Tag Archives: Islington

Care in the UK makes progress

Last week saw the final stage of the hearings, at one of numerous NMC locations that have hosted the fitness-to-practise procedures, into the lack of nursing care provided to you during the time you were in Lennox House care home, Holloway/Islington, in 2007, and just before your death.  Appropriately enough, we were directly opposite the Old Bailey for the finale.

Over the main entrance to the Old Bailey, which opened in 1907, figures were placed representing fortitude, the recording angel, and truth, along with the inscription

“DEFEND THE CHILDREN OF THE POOR & PUNISH THE WRONGDOER”

As I sat in the hearing room on the 5th floor of the building,  those words were directly in front of my eyes all week.

On 17th April 2013, Sheila Ali the former care home manager / nurse  was struck off; her name is removed from the register of nurses allowed to provide nursing care to people.   She wasn’t present to hear the decision because, overnight, she decided suddenly to withdraw from the proceedings, and to remove her instructions from the barrister who had represented her.  When he announced this to the hearing, he was invited to leave.  He left.  So neither of them was present to hear the decision.

On 19th April 2013, Dahlia Dela Cerna/Enriquez wept as she received a 2-year caution order, having been found guilty of misconduct and with current impairment.  That’s the first time she’s shown anything that resembled human emotion.  They have all shown callous disregard for you – and for me.

On 21st December 2012, Catherine Igbokwe was struck off,  having been found guilty of misconduct and with current impairment, so her name was removed from the register.

On 21st December 2012, Maria Rholyn Secuya/Baquerfo received a 3-year caution order, having been found guilty of misconduct and with current impairment.

The documents in the above links are very long but very detailed.  Words I’ve heard used to describe the hearings include ‘complex’, ‘extremely involved’, ‘complicated’ and ‘very difficult’.  The decision documents are just that too.  Presumably to deter people from reading them in full, and in detail.

After you died, over 5 years ago in December 2007, there were lots of investigations and reports written, some of which I have never been allowed to see.   No matter how hard I’ve tried, the words written have all been kept behind closed doors, far away from the eyes of those who cared about you.  We, your family, have never been granted access to the full reports of the investigations by Islington local authority.

It was on 1st October 2008 that I first referred these nurses to the NMC.  The hearings at the NMC began on 6th February 2012 and concluded almost 15 months later  on 19th April 2013.  Once I had been called as a witness and had given my evidence, I attended every single day as an Observer.  So I observed and heard every single word spoken in public.

Needless to say, I’ve heard things said that I have never known about.  I never knew before now, for example, that the care home manager Sheila Ali had been in Lennox House all day on 7 December 2007 without bothering to come to see you or to dial 999, even though she had apparently been alerted to the fact that you were in spasm for long periods, unable to speak, unable to swallow, unable to move.   She didn’t care.

She didn’t care much for those residents mentioned in this article in the Daily Mail in August 2008, bearing the gruesome title ‘Care home boss suspended after dead bodies of two pensioners ‘are left for days’.  That was 8 months after you’d died.

It goes without saying that there were many other revelations at the hearings too.  No wonder we have never been allowed the full knowledge of your last days.

It’s been extremely difficult for me to sit through those sessions, but I owed that to you and I had to represent you.  It was the only thing I could do on your behalf and in in your absence.  Your voice was taken from you by  Care UK and its so-called care home, Lennox House.

I’ve found it hard to be told, by the legal representatives of the nurses involved, “You have no need to be here” – “These proceedings are nothing to do with you” – “You are not involved in these proceedings”, and so on.  I had every need to be there; the proceedings had much to do with me and with you; I will always remain involved.  There’s more I have to tell, and tell it I will.  Honestly, openly and transparently.

They took away your voice.  Nobody took away my presence.

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Care Circus is back in town next week

Well, here we go again.

Next week the Care Circus is back in town.

The latest batch of NMC hearings is about to stir its loins again and get on with the work that it was charged with handling long ago on 1 October 2008.  That was only a few very short months after you died, thanks to the rubbish care that came your way, courtesy of Care UK and Lennox House so-called care home in Islington, London.

It was also a few very short months after I’d asked so many questions of Islington’s Mental Health Care of Older People team, and then Islington’s Social Services, and then the CQC (or CSCI as it was called back at the beginning of 2008), and the Coroner’s Office, and Islington’s Safeguarding of Vulnerable Adults Team, and  most of all of Care UK … well, you will know how many questions I asked of them all, each and every one of them.

