust analysis.

There was evidence in the records seen, of the voice of the child. Where young people can communicate, their views regarding their treatment and care was documented and responded to whenever possible. We saw in one care record that transition to adulthood was considered, and things were being put in place to ensure that the young person was provided with opportunit