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

lovestruck@flickr
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.

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.

Trouble at the CQC

A lot of people working within the social care sector have had misgivings about some of the changes that have been taking place at the CQC (care quality commission). The CQC is responsible for monitoring and registering care services (as well as health services,  but I’m going to concentrate on care services because it’s what I know best) since its inception when it pulled together various previous regulatory bodies and picked up their functions.

There are a lot of lessons to be learnt for the future within the CQC  as we draw to a point where lots of services across health and social care will be merging and we are pushed towards joint management. There is a lot to be wary of.

Private Eye has an expose’ piece in the current issue (dated 29/10-11/1, in the ‘In the Back’ Section p29). Unfortunately the piece doesn’t appear in full on their website so you will all have to go out and buy a copy (seriously, if you are concerned about the CQC it is definitely worth a read and to be honest, I can’t recommend Private Eye highly enough!).

I wanted to draw on some of the issues raised in the piece so forgive the lack of links for the time-being.

The investigation carried out by Private Eye was alongside ‘Compassion in Care’ which is a charity set up to counter abuse in care homes. The organisation was set up by Eileen Chubb, a former care worker who witnessed abuse and who lost her job because she was a ‘whistleblower’. The organisation campaigns for the vulnerable in care homes.

The report highlights a number of concerns related to the CQC particularly how they have either ignored and in one case ‘upgraded’ via the now defunct star-system homes in which proven maltreatment has occurred.

As the Eye says

‘Only last month we reported how – just two months before a hospital nurse described a care home resident as suffering ‘the worst care of neglect’ she had seen, the CQC had wrongly promoted what had been a failing home, run by care home giants Southern Cross, back up to a two-star ‘rating’.

I don’t have the time to relay all of the information and quite unbelievable lack of teeth of the CQC in the face of appalling care services as relayed by the Eye but it makes for frightening although worryingly not surprising reading to me.

Another part of the article refers to the leaked staff survey results published in Community Care and that backs up informal discussions I have with some good friends who currently work in the CQC.

The Eye states that

CQC Insiders were worried that attempts to push through registration for all homes and agencies ahead of the 1 October deadline was compromising safety in the homes themselves’.

This absolutely mirrors the conversations that I have had with CQC friends, including being told that they were told to concentrate on these registrations at the expense of visiting homes where issues may have been arising –much to their own chagrin.

The other concerning conversation I had with said friends was that the CQC seemed to be increasingly reliant on local authorities ‘quality assurance’ teams to check on the local residential, nursing and domiciliary services. We can only guess at what might happen to some of these teams as the local councils make massive cuts. I don’t know if they will be able to provide as strong a service as they might in less frugal times.

The Eye pulls up the report and interviews given by the head of the CQC last month stating that 34 homes and 8 agencies were closed after they took ‘enforcement’ action as a way to prove their ‘strong arm’ regulation as well as 51 other services which had closed after poor ratings.

This is an area that Private Eye has been investigating and has tried to push CQC to provide details of these ‘enforcements’ as there was nothing about them in the CQC’s annual report published in April 2010. Private Eye and Compassion in Care have tried to find details of the deregistered homes b ut the information  has ‘disappeared’ from the CQC website and they have been stalled in their attempts to investigate.

Cynthia Bower, the Chief Executive of the CQC in her previous incarnation was the West Midland Strategic Health Authority which was responsible for overseeing the Mid-Staffordshire Foundation Trust Hospital. It is quite staggering that the responsibility for protecting standard of care for those who are arguably some of the most vulnerable in society should be under her charge.

I’ve railed against ‘desk based’ assessments which were happening prior to the existence of the CQC where inspectors do not actually visit homes that have previously scored ‘well’ in inspectors but rather rely on ‘self-assessments’. It is a national scandal that we have no reliable and functioning way of monitoring care homes and that the CQC itself is relying on local authority quality assurance visits when it should be setting the gold standard itself.

The piece ends with the comment that while the CQC hasn’t responded to the piece, John McDonnell MP will be raising the issue in the House of Commons so hopefully they will respond to him.

I rail where I can but the difficulty I sometimes face is time and that often homes are able to ‘put on their best face’ for social workers when we visit. We have limited roles usually in reference to one particular resident.

I have to say that all the personal contact I have had with CQC inspectors has been exceptional – when I have picked up concerns at a care home and contacted them directly but it is clear that the time is not allowed in the same way that it had been previously.

We are back to penny pinching and cost-cutting.

Thank you to Private Eye and Compassion in Care for investigating these issues. They should be on the front page of every national newspaper rather than tucked away in the pages of Private Eye – but I have a lot of time and faith in Private Eye to be honest. They have some of the better investigative journalism in  my very simplistic terms. Go out and buy this edition, all the editions and subscribe!

We cannot let it lie.