Mrs J and the Mystery Bristol Care Home (update – it’s Amerind Grove Nursing Home)

There is a story on the Community Care website this morning about an ombudsman’s report relating a woman, Mrs J, who was placed in a care home in Bristol.

Bristol waterfront at night

This was a  care home which was not only rated ‘poor’ or had no stars under the old rating system that doesn’t exist anymore but from the time she was placed in 2005 until Feb 2009 when she finally did move (only to die later that year) , the responsible council – Bristol City Council – did not monitor or review her placement adequately.

Her son, Mr P, asked for his mother to be moved however as the cost of the identified ‘replacement’ care home was higher than the cost that the local authority would pay, he had to make ‘top up’ payments.

The Care Home which strangely is not named in the report – and I find that rather suspicious to be honest, had had a number of safeguarding alerts over the period of Mrs J’s placement there. It had received a zero star rating and there had been a couple of ‘freezes on admissions’ – probably relating to the safeguarding alerts.

The council investigated and placed the responsibility entirely on the care home however the ombudsman found that the  council had failed Mrs J as it was the commissioner of the service

As the press release on the site of the Local Government Ombudsman says

The Ombudsman considers that there was maladministration in the Council’s reviewing and safeguarding strategy and is concerned about the poor communication between the Council and the family. The Ombudsman also finds that the Council had not properly considered the circumstances around Mrs J’s move to an alternative placement, which had led to Mr J contributing to the cost.

For the pain and suffering caused by the lack of appropriate safeguarding and review procedures, Bristol City Council were ordered to pay compensation to Mrs J of £6000 and to Mr J of £500 as well as pay back the contributions Mr J made towards his mother’s care between February 2009 and October 2009 when she died.

That’s the background and now my thoughts about this – deep breath.

It’s horrific. Firstly not everyone has family that are as determined as Mr J to pursue and stand up for residents in care homes. If Mrs J had not had a son, this poor practice and abusive situation may have continued with perhaps, some perfunctory safeguarding alerts but with little action in relation to the management of the care home taking place. The care home working in conjunction with the CSCI (predecessor to the CQC as inspection service) where people living in homes that are rated as poor (of course, they are not rated at all now – easy get out of this situation?) continue to do so without batting an eyelid as long as the fees are low enough to be met by the local authority.

Another thing – what about everyone else living in the same care home? Seriously. Were they moved as well?

Why is the name of the care home not given? Surely this information should be transparent. A government (and this not not just the present one but the previous one too – I am making no party political point here) which is bound to link choice to care decisions is finding it quite handy to mask the names of inadequate and frankly, dangerous, care homes.

I did a search of care homes in Bristol which had poor ratings at the time that the rating system was abolished in 2010 and there were none listed. Perhaps they had managed to haul one more star. These are the homes I found that had one star. It may well be none of these homes but it makes pretty depressing reading looking through inspection reports from ‘adequate’ care homes.

This raises a number of issues – mostly why on earth can’t family members and social workers making placements in residential homes know which home it was that failed so appallingly? Isn’t that how ‘markets’ work? Or is it through hiding behind reports which obfuscate and confuse and seem to dance around the real issues of care – in the long periods between when they appear.

Finally, a thought or two about the way the council were criticised and censured. £6500 will not deter a council from acting in the same way again. The cost of fully staffing/training a competent review team may be much much higher than that. Quality Assurance Teams in the councils are one of those ‘non-jobs’ or ‘back-office’ jobs that Pickles seems to like to mock but in the face of a national regulatory system that is little more than a joke, they could and would provide a great service to citizens who need placement – particularly those without strong advocates and family members to stand up for them.

We need these stories to have more publicity though because there needs to be a greater understanding of the challenges faced and the poor quality that has almost become tacitly acceptable in the ‘free market’ of care.

The imposition of the market economy into the care sector hasn’t allowed the cream to rise to the top for those who are wholly reliant on support for placement from local authorities. It has allowed care homes which charge low fees to thrive despite poor care provision because it suits both parties to allow them to continue and to allow their names to be protected.

This makes me angry. I did not come into social work to deliver what I consider to be poor care or poor care services. I want everyone to be able to access good quality care and support regardless of their income, savings, property values or their family or friends’ willingness and ability to advocate on their behalf.

In a world of rose-tinted spectacles through which the Care Minister seems to envisage that people like Mrs P will have more ‘choice and control’, we have to make sure that basic minimum standards of care are respected for everyone who is reliant on them.

