Secrets and Lies

Today’s publication of the Care Quality Commission report on Southern Health reminds us that the days when care homes were run without anyone investigating their work are long gone. Now such organisations are held accountable and the CQC shines a bright light into all the dark corners of their work. These days it’s impossible for such organisations to cover up any wrong doing or evade examination of their methods, staffing, policies and finances.

Or is it?

Supported living care homes are not registered with the CQC. Supported living care does not fall under the Health and Social Care Act of 2008. The CQC has no powers to inspect a supported living care home unless they are invited to do so. No independent inspection of these homes is ever carried out. The closest they get to an inspection is when a quality monitoring review is carried out by the Local Authority, who has commissioned the care anyway.

Southern Health run supported living care homes in Hampshire and Oxfordshire. They run the supported living house where Nico died.

In July 2014 I contacted the CQC to find out how much they knew about Nico’s death. They told me that they had never heard of the home where my son died. They were unaware that a service was being run there, let alone that someone had died there. Supported living homes don’t have to be registered as care homes and the lack of registration means that they don’t even appear on the CQCs radar.

The CQC told me that everything run by Southern Health Foundation Trust is the responsibility of their mental health team and then passed my emails onto the correct member of staff. He is a very senior member of staff (actually named in today’s report), who responded very quickly. He emailed me and explained that the CQC received notification of Nico’s death from one of the managers at the home on the day he died but it didn’t name the home or say it was a supported living care home. None of this information was given in the notification. But of course, they didn’t have to give the name because they knew the home wasn’t registered with the CQC. Although the notification said that a post mortem was going to be carried out, it in no way suggested that Nico’s death was unexpected or required investigation.

The email went onto tell me that as part of the report on Southern Health carried out by the CQC, they would be asking them for “information regarding their investigation into the death of your son”. Whether they asked Southern Health about Nico as part of their review or not, we don’t know. His name does not appear anywhere in the CQC report. There is no mention that the CQC asked for information or followed up on Nico’s death. The name of the supported living care home where he died is not even amongst the very extensive list of care facilities run by Southern Health at the start of the CQC report.

In fact none of the supported living care homes run by Southern Health NHS Trust are included on this list. Nor has any of the supported living care homes run by Southern Health NHS Trust ever been inspected (to our knowledge) by the CQC for the simple reason that they do not fall under their jurisdiction.

Our golden boy fell through the cracks. The CQC didn’t know he existed. They didn’t know the place he lived in existed.

With no-one watching what you do; no-one keeping an eye on the way that things are run, it’s all too easy for mistakes to be covered up and vitally important things like dangerously low staffing levels to go unnoticed. Lesley Stevens (see blog post https://justicefornico.org/2015/01/25/dear-southern-health/) was interviewed this morning on the Phil Gayle show (BBC Radio Oxford) and said she isn’t concerned about low staffing levels at Southern Health run care homes.

At Nico’s inquest the coroner said “Nico would have been saved if he was checked within the guidelines of his care”. Mr Aubrey Harris of Southern Health said “There was a guideline in place that Nico would be checked every 20 minutes but it was inevitable that with one staff member to four other severely disabled people that on occasion these checks wouldn’t be able to be maintained and I’m inclined to agree with the coroner with the benefit of hindsight”.

He went on to say “Lessons have been learned, but we believe that one staff member to 4 young people was adequate”.

I think that Nico would disagree with that. Following Nico’s inquest, Southern Health have made no changes to their staffing levels and tonight, in that supported living care home that the CQC didn’t even know existed, four young people will be cared for through the night by one care worker. I hope and pray with all my heart that tonight nothing goes wrong.

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17 thoughts on “Secrets and Lies

  1. How can anyone say lessons have been learnt when nothing has changed? Staffing levels are the same! Was his need to be checked every 20 Minutes a “guideline” or was it in his care plan? Hugs x

    • The 20-minute checks were specified in Nico’s care plan, to manage his well-documented risks of vomiting and aspiration in the early morning. But at the inquest, the care plan specifications were said by ‘care’ managers to be “only guidelines”.

  2. One of the major points that came out of Nico’s inquest was that there was no risk assessment in place regarding his early morning vomiting. When challenged on that the care manager claimed that the “guidelines” were as good as a risk assessment, although the care staff, under oath, admitted that they were unaware of the guidelines anyway.

