People often not at the centre of their own care, says CQC as it publishes reports from its review of services for people with learning disabilities

The Care Quality Commission (CQC) today publishes a further 20 reports from a targeted programme of 150 unannounced inspections of hospitals and care homes that care for people with learning disabilities.

The programme is looking at whether people experience safe and appropriate care, treatment and support and whether they are protected from abuse. A national report into the findings of the programme will be published in the Spring.

An area of concern to emerge from an initial analysis of the first 40 reports is that many services are failing to provide patient-centred care – that is, care that is based on the individual needs of people using the services.

Bernadette Hanney, National project lead for the learning disability review said: “People must be placed at the centre of their care. We have found that too often people are not involved in the development of their care plans. And often those care plans lack detail about the person’s preferences, which can have an adverse impact on the quality of care provided.

“Our inspection teams have found that often people don’t get enough activities. A varied range of activities that people enjoy and that meet their needs promotes and supports independence and is vital to the well being of people using the services. In some cases we have found there have not been enough staff to deliver activities that have been planned.”

The 20 inspections covered locations that provided a range of services including assessment and treatment, rehabilitation and longer term care.

Inspections were focused on two outcomes relating to the government’s essential standards of quality and safety: the care and welfare of people who use services, and safeguarding people who use services from abuse.

One location, Beech House in Newmarket, run by Four Seasons (Granby One Ltd) was found to have major concerns with both outcomes. Because of the seriousness of our concerns about the care and welfare of people using the service, we served a warning notice on the provider. We have been back to inspect again and found that Beech House is now compliant.

A lack of patient-centred care featured among our concerns at Beech House. For example, we reviewed five care plans during the inspection and found they were disorganised and difficult to locate. Care plans were not person-centred and the terminology reflected what staff would do for the patient rather than focussing on the patient’s desires, wishes and choices.

We also found major concerns in relation to the care and welfare of people using the service at North Lodge (Calderstones Partnership NHS Foundation Trust) and Langdon Hospital (Owen House) (Devon Partnership NHS Trust).

At North Lodge, while some areas of the care records were person-centred and involved people in their care, other care records were inaccessible to people. Restrictive and institutional rules and practices did not promote person-centred care and affected how fully people were involved in planning their daily lives.

And at Langdon Hospital (Owen House) evidence showed that some care plans were not person centred, were not written in plain English and in the majority of cases did not identify a goal. We found no evidence of patient involvement in developing the care plans and found nine instances where care plans had not been reviewed in 12 months.

Overall, of the 20 locations inspected:

• one location had major concerns with both outcomes, two locations had one major and one moderate concern, and five locations had moderate concerns with both outcomes

Specifically for outcome 4 (care and welfare):

• four locations were compliant, three had major concerns, eight had moderate comcerns

Specifically for outcome 7 (safeguarding):

• seven locations were compliant, one had a major concern, eight had moderate concerns.

Thirteen locations were from the NHS and seven from independent healthcare.

CQC inspectors were joined by ‘experts by experience’ – people who have first hand experience of care or as a family carer and who can provide the patient or carer perspective as well as professional experts in our learning disability inspections.

Where inspectors identified concerns, they raised these immediately with the providers and managers of services.

All the services where concerns are identified must tell the CQC how and when they will improve. Those failing to meet essential standards could face enforcement action by the regulator if improvements are not made.

The national report will be based on the findings from all the 150 inspections and will make conclusions about the overall state of this type of service.

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Notes to editors

For media enquires call the CQC press office on 0207 448 9401

The reports will be published on CQC’s website on Wednesday 8 February at www.cqc.org.uk/LDreports3

The reports published today are for the following providers and locations. The table shows our findings in relation to the two outcomes we focussed on, but some reports also show concerns in respect of other outcomes.

Provider name	Organisation Name	Findings	Region
Coventryand Warwickshire Partnership NHST	Brooklands	2 Moderate	West Midlands
Calderstones Partnership NHSFT	North Lodge	1 Major 1 Moderate	North West
Calderstones Partnership NHSFT	Gisburne Lodge	2 Moderate	North West
CumbriaPartnership NHSFT	Carleton Clinic (Edenwood)	1 Moderate 1 Minor	North West
DevonPartnership NHST	LangdonHospital(Owen House)	1 Major 1 Moderate	South West
MerseyCare NHST	MossleyHill Hospital	Compliant	North West
Modus care Ltd	Penhayes	1 Moderate	South West
Acorn care Ltd	The Woodhouse Independent Hospital	1 Moderate 1 Minor	West Midlands
Mild Professional Homes Ltd	Bostall House	2 Minor	London
Four Seasons (Granby One Ltd)	Hungate Lodge	2 Minor	East
Calderstones Partnership NHSFT	Calderstones (Main Site)	2 Minor	North West
Devonpartnership NHST	WhiptonHospital(Knightshayes)	2 Moderate	South West
Four seasons (Granby One Ltd)	Rowan House	2 Moderate	East
Equilibrium healthcare	BigfootIndependent Hospital	Compliant	North West
Four Seasons (Granby One Ltd)	Beech House	2 Major	East
Avonand Wiltshire NHST	Lansdowne House/Blackberry Hill	2 Moderate	South West
Tees, Esk and Wear Valley NHSFT	Bankfields Court	Compliant	North East
SheffieldHealth and Social Care NHSFT	Northern General Hospital-Assessment & Treatment Unit	Compliant	Yorkshire & Humberside
Black Countrypartnership NHSFT	Pond Lane	1 Moderate	West Midlands
LincolnshirePartnership NHSFT	Long Leys Road	1 Minor	East Midlands

Inspection teams are making unannounced visits to 150 services. More than 100 are NHS and independent services that provide services such as assessment and treatment, rehabilitation and longer term care. The others are adult social care locations.

