Summary of A designated centre for people with disabilities operated by Stepping Stones Residential Care Limited run by Stepping Stones Residential Care Limited Provider Nominee: Darren Wright. Another inspection by HIQA on stepping stones care residential care limited, the same company managing Lois Bridges found “A designated centre for people with disabilities operated by Stepping Stones Residential” failing in 26 areas.
Social care needs not compliant
Health and safety and risk not compliant
Safeguarding and safety not compliant
Medication management not compliant
Governance and management not compliant
Workforce not compliant
Of note in this report the Hiqa inspectors found that management of Lois Bridges were not providing formal education to children in the centre named “A designated centre for people with disabilities operated by Stepping Stones Residential” children’s needs were not assessed, There had been significant staff turnover and lack of guidance for staff, gaps in mandatory training and vetting. Children’s progess not reviewed, quality of personal plans needed improvement, not all staff were trained, children lock in, staff not trained in giving epilepsy medication, “Management was not trained” Individual intimate care plans were not in place for children, Peer to Peer abuse, staff unaware of roles, medication given or not given questions asked, management unable to spot mistakes or file reports on mistakes, management not at management meetings, external auditor failed to identify the issues they were brought into audit. No performance management system in place, staff were newly qualified and were not experienced or trained and high turnover of staff, Rota not kept, who was the person in charge, staff not aware, Staff not vetted
Centre name: A designated centre for people with disabilities operated by Stepping Stones Residential Care Limited
Centre ID: OSV-0003257
Centre county: Dublin 3
Registered provider: Stepping Stones Residential Care Limited
Provider Nominee: Darren Wright
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https://www.lenus.ie/handle/2262/81106
Summary of findings from this inspection This was the centre’s fourth inspection and was an unannounced monitoring inspection. Inspectors found that while some deficits from previous inspections had been addressed, some had not been addressed in a timely way and other deficits were identified. The centre was located in Dublin and provided residential services to three children aged between 10 to 18 years old with intellectual disabilities and autistic disorders. At the time of the last inspection, children were not receiving formal education. Children’s needs were not comprehensively assessed, therefore there was a lack of guidance for staff in relation to their needs. Personal plans were not always updated to reflect changes in children’s needs. There were regular multi-disciplinary meetings, but it was not clear that the child’s progress against their personal plan was consistently reviewed at these meetings. Some management systems had improved but the centre manager had changed three times in a 12 month period. Risk management, managerial oversight of care practices and quality management systems required improvement. There had been significant staff turnover since the last inspection. There remained gaps in mandatory training, staff files and vetting.
Further deficits identified are outlined in the body of this report.
Outcome 05: Social Care Needs
Findings:
At the time of the last inspection, multidisciplinary meetings did not consistently review the progress of the previous plans and children did not engage in personal plan reviews. Not all children’s needs were reassessed on an annual basis. Parents had not received copies of personal plans and there were no child friendly versions of these plans available. In addition deficits were identified in the quality of assessment and personal plans.
Children’s assessment of need were not always comprehensive. Children’s needs were assessed on admission to the centre. These assessments included children’s physical and mental health, family, education and behavioural needs. However, inspectors found that some assessments did not provide sufficient detail to inform the personal plan. The quality of personal plans required improvement. Children had personal plans outlining their individual needs, choices, goals and supports they required but they were not informed by a comprehensive assessment. Since the last inspection, inspectors found that children were consulted through keyworking sessions where they were supported to make choices regarding their care but these sessions did not take place regularly. There were child friendly versions of the personal plans which were accessible to the children. However, inspectors found that personal plans were not updated to reflect on-going changes in children’s needs. Goals were developed through the personal planning process. Inspectors found that children’s goals were not fully developed in
order to guide staff in their practical implementation. For example, one goal for a child was to identify what the child needs to work on for independent living skills. It was not clear how personal plan goals were monitored to ensure improved outcomes for children. Deficits in relation to person plan reviews had not been addressed. There were multidisciplinary review meetings held in order to re-assess children’s needs, but not all up-to-date minutes were on children’s records. Parents attended some reviews. However, inspectors found that review meetings did not consistently review the progress of the child against the previous personal plan. Review meeting minutes on file did reflect clear actions and agreed persons responsible. Children were supported to transition between services.
