One in four care homes failing to meet standards - but are inspections too tough?

Care homes

Care homes

Tougher inspections of care homes have led to high numbers in the region being labelled as inadequate. But are many of our elderly enduring unacceptable standards? Investigations editor David Powles reports.

Thousands of the region's frail and elderly are living in care homes deemed to be failing to meet acceptable standards, an investigation can reveal.

Since a new inspection regime of care homes was launched in November 2014, four out of ten in Norfolk and Suffolk and three out of ten in Cambridgeshire have been classed as not good enough.

However, today those working in the sector claimed the Care Quality Commission (CQC), which conducts the inspections, was unfairly tough and that the majority of homes were providing good quality care.

But an in-depth analysis of the reports has found many of the same themes regularly highlighted by inspectors, such as lack of staff, poor training, high-turnover rates, the elderly going long periods unattended and failures to properly assess people's risks.

Dorrington House, Dereham. Pictured are owners Steve and Lorraine Dorrington. Picture: Ian Burt

Dorrington House, Dereham. Pictured are owners Steve and Lorraine Dorrington. Picture: Ian Burt - Credit: Ian Burt

In one newly published report, a Norfolk care home was found to be so under-staffed residents were being made to get up from as early as 3am, so they were all awake by the time the next shift started. It also reported claims elderly were being locked in their rooms.

The majority of homes inspected under the new regime so far, which includes residential and those which provide specialist nursing care, were found to be caring or responsive, just over half were classed as being well-led.

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Our two-day special report also reveals concerns about the sector's future financial viability as it struggles to cope with an increasingly elderly population, the introduction of the National Living Wage and local authority spending cuts.

Norfolk County Council, which places around 3,600 people in 370 residential and nursing care homes, says its policy is to ensure people can stay in their homes as long as possible, but social care campaigners say they fear this decision has been taken to save money and means some elderly don't receive enough regular care.

Alex Stewart, of Healthwatch Norfolk.

Alex Stewart, of Healthwatch Norfolk. - Credit: Archant

We analysed the results and reports from more than 300 inspections carried out since the end of 2014 in Norfolk, Suffolk and Cambridgeshire. Many homes are yet to receive a visit as part of the new inspections.

Each home is given an overall rating of either outstanding, good, requires improvement or inadequate.

In Norfolk, 55 of the 138 homes inspected (40%) were found to requires improvement and four inadequate (3%). Some 79 were good (57%) but none outstanding.

In Suffolk, 118 inspections have taken place so far, 1% outstanding, 59% good, 34% requires improvement and 6% inadequate. For Cambridgeshire, 98 homes have been inspected, 1% outstanding, 70% good, 26% requires improvement and 3% inadequate.

The Lodge Care Home on Watton Road in Ashill. Picture: Matthew Usher.

The Lodge Care Home on Watton Road in Ashill. Picture: Matthew Usher.

Each provider is rated in five key areas and in Norfolk they were more likely to be rated outstanding or good for being caring (81%) or responsive (67%) and less likely for being safe (62%), well-led (57%) or effective (56%).

Steve Dorrington, who owns three homes in Dereham, Wells and Watton, saw one of them go from being rated inadequate to good in a matter of a few months last year and denied it was because standards were unacceptable.

He said: 'The CQC were accused of being soft but they have gone from one extreme to another and I'd question whether they are fit for purpose themselves. They don't focus on any of the positives and if they find one thing wrong, it knocks everything down.'

He also questioned the scale of the rates paid by public bodies to private homes for placing people in residential care, which he claims puts financial pressure on homes.

Norfolk County Council, said any homes classed as not meeting standards was 'a concern', but that only a third in Norfolk had been inspected so far and the CQC had been concentrating on those flagged up as a potential problem.

A spokeswoman added: 'The position in Norfolk reflects the national position, slightly better for nursing homes and slightly worse for residential care homes.

'The CQC and the council both expect high standards from Norfolk's care sector and we have some very good care homes in Norfolk. However, where providers are found to be falling short of those expectations, we offer support to the provider to ensure swift action is taken but also support to residents and their relatives to check they are satisfied with the service they are receiving.'

