Q&A: Ask the Chief Inspector for Adult Social Care

I am interested to know how the "inspection" of "in home" carers can possibly be carried out objectively? My grandma has carers going in to her three/four times a day. As her main carer I find this service (she pays a contribution towards this) invaluable as I hope it will enable her to stay in her own (rented) home for rest of her life. She will be 99 this year. It gives me the peace of mind to know someone will be looking in on her while I am at work or looking after my own grandchildren. However it worries me that my grandma does not like some of the carers who go in to see her. She moans that they only stay for 5 minutes (or less) and often don't even bother to take their coat off spending most of their time scribbling in their folder "to keep themselves right".Her night carer comes at 7.30 to put her to bed and she doesn't want to go to bed "like a child" however the company say that they have no other slots available. It's fine on the nights I can go but I can't be there every night at 9pm. I also worry that a couple of the carers are overly nice (sickly) when I am there. Grandma says "hmm you should hear her when you are not here". I appreciate that at her advanced age she can be quite challenging but I wonder how this type of service can possibly be inspected without the care provider knowing and therefore being on their best behaviour (so to speak). Surely if the carer is suddenly accompanied on a visit then they will know they are being checked up on.

Sorry for long winded post. I just worry.

I worry about:
Announced inspections that give the provider notice and therefore time to prepare/cover up deficiencies.

15 minute Dom care visits where the client has to make a choice between say being toileted or eating. I don't know of many/any fit, healthy people who can get up, washed, dressed and fed in such a ludicrously short period of time.

There is no leeway for responsive, person-centred care whatsoever, what are you going to do about this with the pressures already evident on care services?

How do you ensure that private care providers don't put profit above care?

How does safeguarding fit with the employment of many non-English speaking carers, who are barely trained for the job (this is from personal experience)?

My mother had dementia. Her carer visited 4 times daily.
Officially, to get mother washed and ready for the day, to toilet her, give her breakfast, all in 15 minutes.

Mother told the carer that she was already washed when she clearly was not, this went on for days/weeks and when I spoke to the Carer I was told that the patient wishes were paramount and accepted. Difficult when the patient has dementia and has no idea if and when she was last washed.

Meals on Wheels were delivered and put into the fridge. Mother would tell the carer that she had already eaten. The fridge was jam packed with uneaten food. Again the carer said that if the patient said they had eaten, then so be it.

There were many emergency admissions into hospital because of dehydration, blood sugars et al.

I worked full time and visited at least twice a week, a 40 mile trip. Mid week I'd wash mum's hair, take some shopping, bring back to my home the laundry etc etc.
At the weekend I'd do some cleaning in her house. Rubber sheets off bed and sofa etc to be washed down and discinfected. Scrub the toilet that was never flushed, the bathroom floor that was wet with urine.

I arranged for folk to cut the hedges, and do minor maintenance work.

Social Services determined that home care was giving my mother the ability to live at home. They would not listen to me.

Eventually I got an emergency call from the Social Services. Mum's social worker had called and mum answered the door wearing only a continence pad. How sad. Social services finally agreed that she was at risk at home.

Mother was always a difficult person and my brother who lived just 3 miles from her, called with her every few weeks, read the paper for a half hour and left.

All this is a long winded way of saying.... how can care in the home be monitored. And as in the case of my mother, it is not necessarily the carer being neglectful..... to what extent can they take the word of a patient suffering from dementia.

And at what point should the paid carer be reporting to the authorities their doubts that the home care is or is not working for the particular patient.

Visiting paid carers are in a position of trust and honour, families rely heavily on them.
Tell me how a visiting carer can be monitored.

Exactly Coolgran65. Almost impossible to monitor without using a hidden camera I would say.

My MIL was discharged from hospital (had a form of leukaemia) and cried all the way home. She had wanted to go to a care home and we had found one for her. The Doctor said she couldn't go to one as she was best living in her own flat. She dreaded living by herself even with us in to see her twice a day for several hours, doing all shopping and taking her out etc etc. She was so lonely we got a "care company" to provide someone to chat to her for a couple of hours a day while we were at work . Despite this she slumped into misery. Finally, she fell and had to be admitted to hospital. It was as though the old Gran had come back. She perked up and thoroughly enjoyed the comings and goings in the ward. She had been desperately lonely. She didn't want to stay in her own home. She wanted to live with other elderly people. The emphasis on "Care in the Community" was cruelty for poor old Gran. Please can you understand that just because its politically correct to promote the "care at home" lobby its not right for everyone.

The reality is that the CQC cannot do its job adequately. I have witnessed this in two capacities: as a social worker in adult care and a child of parents who needed care.

