Care home concerns

[catgirl1976]

DF is in a care home. He has dementia.

I am not hugely happy with the hole generally. They don’t seem to do any activities or enrichment just leave them sat in chairs all day. His clothes are often filthy and he smells. I visit at least once a week as do DB and DSis but it’s getting harder to take him out as his
mobility is getting worse and his dementia is progressing.

Last night about 8pm DB got a call from our local hospital saying DF had a fall and had been admitted to A and E. He’s ok but it now transpires he had the fall about 12 hours earlier and was taken to hospital by ambulance yesterday morning. The home did not contact any of us. DF had been left in A and E alone and confused for 12 hours by this point. Had we known we could have gone up and been with him, made sure he ate etc. he is diabetic and would not be well enough to advocate for his own needs. He’s also under DOLS. The hospital did not know this and did not know he was diabetic. They only rang my brother because DF was asking for his wife (they’ve been divorced years and have no contact) so they rang to get her details. Had that not happened we would still not know he was in hospital.

We went to see the care home today. The person in charge did not know how he had fallen. It was in observed.

He had a less serious fall about ten days ago. I asked after that first fall what measure had been put in place. She did not know. I asked if a risk assessment had been done or any changes to his care plan. She did not know. She said it might have been but I pointed out even if it had if the person I. Charge at the weekend didn’t know it wasn’t much use.

They insisted they had rung both me and DB. We showed them our call logs from yesterday clearly showing no one had called. We checked the numbers they had on file which were correct.

We’ve got a meeting tomorrow with the actual manager but I am so unhappy and feel this maybe needs formally raising or he needs to move to a better home. He’s council funded so I’ve no idea how this works

AIBU to think this simply isn’t good enough and to consider raising as a safeguarding issue and looking for an alternative home?

Are there any communication issues with the staff team at the home? I have found that many care staff come from abroad now and their English is not always as good as it should be, considering the important work they do with vulnerable people. It's entirely possible that whoever was on duty didn't have the language skills to adequately hand over to the hospital. It's a sorry state of affairs in the care sector, I'm afraid.

From what you say, the care home sounds very neglectful. Quite apart from anything else, someone should certainly have accompanied him to A&E.

Re falls, though, I’m afraid they will happen no matter how good the care. My DM’s (dementia only) CH was excellent, but being a fairly determined ‘wanderer’ she still fell now and then - and after one such, her face looked as if she’d done 10 rounds with Mike Tyson - black and blue almost all over. But unless a staff member had been permanently glued to her side, or she’d literally been tied to a chair, it would have been impossible to prevent all falls.

Aww, your poor dad. I'm so sorry this happened to him

And YANBU for taking it further. You absolutely should!
Good luck.

When we looked around they told me they did all sorts of enrichment - there is none.

They always seem short staffed and there are communication issues with some staff especially at weekends where English is not the first language

Just to save you some time report to adult social care rather than CQC. All CQC will do is report their version of what you have reported to them to adult social care and ask them to look into it.

It's like ofsted- they don't deal with individual complaints.

Adult social care may not agree it meets the threshold for a full S.42 safeguarding enquiry but they will look into it and take the care home to task and ask that they demonstrate what they plan to do to reduce the risk of it happening again. If it were me taking the call from you though I would feel the threshold was met, but each Safeguarding Adults Board sets its own criteria.

I've had a search and https://blackpoolsafeguardingpartnerships.org.uk/assets/b97d549a/adult_social_care_guidance_for_responding_to_safeguarding_concerns_v1_nov_2024.pdf sets out (from pg 17) what Blackpools safeguarding thresholds are. These would apply to any issues in hospital - if the care home is in an another Local Authority (e.g. Lancashire) you would need to check their thresholds as well.

I do not understand why they didn't call you . That is a massive massive error if they couldn't send anyone themselves.

