The country may be shocked, but the Care Quality Commission cannot be surprised at the recent increase of COVID-19 in some of the care homes it supervises. Figures show a near doubling of care home outbreaks in recent weeks – despite relatives been banned or visits severely restricted and a supposed ramping up of prevention measures.
England’s care regulator knows that some homes remain unsafe for older residents. Read the weekly CQC reports and quite literally weep. Some reveal horrifying evidence of continuing poor practice and open defiance of basic hygiene, let alone adherence to any Covid regulations. Older people are at risk and the CQC knows it.
One inspection report from November (hardly the beginning of the pandemic) states: ‘We identified numerous shortfalls in infection prevention and control. Our findings did not assure us the provider was making sure COVID-19 outbreaks were effectively managed.
‘One staff member told us, "We work on different wings each day, it's not right. Yesterday I was on a COVID-19 wing, today I'm on another unit." We raised our immediate concerns with the provider.’
Remember, this inspection happened in November. And what has the CQC done in response? Has it taken the residents to safety? Has it parachuted in new management? Has it stopped new residents being admitted? No. It has served a warning notice.
Another care home report, also from November, states: ‘People were being put at risk from the transmission of Covid-19 and other infectious disease because of inadequate infection prevention, cleaning and control processes... On the first day of the inspection we observed inappropriate practices for the disposal of Personal Protective Equipment (PPE.’
Yet another recent report says: ‘Infection control procedures were not sufficient to reduce the risk of infection, particularly in the time of the current pandemic. Government guidance to protect people living in care homes during Covid 19 were not adhered to.’
The shocking revelations continue: ‘Comments received from staff included, "PPE is all locked up." And "We get one mask to use for the day. So, on a 12 hrs shift we have to use the same mask even after our break." And "The manager keeps questioning us why soap, gloves and masks are finished. They [meaning management] don't care about us [staff] or the residents; only using up PPE and the cost to replace it." Some staff told us that they had to purchase their own PPE to stay safe.’
Meanwhile, a recent report from a previously ‘Good’ home states: ‘People were not protected against the risk of cross infection. During the inspection we saw poor infection prevention and control practices in relation to COVID-19 and measures recommended by the Government were not being followed....
‘People who had recently moved into the service were not socially isolated from other people to prevent the potential spread of COVID-19. People were sharing mobility aids without cleaning in-between uses. High traffic areas within the home were not subject to any additional cleaning...
‘The provider had failed to ensure risks to people were adequately assessed, and plans were put in place to mitigate them. People and staff had not been risk assessed to identify if they were at additional risk of Covid-19 due to additional health conditions or being from Black Asian Minority Ethnic heritage (BAME).’
Such care home reports are hard to read, especially given they were issued in the last few weeks. But the CQC’s role in this pandemic has largely been confined to protecting its back and, by extension, the back of the care home sector.
Much of the responsibility for care home outbreaks earlier in the pandemic, was blamed on the NHS releasing infected individuals without warning and then on casual staff working across different homes. But, eight months on, these excuses look lame. The CQC cannot claim it or these care homes have been taken unawares.
Throughout the pandemic, the regulator has refused to give details of care home outbreaks – even in response to Freedom of Information requests. In has issued highly-tailored data, ‘proving’ that care homes (and it) were not responsible. And yet, these latest reports, written by qualified inspectors not administrators, scream otherwise.
The CQC’s chosen narrative - that the entire sector was caught out by the pandemic - will not wash now, when reports clearly show that some homes are simply not paying any attention to the safety of their residents. And it is really worrying to think, of course, as suggested by the CQC, that older people were no better protected in a ‘Good’ care home than an ‘Inadequate’ one.
This stems, of course, from the regulator’s anxiety that people should not think their relatives are unsafer in unsafe homes. But it suggests the entire industry is unsafe, even the ones it says are safe – so much for 'regulation'.
If this is true, that good homes are as bad as officially-bad homes, what does this say about the CQC’s system of inspection? Can any of its ratings be trusted? Is there such a thing as a ‘Good’ home? Or is the CQC’s snapshot inspection system, where homes are judged and rated on the basis of a short visit, completely useless?
Covid has thrown an unforgiving light on the care home sector and its regulator. People are dying and the CQC will be asked what it has done, aside from covering its own back.
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