They don’t like answering questions, do they?  Especially if those demanding but necessary questions are likely to cast a very dim and dark shadow over their (lack of) accomplishments.

Last December 2012, the NMC decided that one nurse involved in your demise should be struck off, from their register of nurses allowed to nurse in the UK.  Another nurse was delivered a 3 year caution order, requiring her to be on her best behaviour.

Next week, 15 to 19 April 2013,  the Circus is back in town.  Fifteen months after the NMC hearings first started, looking in depth at the circumstances surrounding your rapid decline, within 10 days of arrival in that so-called care home, Lennox House, and your admission to hospital in a diabetic coma.  You died 3 weeks later.

The  final 2 cases, still waiting in the wings, are to be dealt with by the NMC next week.

One case  is that of the care home manager, who is mid-way through an interim 9 months suspension order, placed to allow time for her to seek permission for a Judicial Review in the High Court, of the NMC decisions thus far.  The High Court refused permission to seek a Judicial Review.

The clowns will all be wearing their costumes.  Their faces will all be heavily disguised beneath the cake of their make-up.  They will all have their props to support them.  Their scripts will all have been written, re-written and then written again.  Edited, heavily edited, and then edited again.

You weren’t allowed to write a script of  your own, were you?  Let alone edit it.

The script of your final years, months and weeks of your life was snatched from you.  Grabbed by thugs.  The uncaring, unqualified, untrained, unmonitored, unsupervised, unsuitable thugs who were charged with the most basic and fairly simple duty of looking after you.

Next week, they will still be wearing their masks, their costumes  and their heavy make-up.

As they will continue to do year after year.  Uncaring as always.  Unkind in their presentation thus far.  Unwilling to admit that they failed miserably in their duty of care to you, for you and about you.  They didn’t care enough to care.

The chance to wear your dresses, your gentle make-up and to present your smiling face to the world was taken from you.  By the thugs of care.  The thieves of care.  The robbers of care.

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Why I despise the so-called system of care for vulnerable people

I’ve been fairly controlled over recent weeks, months or even years.  I suppose I’ve been waiting and hoping for a chink of light to emerge, for a culture change to emerge, for a way forward to emerge in the so-called system of care that we have allowed to be in place.

However, I am reaching screaming point.  Hardly surprising.  When someone is destroyed because of absent systems of protection, and when it then takes almost 5 years to work your way through to a full understanding of why the so-callled system of care for vulnerable people fails to provide decent care so very often – that’s when you reach screaming point.

Time and time again, the CQC comes up with yet another report as it did today, with a report into the ‘care’ afforded to people with learning disabilities.  Or rather the lack of  care.  I’ve read it all, but there’s not much hope for real change.

Week and month after week and month, our government comes up with …… not one single plan to improve things.

Year after year, the same old same old same old gets published in the press, reported on radio, featured on TV.

Still nothing changes, so I need to scream now.  It won’t change anything – but it may just help me to scream.

[Next section of this particular blog post: Deleted temporarily pending the return of sense to the world of care.]

Therewith, I will leave this one for today.  But not for long.

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Absolute privilege in the world of politics v. absolutely no privilege in the world of care

The concept of absolute privilege is not something that I’ve ever contemplated seriously before this afternoon. It’s been known for more than a few years that MPs have a comfortably convenient place for them all to ‘protect themselves, in their own best interests’.  It’s called the House of Commons.

Today’s non-world-shattering news is  all about the privacy of an individual to keep their own ‘affairs of life’ private and personal and away from the public gaze, and the public magnifying glass.  I can’t claim to be interested in this particular individual’s personal circumstances, personal life, personal affairs; I can declare that I’m not interested at all in whatever  may have caused the need for an injunction, super though that injunction may have been in legal terms.

But I do care about the double standards that are operating here.

An elected MP  that I’ve never heard of before – sorry,  MP, but you haven’t made your mark in my world – can  overturn something that has been observed and not flouted by our reliably (un?) reliable media.  All it took was for this particular MP – a representative of the people – to open his mouth and speak two words.  Then the rest of the reliably (un?) reliable media can duplicate those two words.  Not that we didn’t know those two words anyway!

