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Archived: Rydan Lodge Residential Home

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Inspection report

Date of Inspection: 17, 18, 22 October 2013
Date of Publication: 15 March 2014
Inspection Report published 15 March 2014 PDF | 118.17 KB

Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Not met this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 17 October 2013, 18 October 2013 and 22 October 2013, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information sent to us by commissioners of services and reviewed information sent to us by local groups of people in the community or voluntary sector. We talked with commissioners of services and talked with other authorities.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Our judgement

People were not always asked for their consent to their care and treatment and the provider did not always act in accordance with their wishes. Where people did not have the capacity to consent, the provider had not always acted in accordance with legal requirements

Reasons for our judgement

Prior to the inspection we had received concerns that some restrictions were placed on people living in the care home without obtaining the necessary consent. We received allegations that people were confined to their rooms at night, with chairs being used to prevent people from getting out of bed. We visited the home unannounced at 05:15am on the 17 October 2013.

We checked each occupied bedroom during our night time visit. We did not see evidence of furniture being used as a restraint in bedrooms. We saw that one chair was placed beside a bed, but not in a manner that would prevent the person from getting out of bed. We asked the night duty staff whether chairs were used to keep people inside their rooms or in bed and they told us they were not.

Staff files recorded that some care workers had completed training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. These legal safeguards protect the rights of people who may not be able to make decisions for themselves. Newer staff had yet to complete this training.

Care records indicated that some people who lived at the home did not have the mental capacity to consent to their care or make some decisions about their care. Best interests meetings and decisions are a way of ensuring that when a person did not have capacity to make a decision the staff talked with relatives, representatives and other professionals who had knowledge of the individual. Those discussions would inform any decisions to ensure that what they were doing for people was only being done in their best interests and in accordance with (Section 4 Best Interests) of the Mental Capacity Act 2005.

We saw that care plans in Rydan Lodge residential home contained a document entitled "Best interest summary of your needs and outcomes you wish to achieve". The records of ‘best interests’ decisions taken at Rydan lodge were generic with minor alterations for each person. There was no record of any discussions about each individual. There were spaces for family members, carers, and advocates to comment on decisions and sign. These were blank and documents we saw had been signed solely by the registered manager.

We spoke jointly with the registered manager, the manager of the domiciliary care service and one of the owners of the home about issues of consent. We found that they did not always obtain appropriate consent in their practice. For example, one person's care package had been cancelled without their involvement or consent. We confirmed with the domiciliary care manager that the person concerned had capacity to make decisions about their care. The person's care package with the domiciliary care service had been stopped following a complaint by another person.

We asked if anyone had spoken to the person who received the care before cancelling the planned care. The owner of the home told us they had made the decision to cancel the care but they had not spoken to the person. Neither had the domiciliary care manager. We were shown a document which recorded that the person who had received care wanted to know why their care had been stopped. We made the owner and domiciliary care manager aware of the requirement to obtain appropriate consent in relation to such decisions.