Troubled care facility: now replacement service is raising concerns

By Niall McCracken

A DISABILITY charity, brought into run a Belfast care facility after a series of damning inspections saw the previous service provider pull out of Northern Ireland, has now itself been criticised for serious and repeated breaches in regulations less than a year after taking over.

In July last year the Saint John of God Association, the then provider of residential care services at Dympna House in West Belfast, removed itself from the delivery of all care services in Northern Ireland after “significant concerns” about its management of services were raised by the Regulation Quality and Improvement Authority (RQIA).

From September 2012 the Cedar Foundation assumed responsibility for the management of Dympna House on the Glen Road in Andersonstown and it was re-registered as a supported living service.

But the most recent enforcement action, published by the regulator this month, shows the new domiciliary care service has been criticised for infrequent staff supervision, gaps in training records and use of external agency staff without adequate assurances regarding their identity or fitness to practice.

As well as staffing issues, inspections by RQIA from March and June this year highlighted shortcomings in the record-keeping of safeguarding vulnerable adult referrals. Inspectors were also concerned that seven months after the new service commenced, residents still did not have tenancy agreements.

RQIA stressed the current assisted living services operating out of Dympna House are measured against different standards and regulations than those used with the previous residential care home facility.

The Cedar Foundation is a disability charity that manages a number of assisted living facilities that are designed to provide tenants with support in the areas of personal and social care.

In a statement to The Detail the Cedar Foundation said that it has “worked hard to correct the issues identified and put additional controls in place to ensure that the service continues to be of a high standard”. It stated that it has been actively co-operating with RQIA and the Belfast Trust.

SAINT JOHN OF GOD ASSOCIATION

In July 2012 RQIA issued a notice of decision to cancel the registration of Saint John of God Association which ran the residential care home, Dympna House, at the time.

The regulator had previously identified a series of “significant concerns” in a February 2012 inspection. A range of issues were identified from issues with risk management to problems with the management of medicines.

In a meeting in June 2012 between RQIA and the management of Saint John of God Association the regulator stressed that the concerns raised about medicine management had already been identified over the previous four years.

In its Notice of Decision Report to cancel registration from July 2012, RQIA stated that it was concerned that St John of God Association failed to demonstrate “sufficient and sustained care, competence and skill in providing for the safety and well-being of residents.”

The regulator had noted that similar situations had arisen and resulted in the cancellation of the registration of Owenvale Court Residential Care Home, which was also run by the Saint John of God Association.

In May 2012 RQIA had identified a range of concerns about Saint John of God Association’s running of Owenvale Court Care Home after an elderly woman died in a fire at the location the previous month.

When issuing its notice about Dympna House afterwards, the regulator said the problems facing the home had suggested that Saint John of God Association had not “transferred the learning from the regulatory enforcement” of Owenvale Court.

Following the Notice of Proposal to cancel registration, the Saint John of God Association informed RQIA that it was not its intention to appeal the decision and that it would remove itself from the delivery of all care services in Northern Ireland.

At the time Saint John of God Association, in conjunction with Oaklee Housing, said it had identified a potential provider to take over the responsibility of running Dympna House.

NEW MANAGEMENT

The Cedar Foundation assumed responsibility for the management of Dympna House from September 2012. In conjunction with the Belfast Health and Social Care Trust, Oaklee Housing and the Cedar Foundation, the residential accommodation was reconfigured to change from a residential care home to an assisted living service.

Saint John Of God Association no longer manages any regulated service in Northern Ireland and was also de-registered by RQIA in relation to two other services during 2012.

The regulator stressed that the Cedar Foundation which is now the registered provider of Dympna house has no connection to the previous residential care home run by Saint John of God association. A spokesperson said RQIA does not record the identity of individual service users and therefore could not comment on how many residents from the Saint John of God service still resided at Dympna House.

Currently the Cedar Foundation provides community-based personal care and supported living for people with a learning disability who currently live on the Dympna House site.

In an inspection report by RQIA from March 2013 inspectors stated that the supported living services provided to service users in Dympna House were described by the Belfast Trust as a “temporary arrangement” and would be reviewed.

RQIA was also advised by the Cedar Foundation that there were potential plans for tenants to be offered alternative accommodation in the locality if plans to rebuild on the Dympna House site were successful.

We asked the Belfast Trust for further clarification on the future plans for the supported living service at Dympna House. In a statement it said: “The Belfast Health and Social Care Trust continue to work with Cedar Foundation, the Northern Ireland Housing Executive (NIHE), service users and carers in order to ensure the current and future needs of service users care are met.”

During the March inspection the regulator found that the agency had been supplying staff from other domiciliary care agencies to work in the home of service users. Inspectors found that the agency had failed to seek or obtain information necessary to provide assurances as to the suitability and fitness of these workers.

Concerns were also raised about the safeguarding of vulnerable adults. Inspectors were advised that the agency had made a number of referrals to the Belfast Trust in relation to a range of safeguarding matters but when the records of these referrals were requested not all of them were available.

Inspectors stated that they were also concerned to learn that seven months after the supported living service commenced, the new agency brought in had not provided service users with tenancy agreements.

The inspection report stated that in the absence of tenancy agreements the rights of the tenants and the responsibilities of the housing provider were not explicit. One service user described issues in relation to the heating supply and provision of hot water in their home.

Inspectors were advised by agency staff during the inspection that there had been a range of problems in relation to the heating system which had not been fully resolved. The inspector noted that the heating system was faulty at the time of the inspection.

A further inspection was undertaken in June 2013 and the regulator found that Dympna House domiciliary care agency continued to regularly supply staff from three other domiciliary care agencies to work in the homes of service users.

Inspectors found that the information obtained in respect of two staff supplied by another agency did not contain photographic identification and there was a member of staff from another agency on the rota whose name was not recognised by the manager.

Following the inspections earlier this year RQIA issued three Failure to Comply (FTC) notices to the Cedar Foundation on July 8 2013.

FTC notices are are issued when RQIA has identified serious or repeated breaches in regulations. A formal notice is issued and compliance is required within a stated time frame, determined by the urgency of the matter.

Two of the notices prompted re-inspection within a fortnight and the issues were said to have gained compliance last week. However another inspection relating to the remaining notice is not due to happen again until September 2013.

The notice concerns quality monitoring issues in relation to infrequent staff supervision, gaps in mandatory staff training and use of external agency staff without adequate assurances regarding their fitness and identity.

The Belfast Trust said it was “satisfied that plans are agreed and in place to address the outstanding area of monthly monitoring by or before September 2013.”

In a statement to The Detail a spokesperson for the Cedar Foundation said: “The Inspection Report in June 2013 highlights that Dympna was fully compliant in terms of the care, support and safeguarding of tenants; nevertheless we are disappointed that the standard of certain aspects of the service have let us down in this instance.

“We have kept our staff and families fully informed of the outcome of the inspection and will continue to review with them the quality of service in Dympna on a regular basis. We want to provide reassurance that the wellbeing of our service users is our first priority and we are committed to ensuring that our systems and management structure meet all statutory requirements.”

© The Detail 2013