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CQC uncovers staffing problems at care homes rated 'inadequate'


Staffing shortages, a lack of training for employees, problems with administering and managing medicines and an over-reliance on district nursing teams were among the issues identified in the latest round of care home inspections by regulators.

The Care Quality Commission has published 132 reports on adult social care organisations based in central England in the past week, with 11 being rated “inadequate”. Among the 11, inspectors noted concerns about staffing levels in nine.

At Rose Villa Nursing Home in Dudley, which provides care for up to around 30 residents, a shortage of nursing staff meant the manager had to cover shifts. As a result, at the time of inspection in June, when there were 11 residents, she said she had worked 12-hour shifts for the previous seven days.

“One side [of the house] we get up Monday, Wednesday and Friday. The other side we get up Tuesday, Thursday, Saturday”

Staff comment to CQC

The manager told inspectors that the owner of the home had initially agreed to use agency staff following a meeting with the local authority. However, “when he saw the bill the owner said ’no more agency’”, added the manager.

In the CQC’s report on the provider, it also found people were not receiving medicines as prescribed and there was insufficient guidance on how to prepare and administer medication.

“We saw that for one person, their antibiotics were being administered with their lunch, instead of an hour prior to eating, thus making them ineffective,” said inspectors.

They concluded that “quality was not an integral part of the home”, and “there was no evidence of investment” in it.

At the 120-bed Chilton Meadows Residential and Nursing Home in Suffolk, run by Bupa Care Homes, inspectors found “significant shortfalls” in the care provided to people across all four homes within the service, which they said was linked to a lack of oversight from management.

In three of the four homes, inspectors noted many people remained in bed all day with no rationale behind it. This was due to low staffing numbers, inspectors were told by employees.

“Their antibiotics were being administered with their lunch, instead of an hour prior to eating, thus making them ineffective”

CQC report on Rose Villa

“We spoke with a staff member who commented, ‘One side [of the house] we get up Monday, Wednesday and Friday. The other side we get up Tuesday, Thursday, Saturday,” inspectors noted in their report on the provider.

In addition, the nurse in charge of one of the homes said they did not have time to provide the direct care they should be giving, and so had to rely on support workers to deliver this instead.

Staff, including registered nurses, did not receive regular meaningful supervision or appraisals that focused on their development within their role, said the regulator.

A Bupa spokeswoman said immediate action had been taken to address the concerns.

”Since May, we have invested heavily in training for our staff, and hired a new management team. We have also reinvigorated our activities programme.

”The health and wellbeing of our residents is our top priority and we will continue to embed best practices at the home,” she said.

At Harmony House in Nuneaton, which provides nursing care for up to around 60 people living with physical frailty, inspectors found people did not always have their prescribed medicines because staff had not ensured adequate stocks were available.

During the visit in June, a nurse told inspectors that they were ordering new medicine on the day because there was none left, while records showed one resident had missed eight doses of their medicine due to stock running out.

In addition, “people felt there were not always enough staff available on shift to meet their needs when support was requested,” said the CQC in its report on the home, adding: “Some people felt staff were positive towards them but this was not consistent and care was not personalised”.

“Some people felt staff were positive towards them but this was not consistent and care was not personalised”

CQC report on Harmony House

However, at a later unannounced visit to check what had been done to tackle immediate concerns, inspectors noted that the care home had introduced a daily medicine audit checklist and had brought in supervision meetings to address poor care practice.

A spokeswoman for the home told Nursing Times it was disappointed with the report and had an action plan in place to address the concerns raised. She said the manager of the home was receiving support from a local operations team.

Meanwhile, at Bearnett House in Wolverhampton problems were uncovered around a reliance on district nurses to refer residents to specialist services.

In one example noted by the regulator, a person who was losing weight was only referred to a dietician after they had been seen by a district nurse. The home’s management team said staff had not known about the weight loss.

Meanwhile, at The Cottage Nursing Home Limited in Wellingborough, the CQC found that while staffing numbers were sufficient to meet peoples basic care needs, the deployment of them “did not ensure people’s emotional and social care needs were met consistently and in a timely manner”.

There was also no formal induction programme in place and gaps in staff training to develop their skills and knowledge.

All of the providers rated “inadequate” by the CQC have now been placed in its special measures regime for struggling providers, which means they will be kept under review by the regulator.


Readers' comments (8)

  • Pussy

    What kept them? Care homes so often have appalling standards with even qualified staff unable to do the most basic of dressings and totally in the dark about diabetics! This is nothing new so I really don't know what the CQC have been up to! I expect Corbyn or Brexit will be deemed responsible!

