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RNIB Pears Centre for Specialist Learning Inadequate

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Inadequate

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 20

Inspection areas

Safe

Inadequate

Updated 22 November 2018

The service was not safe.

Not all staff had been trained to the appropriate levels in safeguarding and this may result in staff not being able to effectively identify and respond to safeguarding concerns.

Whilst we found there to be a number of risk management plans in place within care records, key information about the risks to children and young people�s health needs were incomplete. Staff did not have guidelines and information to enable them mitigate risks associated with certain health conditions to ensure the safety of children and young people.

Appropriate systems were not always in place to ensure that people received their medicines safely and effectively..

Whilst staff were recruited safety, nursing staff were frequently called to support staff elsewhere. This practice meant that staffing levels were reduced, and children could be left unattended by a nurse in an emergency.

There was a heavy reliance on temporary staff. Whilst the home does make efforts to ensure that the same agency nurses are used to provide familiarity and continuity of care.

Quality of contributions to care records were variable. One of the care records were incomplete as pertinent and important health information was found to be missing.

Although the home was clean and well maintained, infection control guidelines were not always adhered to.

Effective

Requires improvement

Updated 22 November 2018

The service was not always effective.

The care records reviewed showed that young people had been consulted about their care needs and their capacity to consent to treatment and care had been assessed and considered, protecting their rights under the Mental Capacity Act 2005.

Whilst we saw some evidence of children and young people being given the opportunity to voice their views and preferences, effective outcomes were not always delivered to meet children and young people�s needs.

Supervision was carried out for all staff on a regular basis. Staff had received training to reflect some needs of the children and young people they supported.

The home has been purpose built to effectively meet the needs of children and young people with complex health needs and disabilities.

Children and young people were sufficiently supported with their nutritional needs.

Caring

Requires improvement

Updated 22 November 2018

The service was not always caring.

Children and young people�s dignity and privacy were not respected. Door to bedrooms were left open when a young person was asleep and a medical procedure was carried out in a public place in full view of the inspection team leaving a young person visibly embarrassed.

There was evidence of children and young people being involved in decisions regarding their care and treatment. We also saw some evidence of transition planning and providing young people with opportunities to be more independent provided it is safe to do so.

Responsive

Requires improvement

Updated 22 November 2018

The service was not always responsive.

Children and young people were being supported to take part in an increased number of social activities. However, opportunities for children and young people to develop their social relationships were limited.

Children and young people did not always have their needs, preferences and choices met.

Children and young people were not always being supported to participate in some activities which were important to their wellbeing and development.

Well-led

Inadequate

Updated 22 November 2018

The service was not well led.

There were a lack of effective systems in place to monitor the quality of the service or identify the concerns that we found.

The provider did not keep the Care Quality Commission (CQC) informed of notifications in relation to incidents as required by law.

There was limited information to show that were incidents had been reported and investigated that lessons had been learnt and shared with staff and the wider organisation.

The ratings from the last inspection were not displayed in the service. The ratings were also not displayed on the providers website. This was despite the CQC providing instruction, support and guidance about this concern on numerous occasions.

The interim manager has carried out several audits into historical and current incidents and complaints. Despite this, there was little evidence found of any learning and improvements being made to mitigate future risk.

The interim manager informed us that they had not been aware that nurses had been practicing in other bungalows and this highlighted a lack of managerial oversight.

Some incidents that had been recorded had not been reported to CQC by way of a statutory notification as the interim manager lacked understanding that these incidents were safeguarding concerns.

An interim manager and clinical lead has been successfully recruited since the previous inspection. However the interim manager has clinical responsibility for the whole Pears site, reducing the time that they have available to make the improvements that are needed in Bungalow 5.

Staff, including agency nurses are receiving supervision which provides them with an opportunity to reflect and continually develop their practice.