Castlebeck and CQC – Brief Thoughts

Paul Burstow MP addressing a Liberal Democrat ...

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I don’t have time for a long post today, just a few brief thoughts that came to me as I considered the unsurprisingly critical report on Castlebeck by the CQC.

Of course it’s easy to be wise after the event but it leaves a bitter taste in the mouth when the CQC comes down hard on Castlebeck after it required a TV undercover programme to uncover the widespread abuse at Winterbourne View. Where is our faith in the CQC? Well, personally, I didn’t have any to begin with but this report is not a solution, it smacks of a desperation to gain any kind of public recognition of the CQC itself rather than a real attempt to improve any system of regulation.

Regulation costs. Good regulation costs. In the week that the Ofsted is planning two week, unannounced inspections of childrens’ services, I ask why services for adults have been allowed to be neglected?

Yesterday I heard Paul Burstow on the radio on my way home. Two things struck me, firstly that he didn’t seem to have any understanding of the difference between a hospital such as Winterbourne View and a care home. He  seemed to be happy to blame local commissioners for the quality of the placements that they commissioned in hospitals without an understanding of what had led to this situation – namely chasing the lowest prices.  He still is banging on about his so-called Excellence scheme which, if anything, will make things worse as I wrote here. The Excellence scheme is opt-in and it is for companies to pay to be a part of. That is not about excellence, that is about money-making.

The CQC should be demanding excellence from every single service it inspects. Every day. It doesn’t. It demands sufficient paperwork every couple of years, at most. That is how it inspects. Actually, the CQC doesn’t inspect any more. It does not have enough people to inspect, control and check.

We have allowed companies like Castlebeck to rake in millions of pounds of profits on the back of providing poor care to vulnerable residents and patients. We have allowed this because noone is calling the CQC and the government to account for destroying adult care services.

The CQC criticising Castlebeck – of course it will but remember this is on the back of one television programme with hidden cameras. What about the thousands of homes without hidden cameras? Where are the checks? Where is the scrutiny? Where is the excellence?

Light Touch Inspections, Winterbourne View and the CQC

There was a report on the Community Care website on Friday that the CQC were ‘calling time’ on their so-called light touch inspection ‘regime’ thereby rolling out potentially to annual inspections for adult services and care homes.

As the article emphasises

Bower said that the CQC had favoured a “proportionate, risk-based, light-touch” approach to regulation – in which services were left uninspected for up to two years in the absence of issues coming to light – but service users, providers and staff favoured more inspections.

“What people want, particularly people who use services, is for us to put our boots on the ground,” she said. “Inspections are a really positive quality assurance for providers.”

It’s hard to believe Bower would have been saying this if she had not been forced into the position by the Winterbourne View scandal where substantial abuse was uncovered.

A shame that she did not show more backbone and spirit in protecting the organisation that was handed to her to lead when all the cuts were coming hard and fast. It did not take a genius to work out that the only reason the so-called ‘light touch’ system was implemented in the first place was to save money. The problem is, that it has stripped the CQC of any credibility it might have had as a regulator.

And yesterday, this same CQC criticised Winterbourne View and it’s owners, Castlebeck had misled that self-same regulator about issues that where taking place and abuse that was taking place while they were inspecting the service.

Interesting to see the Independent highlight the issues which the CQC raised as criticisms of Castlebeck

Inspectors said they found people who had no background in care services had been working at the centre, references were not always checked and staff were not trained or supervised properly.

They added Castlebeck failed to meet essential standards, required by law, including:

:: The managers did not ensure that major incidents were reported to the Care Quality Commission as required;

:: Planning and delivery of care did not meet people’s individual needs;

:: They did not have robust systems to assess and monitor the quality of services;

:: They did not identify, and manage, risks relating to the health, welfare and safety of patients;

:: They had not responded to or considered complaints and views of people about the service;

:: Investigations into the conduct of staff were not robust and had not safeguarded people;

:: They did not take reasonable steps to identify the possibility of abuse and prevent it before it occurred;

:: They did not respond appropriately to allegations of abuse;

:: They did not have arrangements in place to protect the people against unlawful or excessive use of restraint;

:: They did not operate effective recruitment procedures or take appropriate steps in relation to persons who were not fit to work in care settings;

:: They failed in their responsibilities to provide appropriate training and supervision to staff.