A recent report to the council's Adult Social Care Committee on its own risk evaluation approach reveals that it suspended placements of adults in homes on 18 occasions between July 2015 and October 15 due to safety concerns. It also revealed six care homes have closed in the past year and others have stopped offering nursing care due to recruitment problems.

Rebecca Hopfensperger, who is responsible for adult care at Suffolk County Council, highlighted the increasing numbers of care homes rated 'good' in Suffolk, which she said had risen by 15 to 73 since October 2015.

'The council remains vigilant about the standard of care provided in care homes and continues to intervene to provide support and guidance to homes that are not meeting the expected standard,' she added.

Alex Stewart, chief executive of Healthwatch Norfolk, said the quality of care in homes across the county was in general high and the watchdog did not receive many complaints about the sector.

However, he added: 'A poor rating does not always mean the care they are receiving is not excellent. We do see some issues relating to the skills of staff and that probably comes down to the fact care homes are not cheap places to run.

'That said, if someone chooses to run a home, they must make sure they have the necessary staff, with the necessary training.'

Healthwatch Norfolk published a report last year which raised concerns about a shortfall in Norfolk and Waveney of specialist dementia services, meaning any families complained of struggling to find long-term residential care for a loved one.

The CQC itself raised concerns about the state of health care and adult social care in England for its 2014/15 State of Care report.

It concluded: 'The adult social care sector is under pressure and there are issues around the sustainability of provision due to the increasing complexity of people's care needs, significant cuts to local authority budgets, increasing costs, high vacancy rates and pressures from local commissioners to keep fees as low as possible.'

It did find, however, that 60% of services were providing good or outstanding care.

It found providers struggle to recruit staff and that turnover can be as high as 11% for nurses in residential care. Meanwhile, the number of adults receiving local authority-funded social care services fell from a high of around 1.8m in 2008/09 to just over 1.2m in 2013/14, placing further pressure on those who run homes.

A 2015 report by Community Care found residential staff were missing out on vital training in dementia care, safeguarding and the Mental Capacity Act.

Meanwhile, a November report by the think tank ResPublica, in partnership with Four Seasons Health Care, HC-One and GMB, described Britain's residential care sector as being 'in crisis'.

It said providers were being faced with a combination of declining funding, rising demand for their services and increasing financial liabilities.

We sent a series of questions to the CQC, but they did not respond.

•Tomorrow: What's it like to run a care home? And what does the future hold?

•Are you prepared to share your experience of care home provision in Norfolk or Suffolk? Email David Powles on david.powles@archant.co.uk

HOW TO CHOSE THE RIGHT HOME

Deciding whether you or a loved one should go into a care home and then working out what you need to do can be one of the most stressful periods in life.

There are two main types of care home. Some offer accommodation and help with personal care – activities such as washing, dressing and going to the toilet and others also provide nursing care. There are also some specialist homes for those who require extra care and support, often due to dementia.

Often the first thing to do is work out how to cover the costs and most people can expect to pay something. If the local authority is involved in arranging a placement, the amount that person will have to pay will be worked out via a means test, which is based on nationally set guidelines.

Your local authority will carry out a care needs assessment to identify what help may be needed. Then they will carry out a means test to work out how much you have to pay towards the fees.

Currently, if you have assets of more than £23,250, you will need to pay the full cost of your care. Your home won't be included in this if a partner or close relative still lives there.

When it comes to choosing the right home, Professor Martin Green, of Care England, had this advice for families: 'I would start by looking at the CQC report and try to find out if you can speak to anyone else who had a relative their. Visit the care home at different times of the day so you can get a feel for what it is like.

'Think about the needs and interests of your relative and make sure it's suitable. If they like to be out in the garden, make sure it has a garden.

'All too often people don't tend to start thinking about it until they are in a crisis and their loved one is in a hospital, that can pressurise people to make the wrong choices. I would encourage people to start thinking about it as early as possible.'

•More information is available at www.ageuk.org.uk/home-and-care/care-homes

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