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  • Sarah Whitebloom

What is the biggest problem in care homes today? It’s the staff, stupid.

Care home owners simply won’t pay for enough staff to provide good care and elderly residents are suffering.

Chronic under-staffing is routinely top of the list of problems found by inspectors in care homes. It is the direct cause of unsafe conditions as well as lack of dignity, compassion, supervision, food and nutrition and meaningful activities. And yet each week, from Sussex to Yorkshire from Devon to Crewe, there are excoriating reports on care homes with too few staff dishing up appalling standards of care to old and vulnerable people - all because the care provider cannot or will not pay for enough staff.

Care home owners claim they cannot get the staff or cannot afford it, but this is just an excuse. In pure economic terms, if you pay enough, you can get the staff.

Care providers ought to pay up if they want adequately to staff their homes. They are being paid for care they are not delivering and should not be permitted to retain these fees until they are. The trouble is, care providers have become drunk on cheap labour and have based their economic models on exploiting employees. Now those employees can get jobs somewhere else and, no wonder, they do. It is no way to run a business – let alone a care home.

These same care home owners bleat that they can’t afford to pay decent wages because Local Authorities do not pay them enough. This is, often, a fiction aimed at extracting money from the taxpayer. In many parts of the country, there is still competition for work, even for pitifully-low wages. And in many care homes, self-funding residents subsidise those funded by the State.

The fact is, many care providers are in the business of making money and want to keep costs as low as possible. How do we know this? Because private care homes, which charge up to £1,400 a week, are also understaffed. Humm. That’s a puzzle....How can that be? The common link is the care home owners. However much money some are given, it will never be enough. Profit will always triumph over care.

This week, we have another bumper crop for the worst care home of the week – with no fewer than 15 homes receiving the worst possible overall rating of ‘Inadequate’. This compares with just four receiving ‘Outstanding’ awards. A further 50+ homes were deemed to 'require improvement' – which is anything but a recommendation.

At the risk of repeating ourselves, OLM has found the reports shocking. As ever, some leading names in the care home business were to the fore.

Barchester’s Kingsland House in Shoreham-by-Sea, was severely criticised by the CQC in a damning report which rated the home as ‘Inadequate’. The care group’s website still boasts the home is ‘recommended’ and claims it ‘offers high quality nursing care to frail older people’.

But the inspectors described ‘unpleasant odours’, the ‘smell of urine’ and said ‘cleanliness was not of the highest standard’. And the CQC maintained: ‘Before this inspection, we had received information of concern that there were insufficient numbers of staff on duty...People, relatives and staff told us there were not enough staff on duty to support people at the times they wanted or needed. One person told us, "There's definitely not enough staff.’

The CQC continued: ‘We fed back the above concerns to the regional director and registered manager. They told us they felt the service had enough staff to provide safe and person centred care. However, our own observations showed that staffing levels were not sufficient to ensure people's needs could be met safely.’

Meanwhile, at the inappropriately-named Calderdale Retreat, inspectors did not have a good word to say about the massive new facility. And it all came back to staffing.

‘Staff were not deployed effectively and there were not enough skilled or competent staff to meet people's needs. Staff were extremely rushed and had little time to spend with people due to them completing physical care tasks.’

Inspectors added: ‘Relatives we spoke with were unhappy with the staffing levels. One told us, "There are never enough, sometimes there are just three over the weekend which meant everybody stayed in their beds" and another relative said, "They need to get a grip on their staffing". Another relative told us, "Nine times out of 10 there are not enough staff". Three relatives reported low staffing had directly impacted on their family members' care.’

The lack of staff had a significant and distressing impact on the lives of residents: ‘Staff lacked the basic skills required to care for people, and they had limited knowledge of how to meet people's needs. Many staff we spoke with said they had received no induction, training or support since starting work in the home

‘Some people had bare feet and mismatched clothing and others had visible stains down their clothing. Some of the gentlemen were unshaven and some people had strong odours of urine. One person walked around the corridors in their nightclothes which were stained with food and urine.

‘We saw one person in bed during the daytime in stained nightwear. We noticed the person had a very dry, dirty mouth and poor dental condition with broken, loose and decayed teeth. We asked staff how they managed the person's oral care. One member of staff said, "We just wipe their mouth with a tissue". We looked at the care plan for this person and it stated staff were to support the person to clean their teeth daily. When we looked in the person's room there was no toothbrush and care staff confirmed they had never seen or helped the person use one. The staff member also could not explain why the person was still in bed and not dressed. The person's care plan said they liked to be in the company of others.’

Meanwhile, at C&V Orchard in Wednesbury, inspectors were returning to ensure that improvements had been made following an inspection earlier this year and, guess what, they had not been. In fact, the situation was even worse. The CQC report speaks for itself.

‘We saw six people had sustained injuries such as bruising the cause of the bruising was unknown....

‘Staff did not have the skills and knowledge they required to meet people's need...

'We saw people were ignored when they shouted out. People did not look happy or appeared to be uncomfortable resulting in some people having increased levels of agitation and restlessness which was not addressed by the staff. We saw no attempt to engage with or distract people and staff accepted these behaviours as normal. On one occasion we saw a member of staff take a person's drink from their hand without speaking with them. The person snatched the cup back....

‘We saw one person had trousers on which were wet and smelt of urine. Staff did not respond to their needs for a period of five hours. The provider did not ensure people had their dignity maintained.

'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.’

Why these homes are permitted to continue taking money from residents is baffling. Surely, the CQC should begin confiscating profits until care matches their promises - or even is adequate.

Barchester's Kingsland House

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