Do you think this care home should be reported?

[Tyrasanchez30]

I've been working there for around a month and I'm fairly new to the industry. There are things I've seen that make me feel uncomfortable and I feel like they shouldn't be happening.

I have seen poo on the floor in random corners of the home.
There is a lady whose birthday it had been one day. I wasn't in that day but noticed it on the calendar when I went back. She seemed surprised and apparently staff hadn't told her or celebrated it in any way. She doesn't have a diagnosis of dementia and she's lucky to still have quite a sharp mind so I don't think they told her and she forgot, I think they just didn't tell her.

There is a lady who likes to be up early. She is wheelchair bound and needs 2 carers to get her out of bed. She asked on the shift I was on to get up at 4am. The 2 colleagues I was shadowing said no it's too early. She said it doesn't matter, I'd like to get up. They said no again and just left the room to her shouting for help.

There is a lady with Parkinson's who needs assistance with eating. They give her an apron but the food ends up everywhere, I tried to help her one day and they told me not to bother as she tries it on with new staff and she can feed herself perfectly well. I have observed her eating by herself and the food still gets absolutely everywhere.

I find some carers too over familiar, saying "love you" to residents at bedtime and kissing them on the cheek/forehead. Some of them have quite a 'bantery' relationship and one colleague told a male resident that his bottom 'absolutely reeked' which I still think is unprofessional.

On one of my first shifts I went to give a resident her dinner in her room and both her and her sheets were soiled with faeces, so I changed her and cleaned the bed, it didn't take more than 5 minutes. When I got back, the senior carer was furious that I hadn't been there to hand out the rest of the plates and said I should make her wait next time.

Stuff like that. I'm not sure about the manager's attitude to the people she cares for either. One day some residents were arguing and being agitated so she just muttered "I'm out, I've had enough."

We have a lady with dementia who can be verbally abusive towards us. The manager joked to us that she "Likes the difficult ones as they're a good challenge."

Just not sure what to think of these issues

They are Good on CQC at the time of last inspection.

Getting Up at 4am surely throws the test if the routine out of whack so I get that one

Changing sheets mid handing out dinner seems a bit kinging, I would have called for help

The rest sounds unprofessional

Yeah maybe, I just thought it should be the resident's choice, as a physically mobile person would be able to get up and walk out of bed at 4am if they pleased.

Keep a record of your concerns with dates and times etc - some of these are safeguarding issues and so you should report to local safeguarding team - they can then take it from there.

I go into care homes and look at what is happening for my current job and i would be raising my concerns if i saw or heard of some of this happening.

That's a very good idea I will do that asap. Just for clarification which ones would you say are safeguarding issues?

I would absolutely expect and do see care homes getting residents up at 4am if that is what they want - some people like the peace and quiet at that time.

Yeah that's it, i think it should be a resident's choice. They're adults and should be treated that way.

I think you should report it
It doesn’t sound like the residents are being treated with respect or dignity
If that home had one of my family members in it and they were being treated like that I’d be horrified
Please report

Leaving in soiled sheets or clothing , hygiene issues, not offering assistance with eating and self care. More neglect than safeguarding.

4am is too early and it may be lighter mornings have thrown the patient's sleeping pattern out.

But if an able bodied resident wants to get up at 4am we can't force them back to bed. We can ask them to go but ultimately it's their choice.
Wheelchair bound residents in this home have zero choice.

Faeces on sheets or in the rooms - what level of supervision are these people on? 1:1 - 15min checks - someone who could foul the bed or the corner of their room should have a quick check frequently to ensure this has not happened.

In relation to the individual not knowing her birthday - this would not concern me if it was a one off - that person many not like celebrating her birthday but if there is a pattern of not treating people with the same dignity and respect that most people would expect - like celebrating birthdays - that would indicate a lack of respect for the residents as individuals and would be really concerning.

The lady with Parkinson's is not being treated with dignity and respect unless she herself asks to be left alone to feed herself - if she feels embarrassed or uncomfortable with the mess she makes then this would absolutely be something i would safeguard.

