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Nursing home quality is 'biggest concern' in social care, say inspectors

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The quality of nursing homes remains the “biggest concern” for inspectors according to a new report on the state of adult social care services, which also stresses that the sector continues to face widespread funding and staffing shortfalls.

The report, published by the Care Quality Commission today, is based on findings from inspections carried out by the regulator from 2014 to 2017 since the introduction of its new approach to assessment.

“Through our inspections, we have seen examples of unacceptable care, occasionally resulting in actual harm”

Andrea Sutcliffe

Between October 2014 and February 2017, the CQC conducted more than 33,000 inspections of around 24,000 services including residential care homes, nursing homes, specialist colleges, domiciliary care services and supported living schemes in England.

While almost four out of five services were assessed as being either “good” or “outstanding” overall, nearly a fifth – 19% – were rated “requires improvement,” while 2% – 343 services – were rated “inadequate”.

“Through our inspections, we have seen examples of unacceptable care, occasionally resulting in actual harm to people using services,” said Andrea Sutcliffe, the CQC’s chief inspector of adult social care.

“This is awful for people receiving this care, as well as their families and carers. But it also undermines the public’s confidence in the sector as a whole – a sector that we are becoming increasingly reliant on as our population ages and people’s needs at all ages become more complex,” she added.

The CQC found “considerable variation” in the quality of different types of services, identifying nursing homes as the “biggest concern”.

“Good leaders, both at registered manager and provider level, have a big influence on the quality of adult social care people receive”

CQC report on state of adult social care

While 68% of nursing homes were rated good or outstanding, 29% were found to require improvement and 3% were inadequate.

This compares with community social care services, such as supported living and “shared lives” schemes, in which 87% were rated good or outstanding.

Meanwhile 82% of domiciliary care agencies and 81% of residential care homes were rated good or outstanding.

The CQC highlighted the importance of strong leadership in ensuring high standards.

“Good leaders, both at registered manager and provider level, have a big influence on the quality of adult social care people receive,” said the report, called The state of adult social care services 2014 to 2017.

“They have an important role in shaping a positive culture in a service – including creating a supportive environment for staff, listening to their concerns and communicating well with them, other professionals, and people who use services and their families and carers,” it said.

The analysis of inspection results also found variation in performance depending on the size of service, with smaller nursing and residential homes more likely to achieve higher ratings.

”We have found that services that care for smaller numbers of people often found it easier to demonstrate a good level of responsiveness”

CQC report on state of adult social care

The report found 89% of both small nursing and small residential homes rated as good or outstanding, compared with just 65% of large nursing homes and 72% of large residential homes.

The CQC said the difference between larger and smaller settings may be partly because many smaller homes are for people with a learning disabilities, and these services tended to perform well.

“We have found that services that care for smaller numbers of people often found it easier to demonstrate a good level of responsiveness – for example, by being able to offer activities that are based on people’s individual interests,” added the report.

“This may be a challenge for larger services, but can be achieved,” it said.

The vast majority of providers were found to perform well when it came to how “caring” their services were with 92 per cent rated good and 3% deemed to be outstanding.

”Poor safety can mean systems and processes that are not adequate for managing medicines or determining staffing levels”

CQC report on state of adult social care

However, safety was the area with the poorest ratings, with 23 % of providers requiring improvement and 2% rated inadequate.

“Low ratings are concerning and indicate poor quality that can have a real impact on people using services,” said the report. “For example, poor safety can mean systems and processes that are not adequate for managing medicines or determining staffing levels.”

Nursing and care organisations highlighted ongoing pressures on a sector hit by lack of funding and recruitment problems and called for urgent investment.

Andrea Sutcliffe

Andrea Sutcliffe

Andrea Sutcliffe

Gary Kirwan, senior employment relations adviser at the Royal College of Nursing, said cuts to funding for local authorities had made attracting and retaining social care staff “extremely difficult”.

“The few remaining registered nurses in the sector are overstretched and responsible for a large number of staff and residents”

Gary Kirwan

“Healthcare assistants work under considerable pressure and are often spread so thin that they are unable to give older people the support they would want,” he said.

“The few remaining registered nurses in the sector are overstretched and responsible for a large number of staff and residents,” he said, highlighting the need for increased government funding to improve pay and conditions for staff.

The National Care Forum, which represents not-for-profit social care providers, said the fact the vast majority of organisations were rated highly for providing a caring service “showed the ‘care’ factor is alive and well”.

“The report also highlights the areas where there is need for significant improvement – demonstrating the critical importance of safeguarding and leadership,” said NCF executive director Vic Rayner

However, she also went on to stress the need for more investment in the sector, especially in “the staff, who deliver 24 hours a day, seven days a week”.

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