And we aren’t.

UPDATE – BBC have published the name of the care home  – it is Amerind Grove Nursing Home owned and run by BUPA.   Mrs J is Mrs Iris Shipway.  This is the report from 2008 which gave Amerind Grove a 0 star rating.  It is a 171 bedded home. Stop and think about that for a while. 171 people in a care home. That’s big business. That’s not a ‘home’ – that’s warehousing. Would we place younger adults in 171-bedded units. Let alone poor 171 bedded units. And what about the other 170 people living there when Mrs Shipway’s treatment was so poor. Can we see how the large companies have local authority commissioners ‘over a barrel’? They would not be able to find alternative placements for that amount of people.

The answer is less institutionalisation – more creative thinking about alternatives to residential and nursing cares – the answer is not 171 bedded homes.

Rant over.

Britain’s Homecare Scandal

I saw Panorama last night. It was an undercover report into the poor state of home care services provided to elderly people in their own homes by a few private companies.

I wish I could say some of the findings surprised me, but they didn’t. Some of the extremes presented perhaps, did – but cutting short visits because of overloaded rotas, lack of basic training and cost cutting above everything else – it all rings a bell with me having worked closely with home care agencies for a good few years.

image moogan at Flickr

It never fails to anger me either. These companies are paid to provide a service and a service of care at that and sometimes, particularly when the user of the service is particularly vulnerable, take advantage of the situations they are in to promote abusive environments in just those situations in which they should be empowering and promoting.

In the world of the local authority, home care for the elderly seems to be something of a burden. The process of tendering by councils was explored in the programme and the competition to drive costs lower and lower by the councils. This hit particularly close to home as I have a lot of anger at the moment towards my own local authority as a result of their tendering processes and a contracts department that sees little beyond figures.

Of course local authorities, being funded on taxation, need to have some kind of accountability regarding contracts but there has to be a better trade-off between cost and quality.

I have to say that I have come across more than a few exceptional home carers and home care agencies. I have particularly strong ties with one of the agencies we use because I’ve worked very closely with the area manager. I know when I ask for something or for someone with a particular sensitivity – for example a carer with experience of working with someone with dementia, or sensory impairment – she will locate such a person and if she can’t, will ensure that the carer is fully briefed before attending. As for me, I’ll tinker around with timings to make sure that I can be realistic about how long things take and try to not rush people through tasks. Her agency recently lost the contract in our local authority. That annoys me too. She told me, off the record, they just couldn’t make their bid low enough to make money or keep their experienced carers.

I hope more people become aware of what is happening in the home care sector. It is such an easy area to cut costs in because while spot checks do happen, they are not as frequent as they should be and a user who doesn’t remember or cannot report back on poor treatment, is almost too ripe to be picked off by unscrupulous, hurried or inexperienced carers.

Part of the problem is also the poor pay and poor status of those who are employed in home care jobs. They are seen as ‘entry level’ jobs for those who have little experience – perhaps straight from school. Obviously there is a place for entry level positions but how much more of a role for experienced, quality, respected home carers to be mentoring newer starters. There is little scope though for higher pay rates when the margins are cut so tightly in order to win the local authority contracts.

I have a rather old-fashioned solution that has made me the mockery of colleagues in the past, but I honestly believe the local authority should employ carers directly. Even with lower than deserved pay, they would at least have the benefit of a secure contract, good training which could be followed up, a clear appraisal and management structure and good benefits such as holiday pay and pension.

In my experience, some of the most effective and competent care managers have got to where they are at from being hands-on carers (er.. myself included.. ok, I didn’t say I wasn’t biased!). My experience of working as a carer (I was in residential care rather the domiciliary care) has informed so much of my judgement and perception through my work as a qualified social worker that I know I would have been infinitely less able and competent if I hadn’t had that experience and likewise for some of my colleagues who have worked in domiciliary care. You see and know the pressures of time, the type of work that is expected and most importantly, the corners that can be cut – and can then spend more time pursuing them.

The career structure though, from home (or residential) carer, to senior home care manager to a care manager post including sponsored training through the social work degree seems almost to have disappeared in the local authority where I work – and possibly others too. In-house care is all too rare, although I don’t think there is any doubt that better quality could be provided due to better conditions and prospects being established. But the tide seems to have good out too far now – in the tide of privatisations and tenderings.

The NHS and Community Care Act 1990 is too firmly entrenched in our system now and private enterprise is pushed as the solution. I just have an issue about profit-making companies ‘selling’ care and cutting corners in order to amass greater profit.