While there is no excuse for such considerable failures, you’d think that a good regulator worth it’s proverbial salt should have picked up some of these issues through a thorough and robust regulation system.

Remember this is the same Bower who has promoted extensively the use of whistleblowing and family members as a ‘resource’ to augment their inspection processes. And then the organisation feigns upset when things are concealed to it.

How did we come to this? How did we, as a society, allow the organisation that regulates Health and Social Care to be stripped bare due to a resource-led decision and blunt its teeth so incredibly that people who depend on these services can have no confidence in its position to protect?

Money, cost, closed eyes and an ability to discharge responsibility for the care of those in our society who need particular protection has led for this situation to emerge.

Unfortunately I can’t go into details about some of the things I  have seen over the past week that makes me feel  much more strongly about these issues but suffice to say this – which, in itself – could even be too much.

I visited a care home which had an ‘excellent’ star rating. Yes, the stars are outdated but it is an easy way to check and remains so. There had been no inspections over the past year, at least, anyway. Excellent. And it looked it on the outside. My involvement was due to a large scale safeguarding investigation. Let’s just say it was very far from excellent and had been for a number of years, including when the last ‘excellent’ inspection rating had been given.

The inspections depend too heavily on self-reported data and too little on ‘feet on the ground’ and investigations skills. I sometimes wish I could try doing a really thorough, wholesale inspection of any given inspection service. I’ve worked in residential care. I know what I would look for. It angers and upsets me that self-reporting and the ‘light-touch’ were ever permitted for purely cost-related reasons.

But the CQC says it is increasing inspections – still it will not be close to previous levels. To see them criticise Castlebeck – all well and good – but it doesn’t take the responsibility for inspection and regulation away from them. It bears some resemblence to the social workers who are told they are more easily led by parents who conceal information from them. If the social workers are chastised for ‘believing’ why not the regulator.

It makes me angry. Maybe time to invest in regulation and inspection and demand better services that actually protect against, rather than mask poor care. It is ever more important.

Distractions and Uncertainty

Of Local Distractions

I met one of the hospital social workers earlier this week. We don’t actually catch up with each other very often but when we do we always make a point of hanging around in whatever corridor we bump into each other in and chat.

This time, we again commented on the ebb and flow of work which seems to be balancing on an almost perpetual ebb without much flow at the moment.

We are all on edge at the moment. Another reconfiguration is in the pipeline and so many rumours are abounding that it is making it very difficult to actually get very much done.  Announcements and decisions are in the offing and have been put back again and again so all we know is that ‘this is a big one’ and that some jobs are going.

Good place to leave it with us, management team!

Seriously I do wonder if any of the so-called management executives who are paid most highly with their years of skills of organising complex projects ever remember those very first baby steps in communication skills and ponder on the way that rumours spread when a team of people are bereft of actual facts.

So my kind of friend, the hospital social worker, filled me with a swathe of new rumours that I hadn’t heard before about how our jobs were going to be directly affected by these changes and in turn, I shared with him the hotch-potch rumours that I’d heard from another AMHP at a training session a couple of weeks ago who, although she is prone to hyperbole, still seemed to deliver a fairly gloomy outcome of what might happen to all our jobs.

We smile. We chuckle. We remind ourselves how complicit we are in spreading the uncertainty through these rumours. Then I return to the office and immediately tell everyone what I’ve just heard from my new source about the talk that is going around at the hospital. He, in turn, no doubt returns to his hospital team with the latest gossip in the ‘community teams’.

And in the meantime, of course, work goes on. The increasingly distressed calls. The organisation and co-ordination of assessments and the desperate attempts to make some kind of priority from the pieces of information that have been fed through to us.

This is life at the bottom of an organisation when the top is reorganising. This is the pit of the rumour mill where scraps of invented truths and fears are ground together and occasionally spit out nonsense but this is what we are talking about in the large open plan offices. This is what is happening while the government is talking about pumping more money into the NHS. This is what is happening when officials are prevaricating and making the policies that end up on intranet sites that we don’t have time to access and read.

