2,100 CARE HOMES HAVE NEVER
HAD A 'GOOD' CQC REPORT JJan 2018
MORE than 2,100 care homes in England - has never had a ‘Good’ inspection report, OlderLivingMatters has found.
Before Christmas, there was an outcry when Ofsted revealed 138 schools, out of more than 24,000, have never had a ‘Good’ mark. But the revelation from the Care Quality Commission that one in eight care homes has never had a 'Good' rating means that England’s care homes are failing elderly and vulnerable people on a scale unimaginable.
The CQC admitted that 2,108 out of 16,000 care homes have yet to receive a positive rating under its 2014 inspection regime.
The CQC’s ‘blacklist’ reveals a malaise in a care homes industry, apparently content with substandard reports from the regulator. Homes throughout the country feature on the list – with 363 in the North West, 447 in the South East, 260 in the South West, and 130 in London alone. Many have repeated poor inspection results - some even get worse over time!
Inspectors have found elderly people and dementia sufferers living in filth and squalor, without decent care, clothing or food. In the reports from the regulator’s archive, are stories of mattresses encrusted with faeces, urine-soaked clothing and helpless residents left naked in degrading situations while carers treat confused older people with disdain and casually humiliate them. In one particularly harrowing report, into New Park House, an elderly resident told the CQC inspectors that she prayed for death, rather than continue living in one of the worst homes on the blacklist.
It is not just privately-owned homes which are on the list and not just homes catering for publicly-funded residents. Dozens of homes belonging to leading and high-end care companies feature, along with 22 local authorities and household name charities.
But, although there are many troubling instances recorded in the CQC’s reports, very few cases ever come to court.
Freedom of Information requests made by OLM before Christmas to 38 police forces throughout England showed that there had been just 1,257 investigations of care abuse since a new specific law was introduced in 2015. And, in two and a half years, only 73 care staff and two home owners had been charged with offences. According to police, the law requires such a high burden of proof, there are serious problems getting enough evidence for a prosecution – unless a relative has installed CCTV or someone turns whistle-blower. Most police forces had prosecuted fewer than five people, since the new law was introduced. This compares with 75,000 people convicted of domestic abuse in a 12 month period.
All the homes on the list have been rated ‘Inadequate’ or ‘Requires Improvement’ since the inspection regime was set up in October 2014 to mirror Ofsted’s system. Each home is rated for safety, effectiveness, responsiveness, leadership and caring and then given an overall rating of Outstanding, Good, Requires Improvement and Inadequate. At present 11,489 homes in England have a ‘Good’ rating, 2,841 ‘Require Improvement’ and 298 are actually ‘Inadequate’. The smallest category is ‘Outstanding’ with just 294 homes receiving the top grade.
All have had overall substandard grades at inspections since October 2014 – but many have had problems for years before that and a string of poor rulings from the regulator. Some have been given as many as 10 negative reports, in which repeated concerns are raised about the safety and treatment of the elderly and vulnerable residents. At the heart of concerns is often the lack of staff, as home owners try to keep costs down but sacrifice standards, quality of life and safety.
At Trippier, in Colchester, one resident heart-breakingly told inspectors: ‘"I do have to wait sometimes for staff to come but I know they have other things to do. I would like a TV, I have asked for one. It is very lonely and quiet I do not even have a radio. I don't get any visitors.”’
The 'blacklist' is clear evidence of the impact of short staffing and the widespread culture of substandard care. Inspectors frequently find treatment that falls well short of criminal, but is indicative of a dismissive, and casual attitude towards care. Reports are full of stories of residents left in bed or got up before dawn. Helpless people are left ringing and ringing bells, trying to raise help or just to use the lavatory.
Many home owners appear to have become inured to poor reports – accepting them as a matter of business - as years go by and the bad reports continue to be delivered.
Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission (CQC), said: 'Significantly, most people living in care homes are receiving care that we have rated as ‘good’ and the majority of care homes originally rated as ‘inadequate’ have improved on re-inspection.
'However, there are still too many services that are rated as ‘requires improvement’. This is a real concern as it means people living in these services cannot rely on consistent, good quality care, which is what they and their families have every right to expect. I am particularly worried about services that fail to tackle the problems we identify and we are increasing our focus on these services to ensure they take our findings seriously and act upon them.'
She added: 'The adult social care system as a whole needs to take this problem seriously. We should not be content that people in vulnerable circumstances can’t rely on the care and support we would want our own loved ones to experience. By working together, we – providers and their staff, commissioners, funders, regulators and other key partners – have got to ensure that quality really matters.
'As the quality regulator, we will continue to play our part by targeting our work on those services of greatest risk and concern, by using our enforcement powers to end poor care and by publishing clear inspection reports which help people make informed choices about their care. I’d much rather those who are in charge of running care services get to grips with the problems we identify but when it is necessary to force or facilitate a closure, we will and do take that action.'
A key claim of care industry leaders is that they are not given sufficient public money to staff homes properly and provide decent care. Currently, Local Authorities pay up to £615 a week for a dementia sufferer who needs nursing care – less for a residential patient. And in some parts of the country, care homes struggle to recruit staff.
But the ‘blacklist’ undermines the claim that it is all about money. On the list, alongside down-at-heel, state-funded care homes, are numerous exclusive care facilities, charging more than £1,000 a week for care. One of the most expensive homes in the country, where individuals are personally paying up to £1,500 a week is on the list – adding weight to concerns that substandard care is institionalised in the industry.