  3. I’m not sure if this has already been done, but do you think it would be worth someone setting up a petition to try and get supported living homes inspected by the CQC? It seems ridiculous that they’re not covered in the Health and Social Care Act. Not only does it mean that these bad practices are less likely to get picked up on but it also means that family members aren’t aware of what sort of place there loved one may be going to.

    • The reaction to this blog has really worried me. So few people seem to be aware of this or to understand how important this type of independent review is. It’s not just about rooting out any wrongdoing, it’s about setting the bar high in the field of care and making sure that the care givers in these homes understand where that bar is and how best to meet it. Without accountability it’s all too easy for standards to slide.

    • I think that this is something worth looking into but my immediate plan is to try (via Twitter and this blog) to generate as much interest as possible in this issue and then next week contact the CQC for their comments. I respect them as an organisation hugely and they do an essential and very difficult job, so I don’t want to CQC bash! I think that it would be really useful to get their point of view about this and they may even have some good ideas about how we could stich this loophole up.

  4. I am so tired of the glorification of supported living. It is just about council budgets. It is not about all the wonderful aspirations in the REACH guidelines for supported living – why can’t people see this – for people with no voice – lack of external oversight is very serious.

    • Thank you so much for this comment which I completely agree with. I’ve been a bit horrified by the very small reaction and amount of interest to my blog, even though most people replying have said that they were unaware of this. Everyone’s very focussed on the CQC report on Southern Health and frankly it bears quite a lot of focus, so that is absolutely right, but here is another disaster waiting to happen, followed by another and another. If you try to imagine the world without the CQC then you’re getting the idea, because for the hundreds of vulnerable young people as well as older adults living in “supported living care homes” there is NO CQC watching what is done.

  5. Hi there,

    I didn’t think I could be any more shocked about what happened to your son, but I am. It sounds as if the service provided to Nico delivered personal care. This is a regulated activity and is legally required to be registered with the CQC (or, prior to 2009, the CSCI). Failure to do so is not just a minor regulatory blip, it is a criminal offence under s10 of the Health and Social Care Act 2008, see: http://www.legislation.gov.uk/ukpga/2008/14/section/10

    A person could be fined or jailed for this offence.

    It might be worth contacting CQC to confirm whether or not the service was registered, and if not, what action they took in respect of initiating a prosecution against the manager of the service. If indeed the service was not registered, and they chose not to prosecute, it might be worth asking why not.

    Lucy

    • Hi there,

      Just to clarify, it’s possible this service was registered but it wouldn’t be against the address as it’s not a care home. As supported living it would have been registered as a homecare agency.

      L

    • Everything that I’ve written about in my blog came out of me contacting the CQC in July 2014 to ask about whether the service was registered and is they were informed about Nico’s death. Their answers I’ve quoted in the blog and been careful to use their words and quotes as I have great respect for the CQC and didn’t want to get this wrong. This is clearly not only a grey area, but a worryingly grey area as more and more councils favour the “supported living care home” model as it’s one of the cheaper ways to deliver a care package to several disabled young people and adults. However, those two words “growth” and “cheaper” always ring alarm bells with me now.

      There’s a funny little wiggle room here for the supported living care homes, which Southern Health have used to get out of having to have the CQC inspect the ones they run (and I’m absolutely sure that they are very far from being alone in that) and it goes like this “organisations that provide personal care, such as domiciliary care agencies (DCAs), are required to be registered with CQC. The CQC inspected the DCA in February 2014 and it was found at the time to be fully compliant with the Regulations. During this inspection, the inspector visited people in a variety of supported living locations to see and hear about their experiences.” However I would like to point out the although they visited the offices and a few supported living locations suggested by the management, the house my son lived in was not one of them, so a fully robust review of the type the CQC are generally known for, didn’t take place.

      • Hi there,

        Yes, I think you’ve hit on a really important point here. The issue isn’t that the service wasn’t registered – it was registered as home care. But because it was registered as homecare, site visits aren’t required as a matter of routine.

        This is a concern that has been raised about supported living since at least 2005, when CSCI found widespread abuse of adults with learning disabilities in supported living services in Cornwall. It’s a tricky situation, supported living services are technically a person’s private home, and CQC has no more right to enter that home than they have any other private home (whether or not a person receives some home care services in it). Yet, some supported living service users can be very vulnerable. And in cases where they are considered to be deprived of their liberty, there are international legal requirements in a law called OPCAT to ensure that they are regularly monitored by an independent body. This already happens in hospitals and care homes, but there’s no provision for this as yet for people who are deprived of their liberty in supported living. It’s not clear what CQC or the government plant to do about this.