When seeking care for my parents I visited homes that would make your hair stand on end - not places you would dream of placing anyone you cared about - but they all had decent CQC reports or we should not have visited in the first place.

Here were some of the things I saw/heard:

- residents with dementia in a home with narrow internal unlit corridors feeling their way round the walls in the pitch dark, totally lost.
- a tiny unsafe dark room up a narrow staircase with soiled (faeces) towels lying in full view on the floor. This room was unoccupied and the staff happily shpwed it to us with no indication that they were unhappy about the towels being there.
- staff who just wandered into people's rooms without knocking.
- rooms where the call bell was switched off for the convenience of staff during meetings.
- staff speaking to residents inappropriately - "He's been a good boy today and had his bowels open" - this to my father in the middle of a lounge full of people.
- a matron who told me it was a great shame they were no longer allowed to strap people into their beds.
- people in pain ignored.

I could go on and on....it is heartbreaking.

And, I repeat, these were homes with good CQC inspection reports.
The system is a nonsense.

I Just haven't seen care in the community work in any positive fashion. Sufferers, patients and families are overwhelmed and stressed.

And don't start me on care in the ommunity for the elderly with other health issues. Vulnerable and living in the community, especially if there is no close family available or indeed willing to help leaves the way open for the unscrupulous to take advantage. And I'm including the general public.

I'm one of many people who could not see how Care in the Community could ever work unless limitless resources were available for the then foreseeable future.

IMO it has failed far, far more vulnerable people than it has helped, and will continue to do so as the pressures build on statutory agencies to keep people in their own homes and care settings.

I dread becoming dependent on others if services remain as they are today.

32 years ago I was a whistleblower when I worked in a care home. The result? There was apparently no where else the vulnerable residents could go, I was ostracised and left, and guess what, nothing else happened.

I have little confidence that things will change despite the harrowing stories hitting the press.
It's all very, very sad and frightening.

Shocking and very sad Mishap One of the reasons I hope my Grandma can stay in her own home as long as possible is that the local authority care homes in our town do not have a very good reputation.

To walk into a roomful of elderly people and hear one of them begging to go to the toilet is heartbreaking. The lady was my auntie, told by the so called carer that it wasn't toilet time and that's why she'd got a pad on 'so wee in that'.....That was my first experience of a supposedly 'excellent' care home. In the three weeks that she was there the toilet policy in that home had made her incontinent.
She was moved quite quickly into another so called excellent establishment, and at first it was. Changes of ownership altered policies and not always for the better.
The care and carers were patchy and I saw some awful abuse passed off as teasing. Not in my opinion. I did report one particular male carer and he did leave, I like to think I may have had a hand in it.
I always made a point of visiting at random times, so the staff never quite knew if, or when I was visiting as I always had one day off in the week but never the same day.
After one visit by CQC which coincided with reports in the media that elderly people in care were suffering from dehydration a recommendation was made that a jug of juice should be made available to the residents. This was duly implemented and a large jug of orange was duly placed in the lounge. You would have been thrilled Andrea, that your request had been carried out so swiftly, what might have passed you by however was that not one of those residents could access the said juice as not one of them was mobile. It sat there in all its glory wanted but never offered.
I have always thought that there should be a panel in each care home made up of relatives and friends of the residents, almost like a board of governors in a school, they could perhaps report to CQC maybe every three months or so. They could be your eyes and ears, they are the people on the ground and usually know just exactly what is going on.

I don't seem to have asked you any questions which was supposed to be the point of the exercise, just general observations.
Just one more thing, I think you should amend your question 'is this care good enough for my mum' to .....'will this care be as good as this for my mum in a months time when I' m not here in my official capacity'

Sometimes it can be all smoke and mirrors.

I just feel that over the years social services have made monumental blunders one after another, SW have done nothing but moan about how stressed they are, gone on endless training days, team meetings and awaydays, senior managers have been paid a fortune, care has become more and more expensive and less and less effective. Care of the elderly needs to be given back to NHS Community Services and managed by clinically qualified professionals under one umbrella. I speak as one who worked in a combined H & SC unit- the nurses got on with their jobs had low sickness rates and high commitment and the SWs bellyached constantly about how stressed they were had high sickness rates and blew the budget and had to be baled out budget- the nurses had to keep to budget there was no bale out available..

I agree Teetime, my experience too.
A Council recently got rid of a whole tier of management and it was pointed out that between the lowest tier and the top there were still 8 grades of managers!

I think it is interesting that none of the contributors here are asking direct questions, but simply highlighting how awful the system is from bitter experience.

Here is a direct question:

CQC are you listening?

And another:

How is it that these dreadful homes get good inspection reports?

gillybob - there are good homes; there is just no way of telling which is which by looking at the CQC reports.

