Phil's Scrapbook - It rambles along without an end

[Gossamer]

*opens her arms for him to get a hug*

Sometimes you just need a hug. Come get one. I'm not a hugger by nature but for you, Phil, I'll make an exception.

And if you get bored of that, we'll just hang.

[Wrenmae]

Sometimes you just need a break.

I had a breakdown and a move last summer as well, vanished for two months and when I came back I found I may have burned a few bridges. It's tough stuff, but we all have our reasons for falling off the grid now and again, my hope is that whatever was bothering you at the time is well behind you. It's no worries mate, we're glad to see you back and look forward to having you around again.

Best wishes.

[Tessa Poe]

I don't think I could ever get tired of hugs Jen-Jen... and thank you. *huggles*

Thankee to you too Wren, things are better round my way now, calmer certainly.

[Tessa Poe]

A couple of things before I get into what I'm actually going to talk about.

Firstly I've decided to keep Tessa going... I couldn't face not having her around. Slowly but surely getting used to writing with her again too which is nice.

Secondly, I've had an idea for a PC and it's one that I'm not sure if I can pull off, and by that I mean write in a credible way, but I sure as hell want to try. I’ve already got her placed and with a purpose, it’s probably going to take a little research to get it right though.

And when I started this that's what I was going to talk about... but instead I've got to talk about something else, something that I'm really trying very hard not to just scream about:

Abuse of the Elderly

I don’t actually have the words to describe how… revolted I feel by that. The resident in that video suffers from Dementia and has communication difficulties, she's quite literally powerless to do anything about what's going either through her own actions or through those of someone else.

Now you might not be aware but I happen to work for a small group of three care homes for the elderly. My job mostly deals with the paper work side of things, which is good since I'd make an awful carer. The thing is, even though I've got nothing to do with the actual provision of care to the residents I've still been through the Moving and Handling Training, POVA (Protection of Vulnerable Adults), Health and Safety Training and Dementia Care Training. It's mostly for the emergencies, in case I absolutely had to cover a care shift, but it's also so I know when things aren't right in one of the Homes.

How the hell anyone could have missed what was going on in the Home I linked to above is beyond me, a fact I shall begin to illustrate by reviewing the Care Group's repsonse to what's happened. The red text is fairly obviously me.

“We are pleased justice has been done in the case of the male former carer (This bit won't go red for some reason so it's bold instead - Yes, we're all very pleased that this has been dealt with because now we can go back to sweeping things under the rug) and that the prompt actions taken by the home [color=#FF0000](That wouldn't have been taken if the daughter hadn't hidden a camera in her mother's bedroom. Oh and originally the prompt action consisted of suspending four of the members of staff in the video for four days while they went on a training course... because that'll fix everything! They only sacked them 6 months later.) have been validated by the Court’s decision. This matter caused great distress to residents and staff alike. (Ohhhhhh crap. We're in for a kicking in the press... that means we'll start losing clients and that means we'll start losing money! Quick, damage control! Issue a shitty press release!) We apologised both verbally and in writing to the family as soon as the incident came to light. (Which, lest we forget, still required the daughter to HIDE A CAMERA in her mother's room. Also the apology contained the phrase "a good opportunity to move forward positively" in it. I'm not entirely that's actually counts towards an apology.)


“This was an isolated incident, (Bullshit. Complete bullshit. You've just sacked five carers in relation to this, and one of them's in prison for assault? That's not bloody isolated, that's demonstrative of a fundamental lack of care in a home) as demonstrated by thorough investigations by the police, London Borough of Camden and the Care Quality Commission alike, and it is an important reminder that an individual who has been provided with all the appropriate training (Define appropriate. For some reason I get the feeling our definitions may differ) may still commit a criminal act even in the most professionally run and highly regulated environment. (Wait just a minute. You can't be regulating that highly if none of your other members of staff noticed and reported the bruises this client had. If any member of staff in any of the homes I work for notices a bruise they report it. If you're on shift and a client suffers a bruise while you're caring for them you report it. It's not bloody rocket science! It’s basic adult protection procedure!)

