Relatives of care home residents are demanding an urgent restart to statutory inspections, amid fears that safety failures in locked-down homes may be causing unnecessary deaths from Covid-19.
The Care Quality Commission suspended routine inspections of care homes on 16 March to reduce virus spread and pressure on care providers, and set up video conference calls with managers as part of an alternative system.
But more than 20,000 people are believed to have died in care in England and Wales as a direct and an indirect result of the pandemic, and some of their relatives are now warning standards may have slipped as stretched facilities struggle to cope and doctors, relatives and inspectors are largely kept out.
The Relatives and Residents Association said it was receiving daily calls to its helpline with concerns about staffing levels and lack of PPE, medical support and management control in care homes.
“As care homes went into lockdown and restricted visits from family members, this coincided with a relaxing or ceasing of the normal checks and processes to ensure older people receive quality care,” said Helen Wildbore, the chief executive.
“CQC has a vital role to play in ensuring the rights of older people are not put at risk, particularly in care homes that were struggling to maintain care standards before the coronavirus outbreak. Inspections could be restarted with training, PPE and selecting the homes where concerns have been raised or which are known to be struggling.”
“Now is the time they should be inspecting,” said Ivan Pointon, who lost his father Donald Pointon, 91, to Covid-19 at Bupa’s Priory care home in Solihull. “Homes should at least be inspected for cross-infection procedures and cleaning procedures.”
Earlier this month, lawyers for elderly and disabled groups also threatened legal action if inspectors do not return to care homes, claiming to withdraw may breach the CQC’s statutory obligations.
The pressure came as the government announced £600m in extra funding to improve infection control in care homes, which the Association of Directors of Adult Social Services said came “tragically late in the day”.
Nadra Ahmed, the executive chairman of the National Care Association, also said on Thursday that care homes had been “left completely abandoned” in the government’s strategy to protect the NHS, leaving them with “desperate” shortages of PPE, “anxiety and depression” among staff and Covid-positive patients being discharged into care homes.
The CQC says it will still go into services if it sees a significant risk, but has developed an emergency process for monitoring care homes without inspections. It involves “open and honest conversations” via Microsoft Teams, but they are not part of the regulatory process. Usual steps such as “the factual accuracy process” do not apply, and the outcome of any checks is not published, it says.
Based on inspections before the pandemic, 228 care homes in England were rated as “inadequate” in terms of their safety and a further 2,386 were given an amber rating, saying they required improvement. If the CQC had continued at its previous rate it would have carried out checks on around 2,000 homes in the two months since it suspended inspections.
Pointon said he had tried to raise concerns about infection control with the management of his father’s care home, but cleaning did not appear to have been stepped up, carers were not wearing gloves when delivering food, some were wearing masks with their noses exposed and residents were being allowed to fraternise in communal areas and to share dining tables. He said: “Staff were travelling and working in the same clothes.”
Bupa said rooms were cleaned daily and it had seen no evidence of staff wearing the same clothes in and out of the home.
“Everyone at the Priory is devastated,” said Rebecca Pearson, the operations director for Bupa Care Services. “The home is like a big family, and Mr Pointon was very popular and held in great affection. Our heart goes out to his loved ones.
“The safety of our residents and staff is our absolute priority, and we’ve been working hard to ensure they are protected. We increased infection controls and staff training including around the use of PPE and social distancing.”
Shirin Koohyar, the daughter of Ameer Koohyar, 91, who died after being diagnosed with Covid-19 at Nazereth House nursing home in Hammersmith on 26 April, said the continued lack of inspections was “shocking”. The home’s last inspection report in November concluded it was “not always safe” and it had deteriorated with “an increased risk that people could be harmed”. A postmortem is being carried out to establish the cause of Ameer’s death.
“They need to be inspecting equipment, hygiene, care and record-keeping,” Koohyar said. “They should have been all over this with inspectors. Why did this happen? Carers and nurses are going in and out. Why not inspectors?”
Kate Terroni, the CQC’s chief inspector of adult social care, said the regulator is aware that “there are increased risks to people, both to those with coronavirus and those without it, whose treatment and care is being directly or indirectly affected”.
“We will continue to inspect where we see evidence of risk of harm, deliberate abuse, systematic neglect or a significant breakdown in leadership,” she said. “We will continue to regulate services in a variety of ways so that we can identify where support is needed. We will use our powers, or work with the relevant system partners, to take action against those responsible where we find unsafe or poor care.”
