Mum's care home deemed 'Inadequate' on ALL fronts by CQC

[statinisland]

I've written about my Mum's care before. I just checked it was over 5 years ago!!www.mumsnet.com/Talk/elderly_parents/1960118-Stuff-going-missing-in-carehome?pg=2

We kept her in the home. Her money ran out ages ago. My sister has been dealing with it all in the main as I am still in another country, over 300 miles away. There have been ups and downs and of course she's grown older. She's now 92, doubly incontinent, blind (a 'new' discovery), frail and has dementia. She sleeps a lot and can be totally unresponsive when you visit or have the very occasional moment when she sings and talks about Dad as if he is still around but these are rare and never happen when I visit.

Upshot is she got admitted to hospital with high blood sugar and dehydration (she's Type 2). We thought it was her time to go as she was unresponsive too. She's now been in hospital for a week and has improved remarkably with some great nursing care. For one moment I thought they might put her on the Liverpool Care Path but they are treating her and she is having fluids and nutrition. She's responsive in the sense she acknowledges that she knows there are visitors but it's been a long time now since she enjoyed anything like music, audio books, sitting in the garden etc.

We wondered whether she hadn't been given enough fluids at the home or had been neglected. The home has been a bit hit and miss - some lovely staff and my Mum is longest serving resident and isn't as bad in terms of her dementia as most of the other residents. It's had a change of management a couple of times; a few tart ups in terms of decor and increased activities. My sister has complained to the Care Commission a few times about things that have happened and issues.

This week their report came out on the home (after an unannounced visit last Summer). For every area it has received an 'Inadequate' rating. They visited EIGHT months ago and have sat on that news.

We don't want her going back there.

She has only recently started qualifying for 'nursing' care. So now we are trying to find somewhere that will take her. I suppose I am asking on here for advice or to just share experience. We are basically looking to send her somewhere that will nurse her kindly and look after her till she reaches the end of her life. We don't want her put in a room and left to die. We want her medication to be administered, people to talk to her, care for her...

What are our chances of finding anywhere that will take her? We don't have funds to pay for private care. It'll be down to the council ( a very large city in England). Will we realistically have much choice in the matter? Other than refusing to let her go back to her existing home?

[wigglypiggly]

Do either of you have power of attorney. Sorry to hear the home is poor. Your sister can ask for a meeting with the hospital social worker and the discharge team to say you dont want her to go back there for the reasons you've given us. The home may be acting on the cqc's report, you wouldn't know unless you spoke to the cqc's or they have a follow up visit. You can ask the hospital to help you raise a Cause For Concern about her care if you feel she was neglected and the home is not safe for her. The Liverpool Care Pathway does not exist any more.

[statinisland]

Thanks Wiggly. Will check that a Cause for Concern has been raised. I know my sister has said in effect that she has concerns and doesn't want her going back there but whether that's been formalised I don't know.

With regards to the Home doing stuff. It seems they had a 'Requires Improvement' report in 2017 and this was a return unannounced visit to check improvements had been made. They hadn't and they spotted even more 'Inadequate' areas. Record keeping, medicine management, care are all areas of weakness so we won't know whether they cocked up her medication or neglected to make sure she was having adequate fluids because they obviously are a bit of a shower when it comes to that. She's had quite a few UTIs which I know is common but it makes us wonder.

It would be simpler for all involved if she just went back to where she was - bluntly she isn't going to suddenly improve drastically just because she's somewhere different. But if we just know that there is a more vigilant, efficient CARING system in place we would rest happier and Mum would have some dignity.

I thought the Liverpool Pathway had been stopped but I still worry that it goes on 'unofficially' in a busy hospital with conflicting priorities. Latest report is that she's had cereal for breakfast, her blood sugar has come down because they've been giving her insulin and she said hello to my brother. They are still giving her stuff like jelly and ice cream though but maybe they think life is too short to deprive her at this ripe old age - seems a bit odd though to administer insulin on one hand and feed jelly and ice cream on the other but hey ho!

I sense she won't be with us much longer and we just want to know that we've done our best for her,

[wigglypiggly]

She may only be on insulin short term to get her blood sugars stable, I would ask to speak to the doctor and the diabetic nurse specialist to have a plan if she goes back to the home, you don't want her to get insulin with no food or drinks and many homes don't monitor blood sugars or keep accurate food and fluid charts. If you're really unhappy with her going back there do tell the hospital, bad carehomes don't deserve to stay open if they haven't made improvements after inspections, otherwise there's no point in the inspection.

[NewspaperTaxis]

Statinisland, your post is too unreal!