        Lucy

      • Hi Lucy (please call me Rosa or Rosi, as I feel uncomfortable with writing about this as if I’m hiding my identity – which I’m definitely not!).

        You seem to have hit the nail very firmly on the head here. Hence the phrase in my blog about “The CQC has no powers to inspect a supported living care home unless they are invited to do so” because, as you say, technically it’s the person’s private home. But clearly their are real and present dangers around this and in fact at Nico’s inquest we were (eventually) granted an Article 2 (“The death occurred in circumstances the continuance or possible recurrence of which is prejudicial to the health or safety of the public or any section of the public.”) which very much infers serious concerns about this loophole in the law which so few people seem to even be aware of. Nico was clearly very vulnerable and one of the many (again, I don’t want to go off subject here as there’s much I can say about “supported living care” in other blogs) problems we had was having to make appointments to speak to senior staff on extremely important issues and the number of times we raised our concerns about the very circumstances which led to my beautiful boy’s ghastly end. I write rather emotionally. I can’t help this. It’s how I feel. So it’s SO very important that people like you contribute to this blog. You have a strength of knowledge I don’t possess and your additional comments add a validity to what I say, which is very much needed. Thank you.

  6. The nub of the issue lies in what Lucy Series says here: “supported living services are technically a person’s private home”.

    The term ‘Supportive Living Care Home’ is an oxymoron and incompatible with what supportive living is meant to be. Where is the exercise of choice in a private home here? Supportive living is actually about living in the community – the notion of a private home has a context which is easily recognisable to a lay person. Would any lay person describe just having a lock on a door as making a room a home within a care home environment? I would suggest that this fails a basic test.

    Can these semantics be tested? I regret that the concept of supportive living is being degraded like this.

    • Thanks John! This throws up a really interesting angle on this subject. In fact although I haven’t talked about it yet in any of my blogs, I have very strong feelings about the way that the house is described as your child’s “home” when in fact things go on there that would NEVER happen in our house. So when is “your home” not really your home? Perhaps when it’s the cheapest option for the commissioning body. So much more I could say here, but I want to keep this about the role of the CQC (or non- role) with supported living care homes for now.

  7. Hi Rosi,
    I am not at all shocked at the findings/failures of Southern Health, as disturbing as it is. The lack of basic knowledge of the legal framework required to run supported living has been my bone of contention for years.

    This all makes very interesting reading for me. As you know I have a son with a severe disability, he is autistic and without speech or capacity. He is in supported living – a rent paying tenant ( with 1 other ) and 24 hour care provided by Southern Health`s Dom care service TQ21 ( formerly Ridgeway ) commissioned of course by Oxfordshire LA.

    He has been at his home since 2001. Throughout this entire period, up until recently the staff have “run” both his life and home like a care home. As I said in Sara`s blog yesterday, I have complained many times to no avail. From 2005 when the MCA kicked in- absolutely NO ONE took any notice of this as a statutory duty. NO ONE as ever aspired to REACH standards ever. NO ONE has understood his rights as a tenant. I had to ask them to read “The real tenancy test”, to give them some guidance.!!!

    Decisions about his benefits and how they have been spent by unauthorised people have been a major issue for far too long. Many decisions have been made without consulting me – or a best interest meeting being held. It got so bad that I too contacted the CQC to be told exactly the same as you have. The LA monitoring of his service relies on tick box questions which do not reflect on whether the MCA is being followed. It seems to concentrate on cleanliness etc.

    I was left out of the LA monitoring for 14 years, only receiving a monitoring form last year for the first time. How does anyone explain that, I am my son`s only representative.???

    So yes I am all for having better monitoring of who is providing the care, regardless of if it is the CQC or anyone else. But they need to ask better questions and make sure that people who have no voice or capacity do have a family member/representative that they can contact. I feel very angry that I had to resort to applying to the CoP twice in 3 years simply because TQ21 were ignoring their statutory duty for working within the law by not following the MCA. Surely that’s a basic knowledge requirement.??

    One other thing has to stop, staff treating peoples homes like their workplace first, believe me I see it happen. So there also needs to be something in place to monitor this and remind them.

  8. Pingback: A week of blogs “Holes in the net” | Justice for Nico

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