And it made me think of Southern Cross – I’ve been thinking about Southern Cross a lot lately.

Of National Job Losses

The announcement of 3000 job cuts yesterday although, I suppose, unsurprising coming from a company that is in such severe financial straits. Considering that they have sold off their property assets, staff costs are likely to be one of their highest expenditures. I wonder how the staff employed today feel. I wonder how the residents who  might have built up relationships with staff members feel and I wonder how people who are about to make placements in care homes feel.

Am I less likely to place someone in a Southern Cross Care Home today? Yes.

The Independent states that

The jobs to be axed are expected to include over 300 nurses,1,275 care staff, almost 700 catering posts, 440 domestic jobs and 238 maintenance posts

They don’t sound very ‘back office’ to me. Although Southern Cross maintains that this will not affect quality of care provision, it rather makes you wonder what the staff were doing in that case.

Ideally, it would be useful to check the data from CQC inspection reports to see what the inspectors said about staffing. The difficulty is that publicly available inspection reports that are recent enough to give up to date evidence.

I decided to look at a few random Southern Cross inspection reports from the London area.  Professor Google spat out some results and this is by no means scientific as I didn’t have the time for a more extensive ‘study’.

Romford Grange? Good report in 2008. That seems in order. Of course 2008 is three years ago now. A long time between actual inspections but we know they are not actually going to do inspections so frequently now. Still, three years seems to be pushing it. Lots can change overnight, let alone in three years.

Tower Bridge Care Centre? Well, that had an inspection in 2010. Oh good, I think. But wait, that was only because there were concerns regarding medication management that had been raised specifically.

Another random check on Camberwell Green Care Home  – oh, an inspection in 2010, surely that’s a good sign? Silly me, the recent inspections seem only to be where there are problems identified. Here’s what the report says

The service has been performing poorly for some time and matters have not been addressed by Southern Cross.They have started to do that recently but that has lead to lots of staffing changes and a turbulent time including managers leaving quickly. The ship has been steadied by a management team who have been sent in to the home. This inspection has identified some of their successes but more work is needed and a key need is for a stable, consistent management team to be in place. Until such time we can only view the home as adequate

Care planning is not personalised and is not considering all areas of individuals need, therefore the care arrangements are not always well informed.
The complaint’s procedure needs to be improved, it has to be open and transparent with complainants feeling that they are listened to and that issues are acted upon. Communication too is not as good as it should be, all issues whether they are minor concerns or not must be addressed.
Despite staff receiving up to date training on Safeguarding Vulnerable people,
procedures are still not fully robust at the service.

Burgess Park? Oh, it had 4 inspections in 2010. That’s what I call exceptionally good monitoring. Ah, one look at the most recent report and you’ll see that it is because there are problems that there has been so many inspections.

For example, their April 2010 inspection report states that

Our observations of a lunchtime on the second day of the inspection showed us that the systems for shift planning need to be improved. We saw that one member of staff was the only person in the dining room where there were fifteen service users. They needed various degrees of assistance and we observed that the lack of staff caused difficulties for them An example was a service user who had to wait an unreasonably long time to be assisted to go to the WC; another service user fell asleep while waiting to be assisted to eat her meal.

and while the July report says that these issues have been ‘addressed’ and more staff were recruited, it does make you wonder where the cuts are going to come from.

Lauriston House? Home to 100 older and disabled  adults – last inspected in 2007.  In fact, a random glance at the ‘most recent available assessments to view’ tells a sorry tale.

Previous reports

  • Inspection report 2007/10/26
  • Inspection report 2006/09/06
  • Inspection report 2005/11/15
  • Inspection report 2005/08/05
  • Inspection report 2004/12/14
  • Inspection report 2004/06/29

Oh, it got a good report. In 2007. But for 100 people, that’s a pretty poor show. In fact, if anything is to tell the tale of the toothlessness of the CQC and the way that CSCI was heading prior to it’s inception – it’s that list of dates. Look on it, ministers and make a decision if that is the level of scrutiny and regulation you want to maintain?