At the same time as this ‘Who Done What With Whom?’  trivial pursuit has been going on, the world of care continues to puzzle me by its own absolute privilege.  But with a difference.

A local authority and a care provider can call upon the equivalent of a ‘super injunction’ to prevent me from being able to know the precise circumstances of the neglect and subsequent death of a relative who was at risk.  She was most certainly at risk in their care.  Not that we knew that then, when we agreed to her coming under their ‘caring’ wing.  But their need to protect themselves and their own best interests appears to be paramount.

The person they failed had no rights; her best interests were demolished within days.  As her close  relative, as her named personal representative after her death, her executor, I have no rights either to achieve justice on her behalf.

Justice?  Hush my mouth, for using a word that may before long vanish from our dictionary.

I have tried so very hard to restrain myself, so that I don’t name and shame each and every one of those involved, from the care home staff (names all known to me), the care provider, the care home, the care home manager(s) and their regional supervisors, the GPs involved, the local authority and its many responsible departments, the CQC inspectors who failed to notice ‘absent systems of protection’, the adult protection coordinator who failed, the social worker who failed, the whole team of mental health care of older people who all failed, ….. …. …. and so on.

All because I have wanted to achieve a decent outcome.  According to the laws of our land.  But the latest blow that has been landed on my shoulders – via one of the regulatory bodies involved – is beyond explanation or even understanding.  And yet, I am still – stupidly, perhaps – hesitating to name and shame the whole bunch of them.  Almost 4 years after her death in so-called care,  almost 3 years after I placed onto the ‘responsible regulatory body’ what they call ‘a complaint’, I am being treated still with contempt.  The Case Officer involved could not even bother to inform me about the latest hurdle that I now have to jump.

So,  I’ve played by the rules.  But they still can’t

I’ve been throttled, strangled, constrained by  concepts that come close to ‘super injunction’ and ‘absolute privilege’ but perhaps in a converse way.

Is a bonking footballer worthy of more care than a supremely decent 83-year old person in need of care?

Am I the fool?

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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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Care home secrecy slammed

It is with some considerable personal pleasure that I have just read  in the East Anglian Daily Times that POLITICIANS have hit out over secrecy surrounding an Essex care home which was shut down amid abuse allegations.

If any politicians would like to ‘hit out’ over the secrecy surrounding Lennox House care home in Islington, they only have to ask me, and I will provide as much detail as has so far been available in the public domain – and I can provide far far more than has ever been made available in the public domain, if that’s what would help you, Politicians, to achieve honest, decent, caring systems of care for our honest, decent, caring vulnerable elderly citizens.  The rest is still shrouded in secrecy.

They have slammed a decision to bar the public from a meeting next week where lessons learned from the saga at Greenways Care Home, Colchester, will be discussed.

Well, in Islington family were barred from meetings too – let alone the public.

Why does this all interest me enormously?  Because my own relative was the person who suffered neglect, which is a form of abuse, in that Islington care home, Lennox House.  Nobody from our family was allowed to attend any one of the ‘meetings’ held.  We have never been allowed to see the full report either.

But the care home management, the care home provider, the healthcare professionals, the social care professionals were all invited to attend those meetings.  The care home management, the care home provider, the healthcare professionals and the social care professionals were all provided with a copy of the full report of the investigation carried out into the neglect of my relative.  So that they could all comment on  it and have any ‘amendments/alterations’ made before it was finalised.  That is one aspect of the whole mess that I will never understand.

The family of the person who was the vicitim of abuse in care, neglect in care,  was not allowed that same privilege.  No ability to attend meetings; no ability to contribute significantly to the final report; no ability to inisist on changes to that final report – other than simple factual inaccuracies, that is.

Our family member was no longer in a position to ask to attend meetings, to see the report before it was finalised – she died within 3 weeks of suffering that abuse/neglect in care.

The Safeguarding Adults team ‘chose not to inform the police’; they chose not to inform the Coroner either; they chose not to inform family that they had the right to ask the Coroner to conduct an inquest.

And yet, the whole situation was considered sufficiently serious for the then CSCI  to impose ‘enforcement action’ and to refuse new admissions for a year to Lennox House.  The CSCI inspection reports are all still available on the CQC website.

The perpetrators  are the ones to have been protected.  The care home provider that couldn’t provide care has been protected.

