A shave and a haircut… the CQC way

Lengthy twitter discussions earlier today following on from news of the 80 bed unit planned up in the North East, blogged about by Mark Neary yesterday. The proposed unit is to be run by the same manager of the Lenore Care Home in Whitley Bay which had a pretty positive CQC inspection report in June 2015.

cqc ratings

The two sides of the twitter discussion today can be summarised (roughly) as:

This home is well run, ‘residents’ reported good quality of life and the proposed unit could be equally as well run for people to lead independent lives without becoming isolated in the community.

The CQC report findings don’t capture anything approaching a typical home and it ain’t remotely likely that the proposed new unit will be ‘home like’. It represents a return to institutionalisation.

I wrote a post soon after LB died about accepting the unacceptable. Something people, parents, carers, health and social care professionals do. For different reasons. The unacceptable becomes unremarkable and the norm. And we use different criteria to judge the treatment certain people receive.

So let’s have a closer gander at this inspection report. Thinking about what is typical for many/most people. Rather than typical for a few.

The 23 bed ‘care home’ has 21 people, a manager and three staff on during the day, two staff on sleeping over duty at night. I assume there’s a range of different aged people living there. Learning disabled people tend to be lumped together in an ageless way. Which is pretty grim.

The inspection involved observation, interviews and reviewing documents. There are a lot of positive comments; friendly, supportive, well trained, supervised and informed staff. People were clearly supported to attend health appointments and the manager was praised by people. There was a dog that one person looked after to learn about keeping a pet. All good.

A big part of the dispute on twitter revolved around the clear lack of available support to enable people to go out and about. Such a small number of staff meant that, if people weren’t able to take themselves off, they’d be stuck indoors. We don’t know how many people were able to go out without support from the report. An important omission.

Alarm bells rang for several reasons:

  1. A finger print keypad security system. 
  2. Computers available in the communal lounge and staff supporting people to stay safe when using the internet. 
  3. ‘The food is good; always two choices on the menu and you choose before 11am.’
  4. The provider continued to be the corporate appointee for a small number of people living at the home with regard to their financial oversight (plans to change this apparently). 
  5. A resident saying “I feel safe. I hardly ever go out because it’s safe here.” 
  6. No one at the home was currently accessing support from an advocate or advocacy service.
  7. At night people could call for assistance through the use of buzzers in their rooms or by knocking on the staff room door.  
  8. There were no specific care plans or instructions in place to indicate when ’as required’ (PRN) medicine should be given.  
  9. ‘We looked at the social activities records for people that were updated on a daily basis. This document was task based and most recent comments noted only that people had been given a haircut or a shave

You can read into this report that a small bunch of good staff, lead by a thoughtful and competent manager provide a (pretty much safe) and well run outfit. Or you can think about people’s lives. About potential, aspiration, social interaction, fun, work, engagement, holidays and so on. Most of which seem to be absent.

Has everyone got fingerprint access to come and go? Why has no one got their own laptop or tablet, and is there no wifi? Why, if the aim of the home is to prepare people for independent living, is no one involved in shopping, cooking or choosing food to prepare/cook?

Why have none of the 21 people got advocacy support? Surely some would need it?How can the provider be in charge of people’s finances without external scrutiny? How can people never leave their ‘home’ and this not be queried? Does anyone go out in the evening (the emphasis on the buzzer situation suggests people stay in/in their bedrooms)?

How much PRN (which is typically sedative type stuff) is given to people and how often? And why are no social activities recorded other than personal hygiene activities?

Oh, and the biggy. Why are 21 adults living in a ‘care home’ in the 21st century?

L1017348

Nothing in this report suggests anything approaching what I would describe as home life. Quite the opposite. Which raises the question; how often do CQC inspectors use the unacceptable as the bar for good, or good enough, when it comes to learning disability provision? [And the answer should not involve mention of ‘experts by experience’].

 

8 thoughts on “A shave and a haircut… the CQC way

  1. CQC would you be happy (fulfilled being an extra/a ‘want ‘ not a need.) living with 21 plus others; people you may have little in common with, people you may not even like? Would you, could you call it home ? Would you put your son or daughter in there and walk away to your family home happy? If not, why do you say it is good enough life for my son? If you find out the
    place is failing or the care is way below your lowest standard, how long would you leave you own son or daughter in there?

  2. I feel the same way about the supported living homes, people bunched together. I think that Shared Lives should be the front runner in care.

  3. The ratings are interesting in themselves
    Good and safe mean you are doing everything ok
    Outstanding, which I think and you would think is in fact good, includes the sort of things you are mentioning here. People go away thinking they are ok because they just made the grade which isn’t that good in our view. It needs challenging I feel because adequate is not good enough.

