• Sarah Whitebloom

Authorities fail to notice serious care home failings - Worst Homes of Week


See no evil, speak no evil - until someone (preferably the police) tells us about some evil.

It may be a little harsh, but this could be the motto of those safeguarding vulnerable people in Britain. Week after week there are cases where Local Authorities and/or the Care Quality Commission have failed to notice or warn of bad care - until someone else tells them about it. Then, there is the unmistakable sound of stable doors being bolted as the authorities rush to 'do' something.

Take a look at the CQC website, there is growing list of awful homes which were only found to be poor when an outside body or person has informed the authorities, who have previously been doling out good reports. How many deaths and injuries are missed? How much neglect and abuse not spotted by the authorities, who simply do not see what is happening? It is sobering to think that a number of recent cases have been sparked by a police investigation or a whistle-blower - not by inspectors or adult social care social workers.

Last year, the care regulation community went into overdrive when police launched an investigation into 13 deaths in Sussex Healthcare homes. But, look at the CQC reports, and they disclose that the seven SHC homes currently rated as 'Requiring Improvement' and the three care homes branded 'Inadequate' were all previously rated 'Good' by the care regulator. Some were inspected a few months before the 'scandal' broke and yet they received glowing reports. Apparently, the CQC did not notice all the many problems that now fill their reports. What's that sound? A banging door.

And lest we not forget, Local Authorities are supposed to oversee adult social care. Why were they not alerting the CQC, issuing the sort of warning statements which currently pepper West Sussex County Council's website - about SHC, whose adviser even sat on the County Council.

Part of the problem is the fact that our whole adult social care system is based on a ‘lessons learned’ premise. This assumes that care homes are doing fine and will get better, if told where they are going wrong. But they don’t. Not only does this turn a blind eye to serious problems, all too often care homes go downhill in the face of warnings from the care regulator and the intervention of the local authority. Don't take OLM's word for it.

This week are several cases in point. These are three homes which were 'Good' but, following intervention from outside authorities, are given poor reports, pointing out serious faults. Then, when the regulator returns, they are reported to have got worse. Sometimes, they still have the same old problems, sometimes they have new ones. Whatever is the case, the 'Good' care home now has an 'Inadequate' report - and all in the space of a few months.

Either the ‘lessons learned’ system is not working, and care providers simply don’t care what the regulator says, or it could be that the regulator wants to demonstrate that it is doing something? Cue the now familiar sound of slamming stable doors.

What is really worrying is that, older and vulnerable people are suffering bad, sometimes dreadful, care over extended periods because the regulator and the responsible authorities do not notice there are major problems or they have the mistaken belief that the home is going to improve. It isn’t and it doesn’t. Very vulnerable people are living in ‘unsafe’ homes, either recognised as such, or not, and having to pay for the privilege.

Our three Worst Homes of the Week all demonstrate problems with inspection and safeguarding systems.

The first is Elmwood Nursing home in Croydon, Surrey. Just three years ago, it was judged ‘Good’ on all measures. In 2016, it ‘Required Improvement’ in three areas. In September 2017, it ‘Required Improvement’ in four areas.

Then, in October 2017, home owner HC-One was fined nearly £60,000 for allowing an elderly person with dementia to suffer serious burns on a free standing heater.

So, when Elmwood was inspected again in March 2018, it was judged ‘Inadequate’ overall. It actually received the worst possible mark for ‘care’ – usually the one saving grace of an ‘Inadequate’ home since the staff can usually be relied upon to be kind.

The home owner, Britain’s biggest homes group HC-One apparently did not ‘learn lessons’.

According to the CQC report: ‘At our last comprehensive inspection of the service in September 2017 we found the provider to be in breach of regulation. This was because people were at risk of unsafe care as a result of care records containing inaccurate information. We served a warning notice to the provider and told them they must be compliant with the regulation by January 2018. At this inspection we found people continued to be placed a risk of receiving unsafe care and treatment.’

Our second ‘Worst Home’ was judged to be ‘Good’ at its previous inspection. In 2015, Horncastle House, apparently had no failings whatsoever.

The care home, owned by Sussex Healthcare, was this week, however, given a damning ‘Inadequate’ report. The home is not part of the police investigation and was not inspected last year, along with most other SHC homes.

According to last week's report: ‘Most people said they generally felt safe and that staff were caring towards them. However they went on to tell us that they thought there were not enough staff, and that call bells took unreasonably long to answer.'

OlderLivingMatters holds no brief for this home or the provider but is aware that this description of life at Horncastle House is nothing new. It was certainly the case every time OLM visited - which it has done on several occasions. But the CQC has only recently realised this. Call us cynics, but maybe that is connected to the police investigation? Slam.

Does the CQC only notice failings, when a criminal investigation is underway or a whistle-blower provides evidence? Families complain that they have contacted the CQC only for their concerns not to be taken seriously. The Bates and Lewis families voiced concerns over an SHC home in 2015, when their relatives received serious injuries - but their concerns were not properly investigated by the authorities - as revealed in a report last month. And it was another two years before any of SHC's 'Good' homes received bad reports and, by then, the police were investigating 13 deaths.

Our final Worst Home, Edgeview Nursing Home in Stourbridge, has gone from entirely ‘Good’ to almost totally ‘Inadequate’ via really ‘Requires Improvement’ in less than four years – each time getting worse and worse.

The Midlands nursing home was at capacity when the CQC went calling in March. It is home for 24 people with learning disabilities and mental health needs. In its latest report, the inspectors found the home to be unsafe, uncaring, unresponsive and badly managed.

How had it gone downhill so much, given that many of the residents were publicly funded and presumably cared for by the local authority?

The truth is, the CQC did not chance upon these concerns when inspecting Edgeview. It went into this home on the back of whistle-blowing information.

Concerns about the awareness and effectiveness of the authorities, including the CQC and the local adult social care teams, do not in any way excuse bad care. But it is very worrying to consider how many other homes could be dishing up daily neglect – which goes unnoticed by the regulator. Care providers go out of their way to put on a good face when the CQC comes calling. But professional inspectors and social workers should be able to see through that.

There is no knowing for how long these homes have been ‘Inadequate’. Two years is too long between inspections. And the culture needs to change so that 'lessons learned' is not an excuse to do nothing. At the moment, bad practice is regularly not picked up and when it finally is, it just gets worse. Meanwhile, vulnerable people are exposed to unsafe care.

#CareHomes #CQC

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