Judgment: Non Compliant Stepping Stones Residential Care Limited run by Stepping Stones Residential Care Limited Provider Nominee: Darren Wright
Outcome 07: Health and Safety and Risk Management The health and safety of residents, visitors and staff is promoted and protected.
Theme: Effective Services
Findings:
At the time of the last inspection the risk management policy was not in line with the regulations and not all staff were trained in fire safety. While the risk management policy had been reviewed it remained non compliant with the regulations. The policy did not adequately outline the arrangements for the learning from serious incident nor the arrangements in place to ensure risk control measures were proportional to the risk identified. The majority of risks on the risk register were rated as low risks. However, some potential risks in the centre were not identified on the risk register. For example, all of the perimeter doors of the house were locked at all times which posed a risk in the event of fire, but this risk had not been assessed. Inspectors also found that some control measures identified to manage risks were not implemented. For example, one measure was to ensure all staff received training in the administration of medication to treat epilepsy but not all staff had received this training. The centre manager was not trained in risk management. An incident reporting system was in place and staff completed the relevant reports following an incident. However, while the manager reviewed the completed reports there was no learning being shared with the staff team to prevent other incidents occurring Some infection prevention and control measures required improvement. There were some systems in place to promote infection control, but these systems were not always implemented. A colour coded cleaning system and cleaning rota had been introduced but staff were not using this system on the day of inspection. Inspectors also observed cloth towels rather than paper towels in bathrooms. There had been some improvements in fire safety measures but further improvements were required. However, on review of records inspectors found that not all staff had participated in a fire drill. Fire records were kept which included details of fire drills, fire alarm testing and fire fighting equipment. However, these checks were not monitored effectively as inspectors found some gaps in records for example daily and weekly fire checks.
Judgment: Non Compliant Stepping Stones Residential Care Limited run by Stepping Stones Residential Care Limited Provider Nominee: Darren Wright
Outcome 08: Safeguarding and Safety
Findings:
At the time of the last inspection, not all staff were trained in the management of behaviour and there was no clear mechanism for review and approval of restrictive practices. Individual intimate care plans were not in place for children. However, inspectors found that a collective pre-admission risk assessment had not been completed prior to a recent admission in order to determine a child’s suitability and the impact of their admission on other children already living in the centre. There had been some incidents of peer to peer abuse following this admission. Intimate care plans had been reviewed and were more individualised. The plans provided adequate guidance to staff in completing the task but did not direct staff to tell children what was happening. However, staff told inspectors that they spoke to the child in advance of completing any intimate care task. The centre manager was the designated liaison person (DLP) for child protection but had not received specific training for this role and staff were aware of her role. A child protection concern had been notified appropriately to the relevant authorities and one concern from the last inspection was awaiting formal conclusion by the Child and Family Agency.
Judgment: Non Compliant Stepping Stones Residential Care Limited run by Stepping Stones Residential Care Limited Provider Nominee: Darren Wright
Outcome 12. Medication Management Each resident is protected by the designated centres policies and procedures for medication management. Provider Nominee: Darren Wright
Theme: Health and Development
Findings:
At the time of the last inspection, administration sheets did not reflect good practice, there were gaps in recording of medication and controlled drugs were not stored safely. Drug errors were not always identified or recorded. Medication practices were not safe. Not all children had an up to date prescription available in the centre. Staff had not always administered medication as per the prescription and administration log. Inspectors found that some staff had not signed the administration sheet and there were also a number of administration sheets which were not co signed by a witnessing staff member in line with the policy. There were signature sheet on children’s files for staff members. However, inspectors found that not all new staff had signed the signature sheets. The centre manager told inspectors she had also identified gaps in recording and some measures were taken to address deficits. However, not all gaps had been identified by the centre manager. The controlled drugs register was not up-to-date. Medication errors were not formally reported and oversight of errors was ineffective. The centre manager reviewed medication practices, but not all errors were identified by the manager.