I'll add a question here. How much of an care home inspection is more than a paper based exercise? When I was a Nursing Homes Inspector under the old Act we looked in people beds, their wardrobes, tasted the food, went through the laundry, looked at the accounts, audited the care plans e.g. if it said someone had a bath we asked them ' when did you last have a bath' etc etc. my colleagues in SS when we did joint inspections did no such thing but sat in the office looking at paperwork like policies and procedures said they weren't supposed to 'intrude'.

Oh dear you don't like Social Workers very much do you Teetime?

Even as an ex-SW I do understand Teetime's frustration. The rules and regulations that they have to follow are not helpful, and tend to place the greatest emphasis on policies and procedures. That is the nub of the problem. You need people with nouse, imagination and compassion to do these inspections, with the freedom to be flexible rather than just box tick.

I vividly remember that one of the best local homes for people with dementia was closed down because the owner was a bit haphazard with her paper work and her approach to the residents was a bit off piste. Every resident that I ever knew there was happy, well-looked after and respected. Each person was involved in how the home was run, and were to be found washing up, digging up the garden etc, and basically feeling they had a role - everything they did had to be done again of course, but that was not the point. And if they had a fancy for fish and chips in newspaper, the set menu would be abandoned and anyone who was fit enough would hop in the minibus and go to the chippy with the staff - they loved it! Unfortunately the inspectors wanted efficiency rather than imagination.

Don't even start me on social workers. I am another one who does not have a question. I am still traumatised after trying to do my best to look after my mother when she had Alzheimers and that was over seven years ago. The social workers were a nightmare.

The only person who helped me was an EMI nurse who was sent by the doctor to help my mum. He wasn't able to do much for her but kept me going until I finally had to admit defeat and sell her house to pay the home fees.

Lip service seems to be paid to carers but they really need more help. I have no confidence that this will happen.

Mishap. I have just read your post. it sounds as though it was a lovely home. What a pity.

And I used to be a SW Liz!!! - and in spite of that, I understood the value of that home and fought tooth and nail to keep it open.

All I can tell you is that all the SWs I worked with were indescribably frustrated with the change in their role from someone who might be useful to the community to financial gatekeepers, form fillers and box tickers. This was why I resigned and sought a new career; but believe me it hurt to turn my back on what had felt like a vocation.

I have no doubt that current SWs are equally frustrated; and this probably includes homes inspectors.

Having said that I too have of course met some who were not up to the job.

I know exactly what you mean Juliette I had a similar experience with my grandma but this was a carer in her own home telling her that she "had a pad in and so she should use it". Grandma was absolutely distraught as wanted to be helped to the toilet. She is not incontinent but is very unsteady on her feet some times. I ended up making a complaint to the company and she is now helped to the toilet (I don't think I am popular with the care providers). I wonder how these people would feel to lose the last bit of dignity they have?

My dad is moving to an extra care facility this next week so I do hope that it is a nice place for him. He went for a look round on Tuesday but, as I am going to see him later today to start packing and the facility is only a stone's throw away, I am taking him back so that I can see it too and to show them that he does have someone in the family who is concerned for his welfare. I think it will do them good to know this.

I have had experience in this field as I nursed on a geriatric ward where patients were rushed out of bed, washed, breakfasted and put in a chair in the day room so that the staff could sit around in the office and chat. The patients then sat looking at each other until drinks/food/toileting happened. It was awful and I used to go off and talk to them, get told off off staff but I didn't care. The patients came first for me.

I then worked in a nursing home where a similar thing happened. Or they were left in bed and on their own apart from at meal times. I was asked to do my carer training but refused as I didn't want to be one of the people who got the patients out of bed, in a chair and then didn't do anything stimulating with them. I wouldn't be able to live with myself. My role was to make breakfasts for them all, feed the ones not able to feed themselves and then go on to do all their laundry and put it away etc. It was a good job as I could chat to the ladies and gents as I did my work.

I then went on to be a personal assistant to a disabled lady in her 20's. I wouldn't dream of leaving her in any sort of mess and would occasionally be called on out of hours to attend to her needs and go willingly. To not be able to get out of a wheelchair at 25 years old is awful (although she had been in a wheelchair from much earlier) and I looked after her like she was my own.

Reading all the above posts makes me shudder. My Mother is 86 this year and not yet ready for care. However, I know she is living on borrowed time and that one day I may have to face up to the question of 'care'. My question is, what confidence can I have in the CQC after reading all these posts about its failings? How can anyone trust the care of their beloved relatives to the people in these 'care' homes? I think they should be re-named SCARE homes because it seems that is what they all are.