Archived: RNIB Pears Centre for Specialist Learning

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

RNIB Pears Centre for Specialist Learning; 5 Pears Court 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.

Five Pears Court is one of a group of specialist built bungalows at Pears Centre. The centre provides care for children and young people up to the age of nineteen. Four children or young people lived at 5 Pears Court at the time of our first two inspection visits. These four children / young people received accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

When we inspected on 05 April 2018 one child had been removed from the service by commissioners, due to concerns about their care and welfare.

There was a registered manager in post at the time of our first two inspection visits in February 2018. In April 2018 the registered manager had left the service. An interim centre manager was in place with recruitment underway for a new registered manager. A requirement of the service’s registration is that they have a registered manager. 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.

This was the first time we had inspected the home under its current registration. The service had previously been registered under a different provider name under the RNIB legal entity. We have rated this service as Inadequate overall.

The ethos was to provide care to children and young people in a homely environment to encourage and support them with developing their social skills and provide them with opportunities to access education. There was a school and accommodation for children attending the school on the same site regulated by Ofsted.

We found safeguarding concerns were not always recognised by staff and managers when incidents occurred at Bungalow 5. Staff and managers had not received the appropriate level of safeguarding training to meet the needs of children and young people at the home.

Risks to people’s health and wellbeing were not always identified, and risk management plans were not always in place to instruct staff on how they should manage risks to people consistently and safely.

There were not always sufficient qualified and trained staff on duty to care for children and young people safely, and to meet their social needs. There was a lack of leadership for staff at the home, including clinical leadership.

We found there was no current analysis and overview of accidents, incidents, complaints, feedback and safeguarding concerns at the home to assess whether any trends or patterns were identified and future risks could be mitigated. The registered manager told us this was due to a lack of management resources at the Bungalow.

The registered manager and provider did not fully understand their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and work within the principles of this. Young people over the age of 16 were not supported as if they were adults, to make decisions in accordance with the MCA. Some clinical and nursing staff however did have an understanding of the Deprivation of Liberty Safeguards (DoLS).

Children’s and young people’s agreed care and support was reviewed by health professionals and commissioners of services. However, it was unclear from care records how children and young people had been involved in planning and agreeing their own care.

The provider sought feedback from children and young people’s through questionnaires about Pears. However, it was unclear what action had been taken following this feedback. It was clear children and young people were able to make complaints about the service, which were documented.

Children and young people were not always supported in a way that respected their privacy and dignity. Children and young people were not always offered activities and social experiences that met their requirements and social needs.

The provider had quality monitoring processes which included audits and checks on medicines management, care records and staff practices. However, existing quality assurance procedures did not always identify where improvements were required. Quality monitoring procedures needed improvement to ensure these were undertaken regularly, to monitor service provision.

Staff were recruited safely. We found the home was clean and well maintained. Infection control procedures were in place to prevent the spread of infection.

Medicines were administered to children and young people safely by trained and competent staff. A medication ‘champion’ operated at Bungalow 5, who had responsibility for monitoring medication administration.

Permanent staff read children’s and young people’s care plans and received an induction and training programme to understand the needs of the children and young people they supported. Further regular training took place to update and refresh permanent staff’s skills and knowledge.

Staff supported children and young people to access healthcare appointments to maintain their wellbeing. Health care professionals and advocates were involved in children and young people’s care plans and staff followed guidance given by multi-disciplinary team professionals.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.