Direct Payments were seen as a possible solution save that the people who are most dependent and vulnerable and have no other family are not in any place to make arrangements to hire and employ carers or personal assistants directly. Personalisation agenda? I don’t want to be overly sceptical but I can’t see any solutions to the problems thrown up by Direct Payments which have had a particularly poor take up by those who are over 65 and those who are mentally ill.

For me, one of less obvious but equally horrific failings highlighted in the programme was that of the regulators, CSCI (Commission for Social Care Inspection) – which ceased to exist last week and became a part of the amalgamated CQC (Care Quality Commission). How ineffectual is this body? It has moved to desk-based inspections of care homes – has it done the same with domiciliary agencies? Is there any way that inspections and regulators can actually provide a service which is better than a mere star rating and mealy-mouthed platitudes even in the ‘one star’ organisations. The language of the inspection reports is rarely cutting and usually couched in comforting language except in the most exceptional examples – possibly due to fears of legal action by the companies involved.

As it’s probably clear by now, I have a lot of difficulties with home care, the way the system is tilted towards an almost industrial-style turnover of short impersonal visits by staff that are constantly changing and perhaps poorly trained, regulated and paid.

It is not the staff on the ground who bear the responsibility for this, some of whom are desperate to do a good job, but they are pushed to work to timetables that are impossible – to do more work than is physically possible in the time that is available – by companies who are desperate to make increased profits and local authorities pushed to reduce costs at all levels.

And what do the home care agencies and managers do? They blame the care workers they are sending out on minimum wage and with little guidance.

I think this might have turned from a review of a programme into a more general rant but it is an issue I feel exceptionally strongly about.

It truly is scandalous. Older people are not other people. They are all of us eventually. They are and will be our grandparents, our parents, our siblings, spouses and children. We might want to forget. But some day we won’t be able to.

DoLs, IMHAs and CQC

Lots of jargon and initials today. I should apologise in advance but they are certainly new phrases and words that will be becoming ever more familiar.

image Sidelong @ flickr

As, 1 April 2009 sees the implementation of three new nuggets of legislation which will have differing levels of impact on my day to day work.

I have written extensively about the introduction of the Deprivation of Liberty Safeguards (DoLs) introduced as an amendment to the Mental Capacity Act 2005. This will, without doubt, be of significant relevance to our team and my personal work – firstly because I am trained now as a Best Interests Assessor meaning that I will be actively involved in the assessments which form a part of the decision-making regarding whether someone without capacity can be lawfully ‘deprived of their liberty’ can be authorised or not. Secondly because I work in a team where we work a lot with capacity or rather, lack of it.

Not really sure where this will go in the longer term but I am almost looking forward to my first opportunity to put into practice some of the information that I studied about. Although the general feeling is that there will not be a flood of assessments, it is something I will, I expect, be in a good position to feed back on this site.

I had almost forgotten about the mandatory provision for IMHAs (Independent Mental Health Advocates) until I read The Shrink’s post on it last week. Subsequently, on Monday, I think, we had a mass email sent around the Trust reminding us of the implementation of the IMHA system with contact details and a reminder of who and when to refer people. I was both surprised and comforted. Surprised because I had not had any information about this service prior to Monday and comforted because obviously although we were completely oblivious to it, some work was being done somewhere to prepare people for this!

And finally RIP CSCI (Commission for Social Care Inspection), Healthcare Commission and MHAC (Mental Health Act Commission). These three organisations merge into the Care Quality Commission today.

The Guardian print a piece about the merger today. In the article there is a quote from Barbara Young, the CQC chair from last year where she says

the HCC (Healthcare Commission) had taken a “big brain” approach to regulation, using intelligence systems to identify risks in the NHS and target inspections accordingly. The CSCI approach was more about “running the finger around the toilet bowl”. It had thousands of care homes to regulate and fewer statistical tools to identify where problems might lie. So, inevitably, it relied more on regularly visiting establishments.

Young was not trying to characterise social care inspectors as brainless people who spent all their time in toilets, although some of them chose to interpret her that way.

Well, I have news for Barbara Young. CSCI have been undertaking ‘desk inspections’ for a few years now. If only they would actually visit residential and nursing homes regularly as they used to – carrying out regular announced and unannounced inspections – then their may be a better service all round.

