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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

People should be protected from abuse and staff should respect their human rights (outcome 7)

Not met this standard

We checked that people who use this service

  • Are protected from abuse, or the risk of abuse, and their human rights are respected and upheld.

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 who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider had not responded appropriately to allegations of abuse.

Reasons for our judgement

Prior to the inspection we had received reports of concern that people were not protected from the risk of abuse within Rydan Lodge residential home. We received information that when concerns had been identified and reported to the registered manager they had not been acted upon in a timely or appropriate manner. We also received reports that potential abuse within the domiciliary care service had not been responded to appropriately.

During our inspection visits we found that those concerns were substantiated. We found that the provider had not taken reasonable steps to identify abuse or responded appropriately to some allegations. They did not have suitable arrangements in place to protect people from the risk of abuse.

We asked the registered manager if the home had a restraint policy. They told us that they had a restraint procedure for equipment such as bed rails, which could restrict a person's movement. We asked for a copy of the current restraint procedure. This recorded that a full risk assessment should be carried out before the use of any restrictive equipment and necessary consent obtained from the person or their representative. The policy listed the restraints that were used at the home as ‘cot sides (bed rails),a keypad on front door and alarms outside bedrooms.The registered manager said that physical restraint techniques were not used by staff and they were not trained to do this.

We found that some objects which were not listed in the policy were being used as restraints. During the early morning we observed a care worker push a stair lift chair into a position which would block access down the stairs. We asked them what they were doing. They told us this ensured that people did not come out of their rooms, try to go down stairs and fall. There were no risk assessments for the use of this stair lift chair as a barrier and there was no record of people having consented to this restriction on their movement. Care records also indicated that clothing was used for one person that restricted their movements. There was no record of a risk assessment for this or that the person or their representative had consented to this.

We asked the registered manager about their response to a concern that had been reported to us. We asked if care workers had brought the concern to their attention. The registered manager told us care workers had raised a concern. The registered manager told has they had then ‘monitored’ the situation. We asked to see staff files. There was no record of immediate monitoring in relation to the incident. We asked the manager if they had made any referrals with regard to the concern, for example to the safeguarding team of the local authority. They said they had not. They told us they were not aware that they had to. We asked about how they were managing on- going risks. Their response did not reassure us that risk had been managed appropriately and we contacted the local adult safe guarding team.

We asked the registered manager for a copy of the current safeguarding policy. The policy document was recorded as having been updated in July 2011. We asked if it had been updated since and were told by the registered manager that it had not. The policy set out definitions of abuse, the duty of staff to report concerns to the management and actions to be taken. The policy recorded that the management would “institute immediate action”. It did not contain contact details for the local adult safeguarding team. When we spoke to care workers on the first day of our inspection, none of them were aware of the role of the local adult safeguarding team or how to contact them about concerns.

The home and the domiciliary care agency each had a whistleblowing policy. The home’s whistleblowing policy recorded that the “owner/managers encourage a culture of openness within the home”. We did not find this to be the case. Some care workers expressed concerns about speaking with us and telling us about when t