Recently RedRoyal was asked to assist a Registered Care Home in Norfolk, on arrival we could see that the communal areas were dirty and there was a distinct lack of organisation. Staff, if trained at all, were very poor at care provision and were poorly led. This lead to a lack of consistency and neglect of customers who were visibly sitting in soiled clothing and actively discouraged from moving and walking themselves. Often a resident would ask to go for a walk or, to the toilet as they need assistance to get up from the chair. The response was often “wait there a minute we are busy”. And this was a fairly standard response; the minute could and usually would in fact be considerably longer. Regulation 10 – Dignity and Respect. Regulation 18 – Staffing.
Much of the issue was apparently due to the staff shortages that the Service Provider was experiencing. I say apparently because this was the reason that most people would give for any and all of the poor standards, and the neglect and safeguarding concerns that were raised. Yet it was very clear to see that leadership and support was inadequate. Regulation 12 – Safe Care and Treatment.
Training was conducted sporadically and was of a very poor quality, some staff members had not been trained in many of the important areas after having being employed there for more than a year. One example of this was Moving and Handling training, one member of their night staff who was involved with transfers by hoist on every shift that she had worked there for more than twelve months and had not been trained to use the equipments correctly. This had led to examples where a single member of staff would hoist a customer with no assistance, often the same sling was being used for all the hoisting with no consideration to the difference in size, shape or weight of their customer. A new member of staff working nights with no care experience was inducted by shadowing another team member on the night shift. No training was given at all! Unfortunately by shadowing another team member the bad habits were being passed on as the’norm’. Regulation 12 – Safe Care and Treatment. Regulation 17 – Good Governance.
Another example of poor practice during hoisting would be the practice, adopted by the majority of their staff during the hoisting of an individual, while dangling in the hoist, their customers would endure some rough handling while their trousers or skirt would be jerked down to enable the less than caring care worker access to continence pads. It is no exaggeration when I say clothing would be jerked down as you can imagine the weight of customer against the sling would very often be holding the garment firmly in place. There was no thought for dignity or respect during this and staff would disregard customers when they would should “oh stop it”.
One poor soul who often resisted personal care and preferred not to be moved, either by standing to walk with assistance using a frame or simply moving from her bed to her chair in her own room suffered further as a result. Often this lady would be left in her bed, this would mean that she would often suffer from dehydration or malnutrition issues as a result. As shocking as this was, it resulted from being understaffed and those on shift would feel that they could not give enough time to ensure the lady consumed her food and drink. In addition this lady was then subjected to being hoisted, simply because staff wished to avoid the challenges due to her resistance to standing. With no assessment in place the lady did not have her own sling. Regulation 10 – Dignity and Respect. Regulation 12 – Safe Care and Treatment. Regulation 14 – Meeting nutritional and hydration needs
Records were generally maintained, and often the cases were completed by one person for all the customers. Clearly the person completing the records would not have dealt with all the customers and therefore the records were inaccurate and at times misleading.
None of the Care Assistants had knowledge of the Care Plan content! When asked about the diagnosis of one customer an experienced Care Assistant told me Mental Health, no mention of the diagnosis. Another Care Assistant told me Dementia, and a third said Learning Difficulties. Without such basic knowledge how on earth can care needs be met? None of the Care Assistants were aware of any Behavioural Programmes, and indeed risks were also largely unknown.
Infection Control was not apparent! Generally speaking the concession towards Infection Control was that staff would wear gloves and soiled laundry would be placed in sealed bags. That’s a start! Unfortunately that really was it. Care Workers would administer personal care in the customer’s room; the soiled items generally would be thrown to the floor to be moved when the Personal Care was completed. The soiled items would then be carried by the glove wearing Care Assistant to the storage bins. Soiled pads would be placed in clinical waste bins; soiled laundry would then be placed in sealed bags and placed in the appropriate storage bins. Of course waste could be dripped across floors; gloves would contaminate door handles, wheelchairs and hoists which were not subjected to any cleaning. In fact one of the slings was guilty of an extremely offensive odour. Regulation 9 – Person Centred Care. Regulation 10 – Dignity and Respect. Regulation 12 – Safe Care and Treatment. Regulation 17 – Good Governance.
Whistle blowing had become common place, and quite rightly so. Unfortunately the Management instructed staff to inform them directly of issues first. A member of staff raised concerns regarding medications some weeks later. Tablets had been found on a regular basis down the side of chairs and on the floor during cleaning. The Service Manager, while discussing the concerns informed all his Senior staff which staff member had raised the concerns, as the medication was administered by Seniors the staff member was subjected to bullying as a result. Regulation 12 – Safe Care and Treatment. Regulation 17 – Good Governance.
The above are just some of the concerns that we raised, as you can clearly see there were many areas of the service that were in desperate need of improvement. A standard quality Assurance Audit or Mock CQC Inspection can be a very positive tool to raise and maintain standards of Care within a service. RedRoyal Consultancy Ltd strives to raise the bar to ensure quality Care is delivered which in turn has a very positive impact on daily lives by providing a detailed action plan and support with each audit provided. Why be less when you can be Outstanding!