Failing care homes and the failing care industry

This latest BBC report alarms me.  As does the video in this updated BBC link to the same report.

A new way of checking up on care homes for the elderly in England will put vulnerable residents at greater risk, says a union representing inspectors.

Unison claims the system, which relies more on written self-assessments, will mean thousands of homes will avoid inspections if they look good on paper.

Thousands of residential care homes (with or without nursing) are to be allowed to inspect themselves – without rigorous care and quality control by anybody other than themselves, certainly not the CQC, the very body that allows them to become registered in the first place and to accept vulnerable residents in need of quality care.  All a care home will need to do is to provide a good written self-assessment, then it may remain inspection free, unless serious complaints are brought to the attention of the CQC.

The BBC report states The new system replaces yearly automatic inspections for all homes. It came into force in October and now means that homes which provide a good written self-assessment may not be inspected again, unless there is a serious complaint made about them to the commission (CQC).

I question that, BBC, because there are many many care homes and domiciliary care agencies that have not been inspected for years, so October may only be the date when the CQC declared its hand!

I’ll begin with a domiciliary care agency that I know of.  If only to indicate a point about inspections and reports, let alone the dangers of self-assessment.

The care provider that provides the domiciliary care agency and also provides the extra-care sheltered housing (where my relative lived for a while) went three full years between inspections and has only had 3 inspection visits since it came into being in early 2003.  The first inspection (two years after it opened) resulted in 3 statutory requirements being made, plus 2 recommendations, in order that it should meet the Care Standards Act 2000, Domiciliary Care Regulations 2003 and the National Minimum Standards.

Next year, there were no requirements made, but the report mentions issues about medication, record keeping, ‘issues about truth telling’, but no requirements made.

Three years on, the same extra-care sheltered housing was given a 3-star excellent rating.  It’s only when you read the report in full you see that the residents are not as happy about their living as the 3-star rating might imply.  And it’s only if you know what is not mentioned in the report that you can possibly realise how misleading some of these inspection reports can be.

One statutory requirement was made – that had also been made 4 years earlier in 2005 – plus two recommendations, one of which was that The registered person should review the staffing situation to ensure the meeting of needs and a more responsive service for people using the service.  The residents had complained about shortages of staff, about staff-changeover to different areas every couple of weeks, about lack of any kind of continuity of care.  All in the best interests of the staff, of course, not the residents.

The second recommendation was that The registered person should review the risk management plans in respect to medication management for people suffering with seizures.  The report refers to mistakes being made with medication, and bad record-keeping with regard to medication.  The manager needed to be reminded to instruct staff of the serious consequences for any individual if prescribed medication was not being administered regularly and correctly.

Would they be described as ‘serious’ concerns, CQC?  Or would you see those as relatively inconsequential.  And would the care provider be likely to note those in their self-assessment?

What is missing from any of the inspection reports are most of the ‘before and after’ day-to-day and day-by-day experiences of the residents.  When we visited for the very first time before signing a contract, there was a large notice on the front door to say that the premises were being decorated in advance of an inspection visit by the CSCI!!!   The flat we were shown was in good decorative order – and we were assured that would be the flat where our relative would live.  Not so!  (But it may well have been the flat shown to the CSCI inspector.)  Three weeks later, a different flat was made available – in need of decoration; filthy, stained carpets; dirty smelly bathroom; shabby kitchen area.  All would be put right, we were assured.  A year on and we were still fighting to get those things put right.

Before admission, we were assured the place was lively, with good activities going on, with regular events, lounge where residents could meet and chat.  All were non-existent, in the reality.  Not even watchable television reception – we were told the building had never had good TV reception.  It does now – because we fixed it!!  The support workers fabricated all the daily contact logs, with fictitious times of arrival and departure; they knew nothing about ‘with food’ requirements of meds; couldn’t tell the difference between a painkiller and an antibiotic; would not/could not manage to ensure  that vulnerable elderly people were cared for properly, with the ‘extra care shelter’ that had been promised.

CSCI then could not identify and deal with serious concerns.  Would the care provider have notified the regulatory body about any/all/each and every single serious concern via a self-assessment form?

How does the CQC define a serious complaint?

CQC chief executive Cynthia Bower has said “pockets of poor practice” remain – but if one in five nursing homes is failing  to offer good care, those pockets should be mended – and quickly – before you allow those failing care homes to slip through your future net which will also be full of holes.  This is the same Cynthia Bower.

I’m not known to be a fan of the Care Quality Commission (CQC) and I was even less keen on its predecessor, the CSCI (Commission for Social Care Inspection) for personal reasons.  CSCI failed miserably in its inspection of many care homes, and it looks as though the CQC is about to sink into the same abyss of neglect.  If it takes a serious concern or complaint for a care home to be inspected, that’s a disgrace in my view.  No matter how many of us, the relatives of people in care, complained about the quality (or lack of it) provided in care homes for vulnerable elderly people, CSCI/CQC never listened.  The CSCI and CQC merely referred us back to the care home manager.   Pass the buck, eh, and just devise a system whereby the buck will never stop with you, CQC.  And that’s what you’ve now done, with this latest plan of yours.

Now, I’ll move onto care homes and the way in which I am feeling scared, on behalf of all care home residents, present and future.  What follows all came to pass under the CSCI, so I may refer to CSCI, even though it’s only a name change from CSCI to CQC – only the name has changed.  I was pleased when the CQC announced that it was to do away with the star-rating system, because it trivialised the assessment and inspection process.   But now that Social Care Inspection is also about to vanish, apart from worthless paper-exercises, the reason for the name change all begins to become clear.

