Real inspection cases

In August 2011, our inspectors visited a care home in the South West which cares for 40 older people, some of whom need nursing as well as personal care. We found concerns with eight of the 16 government standards and in four of these cases our concerns were serious enough for us to issue warning notices.

In February this year, our inspectors returned to the care home to check what kind of action the care home management had taken in response to our warnings and concerns. We spoke to the people in the home, to their relatives visiting them and to staff at the home, not only the nursing and care staff but to laundry, kitchen staff and the cook.

Last summer our inspectors found that people in the home were not being treated with dignity and respect and there were failings over their care and welfare. Serious concerns included communal use of laundered continence underwear, lack of privacy in toileting, the use of a hoist in the living room to relieve pressure, no choice of activity offered to people in the home and failure to knock before entering bedrooms.

One resident complained of the lack of activity and respect for her individual needs: "There is nothing to do here," she said, "I was asked if I’d like to make a pom-pom."

Our inspectors issued a warning notice to the home relating to this outcome, demanding an action plan to make improvements. A similar warning notice related to the poor level of food and drink provided and a third demanded repairs to the inadequate bathing facilities at the home where some of the rooms had no running hot water. The final warning notice we issued mandated improvements in record-keeping.

Further concerns related to insufficient staff to meet peoples’ needs, to the management of medicines and the monitoring on a continual basis of the quality of service provided.

When our inspectors returned four months later, we found that fair progress was being made in overcoming the home’s failings. A new acting manager was in post and additional staff had been recruited.

Our inspectors spoke again with people in the home to understand their experience of being treated with dignity and recorded their views in the report such as "Staff knock and wait more than they used to". The laundry and the kitchen staff now follow new rules of hygiene and meet nutritional needs and keep meticulous records on the personal care and nutritional needs of the people in the home.

New hoist equipment and hot water to rooms is now in place although our inspectors noted that there are still inadequate bathing facilities. There is still room for improvement too in how the care home will audit the quality of the service it provides to people on a continuous basis although the acting manager was able to share with us her plans for doing so.

We have informed the home that they are still required to respond to us with an action plan to make sure they are fully compliant. Our inspectors will return to the home this spring to report on the home’s further progress with meeting all government standards.

In November last year CQC carried out a routine inspection of a care home in the East Midlands which cared for 20 adults, many of whom had severe learning disabilities. The date coincided with the day that a new registered provider, a large care home group, took over responsibility for the delivery of the service.

Our inspector, Lyn, was accompanied by a second inspector and two Experts by experience, members of the public who support CQC’s inspections and experience of using or caring for someone who uses care services.

They found evidence to show that people were not being cared for according to the government standards of quality and safety. Residents were not being treated with respect or involved in discussions about their care.

Our inspector and Experts by experience noted that some people were left sitting on the floor in a corridor, were improperly dressed and without shoes. No choice of the day’s activities was offered and staff did not attempt to communicate with people using the service, using methods designed for people who cannot use verbal communication. Lyn found no record to suggest that staff had been properly trained to do so.

Lyn observed two serious incidents where staff failed to protect people or restrained them inappropriately during her first inspection visit. We found major concerns with four government standards.

We took action immediately to safeguard the people using the service, working jointly with the new manager, the city council concerned and the primary care trust (PCT). The new manager shared our concerns and was very keen to work with us and with the City Council to address the home’s serious failings. It was clear that the previous manager had failed to notify CQC of serious incidents, a legal requirement for all care providers, and had not made safeguarding referrals about vulnerable adults to the council as required.

As a result of our findings the new provider applied to voluntarily cancel the registration of the care home.

We monitored the service on a daily basis whilst people using the service were found more suitable accommodation. By 18 November 2011, two weeks after the initial inspection, all service users had moved and the home was empty. Our final report was published on our website in December 2011, showing major concerns over 4 essential standards.

After the closure

Our compliance inspectors for the region continue to monitor the care and welfare of the residents after they moved to new placements.

One lady in particular, who was formerly kept strapped into a lockable basic wheelchair and did not communicate at all with us during the inspections at the home, is now verbalising happily with staff at her new placement; equipped with a state of the art wheelchair, she is making choices about her care and what she does each day. She has access to physiotherapists and other consultants who are taking every care to make sure she enjoys as much independence as she possibly can.

All providers of health or adult social care in England must, by law, be registered with us. If they are not registered, they may not lawfully carry out services. Often it is members of the public who can alert us directly or indirectly about providers who are practicing regulated services without being registered with us.

In this case, a member of the public at first alerted the police when she discovered a private health practice was carrying out cosmetic surgery without being registered with us. In turn, the police contacted us.

We went to the address in question and discovered a shop which sold health remedies at the front with a room at the back which was kept locked when we arrived unannounced to inspect the premises.

When the door was eventually opened to us, we discovered that it was a privately-run surgery where a doctor was carrying out liposuction on patients. Liposuction is a surgical procedure and is a regulated service, meaning those providers carrying it out must be registered with us. Neither the doctor nor the location where he carried out the service were registered and so people using the service were at risk.

We referred the doctor to the General Medical Council (GMC).  The GMC took swift action and ruled that the doctor was not allowed to carry out cosmetic surgical work, nor accept a new post without GMC approval.

One of our inspectors then interviewed the doctor under caution and we prosecuted him for carrying out regulated services without being registered with us. We engaged an expert witness for the prosecution, a cosmetic surgery professional. The court imposed a fine and the practice closed.