By Niall McCracken
NEW information has emerged regarding allegations of abuse of vulnerable adults at a care home in the Western Trust during July and August 2012.
The Regulation & Quality Improvement Authority, which regulates Northern Ireland’s care homes, has published its Independent Review of Safeguarding Arrangements for Ralphs Close Residential Care Home on its website.
The Derry based care home made headlines in September this year when the Western Trust area issued a statement saying that a number of staff had been suspended following allegations of a “serious and concerning nature.”
The review reveals that the suspensions were triggered by an anonymous letter received by the Western Trust in respect of “allegations of physical and psychological abuse of vulnerable adults.” The letter referred to Ralphs Close Residential Care Home.
Key findings from the RQIA review include:
- Trust staff expressed the view that possible actions which could have been taken by the trust following the allegations were constrained by the “primacy of a PSNI investigation.”
- A significant number of unexplained resident injuries have been documented at the home.
- It is possible that staff members who had participated in alleged episodes of abuse remained in work during the investigation.
- There were deficits in vulnerable adult training for staff working at the home.
Ralphs Close is a residential home for adults with a learning disability. The home is situated at the Gransha Hospital site and was constructed in 2010 by Trinity Housing Association.
The home provides single room accommodation for 16 adults and most of the residents who live there moved from long stay learning disability wards on the Gransha site.
In September the Western Trust issued a statement saying that a number of staff had been suspended following allegations of a “serious and concerning nature.”
An RQIA inspection into the home from April last year found that “few staff had completed training in the protection of vulnerable adults”and the RQIA issued a number of Failure to Comply Notices.
A Failure to Comply noti e essentially places the home in a ‘danger zone’ and usually results in a series of follow-up inspections.
Now the latest independent review published by the RQIA provides further details on the timeline of events around the homes failure to comply with standards.INDEPENDENT REVIEW
The Western Trust confirmed to The Detail that it received confirmation on October 25 2012 from the RQIA that the fifth and final failure to comply notice regarding staff training, supervision and appraisal at Ralphs Close had been lifted.
On the same day RQIA published the full details of the independent review on their website.
The review was completed in August 2012. The report outlines that on July 24 2012 an anonymous letter was received by the Western Trust in respect of allegations of physical and psychological abuse of vulnerable adults at Ralphs Close Residential Care Home. The next day the letter was forwarded to RQIA.
In line with the protocol for the “Joint Investigation of Allegedand Suspected Cases of Abuse of Vulnerable Adults” – the Western Trust convened a multi-agency strategy meeting to consider the allegations – decide on the lead agency for the investigation and develop an appropriate protection plan for service users.
It was agreed that the Police Service of Northern Ireland (PSNI) would lead a single agency investigation into the allegations. It was also agreed that the Western Trust would initiate a protection plan in respect of residents living within the establishment.
The reports that a number of trust employees who were interviewed by the review team expressed the view that possible actions which could have been taken by the trust following the allegations were constrained by the primacy of the PSNI investigation.
The review team did not find any evidence that this issue was raised at the strategy meetings so that the potential for additional actions could have been clarified.DETRIMENTAL ACTION
During interviews with trust staff, the RQIA review team discussed the decision making in regard to possible staff suspensions. As no individual staff members were identified in the original letter, the Western Trust considered that it would have been necessary to suspend all day staff.
The trust believed that the disruption to the residents would be "so detrimental that this action would have been disproportionate” as this would have meant the closure of the home. It was claimed that finding accommodation and appropriate support packages for individuals with such complex and challenging needs would have been extremely difficult. The Trust therefore decided to provide a monitoring role using independent staff.
While the RQIA review team concluded that there was “careful consideration” of the issues prior to the decision taken not to suspend staff on a precautionary basis, they highlight that this decision did mean that there was the possibility that “members of staff who had participated in alleged previous episodes of abuse would still be at work during the investigation.”
The review team outlined that it could have been possible through detailed examination of diary logs, incident reports and rotas, to identify members of staff who may have been on duty at the time when the alleged incidents could have occurred. The review states that “this could have restricted the number of staff who would have been subject to the precautionary suspension as part of the interim protection plan.”
In further interviews, the review team was informed by trust staff that it had been possible to identify some staff who were on duty at the time of an incident when a resident sustained a fracture. The trust advised however that this had been considered at a strategy discussion. It was agreed the injury could possibly have taken place prior to the day it was observed, and might then have occurred during the day or night.
For this reason the service division determined it was not possible to suspend the number of staff who may have had contact with the resident during the timeframe prior to the injury.
In light of the allegations the review team concluded that without a satisfactory explanation of the fracture, it could be argued that these staff may have posed a risk to residents.
The review team considered that decisions “as to precautionary suspension should be kept under continuous review as new evidence emerges.”
In early September it emerged through press statements from the trust that a number of staff had eventually been suspended while police investigated allegations of abuse at the home.RECOMMENDATIONS
In the reports presented to the review team, it was noticeable that there were a significant number of unexplained injuries documented. The review team claim that in small, individualised settings such as Ralphs Close, unexplained injuries should be a “rare event.”
The team recommended that the Western Trust should put arrangements in place to ensure that staff and managers are aware of the requirement to report all incidents in Ralphs Close and that regular incident reports should be delivered to
managers in a format that enables them to examine trends and discuss appropriate measures with the staff team.
Issues relating to staff training were also raised during the course of the interviews, and it was reported to the review team that recent RQIA regulatory inspections within learning disability settings had identified deficits in vulnerable adult training.
The review outlined how the Western Trust had attempted to respond to this shortfall through the provision of targeted training. However, from the information received, the review team could not be assured about the uptake for this training by staff within Ralphs Close and the reviewers were concerned that “similar deficits exist in the provision of training in restrictive practices and physical intervention.”
Most significantly, the review team outlined that it was evident that little training had been delivered to help the manager of the home and the staff understand the change in culture from hospital to residential care home.
It was recommended that the Western Trust should review its recruitment strategy within Ralphs Close with regard to reducing its reliance on the use of agency staff and that training should be commissioned by the Western Trust to assist staff in understanding the cultural differences between the provision of hospital care and the support of an individual to be as independent as possible in a residential care setting.
In a statement to The Detail the trust said: "“RQIA undertook the review in August 2012 on the Western Trust’s safeguarding arrangement for Ralphs Close. The review highlights 13 recommendations in respect of the safeguarding arrangements at the facility. The Trust acted promptly and took immediate and appropriate action to address the recommendations as soon as they were highlighted by RQIA.
“Twelve of the recommendations are now in place and the trust has started a procurement process for the final recommendation regarding the establishment of an advocacy service. The trust is confident that it is providing a service which meets the regulatory requirements and the health and social care needs of the adults at the facility.”
The PSNI confirmed to The Detail that investigations into the allegations concerning the mistreatment of residents at Ralphs Close are continuing. They asked for anyone who has information to contact Detectives at Strand Road on 0845 600 8000.