If only the CSCI inspectors actually DID have the ‘running the finger around the toilet bowl’ sense of thoroughness and were given the opportunity to spend time in each and every registered residential home in England in order to collate extensive and thorough reports – we would have a lot more faith in the system.

Anyway, I’m getting waylaid and possibly a bit mean-spirited again. Good luck CQC. We REALLY need good regulation and checking systems in place.

Crown Cleared

I saw on the BBC that the Crown Nursing Home in Harwell was cleared of the responsibility of the death of eight of the residents in January.

As I was so quick to condemn, it’s only right that I raise this again. I wrote about it previously here.

I want to pick up this information with good grace and move on. I really do. But the broken heating issue still niggles a little with me.

A spokesman for Oxfordshire County Council said the pensioners died of natural causes.

An inquiry found that a breakdown in the heating system at the home played no part in the deaths as an alternative had been provided.

While obviously the inquiry is perfectly served to look into exactly these issues and while not responsible, I was hasty to jump to such a conclusion that broken heating would be linked.

The Oxford Mail provides a few more details.

A spokesman for Oxford County Council is quoted as saying

“As a result of the detailed look there was no evidence to suggest a direct link between the breakdown of the central heating at the nursing home and the sad deaths of people living there, who all died of natural causes.

“Alternative heating was provided by the privately-run home and the quality of care provided by staff during this period was found to be of a good standard.”

He said a further review of the case would be undertaken by the Oxfordshire Safeguarding Adults Board so that any further learning from the case can be shared with other care providers in Oxfordshire.

The CSCI, the Government watchdog that oversees adult social care in England, told the home to improve earlier this month after staff failed to inform them of the deaths and heating problem.

It issued the 16-bed home with a requirement notice, which means it must improve within 48 hours or within a set timescale.

It is the first of four steps of action the CSCI can take when care providers breach regulations.

A commission spokesman said: “As part of the commission’s enforcement powers, we issued the Crown Nursing Home with requirement notices for not informing the commission about several deaths in the home and the failure to inform us of the heating system not working.”

When CSCI is taken into the Care Quality Commission next month – well, I hope it has more teeth than CSCI – I hope it will provide less ‘desk’ inspections – I hope it will return to visiting every home regularly, and by regularly I mean at least annually. I don’t think that is a part of its remit though.

If there is one lesson that can be learnt over the last few weeks and possibly months and even years, it is that saving time with ‘desk’ inspections of targets met is a hideously false economy across the board.

Frozen Reading

So I honestly hoped I wouldn’t have to return here, but another Southern Cross Care Home is in the news after a 97 year old woman died last week at the River View Care Centre near Reading as is reported in the Daily Mail.

People die in care homes. It happens. However this particular woman is alleged to have suffered from hypothermia after spending a week, in the afore-mentioned care home, without any heating. In the coldest week for a couple of decades.

It is an allegation still, of course,  but it’s definitely a story as it has been confirmed that the police are investigating – and  I think it is important to follow – the BBC reports a Southern Cross spokesman saying

“On the day that the lady was removed to hospital, the home was visited by nine social workers, and four council engineers,” he said.

“They inspected the heating, which was working normally, and the readings in every room were between 21C and 25C.

“And ever since, all rooms have been inspected twice a day.”

In my experience that is not the usual response to a 97 year old dying in a care home setting.

The local newspaper, the Reading Evening Post reports that

It is alleged the woman died of hypothermia and the police are investigating the privately owned care home, which was given a one-star rating by the Commission for Social Care Inspection in May 2008, deeming it only adequate.

Accusations surrounding the death include a lack of heating in certain parts of the building due to a technical fault which left some rooms in the cold while the outside temperatures were plummeting to well below freezing.

Bench by you.

As usual, I had a look at the latest inspection report for the residential home, dated May 2008. I am not sure what happened to the twice yearly inspections we used to have. River View achieved a one star rating meaning it is ‘adequate’.

Bear in mind that the same inspection report lists the fees as being between £545 and £818 per week.

A quick glance through the report (pdf link)  seems to indicate a lack of social needs being addressed –

Care plans meet residents’ physical needs, they do not address all of people’s social needs and care is not always delivered in a respectful way.

I’ve read a lot of inspection reports in my time, and ‘care is not always delivered in a respectful way’ is actually exceptionally strong by their standards. Definitely worrying. I read on.

During the course of the site visit one member of staff was suspended for inappropriately dealing with a resident.

That has to be remarkable misfortune for there to be an issue at exactly the time the inspector happened to be visiting.