You see, I clicked on the link you provided from 5 years back, and I am there on it, opining about how awful the CQC is, back in January 2014. I am under the name I had back then, Professor Dent.

And guess what then happened in Feb 2014, the very next month? The care home my mother was at was failed on all counts by the CQC! And guess what then? The CQC didn't inform anyone - at least, no residents or relatives, and continues to be coy about whether it informed Surrey County Council's Safeguarding teams, preferring to cover up for them.

Then guess what? On 7 March 2014 my mother was rushed to A&E with aspiration pneumonia, severe kidney injury caused by dehydration, severely underweight and with a long-term grade two pressure wound - again, which we hadn't been told about.
She nearly died on the third night, as her BP dropped to 40/20. That's no lie - it's on her notes.

Eventually she was discharged from hospital under free NHS Continuining Healthcare - that's where, under NHS Surrey Downs policy, it appears they spend the next few months trying to kill your parent under covert 'palliative care' aka dehydration.

More tomorrow...

[statinisland]

Oh God I am so sorry to hear how things went for your mother NewspaperTaxis. Thanks for replying to this thread! I wondered how everyone who contributed to that thread got on in the intervening years. Please do try and update further if you are up to going over it all.

Latest from today is that they want to discharge Mum back to the same Home tomorrow. I don't know how they expect us to be happy about that. I am to talk to the 'Complex Discharge Team' tomorrow and I am just going to ask how a Home that is 'Inadequate' is a fit place to send anyone.

But what are the alternatives? They farm her out to some emergency placement miles away? What's that going to be like. What this does give me an opportunity to do is to make the Discharge team FULLY aware of the report from the Care Commission (or whatever it's called) so that they are abreast of the situation. How can they NOT be though? But at least I will know that they know IYSWIM.

None of the family have any money to pay for Mum to go in a private place. All her own money is gone and we've run down to the last few thousand. As I said, her quality of life is not great and there's little chance of much improvement. But it would be better if we at least know everything was being done that should be done and that she wasn't treated like just some receptacle of pills and fluids.

I wonder if the other residents' relatives are aware of the latest report? Be interesting to know. I am flying home on Friday and will spend the weekend with my family. See what we can do, if anything.

[MereDintofPandiculation]

They farm her out to some emergency placement miles away Keep an open mind. "Emergency" doesn't necessarily mean "bad". Vacancies occur because someone passes on, not because a home is undersubscribed through awfulness.

[statinisland]

MereDintofPandiculation good point. If they turned round and said 'Yes, we understand your concerns and we have a an alternative place for her in X home' and we look that home up and it's rated 'Good' or, God Forbid 'Outstanding' (do they even exist?!) then we'd be happy. Less so if it was the other side of the City ( we live in a BIG city). But take your point about emergency not necessarily meaning bad,

We were told to speak to the Complex Discharge Team this morning about my Mum's imminent discharge but they don't know anything about her yet because the Nursing team haven't done a 'Transfer of Care' yet. So I spoke to the Staff Nurse and she couldn't tell me what was happening as the Doctor was doing his ward rounds so I was to call back in 2 hrs. She couldn't tell me how my Mum was because she was not familiar with her. Not a problem.

What I don't want to happen is for it to be suddenly presented as a fait accompli that 'Your mother is being discharged in 2 hours' back to the 'Inadequate' Care home. I want everyone concerned to know that it has received this 'Inadequate' rating and that they are 'happy' to release someone that they've wonderfully nursed to such an environment. They may not care. They need the bed I know - it's not their problem etc..

I've just phoned the Care Quality Commission and asked what happens after a home receives an 'Inadequate' rating. They said the Home would have normally 6 months to put an 'Action Plan' in place to bring it up to adequate standards. I explained that the inspection that led to the report that was published LAST WEEK was actually carried out 8 months ago in Augutst. She said that they would have initially produced a draft report and that would have been sent back to the Care Home who could question/dispute/counter the findings - bit of back and forth - and then the final report would be published. And then I said, so the report has still come out finding it 'Inadequate' but it's presumably continued to be an 'inadequate' care home in the intervening 8 months??!! So the next inspection will take place in October to check that they are no longer inadequate. I asked what action is taken if it still remains inadequate and she said it depends, they would probably have to put an action plan in place yadda, yadda, yadda and round it goes.

I asked her finally what can the CQC DO and she says it depends; the home could be fined or at the most extreme closed down, but we wouldn't want that to happen because where would all the residents go. Quite. And everybody knows this don't they.

[MereDintofPandiculation]

I don't know whether it'd be the slightest bit of use, but in your position I would put your concerns on paper and ask it to be added to her file. More likely to happen on paper than by you talking to them. Whether anyone would read it, or pay attention if they did, is another matter, but they can't read it if it's not there.