Judgment: Non Compliant Stepping Stones Residential Care Limited run by Stepping Stones Residential Care Limited Provider Nominee: Darren Wright
Theme:
Leadership, Governance and Management
Findings:
At the time of the last inspection, management systems required improvement. The annual and six monthly review of the quality and safety of care and support was not robust. Not all staff were aware of protected disclosure. Inspectors found that while some deficits were addressed on this inspection others were not. Inspectors found that there were some gaps in her knowledge of the relevant legislation, standards and her responsibility under the legislation. Inspectors found that staff were not always aware of who was the shift leader and rosters did not consistently record the person acting as shift leader. There were some improvements in management systems but others required further development. Policies and procedures had recently been updated which provided staff with detailed guidance. The person in charge did not attend senior management meetings where agenda items included staff training, new referrals to the service and children currently attending the services. The person-in charge prepared a report for this meeting in relation to the centre and got written feedback on the report forwarded to the meeting. Risk management systems were not robust. A risk register was in place but not all risks were identified. A risk sub-committee met every second month to review the risk register but the centre manager did not attend this meeting and did not have access to the minutes. There were some improvements in the quality management system but there had not been sufficient time to bed down improvements. An external manager undertook audits of, for example health and safety (weekly), medication management and recording but these audits had not identified the issues found by inspectors. There was no plan to prioritise the implementation of findings from audits. In addition, actions identified following the last inspection had not been progressed in a timely way or in line with the action plan provided to HIQA and nobody was overseeing its implementation. An annual review of some aspects of the quality and safety of care had been undertaken in April 2016 and the report was available in the centre. Inspectors found that there was a good level of consultation with young people and parents in relation to the quality and care to inform the review. While the quality of the review had improved it did not identify all of the issues raised in this report. A meeting was scheduled to agree an action plan.An unannounced six monthly visit was completed in November 2015 by an external manager. A report and action plan was available but some of the actions had not been implemented in a timely way. The provider’s oversight of the required actions was not robust. Effective arrangements were not in place to support, develop and performance manage staff to ensure they exercised their professional responsibility for the quality and safety of service being delivered. There was no performance management system in place. There was a whistle blowing policy. However, not all staff were aware of how to make a protected disclosure.
Judgment: Non Compliant Stepping Stones Residential Care Limited run by Stepping Stones Residential Care Limited Provider Nominee: Darren Wright
Outcome 17: Workforce
Theme: Responsive Workforce
Findings:
At the time of the last inspection, not all staff files contained all the documents required under Schedule 2 of the regulations. Staff members were newly qualified and were not experienced. The frequency and quality of supervision varied. Not all staff received mandatory training. There were improvements in supervision and mandatory training but staff files had dis-improved. There was a high staff turnover which had an impact on the levels of key working available to children. There was a recruitment drive underway and new staff were due to join the team in the coming weeks. However, inspectors found gaps in keyworking due to staff vacancies. While the actual rota was maintained, the centre manager did not keep a record of the planned rota. The roster reflected that there were 16 staff members with a two to one child staff ratio. The centre manager identified that a shift leader was identified on the roster when she was not on duty. However, inspectors found that this was not consistently recorded on the roster and staff were not aware of this role or what their responsibilities were. There was guidance available in relation to on call arrangement should staff need to contact a manager out of hours. However, inspectors found that this was not a formalised system. There were some gaps in child protection, manual handling, safe administration of medication and the administration of a drug to treat epilepsy. There had been no comprehensive training needs analysis undertaken but the centre manger had completed a training audit. While there was no formal training programme in place, the centre manager had identified some behavioural management training requirements that she would deliver. The quality of information in staff files was poor. Staff files did not contain all documents in line with Schedule 2 of the regulations. Inspectors found that some staff files contained incorrect contracts of employment and some contracts were not signed. Some staff files did not contain their employment history. A small number of staff files did not have appropriate vetting disclosure.