There are, of course positives in the report too, that is the nature of them but they are rarely critical even when a home only receives a one star rating. Maybe they should be less bland in their content.

It is staggering that there isn’t more concern about the level of care in some of these homes that house some of the most vulnerable citizens in the country.

The Telegraph covers the same story and lists a litany of previous failings upheld against Southern Cross

Southern Cross Healthcare PLC was fined £200,000 pounds in January this year after pensioner Maisie Jones fell out of an upstairs window as she tried to escape from one of their care homes in Oxford.

The UK’s largest residential care provider admitted two breaches of Health and Safety regulations at Brookfield Christian Care Home in Greater Leys, Oxford.

In November 2002 Southern Cross’s Bishopsgate Lodge Home in County Duham was found to have a mechanism allowing baths to scald patients with water reaching 53 degrees centigrade.

It was fined £8,000 pounds and costs.

In June 2003 an elderly man died at Alexandra Care an elderly man died at Alexandra Care Centre in Hemel Hempstead, Herts., when he was strangled by a strap on a reclining chair due to a lack of supervision.

The firm paid more than £30,000 pounds in costs and fines.

In April 2005 Margaret O’Mara suffocated in a bed following a series of errors by staff at Hornegarth House in Cannock.

The company was given a record £175,000 pounds fine and paid £15,919 pounds in costs.

I wish I could say it was unbelievable. I know it’s the largest provider of residential care in the UK  but  it isn’t a great track record. By any standards.

Protected: On Inspection

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Rated Good

The Commission for Social Care Inspection inspect and rate every registered care home in England – as well as every agency that provides care for others.  The website provides access to inspection reports on every facility in England – both announced inspections and unannounced inspections. It is our first port of call, quite literally, when we are looking to  make a placement.

CSCI introduced a rating system earlier in the year. It’s to make things easier for us to understand. Rather than ploughing through a report – you can just look at the amount of stars a home has. The more, the better. All useful stuff.

Victoria House Care Home in Durham is rated good by the CSCI. Rated good, that’s reassuring. The last available report is dated July 2007 though.

But as reported in Community Care last week, it is closing. Not only that, but according to the article

Durham Police are leading a multi-agency investigation into the care received by a man at a Darlington care home for people with learning disabilities, which is now set to close.

The 75-year-old man, who lived at the Victoria House care home, died last month from septicemia.

There are really more questions raised for me by that paragraph than answers provided. Police being involved in leading an investigation into a death in a care home? That is very far from common and exceptionally worrying.

I decided to see if I could find any more about the situation and came across a blog called Advocacy in Darlington which posts further on the matter here

Advocacy in Darlington was pleased to learn this week that after literally years of evidence gathering (which described a care regime which in the words of a Council manager in 2003 was recognised as being “moribund”), Victoria House, Barton Street is now subject to a 90 day closure notice.

So this evidence has been being collected for YEARS? That’s certainly the implication. The post goes on to state that reports had been collated both 5 and 10 years ago which had recommended closure of this property – and now residents have 90 days in which to move out. As noted by the Alton Centre situation where closure was not recommended, there have to be some quite strong grounds for a closure to be forced.

Another interesting point in the Community Care article was the statement that 19 residents will be moving out. This is from a home which is registered for 45. Quite a discrepancy. It isn’t known (by me, anyway) if there had been a freeze on placements there or whether it was just a place that wasn’t filling – but when you plan for an income from 45 residents and only have 20 – that’s a big difference – especially at a cost of £550 per week each.

So many questions and so few answers.

I went back to the Inspection Report from July 2007. Ironic that one of the recommendations was that

Greater efforts should be made to ensure all staff have mandatory
training in health and safety matters and infection control.

As well as the only standards which were ‘almost met’  as opposed to being ‘met’ are the ones relating to staffing levels. I hate to make assumptions  but cost cutting is screaming in my ear.

I haven’t been able to find out much more about Victoria House in Darlington. Amazing really that the information just doesn’t seem to be ‘out there’. I can’t imagine many people wouldn’t be interested in what had been happening here to lead to a quick closure after the death of a resident – police investigation and all.

I am concerned that, being someone who used the CSCI site and ratings to recommend placements in other parts of the country when I have no means to check them myself, I would have been reassured by the little stars and the ‘good’ rating to have followed through with a placement there when possibly there had been concerns for many years.

Why do we.. and I mean we, as a society.. allow these stories to die quietly?

Reasons to be Angry, part 16.