Back to the job losses though. So what will that mean for today’s residents and staff? Uncertainty. Rumours. Whispering.

Whatever we say when we look back at what we can achieve and improve today for our own old age and for that of our children – we definitely can’t say we are living in uninteresting times.

CQC and Southern Cross – a retrospective

I’ve bemoaned both the changes in the CQC and the financial troubles of Southern Cross over the last few years since I started writing this blog.

For today, a bit of a ‘lazy post’ – I thought I’d collate all the posts that I’d made on those two subjects. It provides a little bit of context and stops me repeating myself.

Southern Cross

Trouble at Southern Cross (2/7/2008)

Active Care – Another Tale of Southern Cross? (16/8/2008  – READ THE COMMENTS!

Alton Centre, Active Care and Southern Cross – An Update (5/9/2008)

Southern Cross and Hillingdon (19/12//2008)

Frozen Reading (12/2/2009)

8 deaths – 10 days (26/2/2009) – oh the irony when I comment that Southern Cross own a lot of real estate.

The concerns and worries about the financial management of Southern Cross go back a long way. This is not ‘new’ news. The ‘new’ news is that the company is now close to the brink of collapse. There is almost an inevitability in this as those who sought to make a quick buck in the care sector realise that sometimes the figures don’t add up. Property doesn’t always pay. But making money on the back of what was a public monopoly (provision of care services) can lead to some rich pickings until some of that money needs to be spent. Corners are cut. Staff costs are cut. Older people are warehoused in increasingly larger residential and nursing homes while the roll-out of the so-called personalisation agenda rings very very hollow at the moment for those who are the most dependent and those who need long term care. Where this the personalisation within residential and nursing care services? Where are the small group homes with support for older adults with dementia? They don’t exist because they wouldn’t make a profit.

That is what those involved with personalisation need to address. Not how people who have capacity and ability to manage personal budgets or have families to help them will manage but how will personal budgets (health and social care) and personalisation help and create better systems for older adults in dementia nursing care. Give me an answer to these questions and I’ll have more faith.

CQC – Care Quality Commission

From the first day the CQC came into ‘being’

DoLs, IMHAs and the CQC (1/4/2009)  – these were all introduced on the same day. Do look at the quote from Barbara Young, the first Chair of the CQC. VERY telling.

Britain’s Homecare Scandal (10/4/2009) – another Panorama investigation.

Inspections (3/12/2009)

Can Gerry Robinson Fix Dementia Care Homes? (8/12/2009) – another TV programme.

Linford Park Nursing Home (3/8/2010)

Closing Care Homes (30/9/2010)

Lessons from the Care Sector (26/10/2010)

Trouble at the CQC (3/11/2010)

Johann Hari’s Manifesto for Change in Care Homes (26/1/2011) – one of which was ‘proper inspections’.

Scrutiny, CQC and ADASS (15/2/2011)

Excellence Ratings for Care Homes (1/3/2011)

Inspections and the CQC (11/3/2011)

Whistleblowing (7/4/2011)

Which Care? What Care? (19/4/2011)

Care Home Crises (16/5/2011)

So is this surprising? I wish it were.  I want to emphasise though that it is the management of the CQC that I feel is badly serving those who need support and care rather than the individual inspectors who I know have as many criticisms of the system as the rest of us do. How did this, or the last government allow regulation so toothless just as they are ratcheting up the OFSTED inspections? Does it say anything about how we, as a society, want to value or hide away adults with disabilities?  I suspect it does.

What makes a good care worker?

I haven’t been able to shake off the Panorama programme about the abusive care environment at Winterbourne View.  We spent quite a lot of time talking about it at work yesterday as well, at meetings and in the office.

It has pushed my mind back to the time, before I qualified when I worked for about 7 years (5 years full time and 2 years part time while I was studying) as a care/support worker before I qualified as a social worker.

I was fortunate to work in well run small group homes for adults with learning disabilities and had generally very good managers who encouraged person centred planning and the environment would not have tolerated any kind of mistreatment of the residents whom we were charged to look after.

