In terms of worst care homes, Treetops in Epping has few rivals. It was so bad that it has closed and makes an appearance in this week’s list only because the Care Quality Commission’s damning report on the Essex-establishment has just emerged. Since it is no longer functioning, however, Bupa’s Greengables and Rosebery’s Stephenson Court share the ‘dishonours’ as OLM’s ‘worst care homes of the week’.
There are few adjectives that could not be applied to Treetops which had a ‘Good’ mark from the CQC as recently as October 2016. In its latest report, however, the care regulator detailed a long list of shocking deficiencies at the home – it was unsafe, not enough staff, invoices were unpaid, lifts were not working and residents not properly cared for. Treetops was judged to be ‘Inadequate’ in respect of all five domains – Safety, Effectiveness, Caring, Responsiveness and Leadership. And yet vulnerable residents were still living at the home, funded by the Local Authority, which is supposed to keep an eye on things. More than a dozen frail people had to be relocated to places of safety.
The inspection team said: ‘In this case we took immediate urgent action to restrict new admissions and impose conditions to force improvement at the service. Despite support from Essex County Council and other health care professionals over the last few months required improvements were not made. Essex County Council have since supported all those living at Treetops to move to alternative accommodation. The home has been empty since 13 October 2017.’
Meanwhile, our other two cases this week further highlight issues around inspections – and whether CQC teams are too quick to believe what they are told by care providers and the image presented to them.
In each case, reports were published last week slapping ‘Inadequate’ notices on the homes and detailing a litany of problems. But a quick glance in the records at their previous reports, shows the CQC had recently given them each glowing reports and ‘Good’ recommendations. Had one of them really deteriorated so much in a few short weeks?
In fact, the regulator had only returned to the homes because concerns had been raised by members of the public and whistle-blowers and, in one case, a police investigation was under way.
Bupa’s Greengables home in Congleton did not impress inspectors, according to their most recent report. In contrast to the largely glowing report a year earlier, the CQC said last week: ‘This comprehensive inspection of Greengables Care Home was undertaken to check on people's safety, welfare and the general management of the home following our receipt of a number of concerns raised on behalf of people who used the service. We found that the service was not safe, responsive or well led and not always effective and caring.’
The inspectors further disclosed: ‘A visitor told us that one of the people living at the home had made an allegation of physical abuse and a member of staff had been suspended for a period of three weeks earlier in that year. We had not been notified of this incident and looked at the home's adult safeguarding records and found that it had not been recorded there. We saw that the home's safeguarding records included the details of four other allegations of abuse which we had not been told about.’
Horrifyingly, the inspectors also said: ‘Before the inspection the registered manager told us that a medication audit had identified that an extremely vulnerable person who was at the end of their life had been administered double the dose of a controlled drug that their doctor had prescribed for pain relief. Records confirmed this. A whistle- blower had also informed us that the home had on occasion run out of a controlled drug for pain relief for the same person and as a result of this the person had suffered unnecessary anxiety and distress.’
But even worse is to come for the CQC. Rosebery’s Stephenson Court in Newcastle was given an unblemished report in August of this year – five ‘Good’ ratings for all of the so-called domains. Two months later, when the CQC went back, the home was found to be ‘Inadequate’ in every respect, except ‘Caring’ – where it ‘Required Improvement’.
According to the most recent inspectors’ report: ‘The inspection was prompted in part by a notification of an incident following which a person using the service may have sustained a serious injury. This incident is subject to criminal investigation and as a result this inspection did not examine the circumstances of the incident.’
This, when the ink was barely dry on the last all-clear report. And in an unflinching record, running entirely counter to the previous report, the inspectors note widespread failings and a damning conclusion: ‘Some people and relatives were positive about the care provided at Stephenson Court. However, due to the widespread and serious concerns we could not be confident the provider's approach was caring.’
They admitted: ‘All the staff we spoke with felt the home was short staffed. They raised concerns about the lack of permanent nursing staff. Rotas evidenced that agency nurses were covering night shifts so there would be a reliance on care records which we identified did not reflect people's current needs. These concerns were raised with the manager and area manager.’
In the previous report, the inspectors said one resident told them: ‘"I can have a bath or a shower, whatever I want. I had one recently, it was lovely".’
But this time the CQC discovered: ‘There was a failure to ensure a person's dignity and personal preferences were met. Staff told us that baths and showers were not provided every day, or when people requested them, as they were too busy.’
Meanwhile, in the August report, the CQC declared: ‘People’s care records were person-centred.’
But in October, the CQC admitted: ‘Some of the language used within care documentation was disrespectful and evidenced poor compassion and understanding of people living with a dementia.’
They cannot both be right...Can they?