The Care Quality Commission (CQC), the care homes regulator, has warned many homes are “failing on safety”.

Its inspectors found around a quarter of care homes in England are either inadequate or need to improve performance to ensure residents are safe.

Different standards     

A CQC report titled ‘The State of Adult Social Care Services 2014 to 2017’ has for the first time examined care home standards across England.

The regulator carried out 33,000 inspections of residential homes, nursing homes, care in people’s own homes, Shared Lives schemes and supported living services.

The report says the majority of services are safe and of high quality. The CQC currently rate 77% of adult social care services as “good” and 2% as “outstanding”.

However, the report finds too many elderly and disabled people receive care and support which isn’t good enough. The CQC describe the findings as “completely unacceptable”. The reports found standards differed considerably with nearly a fifth of services said to require improvement and 2% rated as “inadequate”.

Big safety concerns

Safety was the CQC’s biggest concern with 23% of services said to require improvement and 2% judged to be inadequate – some 6,000 organisations across the entire adult social care sector. Major problems included drug errors, lack of staff and falls.

The CQC says residential nursing homes have the worst problems: of the 4,042 homes visited, 32% are rated inadequate or require improvement and 1,496 (37%) have been told they must improve safety. Inspectors noted nursing homes had particular problems recruiting and retaining nurses. Just below a quarter of care homes and home helps weren’t rated safe enough while 17% of in-community support, including sheltered housing, fell short.

In particular, the CQC discovered ineffective systems and processes for managing medicines and determining staffing levels. This resulted in people not getting their prescribed medicines, call bells not being answered and home visits being rushed or missed.

Andrea Sutcliffe, chief inspector of adult social care at the CQC, said “I asked my staff to consider whether every service they were inspecting was good enough for their Mum … most of the adult social care sector is meeting the ‘Mum Test’ providing safe and high quality care that we would be happy for anyone we love or ourselves to receive”.

But Ms. Sutcliffe warns “However, there is still too much poor care, some providers are failing to improve and there is even some deterioration. It appears to be increasingly difficult for some providers to deliver the safe high quality and compassionate care people deserve and have every right to expect. With demand for social care expected to rise over the next two decades this is more worrying than ever.”

Russian roulette

Caroline Abrahams, charity director at Age UK, says the CQC’s findings are “alarming” and vulnerable people were “effectively playing Russian roulette when they need care”. She believes the report “makes a compelling case for why considerably more investment in social care is required”.

CQC’s Ms. Sutcliffe said funding remained an issue for the sector and a “long-term solution” is needed but that lack of money was “no excuse”.

In February’s budget, Chancellor Philip Hammond pledged an additional £2billion for social care over the next three years. But the Association of Directors of Adult Social Services say more will be needed. However, the report indicates poor management is also a significant cause of unsafe homes.

Poor care

Examples of poor care reported by the CQC include:

• St Anne’s Community Service in Leeds which was prosecuted by the CQC in 2016 following the fatal fall from a loose shower chair of a nursing home resident. St Anne’s was fined £190,000.
• Hoole in Chester which has twice been rated inadequate after inspectors found residents were forced to wait to go to the toilet with some soiling themselves. Incontinence pads were “rationed”.
• Highcroft Manor, Northamptonshire, was also ranked inadequate. Inspectors found the home was so dirty residents were at risk of infection. The home had an unpleasant odour throughout, beds had dirty linen and walls were stained with food and debris.
• Aamina Home Care, Lincolnshire, which gave residents medicines unsafely and at wrong times. One patient was exposed to neglect having had 19 different carers in a single month.
• Meadowbrook Care Home, Shropshire, where residents told inspectors they sometimes waited an hour before staff responded to calls for help. Ants crawled over dining tables. Inspectors also found a soiled mattress and one resident struggled to eat in full view of staff.

Since 2015, five care providers have been prosecuted by the CQC. All cases involved death or serious injury of residents resulting in cumulative fines of more than half a million pounds.