It made me think about the qualities that would make a good care worker. I’m not saying I was particularly fantastic at my job. I enjoyed it and I enjoyed the interactions with the residents – but not being abusive doesn’t make you necessarily ‘good’ at your job.

The most important thing, I think, is not dependent on personal qualities so much as the ethos and environment that you work in. A team of colleagues who show respect to the residents in their own home and who are respected by their managers and each other will not tolerate one ‘rogue’ care worker stepping over the line.

In an environment like the one portrayed at Winterbourne View, there was no regulation or censure by other staff members or managers. The staff who were abusive were openly abusive and so there was a culture that had permeated the home of mistreatment and abuse. I do wonder how much the culture has been instilled in an organisation by management – not that that excuses any individuals from the personal responsibility they hold – but cultures and systems sometimes allow abuse to be perpetuated in an almost ‘Lord of the Flies’ type way when the management take their collective eyes of the ball. It is for that reason that the management of Castlebeck have to take responsibility.

There is also the issue of training of course, but the deeply developed culture of an organisation is more than a matter of training. It helps, don’t get me wrong. Everyone should know the basics and more about an ethos and environment and what best practice demands but training costs and if you are paying staff a minimum wage without allowing them to develop professionally, you won’t have the same levels of satisfaction and retention. Retention is very important in social care settings. I was lucky to have worked in the same two homes for those 7 years. I built up relationships such that I still pop in for ‘parties’ when I get my invites to the annual ‘anniversary’ celebrations (the anniversary of the home opening!).

So taking the environmental and structural issues into account, a good care worker needs patience. This is not necessarily inherent as a quality and I believe it can be learnt. I believe that self-awareness helps as well. Patience was not high on the lists of qualities displayed in Panorama but you need to be able to show judgement and sensitivity in knowing when to talk and when to walk.

Empathy is vital. Being able to see the people you work with and think about how they feel – about how their families feels and most importantly, treating everyone as you or (insert close family member whether child or parent) to be treated. That’s a very simple catch-all and it is hard to teach to someone but it’s a very basic precept. When you see someone with a disability or someone who is particularly old or young as a ‘victim’ or an ‘other’ type of person, it almost gives you free rein to treat them differently. That is a dangerous position to be in.

An understanding of the power dynamics is also vital. Some people seek out vulnerable people to work with in order to feel more powerful. Power silences people and it instils fear. It is important that the peer group are able to identify this and scotch this. This happens across the social work and social care sector. It will never disappear but having an awareness of it can help.

I often tell families of people who are going to look at residential homes to ask the staff about retention levels in the home – how long have they been there? Are they happy? (they may lie, of course!),  how many permanent staff and how many agency staff there are? Try and talk to staff who are carers and not managers.

There is no doubt that there is a lack of societal respect and appreciation for support workers and care workers in general. We allow our most vulnerable to be cared for by those who receive minimum wages and have poor working conditions.  That won’t change overnight but going back to the CQC and inspection regimes in general, it would be useful to have a deeper understanding of organisational cultures so they can be monitored but perhaps that is too big a job to undertake.

As for me, the years I spent carrying out hands-on care in a residential setting have been crucial to my development as a social worker. In some ways, that’s why I think it’s sad that some of the social care experience needed to go into social work has been reduced as I know I wouldn’t have as much to draw on when I go to review residential homes had I not had that experience.

Sometimes I miss the care work.  It was an honour and privilege to have such an important and significant daily role in the lives of others and in some ways, I was working in a much more person-centred way back then than I am now, through the reams of (virtual) paperwork.

Undercover Care : The abuse exposed – A Review of Panorama

I sat down to watch Panorama yesterday and the trailers and name of the programme were something of a giveaway so I wasn’t exactly unprepared for what was shown.

Panorama had been alerted to abuse within Winterbourne View near Bristol, which is a private hospital run by a company called Castlebeck for people with learning disabilities and autism and according to the description on their own website

..  is a purpose designed acute service, offering assessment and intervention and support for people with learning disabilities, complex needs and challenging behaviour.