  4. reposting this from the article.
    As Chair of national Rescare, Stockport, I think we need a debate about this, my friends. Either we believe in real choice, community living to living at home with pensioner mothers like me, and my daughter being traumatised and homeless when I die. Or you follow on in the liberal con job that only one way, my way is right. And that perpetuate the myth that people with LD are ever going to be truly independent. Let’s get real and debate. My daughter with Downs might like the right to choose to live in this safer, more communal space. Would you deny her that by lobbying against a wide choice? Think hard please. Not one size fits all. That blinkered thinking has led to the destruction of specialised, special needs teaching, smaller schools. And led to the single greatest crisis for teachers abandoning their profession : they cannot, should not, be expected to teach all special needs. The NUT says this is the reason most stated for leaving. And the guilt that surrounds this means no one dare say it. Another debate and rethink needed. Mainstream and integration at any cost is driving single mothers off places like the Humber Bridge, in despair, with their special children. Open up and let loose of old prejudices about “institutions”. Community is the new way of thinking , otherwise Triodos would not be involved.

    • Dear Anita,

      I believe your organisation acts in partnership with Stockport Metropolitan Borough Council, NHS Stockport Clinical Commissioning Group, Stockport NHS Foundation Trust and Pennine Care NHS Foundation Trust.

      The policy of these organisations, appears to be mainly, like all those operating throughout the country, to provide services, mainly, within a residential away from parents setting.

      Whilst, neither parents, nor the LD, have any rights, or choice over where they live or the services they are given.
      https://finolamoss.wordpress.com/2015/07/07/autistic-parents-have-no-rights-and-the-private-corporate-parent-is-unaccountable/

      Parents know, they cannot live for ever, and, that is one of the many horrors they face- what will happen to their children, at the hands of a for profit, unaccountable service, where their child is an audit statistic, with no voice, and no one looking after their welfare.

      Their homes and care, can at any time be ripped off, like all the old made homeless, by the Southcross scandal.
      http://www.dailymail.co.uk/news/article-1393294/Southern-Cross-Healthcare-destroyed-Stephen-Schwarzmans-private-equity-firm-Blackstone.html

      Despite this, it would appear, the only support/facilities available, to the LD, on reaching 18, is institutional private, increasingly backed by venture capital, provision.
      https://finolamoss.wordpress.com/2015/04/27/independent-living-disabled-penned-for-profit/

      Very young adults, all over the country, are being removed at 18, so parents, are not being allowed to grow older with them.

      And even, when they are, parents live constantly, under the Damocles Sword of MCA removal, and limited, removable at any time, access to their own children.

      And once a court order is made, that removal is in their ‘best interests’, their child, is placed at the mercy of the state care system, for life.

      Such provision, being only overseen by those commissioning it, who would be liable, should it prove inadequate.

      There is no central check on the amount, type of medication used, and residential providers increasingly, also own, the specialist hospitals, where the LD are treated ,so there is no independence, and a conflict of interests.

      And we, already know, that the medical care of LD is wholly, inadequate, if not abusive, with 3 a day at the least, dying needlessly, and, it appears, few deaths, are even internally investigated, so this beyond horror for parents, who have no rights, or, even free access to their children..

      These institutions, can be, due to the lack of accountability for their services and their profit motive, more dangerous, than Winterbourne.

      See what happened to poor Thomas Rawnsley in his last two years
      https://finolamoss.wordpress.com/

  5. Another biggy is, is this all legal ?.

    Are each of the decisions, made for the residents by the care provider, assessed, before they are made for them,as to whether the individual residents themselves, are ‘capable’ of making them, at the time the decision was made, and, if not a joint decision attempted first, and, then if not possible, one in their best interests.

    I think not, so therefore illegal under the MCA.

    And, even if this procedure carried out, still illegal under Article 12 United Nations Rights of the Disabled, which does not allow, ‘substitute decision making’.

    Every time a resident wishes to go out, and cannot, this is a deprivation of liberty, has permission for each, been obtained as required by the MCA.

    I think not, so illegal under the MCA.

    So, it would appear, that the CQC, are condoning illegal activities. Now, 2 years after the House of Lords Select Committee, pointed out that the MCA is being applied illegally.

    And why is it thought that this living arrangement, is in these people’s best interests ?

    And why are they there ?

    And why, is so much per week allowed to be spent on these residents, to say nothing of the cost of the build and medication, when parents get on average, £105 on carers allowance, and the disabled £102 in DLA ?

    And why, is there no check on amount, type of medication used, and reference to the relatives of these residents.

    And, why is all orchestrated, and, a tick box, foregone conclusion.

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