What was that policy called?  I remember –

NO SECRETS

No secrets: guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse

Our relative wasn’t protected.  She was dead before anybody thought about massive ‘action plans’ and ‘enforcement action’, all of which the Care Provider willingly complied with of course, and all of which will have been of benefit to the other residents and future residents.  Too late for our relative.

My thanks to Vern Pitt at  Community Care for bringing to my attention the fact that politicians seem to have opened their eyes.  Long may they stay open.

Open up please also the hearings/meetings/serious  case reviews/adult protection procedures to public scrutiny.  Otherwise we will never believe that you really care.  And then we too can see whether lessons have been learned.

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Toxic dementia care in the UK – and my thanks to Tim Farron MP

Thank you, Tim Farron Lib-Dem MP, for your recent use of the word ‘toxic’ when describing some Tory MPs and parts of this peculiar Coalition government for which we did not vote and so did not elect.  I share your concerns, also about the behind closed doors’ arrangements that failed to feature in the pre-election sales pitch to which we were treated.  And, yes, I think you have already been ‘politically compromised’, Mr Farron.  There’s a far less politically correct phrase I could use, but were I to do so my language would sink to the low level attacks that flow from the mouths of some Tory MPs – Michael Gove and Andrew Lansley to name but two – in their attempts to respond to questions in the House of Commons.

So, Tim Farron’s unexpected prompt to consider the word ‘toxic’ and the various definitions of ‘toxic’ and ‘toxicity’ is enabling me to see more clearly.  To see and to understand better what happened in my own experience of dementia care in the UK, courtesy of a well-known local authority and a well-known care provider.

  • A toxic substance is one that is capable of causing injury or damage to a living organism, especially one that is vulnerable.
  • A toxic substance is one that can cause death, abnormalities or disease in an organism, especially one that is vulnerable.
  • Toxicity is the degree to which a substance is able to damage an exposed organism, especially one that is vulnerable.
  • Toxic assets played a fairly significant part in the recent and ongoing financial crisis, resulting now in proposals for drastic changes  to everything some of us have ever cared about, and over which we will have no democratic voice.
  • Toxic = poisonous = deadly.

And my own favourite and particularly personal definition:

  • Toxicity = toxic or poisonous quality, especially in relation to its degree or strength.

As long as you remember that the word ‘quality’ can just mean a characteristic, rather than a measure of value, and as long as you remember that ‘strength’ is one of those changeable qualities, you’ll see where I’m coming from.  But maybe not where I’m heading.

Tim Farron’s ‘cover’ is also something with which I can identify– except that I might need to add the word ‘up’.  There’s not much difference though; they both conceal.

Anyone up for a ‘toxic contract’?    This time in Derbyshire, at the Barlborough Treatment Centre, where “NHS bosses have been forced to pay out more than £8m to end a contract with a controversial independent Derbyshire hospital.”

“Over the last five years it received £21.9m from health trusts in Derby and the rest of the county – but carried out only £15.1m-worth of surgery on local patients.

The Telegraph revealed in January this year that the NHS had decided to end its contract with Barlborough operators Care UK and seek a contractor who would be paid on a patient-by-patient basis instead.

Last month it was announced that the new deal – for 30 years – had also been awarded to Care UK.

But now the Telegraph has discovered that the NHS is paying a further £8.2m to Care UK to buy the centre, with Care UK as a tenant.”

Yes, I’ve mentioned this contract before; it will no doubt surface again at some point in my future.

The words ‘not fit for purpose’ are words I’ve used often in my as yet incomplete struggle to understand the peculiar world of dementia care in the UK, as experienced by my relative and by me.  Toxic would have been a far more fitting description.  But when there emerges  a peculiar coalition of potentially destructive forces, each in their own right, then you may achieve a toxicity that had not previously been envisaged.

  • Take one toxic local authority;
  • add an enormous dose of a toxic mental health care of older people team;
  • add months in a grim and extremely toxic assessment unit, where the toxic staff could have done with a full assessment;
  • stir fiercely but don’t shake yet;
  • then add an unexpected dollop of a toxic care home provider;
  • the real shaking comes in a toxic care home,
  • with the lethal brew administered by the toxic staff.

As I continue to understand the toxicity of it all, so I will begin to remove the cover.

