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CQC raises concerns about safety in nursing homes

latest report of the Care Quality Commission published on 6th July is damaging to the social care industry. The report highlights that one in three nursing homes that has failed its official inspection in results described by the care watchdog as worrying and by the government’s care minister as “completely unacceptable”. The Care Quality Commission said that of 4,000 nursing homes, which care for the most vulnerable people at the end of their lives, 32% have been rated inadequate or requires improvement and 37% have been told they must improve safety. Inspectors making unannounced visits to care homes found medicines being administered unsafely, alarm calls going unanswered and residents not getting help to eat or use the toilet. Some residents were found to have been woken up by night-shift care workers, washed and then put back to bed, apparently to make life easier for staff. Andrea Sutcliffe, chief inspector of adult social care at the Care Quality Commission, which carried out the inspections, said such practice showed a fundamental lack of dignity and respect. She admitted disappointment that only one in 50 of all care services had managed to achieve the top rating of “outstanding”. The picture for nursing homes was the most worrying, Sutcliffe said. “Many of these homes are struggling to recruit and retain well-qualified nursing staff and that means that this is having an impact on delivering good services to people who have got very complex needs,” she said. Of all adult 24,000 social care services in England, 21% have been judged “inadequate” or “requires improvement” in the first full checks of their kind by the Care Quality Commission – which have taken almost three years to complete. One quarter of those checked have been found wanting on grounds of safety. Concern has grown because some services have been downgraded after re-inspection. Of more than 1,800 inspected more than once since 2014, 26% were subsequently relegated to “requires improvement” or even “inadequate” after initially gaining a rating of “good”. Andrea Sutcliffe said that while re-inspections were often prompted by concerns raised by staff, other care professionals or users of the services, the number of facilities downgraded nevertheless underscored the fragility of the sector. Caroline Abrahams, Age UK’s charity director, said it was troubling that a fifth of all services had been judged to need improvement and “pretty scary” that so many nursing homes had fallen below an acceptable threshold. With a quarter of services deemed insufficiently safe, older people and their families were “now effectively playing Russian roulette when they need care,” she said. Referring to the government’s manifesto pledge of a green paper on the future of social care, Abrahams said: “Taken as a whole, this report is a graphic demonstration of why older people desperately need the government to follow through on its commitment to consult on proposals for strengthening social care later this year.” All registered social care services in England have now been inspected on grounds of safety, effectiveness, whether they are caring, whether responsive and quality of leadership. While nursing homes come out worst, services grouped as “community social care” emerge best. These include sheltered housing with “extra-care” support and so-called “shared lives” schemes whereby people accept others needing care and support into their own homes. Interestingly, by size, small care homes and homecare services emerge far better than large ones – three times as many large care homes, with 50 or more beds, being judged inadequate or requiring improvement than small ones with up to 10. Andrea Sutcliffe said that although some big homes had proved they could provide outstanding care, smaller homes were often better at the personal touch and at retaining experienced staff. Barbara Keeley, Labour’s shadow minister for social care, 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. “It is deeply worrying that a quarter of social care services have safety concerns. 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.” Summary This CQC report paints a picture of a social care industry in crises. The safety of service users in nursing homes is of particular concern. There is undoubtedly problems with recruiting and retaining nursing staff, and the question needs to be asked can the safety of services users and the quality of care be raised in an industry confronted by a funding crises. Never the less the safety of service users is paramount and even in this report that whilst 37% of nursing homes have problems with service user’s safety, why is it that 63% of the homes provide safe services? We come back to the point; quality and safe care services are not solely dependent on money, but staff who are made aware of their duty of care and services monitored and audited to ensure that they are operating within the requirements of the fundamental standards. Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy

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