The DoLs thing is a bit of red herring - each setting has to apply for its own DoL so even if the care home had passed on the information it shouldn't have changed any decision making by the hospital about his capacity to make a decision to leave.

Thank you a much that is really really helpful

Its really not straightforward though and is unfortunately symptomatic of a system that is no longer bursting at the seams but actually bust the seams a while ago and has entirely resigned itself to living in an oversized nighty forever aware it is flashing its nether regions in every gust of wind but entirely incapable of doing anything to change the situation.

You have understaffed care homes paying their (often overseas) staff poor wages. Those same staff may not have the level of conversational English to communicate accurately with families/ ambulance staff. If they are agency staff they may even have only been there for one shift.

The ambulance service only see snapshots and the handover between them and A & E is frankly rubbish. I have lost count of the times just in the last month where the ambulance service have reported safeguarding concerns to the local authority but A&E apparently have no idea that anything has been reported and subsequently either discharge the person back or send them to a ward who also have no idea about any concerns raised.

In a busy A & E the priority is treating the critical incidents - as you know they aren't the appropriate place for elderly people with multiple co-morbidities and long term conditions. No one gets 'care' in A&E they get triaged and urgent treatment on a priority basis. Unless the person is admitted with suspected DKA or similar their diabetic status is ultimately irrelevant to them until it isn't. That is wrong but there is no staff/budget/appetite to change it.

I have seen some very sensible care plans in good care homes around avoiding attendance at A&E wherever possible but they rely on good working relationships with the home, the family, the GP, out of hours GP and district nursing teams. If any of that breaks down the care home have no choice but to ring an ambulance or face accusations of neglect.

Do be the squeaky wheel. Things rarely change without families calmly and persistently asking for things to be put right I'm afraid - you are our eyes and ears.

Just to update I’ve reported to the Adult Lancashire Safeguarding team and am waiting for them to get back to me also waiting for a call back from adult social services.

DH works for the council and spoke to some people in the Safeguarding and Contracts team who said it was a massive safeguarding issue and they’d report it internally and they would be put “on radar” whatever that is at the very least.

DB saw the care home manager today who said it wasn’t a safeguarding issue and apologised profusely and also said the hygiene and cleanliness issue was about his dignity and he’d refuse to wash or change but they would promote him more. DB said that was not good enough and hygiene was basic need which they were not fulfilling but he wasn’t confident they do more than prompt which is useless but hopefully we can get him moved

thank you to everyone who has given advice and to those who have shared their worm stories. No one really prepares you for looking after aging parents l. It’s not like having a baby where there are countless magazines and websites and everyone talks about it. Yet (.if we are lucky enough) it comes to most of us

Raise it as a safe guarding issue and also contact the CQC.

RADAR is a multi agency meeting where health, social care, commissioning, quality/governance from the Local Authority, CQC etc all meet to discuss any residential care home or nursing home or domiciliary care providers there are concerns about and put action plans in place.

Any provider put onto Radar monitoring usually can't be taken off again until the meeting agrees that the improvements have been made.

If improvements aren't made then the Local authority/ NHS may decide not to commission care from them any more and CQC may take enforcement action against them.

Glad you have made some progress I bet the manager worried now. I bet she'll lie through her teeth and get the carers to lie too - they did that when I had a safeguarding complaint.

Re the hygiene and keeping your dad clean and tidy of course it shouldn't be an issue for them as where my mum is now she is clean and tidy with her hair combed and trimmed regularly. This is all done despite her being very agitated by any attempts at personal care and she tries to hit the staff and swears at them - so the carers work in threes with her. They are just lazy and neglectful

OMG! Thankfully I've been very lucky, and have never had a relative go into a care home, but now that I'm getting on in years myself, I find this story absolutely HORRIFIC!! I shall be telling my kids that if I get anywhere needing one, to finish me off, or to help me do it myself.

In your shoes OP, I would probably have found myself being thrown out of the home, as if my DF had been treated like this, I'd have ripped them a new one! I know that doesn't achieve anything realistically, but my goodness it would make me feel better.