They are checking two outcomes:

• Outcome 4 Care and welfare
• Outcome 7 Safeguarding adults from abuse.

But where our inspectors find problems with other outcomes, they will report on these.

Our inspection teams are led by CQC inspectors joined by two ‘experts by experience’ - people who have experience of using services, either first hand or as a family carer and who can provide the patient perspective and a professional advisor.

CQC set up an advisory group to help it plan the programme. CQC’s Chair, Dame Jo Williams, chairs the group. The members come from a range of voluntary, charitable and other organisations that work with or represent people with learning disabilities and their families.

The learning disability inspection programme was launched in response to the abuse revealed by undercover filming by the BBC Panorama programme. CQC apologised for failing to respond to warnings of abuse at Winterbourne View. Matters concerning Winterbourne view are the subject of serious case review.

 

 

Further information

There is information on CQC’s web site about how to share concerns and complaints about a social care service, a council, independent healthcare services, the NHS or CQC. http://www.cqc.org.uk/contactus/howtoraiseaconcernorcomplaint.cfm

People can telephone concerns to CQC on 03000 616161

The Challenging Behaviour Foundation has provided this list of organisations providing independent support to families with disabled relatives

Support for families

Families provide long term love, care and support for their disabled relatives, and speak up for them. Even when people leave home, they do not leave the family. Families continue to offer a lifetime of involvement and support, and know a great deal about their relative’s needs and wishes, likes and dislikes.

When the services and support for a relative go wrong it can be very difficult for families to deal with. They may be faced with a barrage of information and decisions to take, as well as coming to terms with what has happened. It is important that families know where they can get impartial information, and find out what support is available to them. There is a list below of organisations which you may find useful.

It is important to note that family carers must be consulted and involved in key decisions about the care and support of a relative who is unable to make these decisions (unless you have specifically asked not to be involved). There is a proper legal process that must be followed, under the Mental Capacity Act 2005. For example, your relative cannot be moved to another service without involving you, and others who know your relative well, in the decision-making process. For more information about this, see “Making Decisions: A guide for family, friends and other unpaid carers” Copies available by phoning 0300 456 0300 or download here.

Organisations providing independent support

Ann Craft Trust

Provides advice to anyone who has a query about the protection of vulnerable children and adults, including professionals, parents, carers and family members.

Telephone: 0115 9515400 (Mon-Thurs 9am-5pm, Fri 9am – 4.30pm)

Email: ann-craft-trust@nottingham.ac.uk

The Challenging Behaviour Foundation

Provides telephone and email support from a Family Support Worker on challenging behaviour associated with severe learning disabilities and related issues.

Telephone: 0845 6027885

Email: info@thecbf.org.uk

Free information sheets and DVDs about good support for people who have a learning disability and behaviour described as challenging. www.challengingbehaviour.org.uk

Disability Law Service

Provides telephone or email advice on community care law. Free to disabled people and their family carers

Website: www.dls.org.uk

Telephone: 020 7791 9800

Email: advice@dls.org.uk

Mencap Learning Disability Helpline

Provides advice and information on all issues relevant to people with learning disabilities and their families in England, Wales & Northern Ireland.

England: Telephone: 0808 808 1111 Email: help@mencap.org.uk

Northern Ireland: Telephone: 0808 808 1111 Email: mencapni@mencap.org.uk

Wales: Telephone: 0808 808 1111 Email: information.wales@mencap.org.uk

National Autistic Society

If your relative has an Autistic Spectrum Condition you can contact the National Autistic Society which offers advice and information to people on the autism spectrum and their families: Mon-Fri, 10am – 4pm.

Website: www.autism.org.uk

Telephone: 0808 8004104

Email: autismhelpline@nas.org.uk

Hft Family Carer Support Service (FCSS)

Provides free information and support to all family carers of people with learning disabilities. For help or more information, write to FCSS at Hft, 5 – 6 Brook Office Park, Emersons Green, Bristol BS16 7FL or use details below.

Website: www.hft.org.uk/family_carer_support

Telephone: 0117 9061751

Email: familycarersupport@hft.org.uk

Respond

Works with children and adults with learning disabilities who have experienced abuse or trauma, as well as those who have abused others, through psychotherapy, advocacy, campaigning and other support. Respond also runs a free helpline. If you call outside opening hours leave a message and someone will get back to you.

Website: www.respond.org.uk/

Telephone: 0808 808 0700

Voice UK

A national charity supporting people with learning disabilities and other vulnerable people who have experienced crime or abuse. They have a helpline for carers, parents and professionals.

Telephone: 080 8802 8686 (Mon-Fri, 9am – 5pm)

Email: helpline@voiceuk.org.uk

Other useful contacts

Samaritans

Confidential emotional support 24 hours a day, 7 days a week to those experiencing despair, distress or suicidal feelings.

Telephone: 08457 909090

Email: jo@samaritans.org