[MereDintofPandiculation]

Just to add - it wasn't until I wrote everything down that the hospital really understood that my father had undergone a catastrophic decline and did some serious testing. Until then, despite what I'd said to them, they were assuming he was an immobile demented elderly man, not an elderly man happily taking himself around town by bus and getting himself to appointments, shopping, going to his bank etc.

[FuzzyLilac]

Did your father or mother serve in the armed forces/national service?

Th Royal British Legion have a hand ful of home nationwide and they are all rated highly by cqc.
If your mum is deemed to need CHC/nursing and will get the funding you could apply to one of their homes.
My uncle is in one in Ripon and it is amazing.

[NewspaperTaxis]

Hi Statinisland, I sent you a PM.

Like I say, what I wrote about the CQC over five years ago still stands today and then some! I was under the name Professor Dent then.

The month after I posted that, the CQC failed Firtree House Nursing Home in Banstead, Surrey, on all counts - but chose not to tell anyone. As with you, the sat on the report for eight months.
It only came out because of my own investigations, phone calls etc.

The month after the 'secret' CQC visit, and exactly one month after Surrey's Safeguarding teams were informed about problems about Firtree (characteristically, SCC don't reveal who made this warning or of what it consisted) my mother was admitted to Epsom General Hospital and nearly died.
The hospital doesn't report such cases to Safeguarding - that's because dead bodies save them a fortune.

Later, when I found out about the failed CQC rating, I took it to the local press, who ran it here:

www.yourlocalguardian.co.uk/news/11547288.care-quality-commission-complicit-in-wrongdoing-of-nursing-homes-says-angry-relative/

This led to a front-page follow up story the next week, with another relative complaining.

I didn't realise this would be seen as whistleblowing, and had no idea how corrupt Surrey's Safeguarding teams are! Naively, I actually thought they'd be pleased I'd alerted the public to this dodgy care home - not a bit of it. Cover up is everything.

Surrey's Safeguarding teams declared war on us.

They tasked my mother's subsequent care home - where she was under free NHS Continuing Healthcare - to spy on us and subject us to surveillance! You can read about it here:

www.goodcareguide.co.uk/eldercare/care-homes/surrey/the-reigate-beaumont-rh29jb/

NHS Choices refused to run the review.

They timed the hit for Christmas Eve - it was authorised by Surrey County Council, the charmers!

We got out just in time - I think they overplayed their hand. We took her to another care home, got her assessed and they accepted her. We didn't take her back. This must have miffed Surrey, who I think were hoping to play a game with us where they could have us banned from seeing her at the previous care home, and basically have her killed via dehydration. We wouldn't have been able to prove anything afterwards.
It seems we nixed their plans!

From thereon, however we were placed under surveillance by the State, basically. I don't have time to go into it, but you find you're pulling at a very long piece of string when you investigate corruption in adult social care.
Staff and carers at subsequent care homes are 'tipped off' about you, that you're trouble, but never let on so you wonder why people are being off with you.

Safeguarding heads and social workers play the game well - they pretend to be your friends and pretend to exonerate you of all concerns raised by the care home against you. You won't know - until you make a Subject Access Request to the Council - that they were ones behind the care home's attack plan!

They suggest you'd like to get your parent back to the family home! Fine, you think, let's go for it. This turns out to be a ruse - it allows them to a) Make out you're likely to abscond with your parent which, like parents who abscond with their kids, is a big deal; it lets them get a Court Order preventing you from seeing your parent and even lets them assume full control via the Deputyship and b) It lets them assume control of your situation. Later you'll find out you were investigated under Section 42 of the Care Act, where 'abuse' is alleged. The abuse, it turns out, is yours and never the care homes, where all allegations and crimes are ignored by the Council.

Complicit you'll find are the CQC, the NMC and even quite likely your local MP - if he's Chris Grayling. It is astonishing that in three meetings we held with him over the course of the year, discussing the odd and negative interest of Social Services, he never even hinted it might be due to my whistleblowing one of their dodgy care homes to the press! Even when I produced evidence of it in our final meeting, he looked disappointed I'd found out, then recovered when he realised it didn't really affect him and he wasn't incriminated.

We were totally played.

While Grayling make out he was raising our case with Safeguarding, this is what happened to our mother:

www.mirror.co.uk/news/uk-news/horrific-footage-shows-how-care-9700188

So far nobody's been held responsible for what happened to her and that's kind of par for the course. For the record, nobody at Surrey County Council has ever even contacted us about the above event, they simply never spoke to us about it. Nor did Chris Grayling, of course. These are the people you are dealing with.