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Filed under abuse, Care UK, dementia care, growing older, neglect, professional responsibility

Briars Retirement home / Briars Care home – and other examples of neglect

The owner and manager of Briars, a ‘retirement/care’ home in Southampton, have been found guilty of ill-treating and neglecting sixteen vulnerable elderly residents with dementia, aged between 77 and 96.  At Southampton Crown court, Annette Hopkins, the 63-year old owner of Briars, was found guilty on 10 charges of wilful neglect, and Margaret Priest, the 54-year old manager, on four.

Both of them had denied all 16 charges.

The Daily Echo reports that Defence barrister Amanda Hamilton asked for Priest to be conditionally discharged, saying she had devoted her time and attention to The Briars.

“She is a kind, caring and altruistic person. She has lost her job, she is unlikely to get another one and she is claiming state benefit.”

That ‘state benefit’ may now be transformed into a different kind of ‘state benefit’, whereby the state places Priest and Hopkins into secure custody, in the best interests of all.  They are both approaching an age when they may need residential care themselves, so I only hope they get the kind of care they deserve.

This is Hampshire, 28 May 2010 reports: “IF ONLY we had had more help.”  Those were the words from the owner of a care home that was closed down over allegations of neglect.    And soon, if she is to receive a prison sentence, that same owner, Annette Hopkins, may well be able to understand that those very words applied to the vulnerable people she was supposed to care for.  They were all desperately in need of care, support and help – that is what they deserved.  But all they found was neglect.  If only they had been given the help they needed.

25 September 2008, and the Daily Echo reported the early beginnings of this case, and that Annette Hopkins, 63 then, admitted she may have made mistakes but denied any allegations of neglect. Mrs Hopkins said a district nurse had assessed up to ten patients – almost half the residents – as needing specialist nursing care after finding they were suffering from bed and pressure sores. That is neglect – and nothing to do with ‘mistakes’.  CSCI had carried out an inspection the previous November.

24 September 2008: Channel 4 news covered the same story in much the same way, as did the Daily Mail.

The list of horrors surrounding the lives of the residents is gruesome reading, again from This is Hampshire:

Police told how the full disturbing catalogue of failures included how:
■ Residents were malnourished and dehydrated
■ The place they called home had a strong stench of urine and the floors were filthy and faeces-stained
■ Dirty bedding and incontinence pads were left lying on the floor, mixed with clean clothing
■ Medication would be handed out by unqualified staff and was sometimes given to the wrong people
■ Bosses were not qualified but claimed they were through years of doing the job
■ Staff didn’t have the right equipment to lift residents who needed to move
■ The wrong beds were used, leaving residents with severe sores
■ Some were so ill or incapable they should have been in a nursing home
.

The Basingstoke Gazette yesterday has several items of interest.

The first The Briars: What to do if concerned about a relative gives the contact details for you to voice your concerns, in the hope that your concerns will be thoroughly investigated.

The second The Briars: Could it happen again? mentions Southampton City Council’s newly formed ‘Safeguarding in Provider Services Team’, and also gives the impression that CQC are a completely new kid on the block, replacing the old CSCI with massively improved powers.

The third I always worried about my Mum at the Briars gives the views of Sue Rennie who placed her trust in the Briars when her mother became a resident there in 2004.   Now Sue is calling for six-monthly anonymous spot checks at all care homes and nursing homes.

“They shouldn’t just be checking the facilities and what entertainment is on offer. Qualified doctors and nurses should be checking individuals who are bedridden, incontinent and prone to skin conditions to make sure they are being cared for on a personal level and the appropriate treatment is given.”

I agree with you there, Sue Rennie.  But there’s more to it than meets the eye, and it can take the novice, the beginner, the concerned relative, several years to unravel what goes on behind closed doors.  (see below!)