“When the male carer was arrested the four female carers were also immediately suspended. For four days while they went on a training course. We made several requests to the family to view the footage in order to complete the disciplinary process, which they agreed to in November 2011. Immediately subsequent to that we completed proceedings and all four were dismissed. From the time the allegations were made until their dismissal these individuals did not work again for the company. (That's all well and good, even if it's bullshit, there's still the bloody problem of why no-one reported these members of staff for poor practice months ago. I mean if they're willing to do this with one client who's to say they don't do it with every client? Is it just that these four got caught this time or this the culture of care that pervades your establishment?)

“The wider staff team at Ash Court have provided many years of excellent care and were shocked by the truly unacceptable behaviour of these individuals. (Bet you they weren't. There's no way in hell they weren't aware of what was going on. Alright it's a big 62 bed home but still the staff mix would have put members of staff who weren't abusing clients on with members who were and they should have reported it immediately.) It is important to note that every member of staff at Ash Court receives comprehensive training, including Moving and Handling and Communications training and this was also the case for the individuals identified in the footage, which makes their actions doubly distressing. (Uhuh... clearly it didn't take then. Did you review the training with the staff at their Supervisions/Appraisals? Did you ever notice that clients were being bruised with no noted cause? No? Then clearly the training wasn't sufficient and clearly you've failed as a bloody manager haven't you?) It is also important to note that the family had not raised concerns with the home manager prior to showing her the video footage on 22nd June 2011. (Ooooo nice! Really very nice. That's right, blame the victim for the fact that you don't supervise your staff properly, that there's been an endemic failure to provide care in line with best practice and that there's been a failure in your own internal reporting mechanisms amongst the staff. Bravo, bra-bloody-vo.)

“Ash Court is committed to working closely with all families and residents and we continue to receive positive support and feedback on the quality of care we provide, (So it's fine so long as some people are happy with the care they receive?) which is subject to a process of continual improvement. (Not exactly showing much improvement then are you?)We remain grateful for the vigilance of our dedicated staff and the professional scrutiny from the Care Quality Commission and London Borough of Camden.”(More on the Care Quality Commission in a minute, but for now let's just say that their professional scrutiny isn't all that great)

So, there you have it. Their response in all its glory. The thing is, for all their attempts to spin this, they've just sacked five of their carers, one of them's in prison. With 62 residents (the number in the Home we're talking about) you're probably looking at a total staff team of... maybe 50? It depends on a few other things but let's take 50 as an estimate. That means that this care home has just sacked 10% of its workforce. When you put it that way it really doesn't sound like a small, isolated issue does it?

What the video in the link I put up at the start of this demonstrates either is a fundamental lack of knowledge amongst the care staff or they're aware that they're working in a home that doesn't place any importance on nationally accepted and approved standards for best practice when providing care. On the one hand they're just ignorant, on the other they're willfully putting people at risk. There's a moment in the video when two carers lift the client under her arms (which can bring on a whole host of issues but I won't go into those) and do you why they do it? Because it's quicker. It's true, it is quicker to throw someone around like a sack of potatoes rather than get a hoist and move them safely and properly but that doesn't mean you should do it! So again we're down to a few most likely reasons as to why the staff feel the need to do things the quick and bloody dangerous route. Either they're the sort of person who has no business being a carer in the first place, they're working in a home where the management don't provide any oversight, they're understaffed and as such they're constantly in a rush to complete however many tasks they've got for the day ,or maybe it's just the way things are done in that home. You turn up on your first shift with ideas about how a care home's supposed to operate and then a senior member of staff tells you to sod off with all that rubbish because it takes to long... so what do you do? Sadly the answer to that for most people is fall into line with what the senior staff member's saying, something that you may know is wrong, but if everyone else is doing it why don't you? Plus you wouldn't want to rock the boat and report it... that'd make working in the home awful! Everyone would know you’re a grass!