I'm SO sorry that your poor Dad went through this, it must have been awfully frightening for him, and the fact that, as you say, you could have been with him, if only they'd called you, is just appalling. I hope he's OK for the moment, and that you can get him moved soon. Sending you a hug, as this must be VERY stressful for you and your siblings too.

I worked in a luxury care home. Just as an activities coordinator. I left after 5 weeks because of what I witnessed and the home did nothing when I raised my concerns. I reported to the CQC and the adult services at the council too

I was just appalled at what was going on. So my advice to you is to put a camera in his room. Is this something you could raise with the manager? There were cameras in a couple of the rooms in the care home I was at for family's peace of kind

*mind

Your dad has a DOLS but the home won’t carry out personal care against his wishes? What do they think a DOLS is for? It allows you to act in someone’s best interests even if they don’t want you to. That includes washing & pad changing.

What you need to do is make an Advanced Directive clearly stating that once you are unable to make decisions yourself about your healthcare that you do not want to be rescuitated if you have a cardiac event, you only want comfort care (I.e. pain relief and fluids) and not antibiotics or any medications that may improve your physical health or prolong your natural life.

You do not want a pacemaker or any surgery or treatment that is life prolonging - e.g you would want a broken leg fixed but perhaps not chemotherapy or heart surgery.

Then make a Lasting Power of Attorney for Health and Welfare and make the attorney someone you trust to observe your advance directive.

Everyone says what you have said but it's vanishingly rare for anyone to actually put the legal stuff in place to make it happen when the time comes (In nearly 20 years I've seen two properly executed Advice Directives). That ultimately means families and medical professionals will continue to treat to preserve life because otherwise they get accused of neglect, or murder if they really do try and help dispatch you.

DoLS is a Deprevation of Liberty Safeguard. It's a legal framework that in most circumstances is used to ensure that people are only being deprived of their liberty lawfully in circumstances where they have lost the capacity to consent to e.g. be cared for in a care home or a hospital.

It's typically about whether they have free will to leave where they are and the capacity to exercise that free will.

Stuff like personal care would normally be managed under a standard mental capacity/best interests process.

personal care would only usually need to be specofically included in a DoLS if it involved restraining or sedating someone in order to carry out the care safely and would have to be specifically authorised as part of the DoLS.

A DoLS Authorisation doesn't give the care home free reign to do what they like if the person is objecting to personal care.

@SafeguardingSocialWorker if you are putting a DOLs in place for a patient who is declining personal care, you would include personal care in it surely?

As a nurse with over 20 years experience in the field I really don’t require your extremely patronising response.

I know exactly what a DOLs is trust me.

Care homes need CCTV.

If you felt patronised it genuinely wasn't my intention.

If I had known you were a nurse working in the care of older adults I would have outright suggested you needed to urgently brush up on your understanding of DoLS, the Mental Capacity Act and the Human Rights act rather than trying to explain to what I thought was a member of the public why a standard DoLS Authorisarion couldn't be used by the care home to justify overriding someone's Article 5 rights.

You might find section 6 of the Mental Capacity Act useful to review. Particularly the section on limitations.

@SafeguardingSocialWorker maybe instead of an admin role you may like to retrain to be actually involved in patient care?

It’s a more than reasonable assumption that in the the OPs circumstances her father would have had personal care arrangements included in his DOLs.

My perceived assumptions are wholly your assumptions.

I'm not going to argue with you about it.

If you don't understand the difference between a standard DoLS Authorisation providing the legal framework to accommodate someone somewhere for the provision of care and the suggestion you made that you can then use the standard DoLS Authorisation to force someone to have care even if they are objecting then that's between you and your professional registration I suppose. Perhaps run it by the 'admin workers' in the DoLS team and see what they say.

Annnyway OP how is your DF and have you made much progress with the Safeguarding team?