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.
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:
- A finger print keypad security system.
- Computers available in the communal lounge and staff supporting people to stay safe when using the internet.
- ‘The food is good; always two choices on the menu and you choose before 11am.’
- 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).
- A resident saying “I feel safe. I hardly ever go out because it’s safe here.”
- No one at the home was currently accessing support from an advocate or advocacy service.
- At night people could call for assistance through the use of buzzers in their rooms or by knocking on the staff room door.
- There were no specific care plans or instructions in place to indicate when ’as required’ (PRN) medicine should be given.
- ‘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?
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’].