The Western Health Trust has apologised to the families of 11 vulnerable adults who were subjected physical and abuse at one of its residential homes in Derry.
An Adult Safeguarding Investigation (ASI) report has made 19 recommendations to Ralphs Close in Gransha where 11 members of staff remain suspended.
The investigation followed allegations by whistleblowers that men and women with severe learning disabilities had been physically and verbally abused.
Sixteen adult residents, aged 18 and over, who stay at the home are accommodated in four buildings split between male and female
A previous Regulation Quality Improvement Authority inspection of the home found it was below minimum standard for staff training.
The inspection, carried out in April 2011, found “few staff had completed training in the protection of vulnerable adults.”
In a statement issued today, the Western Trust said the findings of the investigation had been shared with the families, staff, Trust Board, the Health and Social Care Board, the Department of Health Social Services and Public Safety and the Regulation Quality Improvement Authority (RQIA).
A spokesperson said Trust staff continued to meet the families concerned and had apologised to them for any distress caused to their family members resident in the home.
The spokesperson added: “The Adult Safeguarding Team has carried out a rigorous investigation and have identified 19 recommendations.
“Trust Board accepts and endorses these recommendations.
“Following the allegations in 2012 a service improvement plan was put in place at the home and many of the recommendations from the Adult Safeguarding report have already been actioned and the remainder are in progress.
“The regulatory authority RQIA carried out an unannounced inspection of the facility in February 2014.
“The draft report from that inspection has indicated positive changes in both the working practices and culture at the home and is further evidence of the continuing improvements being made.
“The completion of the Adult Safeguarding Investigation is an integral part to an ongoing process of review.”
The spokesperson concluded: “The Trust would like to assure the families and the general public that it is committed to providing high quality dignified care and continuous improvement of this service.”
The 19 recommendations are:
1. Learning Disability services should review the arrangements for supervision to ensure adherence to professional requirements, minimum care standards and best practice in residential care.
2. Information should be readily available to staff on the Trust Whistleblowing Policy and support made available to the staff member on how to avail of the safeguards as appropriate.
3. Learning Disability services should review the role of care management where clients are placed in a care setting to quality assure the care provided and to ensure clarity of roles and responsibilities.
4. The service should consider the inclusion in the Quality Improvement Plan of the use of appropriate and relevant Key Performance Indicators for the Residential Care setting at Ralphs Close which will assist the service to demonstrate the effectiveness of service improvement. This should include an analysis of reported incidents from a safeguarding perspective.
5. RQIA may wish to consider the systems to ensure the expedient production of reports and follow through of actions.
6. WHSCT should consider and review the governance arrangements for Adult Safeguarding to ensure robust arrangements are in place to quality assure decision making.
7. The manager and staff are responsible for ensuring that the appropriate parties are informed of an incident. These include family, Care Manager, RQIA and Incident Report to Risk Management/RIDDOR and where appropriate refer under Adult Protection Policy as per relevant Policy and Procedures. Staff should be appropriately trained to make such notifications and demonstrate an awareness of the thresholds for reporting to the various bodies. Lessons learned from incidents should inform updated care plans.
8. Learning Disability services should consider reviewing Vulnerable Adult Training through the Abuse in Care training material and strengthen internal protocols for recognising, responding and reporting concerns under Adult Protection policy and Procedures. 
9. All unexplained injuries and allegation of potential abuse abusive practice should be reported under the Regional Vulnerable Adults Policy and Procedures, 2006.
10. Adult Learning Disability services should review and develop quality assurance systems to demonstrate adherence to Trust Policy and Procedures and Professional staff Codes of Conduct. The service should also ensure that there is sufficient information included in resident files of specific conditions.
11. Record keeping and communication processes in residential facilities require revision by the Adult Learning Disability and Professional leads.
12. All staff should receive training on the Trust Policy on the Use of Restrictive Interventions with Adult Service Users and Deprivation of Liberty Safeguards. The facility manager should establish key performance indicators to demonstrate how staff apply learning from training in their interventions with residents. This will evidence better outcomes for residents as a result of learning and development.
13. Learning Disability services should review the training available to staff and managers on managing behaviours that challenge. Training should be sourced and rolled out to all staff to develop understanding and practice of proactive and reactive management strategies. Complete and accurate information should be easily accessible to the trust behavioural Team for assessment when appropriate and the care plans and recommendations of the Trust Behavioural Team should be implemented in a consistent manner by all staff.
14. Learning Disability should review the training available for staff on communication strategies for the resident group in Ralphs Close. Communication care plans should be person centred to include the voice of the resident and their families and should clearly demonstrate how communication with the resident is being developed through a goal setting approach.
15. The assessment and care planning processes be reviewed within Ralphs Close by the management team and professional leads. Person centred care planning should identify resident needs and aspirations to reach their potential in various aspects of their lives to enhance social inclusion and recovery.
16. Moving and handling risk assessments are reviewed within Ralphs Close to ensure assessments inform current are plans which are implemented in practice.
17. Resident’s nutritional care plans should be updated following an assessment from the multidisciplinary team and amendments communicated to the staff team. All staff should adhere to the professional assessment in a consistent manner and request a review in a timely fashion as the residents needs change. Staff should ensure the proactive engagement of specialist assessments where appropriate.
18. The findings evidence cultural and professional practice concerns across the service provided in Ralphs Close. It is recommended that professional nursing in conjunction with the Learning Disability Service should review individual practice, conduct and record keeping in line with Trust Policy and Professional Codes of Practice. The Trust should determine from this if any Human Resource or Professional processes are required.
19. It is noted that there has been a significant service improvement in Ralphs Close since the disclosure of the initial allegations. However it is recommended that there is further development by the service division to consolidate the values and principles that underpin a social care philosophy and environment. Such service improvements should be evidence based and measurable through Key Performance Indicators of Quality Care Standards. The service division should ensure that the learning from such service improvement is shared across other service areas.
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