Okay, I’m going to talk about the Care Quality Commission (CQC) and then I’m going to stop. Basic facts first:
1) The CQC was formed in 2008 and is made up of three previous government departments… unfortunately when the amalgamation happened they only got to keep the budget of one of them. Understandably this caused a few issues, mostly to do with having fewer inspectors to cover the country.
2) The CQC is responsible for monitoring every Care Home (for the young and the elderly), Doctors’ Surgery, Hospital, Hospice, Dental Practice, Physiotherapist etc. in this country. See 1) for why this is particularly difficult for the,
3) The current head of the CQC, Cynthia Bowers, got the job after presiding over one of the worst scandals in the NHS in recent times. (Google Cynthia Bowers Stafford NHS for the details) and was then promoted! Hurray! At least she’s finally quitting now.

I’ll forgive you if you think those three facts are insane. They are, but that’s the situation we’re in. In some ways I feel sorry for them though, they keep being attacked for not inspecting care homes and hospitals enough when really all they’re doing is what they’re legally obligated to do. Under the Health and Social Care Act there’s no legal requirement for the CQC to carry out regular inspections. Yes they have to carry out ‘planned reviews’ where they write to you and ask you to send them some paper work, fill out a few forms, but they only have to inspect if there’s a concern raised or complaint made. And before you ask yes, yes it would be entirely possible to just lie your arse off on the planned review forms without them realising. You’d think that relying on people complaining to tip you off to where standards of care were slipping would actually be a good way round the fact that you’ve not got the staff to inspect all that you’re responsible for wouldn’t you… well until you realise that up until recently there was no way to complain to the CQC if you were a member of the public. If you tried to use the website it simply said “Refer to your service provider” or the person you’re trying to complain about. If you called them they directed you to the website. I don’t know how many times I had to talk to various people from the CQC at the care conferences and consultations I’ve been to pretty much demanding that they do something about that. Apparently I’m not the only one since they seem to have finally done so.

Anyway, moving on again, while the Health and Social Care Act doesn’t have anything to say about the need to physically inspect premises it does have a lot to say about deregulating the care sector. Under the old law there were minimum standards laid down throughout it. Toilets had to X meters away from clients and all times, you had to have X number of bathrooms for X number of rooms, rooms themselves had to be X meters squared, you had to have 1 member of staff per X number of clients in the home with consideration taken over care needs of the client group and so on. All that’s gone now, replaced by the words “What the provider deems suitable”. Or words to that effect anyway. Essentially if a care provider can justify knocking out the interior walls and installing bunk beds along the length of the building, thereby cramming 100 people into it (and getting the fees for 100 people) they can do it. I know that’s an extreme example, but that’s how the care sector’s operating these days and that involves trusting a whole lot of people an awful lot more than I’m comfortable with.

I think I’ll finish this with a more realistic example, one that links back to the case of the care home I was talking about before. Let’s say you wanted to increase the profits a care home generated. Easy thing to do really, all you have to do is spend less. So you sit down and you start trimming the budget and then you realise that at least 50% of your monthly outgoing is on wages for your staff (which is the industry average figure) and if you could drop that a little bit you’d be saving an awful lot of money over the year. Now there’s no set minimum level of staffing for each shift anymore, so take some hours off the rota. The carers will cope, of course they will, they’ll manage somehow. You might even tell them they’ll have to manage, that times are hard and everyone’s got to cut back a bit. Hell the carers should be grateful they’ve got a job at all in this economy, there’re plenty of others who’ll take their place in a heartbeat.

So you’ve cut your wage bill to 48% of your outgoings, saving yourself a nice little sum but what about the carers? Suddenly they’re having to do more than before, possibly with less time to do it in. The clock’s always ticking and they know they’ve got to get through the routine for 4 clients before tea break time… so why should they use the hoist? It’s a waste of time! If they just lifted Mrs A themselves and put her to bed they’d save at least fifteen minutes, and that’d be fifteen minutes they could use for taking care of the house cleaning duties, or the laundry, or any of the other things they’ve got to take care of… and pretty soon it becomes the norm, the way things are done in that care home.

Scary thought isn’t it?

[Tessa Poe]

While following the news about the care home I was talking about yesterday I found this article. It's nice to see a positive bit of news about a care home somewhere in the country, it so rarely happens.