Judgment: Non Compliant Stepping Stones Residential Care Limited run by Stepping Stones Residential Care Limited Provider Nominee: Darren Wright
Closing the Visit
Centre name: A designated centre for people with disabilities operated by Stepping Stones Residential Care Limited Provider Nominee: Darren Wright
Centre ID: OSV-0003257
Centre county: Dublin 3
Registered provider: Stepping Stones Residential Care Limited
Provider Nominee: Darren Wright
Outcome 05: Social Care Needs
Theme: Effective Services
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: Not all assessments were comprehensive.
Theme: Effective Services
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: Personal plan reviews did not assess the effectiveness of the previous personal plan.
Theme: Effective Services
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: The personal plan was not amended in accordance with any changes recommended following a review
Theme: Effective Services
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: Not all review meeting minutes were available in the centre.
Theme: Effective Services
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: Personal plans did not always reflect children’s assessed needs.
Theme: Effective Services
The Registered Provider is failing to comply with a regulatory requirement in the following respect: The risk management policy did not adequately describe arrangements in place for the identification, recording and investigation of and learning from, serious incidents or adverse events involving residents.
Theme: Effective Services
The Registered Provider is failing to comply with a regulatory requirement in the following respect: The risk management policy did not adequately describe the arrangements in place to ensure that risk control measures are proportional to the risk identified, and that any adverse impact such measures might have on the residents quality of life have been considered.
Theme: Effective Services
The Registered Provider is failing to comply with a regulatory requirement in the following respect: The risk register was not up-to-date as it did not reflect all risks.
Theme: Effective Services
The Registered Provider is failing to comply with a regulatory requirement in the following respect: The colour coded cleaning system available to staff was not being used. Paper hand towels were not available in bathrooms.
Theme: Effective Services
The Registered Provider is failing to comply with a regulatory requirement in the following respect: There were gaps in daily and weekly fire checks.
Theme: Effective Services
The Registered Provider is failing to comply with a regulatory requirement in the following respect: Not all staff had participated in a fire drill.
Theme: Safe Services
The Registered Provider is failing to comply with a regulatory requirement in the following respect: Not all restrictive practices were applied in line with policy.
Theme: Safe Services
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: Intimate care plans did not provide sufficient guidance for staff re prompting children to what was going to happen during the provision of intimate care.
Theme: Safe Services
The Registered Provider is failing to comply with a regulatory requirement in the following respect: Not all residents were protected from peer to peer abuse.
Theme: Health and Development
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: Not all prescriptions were available in the centre.
Theme: Health and Development
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: Medicines were not administered as prescribed. Monitoring and review of safe medication administration management practices were not effective. The controlled drugs register was not up-to-date.
Theme: Leadership, Governance and Management
The Registered Provider is failing to comply with a regulatory requirement in the following respect: The person in charge did not have sufficient knowledge of her responsibilities under the regulations.
Theme: Leadership, Governance and Management
The Registered Provider is failing to comply with a regulatory requirement in the following respect: There were no systems in place to support develop and performance manage all members of the work force to exercise their personal and professional responsibility for the quality and safety of the services delivered.
The Registered Provider is failing to comply with a regulatory requirement in the following respect: Not all staff were aware of the whistle blowing policy. Provider Nominee: Darren Wright
Theme: Leadership, Governance and Management
The Registered Provider is failing to comply with a regulatory requirement in the following respect: Not all management systems were effective. The provider had not ensured that identified actions were implemented in a timely way. There was no plan to prioritise the implementation of findings from audits.
Theme: Responsive Workforce
The Registered Provider is failing to comply with a regulatory requirement in the following respect: Staff vacancies had impacted on key work sessions with children.
Theme: Responsive Workforce
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: Planned staff rota’s were not maintained.
Theme: Responsive Workforce
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: Not all staff files contained documents in line with Schedule 2 of the regulations.
Theme: Responsive Workforce
The Person in Charge (PIC) is failing to comply with a regulatory requirement in the following respect: There were some gaps in mandatory training.
Centre name: A designated centre for people with disabilities operated by Stepping Stones Residential Care Limited operated by Darren wright
Centre ID: OSV-0003257
Centre county: Dublin 3
Registered provider: Stepping Stones Residential Care Limited
Provider Nominee: Darren Wright
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