Care UK is alone among the large operators in publishing indicative fees on its website. It discloses that residents in its Ellesmere House in London’s fashionable Chelsea pay ‘from’ £1,535 a week for nursing. A look at the CQC website, however, shows the home, which is on the ‘blacklist’, has received five negative reports going back to 2013.
Operators are required to display the CQC’s rating in the home and on their websites, if they have one. But owners frequently bury the warnings from the regulator at the very bottom of web pages, beneath information about ‘awards’ and glowing recommendations from care industry websites.
Some attempt to gloss over the CQC’s ratings, or suggest there is nothing to worry about. On Care UK’s website, when a home has a poor rating, it states: ‘We are aware that CQC have highlighted we need to make improvements to our service, we have a comprehensive service improvement plan in place to ensure we are acting to make changes that will be sustained and embedded.’
Others brush aside the CQC’s concerns, even when homes have been repeatedly rated as ‘Requiring Improvement’. High-end homes group, Barchester, gives little prominence to the CQC rating and puts a link to the critical report, alongside a link to a ‘response’ from Barchester.
In the case of 'blacklisted' Cherry Blossom Manor, in the picturesque Surrey village of Bramley, Barchester’s response stated: ‘The Care Quality Commission did not find us in breach of any regulations and did not require us to agree an action plan with them, which indicates that their concerns were minor.’
Ashcombe House, Basingstoke, is rated as ‘Requiring Improvement’ for the crucial area of ‘Safety’ and is also on the blacklist. But Barchester declared in its website ‘response’: ‘In some areas where the report is really positive, the Care Quality Commission’s policy is not to give a 'good' or 'outstanding' rating until they can be sure that practice is embedded.’
Home owners could find themselves defending expensive legal actions over the blacklist, however. In December, the Competition and Markets Authority announced that care home residents and their relatives have the same rights as any consumer – and could sue or refuse to pay if they do not receive what they have paid for. In the United States, local authorities and individuals have successfully gone to law to reclaim fees from care groups which have provided inadequate care. Families have banded together to take on owners.
Although repeated negative reports appear to have little impact on attitudes, legal action or the threat of legal action might finally put an end to the endemic scourge of poor care.
TALES FROM THE CQC'S 'BLACKLIST' ARCHIVES
New Park House in Stoke, the CQC reveals,
has an unremittingly awful history of dreadful care. It is so bad that a frail resident told the CQC inspectors: ‘”I'd rather die than live like this." They went on to say: "I pray over and over for the Lord to take me, it's no life."
Home to nearly 70 older people, New Park House looks like a grand Georgian Mansion, but looks can be very deceptive. The home recently won a Worst Care of the Year Award 2017 – and for good reason. It has received 10 negative reports from the regulator since 2011.
Cleveland House in Huddersfield is owned by the leading care group, Bupa, and is home to 36 older people. But, like so many other homes on the list, it is chronically understaffed, according to the latest damning CQC report, which rated the home as ‘Inadequate’ on all measures.
Its 36 elderly residents are left waiting for hours for help, while some have lost weight because of lack of food. Meanwhile care staff are reported to be in tears, unable to offer the sort of care they know they should. According to the CQC: ‘Another person commented, "They are short staffed, they say 'we will be back in a couple of minutes' but it can be half an hour. I do it on the toilet floor”.’
Staffing is a key problem at Trippier in Colchester, home to 20+ elderly and dementia sufferers. The CQC’s recent report paints a picture of danger and misery for the residents – caused by understaffing.
‘There were not enough staff to provide the right level of care...that ensured people's safety. One person told us, "Sometimes you have to wait for up to two hours before somebody may respond to a buzzer. I am paralysed, I can't move and depend on staff. For dinner I have to wait for everybody to be fed downstairs before I have mine...By the time the food gets to me it is very often cold and I have lost my appetite...I eat the food because of hunger, not because I enjoy it."
The inspectors’ report was matter of fact but full of concern: ‘At our last inspection...we identified that people were left at risk because there were insufficient numbers of staff available during meal times...A person who was at risk of choking and requiring supervision when eating and drinking, choked...when having a drink. There were no staff in the dining room.’
Abuse was uncovered by CCTV in 2016 at Perry Locks care home in Birmingham, then owned by Bupa. Secret filming by relatives revealed a care worker abusing 78-year old Betty Boylan, pushing her and spraying deodorant in her face. A carer, Susan Draper, was convicted last summer and Bupa sacked another worker, Bina Begum, for pulling Betty by the head. But the home, under its new owner HC-One, is still on the blacklist and still failing CQC inspections. A CQC team visited last July and found a chaotic situation, with bells sounding, people not receiving attention or care, residents shouting out and confused elderly people drinking other people’s drinks.
A court case followed abuse in 2012 at the Granary Care Home in Nailsea Somerset. Again, secret filming led to prosecutions of carers who mistreated Gladys Wright, a 79-year old dementia sufferer. But since the incidents, the home which is also on the list and is owned by well-known group, Shaw Healthcare, has received a further seven negative reports from the care regulator. Once more, staffing is a major concern: ‘One staff member said, "Staffing levels are awful." A relative said, "Staffing is an issue, they are always changing.’
Time and again, CQC inspectors report residents bored, without meaningful activities. At C&V Orchard, in Wednesbury, another prize ‘winner’ in the worst care awards, inspectors reported: ‘People were isolated and all were lacking stimulation and the lack of activity appeared to escalate the restlessness and agitation of some of the people living at the home. For example, we saw people pulling at their clothing, calling out or sleeping.’