And that's adult social care for you. What happened five years ago is obviously happening today, and that's because it's approved at the highest level. However, I would exercise caution, because if you make waves about it, the State will absolutely go for you. You'll get the South Yorkshire police - Hillsborough relatives treatment; they have a playbook by which they go.

[NewspaperTaxis]

As for your situation, Statinisland, the Liverpool Care Pathway is supposed to be illegal, but it obviously still goes on under a variation of sorts. Mainly dehydration. Look up 'NICE' guidelines, in particular the complaints of the consultant Professor Pullicino, who is quoted in the Daily Mail about it, and also in reference to Gosport.

With death via dehydration, you won't be able to prove a thing.

Google 'dehydration' and 'care homes' and you can see it's still going on, the newspapers are sort of flying a kite on it and letting us read between the lines.

From your description of your parent, I'd be surprised if they weren't put on this pathway programme, though I don't suppose I endear myself when I say from your description that it doesn't sound like your parent is getting much out of life anyway. That wasn't the case with my mother by any means - she enjoyed fork-mashable food, a nice day out, we even took her to see the last James Bond film Spectre at the BFI Imax and she enjoyed it. But that's not the point. The point is, she was on a secret checklist of what she couldn't do, and when that happens - in particular when they have 'severe dementia' on the notes, that allows the State to 'guesstimate' their time left, and put them on end-of-life care, aka murder. Thing is, it's not 'murder' when the State does it.

I'll also point out that even if the State gets it wrong, it never likes to own up to anything! So it will be determined to stick with it until it's fictional narrative becomes a reality! That's why my sister and I had to give up our lives for the next few years or so to go into the care homes to give Sheila drink, while all our appeals fell on deaf ears.

It was a very sinister situation, leavened only by the knowledge that Sheila had survived and was enjoying life still - a fact that seemed to consume the State with fury.

Families who twig what is going on and make waves are subject to a campaign of defamation and it will be made out that in fact they are the danger to their parent - and be barred from seeing them or giving drink. This allows the State - be it the hospital or care home - to carry out the task of killing unimpeded. Any social worker brought in - always by the care provider, never you - will be on their side, not yours. They are to oversee the pathway death.

Therefore I suggest you employ guile in your dealings but remember, if you didn't know to get LPA in Health and Welfare for your parent while you could then a) The State is the decision maker for your parent's care, not you and b) All these smears can go on your parent's medical notes which you aren't even allowed to see! You can make a Subject Access Request to the Council and get some of it (redacted) but it may take half a year to receive it, by which time a) It may be too late and b) You then have to drearily 'refute' all the charges, but to whom? You have to ensure it goes on the medical notes and just hope it does - cos you can't see them, remember.

Welcome to my world.

Oh - and we were self-funding! Our mother got taken off free NHS Continuing Healthcare by Surrey Downs, probably because they realised we were busting the system - by turning up daily and giving Sheila drink! But thereafter we were paying a grand a week for care homes, while Surrey County Council made it clear they were in control - though they'd nearly killed her. Meanwhile, our moves to other care homes mysteriously fell through (clearly a bad word had been put in against us) and so on. Fun.

[statinisland]

What can I say NewspaperTaxis. Am horrified at your story but admire your tenacity, determination and dedication to trying to hold all parties to account and get to the truth. And all just to get a decent, appropriate, effective level of care and treatment. It made for exhausting and upsetting reading. What a fight. And what a reaction from the authorities?! I appreciate, once again, you taking the time to go through all of this. It can’t be easy to rehash it all. Thanks also for the private message.

I went to see Mum yesterday. Bless her, she is mostly asleep. Just being woken up to have injections, take tablets, have eye drops etc. She can hear me and was able to answer yes and no to food and drink. A few other words expressing confusion. But the one nurse administering the medicines was lovely. I was there at meal times which meant I ended up feeding Mum. As I said she’s in there after being admitted with high blood sugars, unresponsive and hypo delirium(?). And they serve her a dried out pasty and mashed potato with gravy followed by a gelatinous sponge with raisins and tons of custard?! She had a few mouthfuls of the mains and most of the desert. But should she be having foods like that? No vegetables in sight. I was just relieved she was eating.

I asked the Nurse to find out what was happening. They hadn’t sent her back to the Home,which they had planned to do the day before until we started asking them whether they were happy sending her to an ‘inadequate’ Care Home. The CQC have obviously changed their rating system and the word ‘Failed’ doesnt seem to feature as an option just ‘Inadequate’. Toothless indeed.