As a new employee you should have known exactly what to prioritise - handing out food or changing sheets or who to go to if you were unsure.

The lack of professional language and over familiarity again is concerning - some residents may really enjoy that but others may not and may feel they cannot do anything about it. This is their home and if they find people giving intimate personal care to be over familiar with them that is horrendous for them.

Do you have independent advocates coming in for residents with no families?

All of these incidents on their own would not concern me unduly - staff are human and things can slip by but the overall picture is one where institutional neglect is gradually slipping in and they need pulling up.

"Some of them have quite a 'bantery' relationship "

Some people prefer that otherwise they feel institutionalised. I've been long term in hospital and prefer staff who are more human than professional. Residents can feel more cared for if interactions are real, as happens in family homes.

Is the woman who has Parkinson's losing weight etc? We had residents who tried it on with new staff. Often because one person used a standing aid, others would want to. It wasn't in their interests because you lose ability quickly, in those circumstances.

The Birthday one is concerning. I'd be taking that to the manager.

Did you hold up serving the dinner? If so, the other resident's suffered because you didn't finish serving and then sort the woman out. There often isn't enough staff to do things as we would want. What's the staff ratio?

I went on to do a BA in SW and had lots of discussions about this. You can't just give baths when wanted. Would the woman who wanted to get up at 4 need a level of supervision? How would that work?

Make a list, but reserve judgement until you know the residents well.

Please please please report your concerns; the clients in your care deserve to be treated with dignity and what you describe sounds horrendous. You can report to CQC or your employer should have a whistleblowing policy. It may seem daunting as you have just started in a new role but trust your instincts and look out for the vulnerable people there. Good luck.

Neglect is safeguarding - the safeguarding team will make an assessment as to whether it meets the threshold for a full investigation - or what action needs to be taken.

They will also know if there have been other concerns raised or if this has been an issue in the past - a chat with the team would be a good idea - they will give you advice.

We have ensured homes get closed down for this type of 'neglect' if it is not put right after concerns are raised.

"Faeces on sheets or in the rooms - what level of supervision are these people on? 1:1 - 15min checks - someone who could foul the bed or the corner of their room should have a quick check frequently to ensure this has not happened."

The issue becomes if people higher up agree on the care needs and funding becomes available for the staff ratios. We had hospitals and SWs push people on to us who should have been under care but was under residential. Even hospitals have these issues. You've got to run to a set order, or have smaller homes with more staff. Which is why we closed the big institutions.

"We have a lady with dementia who can be verbally abusive towards us. The manager joked to us that she "Likes the difficult ones as they're a good challenge.""
That's using humour to lighten up a situation that you've just got to get on with. Unless we go back to over drugging people.

I don’t think you’re suited to this job. You’re complaining about some really trivial issues.

If someone doesn’t realise it’s their birthday, they quite obviously have some degree of cognitive impairment. Banter and black humour are commonplace in care settings, there isn’t a care home or hospital ward in the country without them. And a lot of care home residents would never be shown any affection unless the staff gave it - it’s good care and trumps “professionalism” any day of the week.

The soiled sheets scenario is far from ideal but I suspect the issue there was that the senior carer wanted you to do a task and you decided something else was more important without checking first.

It really isn’t reasonable to get up at 4am, you must know it isn’t.

"I have seen poo on the floor in random corners of the home."

When you took it to a supervisor, what did they say the procedure was?

I think there are some legitimate concerns but you are also naive about the level of care that can realistically be provided. Eg getting up at 4am requires multiple carers, night staff are fewer in quantity and the staff allocated to care for her getting up won't start until a set time possibly 7am. Ambulatory residents up in the night for non essential reasons is tricky unless they have 1:1 waking funding.

During dinner service you can't be changing sheets, it can wait a few mins. Not ideal but councils, health authorities and individuals self funding don't want to pay for higher levels of care.

The banter is preferable to many people, they prefer it - you can't assume