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  • As a lead nurse in a care home, there is no place for poor standards( having recently been rated good) however you need a good management structure with training in place for all staff. If the management are unsupported then the team will be also

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  • Having worked for many years in care homes I wonder if the CQC has finally woken up. Many times I have contacted them regarding poor standards, dangerous staffing levels, poor nutrition and safeguarding. I had to do this anonymously as the CQC inspectors and the home managers are very good friends.
    Care home staff for the most part, know the drill. Inspector arrives - make sure all staff know, tidy up, do things properly, sit with residents who have problems eating, say as little as possible to inspector. Their jobs are at risk so they comply.
    The owners should be charged with neglect and taking money under false pretences if they are rated 'inadequate'

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  • Any amount of supervision, appraisals, training and audits are rendered useless if staffing levels are so inadequate that there is only time to provide basic care. The smaller privately owned homes, in particular, are notorious for being profit- led. This is not news. Correct me if I'm wrong about this and it's already in place, but one idea is that the government imposes a cap on profit that can be made in this industry. Then maybe more money will be plowed back into the services concerned, and quality of care will improve as a consequence.

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  • To Anon 2.30

    I am a retired nurse. I have seen and reported to the CQC very poor care in the home where my relative was detained. Eventually they did take very appropriate action.

    I am so grateful that people like you exist. But do take care.

    Government policies have short-changed care of elderly vulnerable for some time now. It may have started as a miscalculation but is being used as a secondary gain now. If a strata of vulnerable people were to die off early it would make the finances and ultimately the economy look better, no?

    In some areas it is said that the police practise misguided political correctness. So who better for bad NHS Supervisory management to choose for their heinous behaviour than a home run by persons of ethnic minority?

    If there are concerns in a home re lack of person centred care and earlier deaths, it is important to ask the CQC to look into the mortality rate in the home.

    Unfortunately various institutions do not do what they are paid to do in a timely and proper manner because lack of manpower hours is a problem for them, too. In my experience, the CQC were slow, the Court of Protection were unable and unwilling to protect the person, the police were rubbish, the Coroners Court were partial. the NHS supervisory body and NHS top management were the root of the problem, second only to the government.

    I do not know what the answer is. The think tanks say there will not be enough care homes places come 2020 for all the elderly needing them.
    The use of opiates to hasten death is very controlled and blocked. Clearly to anyone with a brain the costs of delivering bad care is far more expensive in peripheral terms and direct and indirect human cost than delivering sound care but they seem blinkered to that.

    I would very much like to see a comparison of costs for a care home run by an organisation like Namaste and one like the Brithdir home in Wales for the same period of time and with estimations for the peripheral costs like paying £500 travel fares to import nurses from abroad because of our nursing retention crisis here.

    Nursing Times - could you do an article showing a cost comparison, plus the peripheral costs, for a well run and badly run home, showing also the mortality rates?

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  • michael stone

    It does seem that there is some good coming from CQC inspections - whether there is enough improvement is another question, but this is encouraging:

    'However, at a later unannounced visit to check what had been done to tackle immediate concerns, inspectors noted that the care home had introduced a daily medicine audit checklist and had brought in supervision meetings to address poor care practice'

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  • The quality of care in nursing homes is historically below par. Bupa care homes are notorious for their lack of management and staff support and to add insult to injury, they pay peanuts (about £12 an hour for an experienced nurse, give or take a few pence) and no extra for unsocial hours, as in most care homes. They are all about the money. Private care homes are not much better. I worked in a small privately run care home and left after three weeks. The care was basic, the place filthy, the equipment old and unreliable (had to unplug the phone to plug in the fax machine!!.) There was no stimulation for the residents, unless you count being sat in front of Jeremy Kyle for hours on end. No trips out (no transport) no activities co-ordinator (when I questioned that I was told they wouldn't want to do anything anyway!) This home had a good rating from CQC. Care of the elderly in this country is beyond awful and if we judge a nation by how it cares for it's vulnerable population, we should be collectively ashamed.

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  • CQC is not fit for purpose and never has been. Keep your books up together, make sure the paperwork is good and hey presto you get through. This also applies to Learning disabilities. Even reporting bad homes does not necessarily get a response from CQC and when you get owners who are part of the system you get a conflict of interest that can protect bad care. Sadly I have worked in some of these atrocious places, although not for long as I have always left hoping the next one would be better. I saw no point in reporting the bad care as others had and either they were ignored, or they had to leave anyway once becoming a whistle blower. I left care of the elderly and moved into a different branch of nursing. I only hope I never have to go into care as it scares the hell out of me.

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