But what worries me most is the Inspection that the then-CSCI (now CQC) carried out in November 2007.  It’s no longer available on the CQC website, of course, because the home is now thankfully closed.  But the Basingstoke Gazette from September 2008 has a link to that inspection report from 24 November 2007.  It’s deeply concerning to read the following:

  • Feedback obtained from professional sources indicate that people feel the staff are knowledgeable, that staff are available to assisted with visits and that overall the service provides and satisfactory level of care.
  • Service user and relative surveys continue to raise concerns over the lack of entertainment and stimulation provided within the home, with people commenting ‘not enough activities, the notice board states that residents will be taken on day trips, this has not happened’ and ‘ this is a very nice care home, the only fault being there is literally no stimulation for the residents apart from a pianist once a month’.
    People met during the visit also criticised the lack of social stimulation saying that they prefer to remain in their bedroom as the opportunities to interact or socialise are limited.
  • During the fieldwork visit it was noticed that people were eating their lunch in the lounge as apposed to the dining room, which initially seemed the result of personal preference. However, during the tour of the premise it was noted that the home has limited dining spacing, with small dining rooms located adjacent to the main lounges, both rooms only capable of sitting approximately ten to twelve people.
  • The dataset also contains information about the home’s complaints activity over the last twelve months:
    No of complaints: 18.
    No of complaints substantiated: 0.
    No of complaints partially substantiated: 0.
    Percentage of complaints responded to within 28 days: 100%.
    No of complaints pending an outcome: 0.
  • The Dataset again establishes that policies for the protection of the service users are in place: ‘Safeguarding adults and the prevention of abuse’ and ‘Disclosure of abuse and bad practice’, however as with the complaints policy no review date is indicated.
  • Following the last inspection the manager has commenced meeting with each service user for approximately five to ten minute a day, discussing their wellbeing, any concerns or issues which they feel are affecting them. The manager documents each meeting and where necessary actions are taken to address any concerns or comments made. During the tour of the premise one service user mentioned her daily meeting with the manager and expressed a concern that this level of commitment could not be sustained due to the manager’s other responsibilities.
  • However, the manager was quick to reassure the service user that ten minutes each day was more than manageable for her and that she enjoyed the one-to-one interactions with people.

There were enough ’causes for concern’ when the inspector called – but the inspector merely ticked all the boxes required and went away.  Mission accomplished!  Or not.  Too many occurrences of “indicated” and “the manager/she stated that” for my liking.  An inspector is supposed to find positive evidence, not indications.  An inspector cannot take for granted that whatever the manager ‘stated’ was fact.

The manager managed to convince the inspector that she could spend 5 to 10 minutes, each day, with each of 34 residents – and document her meetings.  That would consume an awful lot of hours – leaving the manager no time to manage.

There are many other areas within that inspection report that should have rung alarm bells.

Why have I been following the story of Briars?

Because it first came to light in September 2008, just a month after another story of neglect surfaced, at Lennox House, Durham Road, Finsbury, Islington, North London.   Another care home run for profit, this time by Care UK.  The then-manager was ‘allowed to resign’ after she had managed to fail to manage a care home where the bodies of residents who had died were left in their rooms for days after their death.

And that story of neglect came only 8 months after yet another story of serious neglect and sub-standard care emerged.  The Deputy Manager and several staff members were also ‘allowed to resign’.  The world at large will know nothing of that story, because it does not feature in any CSCI/CQC report.  Nor does it feature in the headlines any longer.

The  CSCI/CQC inspection reports for Lennox House:

23 October 2007: brand new care home so this was the first Key Inspection: no major problems are noticed; there are 7 Statutory Requirements made, but nothing to indicate any serious problems.

24 June 2008: 11 Statutory Requirements were made – there were also outstanding Statutory Requirements from the previous inspection of November 2007 when 7 Statutory Requirements were made; Enforcement Action was being ‘considered’ and was taken.

3 December 2008: when the home was still subject to Enforcement Action and still not allowed to accept new residents; 2 Statutory Requirements and still outstanding requirements from the previous inspection;

9 June 2009: and the home is allowed to admit new residents;no outstanding Statutory Requirements from the previous inspection, but a now a further 3 Statutory Requirements made, and 9 recommendations.

You will need a very fine-toothed comb to work your way through what actually was happening, between 23 October 2007 and 24 June 2008, not to mention June 2008 to June 2009.  And you still will not find it in the CSCI/CQC documents – or any other document – easily available to potential residents and their family.  It is all concealed.  The massive Improvement Plan/Action Plan imposed on a care home run by one of the biggest care providers in the country is a real eye-opener.

Behind closed doors much can be concealed from view.  Enough holes to build a golf-course. 

The gaping holes of care in the UK.

And that will be the subject of the next instalment.

No secrets.

These are not isolated incidents.

Sad reflection on the state of care in the UK, but a true one.

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Filed under abuse, care homes, Care UK, dementia care, neglect