When I called back yesterday to speak to them they said Mum was medically fit and would be leaving in next few hours. What about the Complex Discharge Team? She’s not a complex discharge came the reply. After this contact I quickly sent an email in to PALS (after advice on this thread) and within hours got a call from the ward manager. She was lovely too and said she understood our concerns but it wasn’t their place to liaise with the Care Home or make judgements on its fitness for purpose - as long as it was still open and hadn’t been shut down by anyone, they had no choice but to send her there.

But obviously things have stalled as the Ward Manager hasn’t been able to get hold of the Community Social Worker so Mum is in until at least Monday. And the Complex Discharge Team is involved now. Don’t think this will make much difference but let’s see.

What surprises me is that I asked if Mum was going to be on insulin now as she’d only been on Metaformin up till now? ‘Is she on Metaformin?’ came the reply. Errr don’t you know from her medical records?! Have the care home or her GP not sent her list of prescriptions (including anti-depressants)? No apparently. In this day of centralised computerised records that information has not been shared?! So the Nurse said could WE contact the care home and get them to write down what she’s on! It just beggars belief. And how it will work when it comes to the hospital communicating with the Care Home about her new regime of medication and treatments , then it doesn’t auger well.

I’m exhausted and I haven’t borne the brunt of this at all. My sister has dealt with it all and she’s exhausted as she works full time too. It would appear that it does take the full-time involvement of a relative, who needs to learn all about medications, treatment protocols, legislation, policy and safeguarding issues for our parents to get a basic level of care. Oh and be there in person 24/7. I honestly don’t know what the future holds but I hope this sorry mess does not continue much longer for all our sakes.

Sorry for this rant. I might ask for it to be deleted depending on how the next few days go. But there’s something really rotten and dehumanising about it all. There are many good, caring, highly trained people out there doing a brilliant job but they’re unsupported by profit hungry, business-orientated concerns or a mismanaged NHS. It’s very, very sad. Thanks again to MereDint , Wiggly , Fuzzy for your useful contributions. My Mum did spend 5 years in the Forces but not sure if we ever investigated the British Legion Avenue? And thanks once againNewspapers for relating your own experiences.

Will let you know how it goes.

[wigglypiggly]

Oh dear, at least she is still safely in hospital. With her medication, the carehome should have sent a list of her meds and her medication box with her to hospital, it's not your responsibility to chase this up. She may have been started on drugs in the carehome that her GP is not aware of (I know, it's shit but it happens) if they were started by an oncall doctor. The hospital pharmacist needs to contact the GP, carehome, usually by fax, to ask for an up to date list of what she is on and find out which pharmacy usually deliver the meds to the home. Best practice would have been that the carehome staff wrote a transfer letter for hospital and photocopied all her relevant notes. It doesn't sound like they have been managing her diabetes well, she shouldn't be having high glucose and hypo's (low glucose levels), I would ask for a diabetic nurse review before she is discharged. You can also ask for a dietician review, I wouldn't worry too much about what she is eating at the moment, the important thing is that she is eating. Metformin are massive tablets to take. What side of the military was your mum in? is the British Legion RAF? there is an RAF benevolent society who might be able to help you find somewhere else, I don't know if the Army and Navy have the same, there are also homes for ex military personnel. I wonder if it would be a good idea to ask the nurses and social worker to carry out a full care needs assessment on your mum, if her needs or level of care have changed at all then the carehome manager should come and see her to assess whether or not they are able to safely meet her needs. Monitoring blood glucose, giving insulin injections may be out of their remit in which case they could say it's best not return there which would be a good thing.

[wigglypiggly]

www.britishlegion.org.uk/get-support/care/care-homes/

[wigglypiggly]

www.rafbf.org/files/pdf-rafbf-factsheet-c---care-homes-with-links-to-the-services-or-the-raf-benevolent-fund.pdf

[AnnaMagnani]

I strongly advise your mum has a diabetes review before discharge. Someone eating that little would not normally be advised to be on metformin.

I'd also push for a review by the hospital palliative care team as her needs appear complex with feeding, hydration and delirium all an issue as well as her future place of care. It also sounds as if you need a lot of support about what exactly is going on and explanation of what the plan of care is or should be.

Both of these things should happen before discharge, to make sure the right discharge happens and your mum's care is safeguarded going forward.

[statinisland]

Thanks for those links wiggly. And I have been emailing PALS asking for a full diabetes review annamagnani. As a result she has been moved to another ward where medically fit patients await discharge. The social worker is looking into safeguarding at home and we are looking to get her care plan reviewed to check everyone knows her precise needs. I am relieved about this. What happens in the long term remains to be seen.

[wigglypiggly]

That sounds more positive. Hope she finds a good home where she gets the care she deserves.