It can also provide a service for those liable to be detained under the Mental Health Act 1983. It offers a stable, structured and therapeutic environment and the support of caring and dedicated staff.

Winterbourne View, which has 24 bedrooms, offers the chance for people to progress to more community-based living as part of their ongoing rehabilitation, at their own pace.

Winterbourne View charges an average of £3,500 per week for a place. I wonder how much is spent on staff costs and training.

Acting on the information from a former senior nurse there who had been whistleblowing, Panorama sent in an undercover support worker (journalist) and some hidden cameras. I knew I was prepared. I knew we were going to see abuse but nothing prepared me for the actual footage that I saw.

I try not to engage in hyperbole but what we saw was purely and simply torture of adults who have needs which make them more vulnerable.  Physical restraint was used as a punishment and some members of staff were deliberating provoking residents almost as if it were a sport and they were playing at bear baiting. It made for uncomfortable and emotional viewing.

I worked for many years in homes for adults with learning disabilities before I qualified as a support worker and the lack of humanity with with the residents in the hospital were treated was almost physically painful to watch. The programme showed a woman being given showers fully clothed and being dowsed with water outdoors on a cold, March day until she was shivering profusely. They showed her being pinned under a chair.

In one of the most troubling pieces of footage, a girl is shown as she had tried to jump out of the window and the staff mock her attempted suicide and taunt her to ‘try again’ and ‘make a better job of it’ saying things like ‘do you want me to open the window more’ and mockingly telling her she would make a ‘splat noise’. Even writing it out is difficult.

There were other things – comments made, pin downs and the use of martial arts techniques which are, unsurprisingly, wholly inappropriate and this footage was shown to a specialist psychologist with the Tizard Centre who would respond with the same gut horror that you didn’t need to be a psychologist to understand.

The footage really spoke for itself and I wondered about the position of the undercover journalist who stood by and watched some of the abuse occurring. There is an issue of ‘greater good’ versus ‘personal responsibility’ so the argument would be that the programme itself was able to prevent future harm coming to the residents by being transmitted but he admits that it was difficult for him.   He says here

I was watching on the sidelines, resisting putting a stop to this (abuse) and blowing my cover. Simone was staring at me as she lay on the floor, staring at the only person not abusing her.

I could not save Simone on that day. I had to resist my instinct to step in. I was there to gather the evidence that could help save others from a similar fate – and Simone herself from future abuse

Some of the more difficult responses came later in the programme as the CEO of Castlebeck was interviewed and of course expressed disgust and surprise at the levels of abuse in Winterbourne View. A company statement is published here and alongside all the usual guff is an acknowledgement that the whistleblowing policy was not adhered to when an initial complaint was made by a staff nurse on 11 October 2010. The footage was filmed between February and March 2011.

I was more furious by the response of the CQC. The whistleblower also contacted them, you see with the allegations of abuse. He contacted them three times.

Winterbourne View had last been inspected ‘two years ago’. Is that the kind of satisfactory inspection regime that we have, Mr Burstow? Oh, wait, it’s ok, because the statement from the CQC says Burstow has authorised a sample of 150 hospitals receive random unannounced inspections. Woah. Only 150? Only a random sample? Why just hospitals for people with learning disabilities? If random unannounced inspections are seen as necessary to prevent institutional abuse on such a wide scale, surely they should be the NORM for everyone who receives a service via a service inspected by the CQC.

No, you see, Burstow (and the Labour ministers before him) seem to think that self-regulation is the way to go. The way the man from the CQC squirmed as he insisted that the paperwork had been in order at Winterbourne View tells a tale all of its own.

And as for the staff, four have been arrested to be charged under s44 of the Mental Capacity Act which makes it an offence to ill-treat or wilfully neglect a person who lacks capacity.

It also begs the question – where were the Deprivation of Liberty Safeguards? Were any of the residents detained under DoLs  – or the Mental Health Act for that matter (as the hospital was assigned as such to accept people detained) and if that was the case, shouldn’t there be additional checks. Would independent advocates provide a further check?

