Archived: RNIB Pears Centre for Specialist Learning

Updated 14 December 2016

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 inspection visit took place on 14 November 2016 and was unannounced. The inspection team consisted of one inspector, a specialist advisor and an ‘expert by experience.’ A specialist advisor is someone who has current and up to date practice in a specific area. They advise CQC inspection teams but are not directly employed by the CQC. The specialist advisor who supported us had experience and knowledge in providing nursing care to children and young people living with complex health conditions. An expert by experience is a person who has personal experiences of using or caring for someone who uses this type of care service. We told the registered manager that one inspector would return on 15 November 2016 to complete the inspection and give feedback to them.

We co-ordinated our inspection visit to take place jointly with the Office for Standards in Education, Children’s Services and Skills (Ofsted). Ofsted inspectors used their specific framework in conducting their inspection of the residential part of the specialist learning centre of Pears Court.

The provider had completed a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We reviewed the information we held about the service. This included information shared with us by the commissioners. Commissioners are people who work to find appropriate care and support services paid for by the local authority and health care. We reviewed statutory notifications sent to us from the provider. A statutory notification is information about important events which the provider is required to send us by law.

We spoke, and spent time with, three children and young people living at the home, three relatives and one social worker. We spoke with seven care staff, three nurses, the team leader and registered manager.

We reviewed a range of records, including four children’s and young people’s care plans, one medicine administration record and four children’s and young people’s risk assessments. We reviewed staff training, team meeting records and quality assurance audits.

Updated 14 December 2016

The inspection took place on 14 November 2016 and was unannounced. We informed the registered manager we would return for a second day on 15 November 2016. At our last inspection of this service in November 2013, we found the provider met the requirements of the regulations.

The Royal National Institute of Blind People (RNIB) is a registered charity that offers a range of services to people living with sight loss. RNIB Pears Centre for Specialist Learning; 5 Pears Court provides specialist accommodation, nursing and personal care for up to six children and young adults living with complex health and medical needs who require long term ventilation and / or other complex health requirements.

Five Pears Court is one bungalow of a group of specialist built bungalows at Pears Centre providing care for children and young people up to the age of twenty years. Between the ages of eighteen and twenty years of age, young people are supported to transition to adult services. Five children and young people lived at 5 Pears Court on the day of our inspection visit.

There was a 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.

Staff put children at the centre of the service and gave person centred care and support appropriate to children and young people’s ages. Staff received training in core care practices and specialist clinical training in managing children’s complex health care needs. The provider’s aim was to have a nurse on every shift, but challenges in recruitment had meant some shifts were not covered by a nurse at the home. Further nurse recruitment was taking place, but while this was happening detailed contingency plans were in place to ensure children and young people’s complex care needs continued to be met, including on-call nurse cover. Care staff were trained at level three with advanced care skills which included supporting children and young people on long term ventilation, changing tracheotomy tubes and undertaking oral and nasal suction when needed.

Most risks were assessed and actions were taken to minimise identified risks of harm or injury to people. Risks to children and young people’s skin had been assessed but action had not always been taken to implement care plans when people’s skin became sore or damaged. Where skin was sore or damaged, risks of further skin damage or deterioration had not always been assessed. Children and young people had their prescribed medicines available to them and staff supported people in administering these safely. Staff received training in the safe handling, administering and recording of people’s medicines.

Children and young people had been involved in planning their care as far as possible. Staff were very knowledgeable about children’s and young people’s needs and were able to effectively support these. Additional training took place to update and refresh staff skills and knowledge. Staff said children and young people’s care plans provided them with the detailed information they needed to support people safely and effectively. Children and young people’s nutritional and hydration needs were met and the guidance of dieticians was followed. Staff worked closely with healthcare and other professional therapists involved in children and young people’s day to day healthcare and support.

The registered manager and staff understood their responsibility to comply with the requirements of the Mental Capacity Act (2005) and worked within the principles of this. Management had an understanding of the Deprivation of Liberty Safeguards (DoLS).

Staff were kind, respectful and compassionate toward children and young people. Young people were listened to and their views were acted upon. Young people told us they felt they could raise concerns or complaints if they needed to.

The provider had quality monitoring processes which included audits and checks on medicines management, care records and staff practices. However, these were not always effective in identifying where improvements were required. Feedback from children and young people and their relatives was not sought, which meant opportunities to identify where improvement was needed may be missed.