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.

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.

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.

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.

Alton Centre – a further update

I do feel obliged to update on the Alton Centre run by Active Care – a subsidiary of Southern Cross – just as I have been following the story. Active Care won their appeal against closure yesterday and it is reported in the local Northamptonshire Evening Telegraph.

It reports

On Friday the Care Standards Tribunal ruled the appeal would stand and the urgent order obtained from magistrates by CSCI would cease to have effect.

Conditions were attached to the reopening

A CSCI spokesman said although the urgent order had been overturned, the tribunal had placed stringent conditions on Active Care Partnership.
They include extra care and nursing staff and specialist staff over the next six months, limiting the number of residents to 19 over the next six months, and frequent inspections by CSCI.
CSCI’s Regional Director for the East, Norwyn Cole, said: “We welcome the fact that the tribunal has imposed stringent conditions on the Active Care Partnership which are designed to safeguard this very vulnerable group of people.
“This acknowledges that there was a serious risk to the residents.
“The commission will closely monitor and inspect the home on a frequent basis.

I think this sounds like a good solution for the residents. Moving everyone wholesale and quickly would be in no-one’s best interest. It does beg a few questions about the way the home was run prior to these incidents (and I am referring more to wider management by a larger scale employer wanting to cut costs rather than the individual home manager in question).

I see that the additional staff are to be provided over six months. I wonder what will be happening after that. In any case, it will be interesting to follow the CSCI reports.

Corners can’t be cut with care standards and services.