There are a lot of questions that remain and the main one is the way that institutional abuse can fester in a residential care setting. There are wonderful care homes and hospitals around. I see them and I worked in them and often the ethos trickles down from top to bottom. Staff who see other staff abuse residents can ‘join in’ to be accepted – it is a classic position of bullying and unfortunately sometimes people who enjoy this kind of power play are attracted to work in social care. There needs to be an environment that does not accept this and that stamps down on it immediately and that was the real failing of Castleview.

This was not about 4 rogue members of staff. This was about an environment that allowed them to abuse and for that the senior management up to the Chief Executive should be responsible. Where is the support and training for staff who have to work in stressful environments? Where was the supervision that would have stamped out some of the abuse.  That doesn’t excuse those who were responsible for mistreatment  but it draws interesting parallels with the sacking of Shoesmith.  Wouldn’t we be baying for the blood of the CEO of Castleview? Or perhaps because the abuse took place in a private setting there are different lines of responsibility.

I think we should look long and hard about how we, as a society, seek to push people on the peripheries of society, because of age, disability or capacity to the margins of society and people to provide care who are not regulated and not supervised.

When the regulator fails so substantially as to ignore someone who whistleblows explicitly, do we not see a problem the ‘system’ that is increasingly reliant on proactive ‘complaints’ to trigger assessments?

There is much to do and much that needs to be changed.

I wouldn’t say I enjoyed the programme, it upset me and it angered me but I think everyone involved in the sector should watch it.

It can be viewed here on the BBC iPlayer.

Negligence and Care – Kersal Mount Care Home

A nursing home in Sheffield, Kersal Mount, yesterday admitted it was negligent in the treatment of a Doreen Betts, 78,  who was left to suffer with with pressure sores for three months and who eventually died of an infection caused by those same pressure sores.  Mrs Betts died in May 2009. Her GP had recommended that the home refer her to a specialist to manage those pressure sores three months previously. They didn’t.

It’s a horrific abuse.  The inquest found that she would not have died had she not had the pressure sores. Pressure sores are preventable and treatable.

I decided to have a look at the CQC report from this period which would have been between March and May 2009 and sure enough, it is here.

The Home has changed its name though and is now called ‘The Laurels and the Limes Care Home’.

The inspection that the 2009 report refers to took place in August 2009 so it would have been a few months after Doreen Betts’ death for which the home have accepted responsibility. It received a ‘two star good service’ which in some ways goes to show the flaws in the inspection systems and which, incidently, the home still proudly mention on their website – failing to note that all the star systems are now out of date and are not being updating so it will, forever be a two star ‘good’ home.

Among the report there is a note that four safeguarding issues were raised of which two resulted in there being a shortfall in the standard of care that should be expected and one member of staff was dismissed as a result of this. This is a good home, remember and these homes regulate themselves and report themselves to the CQC.

One area that the home only reached an ‘adequate’ standard was in staffing where there were periods when the home was understaffed. Unsurprising as staffing is one of the higher costs. Still, the report says it’s a ‘good’ home.

I find it hard to understand how a report can fail to make explicit reference to the death of a resident under the circumstances noted above after three months of distress in the next inspection just a few months later but for me, that explains very clearly the problem with the inspection regimes. They are very much box ticking exercises and the reports use language which can seem over positive without being clearer about the problems that exist in a care setting.

How can families be expected to make a fully informed decision about the best placement for their family member when the reports are so sanitised.

Words are fudged and hidden away in terms such as ‘safeguarding issues’ when one of those issues is actually the death of a resident.

It’s interesting that Kersal Mount was registered as a new service in March 2009 and by 2010 it had changed its name to The Laurels and The Limes Care Home. To be fair, the 2010 report is better than the 2009 one and it seems that any issues addressed have been handled but it goes to show that the inspection reports rarely tell the full story. Ideally, I’d want to look at reports for the service before 2009 but they could be anywhere due to the changes in registration.

It does show the importance that frequent, regular, spot checks can make in identifying poor practice and although I feel like a broken record at times, as long as mistreatment of older adults in care homes sneaks onto the third page of the local free newspaper and isn’t addressed with the attention and horror that it deserves, we will continue to have to hunt around for details of these cases and the sadness is that they no longer surprise us.