New CQC report finds quarter of social care facilities failing on safety
One in four social care services are failing on safety, the care regulator has said.
Analysis by the Care Quality Commission (CQC) shows that 23% of care homes, nursing homes and home care services require improvement on safety while a further 2% are inadequate.
Almost 20,000 people are cared for in the 343 services rated as inadequate.
Issues seen by inspectors include people being washed and dressed and then put back to bed to make it easier for staff, residents not getting enough to eat and drink, and people not getting help to go to the toilet in time.
When it comes to nursing homes, which care for people with the highest level of need, one in three are failing on safety.
Inspectors also raised concerns about organisations slipping down the ratings, with a quarter of those last rated as good deteriorating since their last inspection.
Andrea Sutcliffe, chief inspector of adult social care at the CQC, said some of the issues raised by inspectors “have a profound impact on people’s lives”.
She added: “From a safety perspective, it may be: ‘Are there enough staff available to provide the care people need in their own homes?’
“If there is not, it may mean people have missed calls, people may be late to be supported to go to the toilet, to have the food and medication they need.
“These are things you do not want to be happening to your loved one or mum.
“If you’re in a residential or nursing home, it may be that there are not enough checks and balances in place to ensure people are getting the right medication and the right support to eat and to drink.”
She said failing services do not always treat people with dignity and respect.
“So, services where we have gone in first thing in the morning and we’ve found people who have been got out of bed, washed, dressed and put back to bed because it’s easier for the night staff to do it than the day staff,” she said.
This was “completely and utterly unacceptable” in the modern age, she added.
Ms Sutcliffe said other issues included a reliance upon agency staff who do not necessarily know the people they were caring for and were therefore not able to provide the services needed.
A failure to carry out proper checks on staff and poor staff training had also been highlighted by inspectors.
More than 21,000 adult social care services in England have been given a rating by the CQC in five areas: safety, leadership, and whether a service is caring, effective and responsive to people’s needs.
Across these five indicators, 19% of services require improvement, 2% are inadequate, 77% are good and 2% are outstanding.
While most services are good and should be praised, Ms Sutcliffe said “nursing homes continue to be the worry area”, with only 67% rated as good.
She said that “many of these homes are struggling to retain and recruit good quality nursing staff and this has an impact on their ability to provide good services”.
Just over 1,800 services rated as good previously have now been re-inspected.
Of these, a quarter have deteriorated from good, including 5% that are now rated as inadequate.
“What it says to me is that there is a struggle for services to continue to maintain the high quality care that we know is vital and important for people,” Ms Sutcliffe said.
“That, I think, shows the fragility in the sector and that good quality care is potentially precarious and we need to make sure that we’re focusing on it and that we’re not complacent about those good quality ratings.”
But she said four out of five services rated previously as inadequate had improved at the point of re-inspection.
Caroline Abrahams, charity director at Age UK, said services across the country were patchy.
On nursing homes, she said: “You can be lucky but it’s a bit like playing Russian roulette.”
Overall, inspectors looked at 1,493 community social care services, 5,511 agencies providing care in people’s homes, 10,858 residential care homes and 4,042 nursing homes.
Margaret Willcox, president of the Association of Directors of Adult Social Services (ADASS), said: “This report recognises that there is a lot of great care provided by committed leaders and staff through high quality services to people in care homes and in their own home.”
She said extra Government funding was welcome but did not meet increasing needs and costs.
“The risk of adult social care approaching its tipping point is still real and we will focus on re-doubling our mutual efforts to ensure that the quality of care doesn’t deteriorate and that older and disabled people and their families get the reliable, personal care they need and deserve.”
Health minister Jackie Doyle-Price said: “While this report shows that the vast majority of people receive ‘good’ or ‘outstanding’ adult social care, it is completely unacceptable that standards in some settings are below those rightly expected by care users and their families.
“That’s why we have introduced tougher inspections of care services, provided an additional £2 billion to the sector, and later this year we will be consulting on the future of social care in this country to put it on a stable footing for the future.”
Shadow health minister, Barbara Keeley, said: “This report confirms that the social care funding crisis caused by this Government is now seriously affecting the quality of care across the country.
“Behind these statistics are thousands of vulnerable adults failing to get the medicines they have been prescribed, being ignored when they ask for help or having home visits missed.”
Examples of poor care at social care services in England
Here are examples of poor care reported by the Care Quality Commission (CQC) at adult social care services across England.
- Crawford’s Walk nursing home in the Hoole area of Chester, operated by Bupa.
This care home has twice been rated inadequate by the CQC. Inspectors found people forced to wait to go to the toilet, with some soiling themselves, and some residents not having received breakfast by 11am. People were also hauled out of bed to be washed and changed from as early as 5.15am to make it “easier” for staff to care for them. Some were then put back to bed.
A separate investigation by Channel 4’s Dispatches found one resident shouted at after filling her incontinence pad. A care assistant told the woman: ‘You’re full of crap again. You’re so naughty!’ When the woman said she was sorry, the assistant replied: ‘No, you’re not sorry, because you know you’re doing it!’
The undercover reporter was told that incontinence pads were “rationed” within the home and one carer was seen reusing a pad with urine and faeces on it. One nurse said she had to get people up at 3.30am for bed baths.
- Highcroft Manor in Northamptonshire.
Ranked as inadequate by the CQC. Inspectors found examples where elderly people with dementia were at risk of falling, many examples of people being left without supervision, poor medicines control and call bells being left out of reach.
Residents said staff shouted at them and residents were left without any access to drinks. Inspectors added: “People were at risk of infections as the home was not clean. People’s rooms, bedding and flooring were visibly dirty.
“We observed that beds had been made with dirty linen and equipment such as bed rail covers were visibly dirty. In bedrooms we found the walls were stained with drink spills and food debris.
“There was an unpleasant odour throughout the home and the laundry was full of heavily soiled bedding and clothes. On the second day of the inspection we noted that many waste bins in toilet and bathing areas were overflowing.”
- Aamina Home Care in Lincolnshire.
Rated as inadequate in April 2017, having had a previous rating of good in April 2015. Call monitoring data showed people assessed as requiring 30 minutes of support received their care in six minutes or less. A person who required support for 45 minutes had their care delivered in six minutes.
One patient had 19 different carers in a single month, exposing them to neglect. Medicines were also administered unsafely and at wrong times. One patient needed medicines administered in four hour gaps but was given them all at once.
Another person who required two staff to support them from bed with personal care and dressing did not receive any support for two days.
- Meadowbrook Care Home in Shropshire.
Rated as inadequate. Ants were found crawling over one of the dining tables where people were expected to eat. Inspectors also found a soiled mattress.
One resident was struggling to eat in full view of staff. They were spilling into their lap and only received help with two spoonfuls of dessert, which was all they really ate. One person told inspectors they sometime had to wait an hour before staff responded to their calls for help.
- St Anne’s Community Services based in Leeds.
Successfully prosecuted by the CQC in June 2016. The CQC brought the prosecution following the death of 62-year-old Kevin McNally, who broke his neck in a fall from a shower chair at a nursing home in Smithies Moor Lane, Birstall, in April 2015. St Anne’s was fined £190,000 following the death.
Bradford Magistrates’ Court was told that Mr McNally, who had Down’s syndrome, epilepsy, dementia and a severe learning disability, had been helped to the shower using a shower commode chair. The shower chair fell forwards while he was loosely strapped in. Staff attempted to resuscitate him, but he was pronounced dead in hospital.
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