How is a whistleblower to blow a whistle that will engage the listening ear of the CQC?   CSCI was conveniently deaf to complaints, did not challenge care home managers sufficiently, did not inspect care homes vigorously and cannot even publish coherent inspection reports with speed and reliability.  It has always taken about 3 months or more for a report to appear.  Understaffed?  Underpaid?  Undervalued?  Under the influence?

CSCI operated hand-in-glove with local authorities, the commissioning agents, and with the care providers.  When you learn that you have a choice of only 3 care homes in one particular London borough, then subsequently discover that those 3 care homes are all made available by the same care provider, with three 25-year contracts to run those 3 care homes, you begin to understand why you have had three hard years since then.  The power of the number 3?  Or the weakness of the number 3?   The failure of CSCI, the local authority and the care home provider to provide care.

A care home opens.  It is described by both the care provider and the local authority as a new flagship care home,  promising to raise the standards of care for the borough’s vulnerable older people, including those with dementia – well, that sounds pretty good, you must admit.  It’s a real achievement and great news for older residents; its completion brings residential care closer to ‘our’ vision of the kind of care we want for older people.   We look forward to working closely with them to provide first class care for elderly, vulnerable citizens in the area.

You visit; you ask as many of the really basic and sensible questions you can think of asking; your questions are all answered well and convincingly so; you are impressed; you look forward to your relative being able to live in carefully caring care.  It’s so brand-spanking new that there cannot be anything you might have missed in your own assessment of it- or can there?  The care provider is one of the most highly esteemed and most valued (especially by some of our closely-connected politicians) in the country – even though serious failings in its domiciliary homecare services came to light later and featured in a Panorama programme.

Within weeks, your relative has arrived.

Within days of arrival, your relative is in hospital in a coma.

Within weeks, your relative is dead.

That’s when you have to become a Whistleblower. Not by choice – but by force.  You have no other option.  Your dead relative would expect that of you, and if you fail your relative as much as all those responsible for providing care failed – well, you wouldn’t  be able to sleep at night.  But you have a heart, whereas they have none.

You blow and blow and blow your whistle, first into the ear of your Social Worker, then into the ear of your SW’s boss, because the SW’s hands are tied (especially as the SW is from another country, is on secondment to the mental health care of older people team, and soon after returns to her homeland, and who could blame her).

Then you try blowing into the ear of the care home manager – but the care home manager is unable to hear.

You blow and blow and blow to CSCI, but the CSCI office you have to deal with is only temporarily responsible for that care home, so the CSCI office believes everything the care home manager says to them.  Foolish fools!!

So you blow your whistle into the ear of the Adult Protection Coordinator.

Eventually, there is an investigation carried out into the circumstances surrounding the sudden admission to hospital of your relative, and there are numerous Establishment Concerns meetings held (without family being able to be present or represented).  CSCI is ‘invited’ but can’t be required to attend, because they are all under the wing of the local authority, so CSCI will merely accept the minutes of those meetings.  The report is published – but is considered now to be ‘an internal matter’, so,  no – family can’t be allowed even to see it.

In the blink of an eye, the flagship care home is not allowed to accept any new residents.  There were no systems in place for staff training, staff supervision, staff monitoring, supervision of record keeping, medication knowledge, knowledge of the way the health and medical care system in this country works, knowledge of various medical conditions, knowledge of swallowing difficulties, knowledge of seizures, knowledge of the dangers of dehydration, knowledge of how to deal with dementia, knowledge of the dangers of not keeping a watch on the decline of a person who has only been in your care for a week, knowledge of basic communication with the emergency services … … … … and … and … and …

… … … and yet, it was called a care home, provided by one of the biggest care home providers in the country.

A year later, and the care home was still not allowed to accept new residents, so serious were the concerns about its lack of care.  Umpteen statutory requirements (20 or so, if I remember correctly) were placed on the care home, alongside the massive improvement plan that was forced upon it.   Numerous members of staff from the manager down were all allowed  to resign, conveniently and without disciplinary action being taken.

The next inspection report still contained numerous statutory requirements, with a few watered-down so that they became recommendations – well, it sounds nicer and more user-friendly, even though they are still serious concerns.  But the problems were all still there.

But it all looked good on paper!!!!  It was fit-for-purpose on paper only.

It was seen as suitable for commissioning by the Local Authority’s care commissioning department, by the Local Authority’s Adult Housing and Social Services department, by the Mental Health Care of Older People Team, by CSCI/CQC, and by the care home provider.  Sadly, it was also seen as suitable by me.  But not for long, in my case.

It is nigh on impossible for me to understand why their own inspections and assessments failed to identify the holes in their so-called care system – and I have to take it on trust that they all carried out proper evaluations of the suitability of this particular care home before allowing it to operate.  Or did they merely place their trust in the name of the Care Provider without caring enough to look beyond the paperwork?

They would all have continued to see it as a suitable care home – on paper.

It took my relative to die, and then it took my big mouth to blow the whistle.  And that’s not what I want for the future of the care ‘industry’ in this country.  Nobody should have to go through that ever again.   That is why I am alarmed by the BBC report.

I had been looking forward to a vigorous, rigorous, powerful and thoroughly dependable system being introduced for the  inspection of care homes.

I know WHAT happened to my relative.  I still do not know WHY it happened.

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Filed under abuse, care, care homes, domiciliary homecare

One response to “Failing care homes and the failing care industry

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