The recent inquest into the tragic death of Ivy Atkin provides a useful summary of the new approach taken by the Care Quality Commission to care home inspections.
Ivy Atkin died aged 86 in 2012 having suffered horrific neglect whilst living at Autumn Grange care home in Nottingham. Her death prompted a complex investigation by the police culminating in a charge of corporate manslaughter against the managing company and a charge of gross negligence manslaughter against one of its directors. The company received a fine which to all intents and purposes amounted to the majority of its financial resources and the director was sentenced to 4 years immediate custody. Following on from the criminal trial, an inquest was held into Ms. Atkin’s death in October 2016. After hearing the evidence the coroner made a finding of unlawful killing.
The main focus of the inquest was the manner in which the local authority and the Care Quality Commission (CQC) had monitored Autumn Grange in the months leading up to Ms. Atkin’s death. Extensive evidence was heard about how the CQC had since changed its inspection methodology. Whilst the changes have now been in place for a number of years this case serves as a useful reminder of how the CQC now aim to inspect and monitor providers of adult social care.
This new vision seeks to raise standards and to put the needs of people first by asking the key questions:
- Is the service safe?
- Is the service effective?
- Is the service caring?
- Is the service responsive?
- Is the service well led?
The methodology sets out to make 10 fundamental changes to the manner in which adult social care is authorized, monitored and inspected:
- More systematic use of people’s views and experiences, including complaints.
- Inspections by expert inspectors, with more experts by experience and specialist advisors
- Tougher action in response to breaches of regulations, particularly when services are without a registered manager for too long.
- Checking providers who apply to be registered have the right values and motives, as well as ability and experience.
- Ratings to support people’s choice of service and drive improvement.
- Frequency of inspection to be based on ratings, rather than annually.
- Better data and analysis to help target their efforts.
- New standards and guidance to underpin the five key questions, with personalisation and choice at their heart.
- Avoiding duplicating activity with local authorities
- Focus on leadership, governance and culture, with a different approach for larger and smaller providers.
In addition, there were also some new significant statutory changes. From the 1st April 2015, the CQC has been empowered to monitor the finances of some providers under s. 55 of the Care Act 2014. The providers who fall within the monitored category must make available to the CQC information about their finances. The aim of this function is to give local authorities early warning of likely failure, so they can put in place plans to ensure people continue to receive care if a service needs to close because of business failure.
Finally, one of the issues which significantly troubled the Coroner in the inquest was the lack of communication between the local authority and the CQC. The CQC has now reorganized its structure to reflect local authority boundaries so that information can be effectively shared. Key information that may trigger an inspection include a high incidence of pressure sores, safeguarding alerts, high incidence of hospital admissions for preventable illnesses, concerns raised by staff, frequent changes in managers.
These changes require a more rigorous approach by those providing adult social care. Strict procedures and policies must be in place covering topics as wide ranging as storage and administration of medication, to feeding and drinking charts and whistleblowing procedures. As the ageing population grows, the importance of the care of elderly people will increase. This means that those who provide care to the elderly will come under increasing scrutiny. Such scrutiny should not be perceived as yet another sign of an overbearing regulator but rather as justified protection not just for the service users but also for the providers. Maintaining the requisite standard will prevent those who provide care from having to live with the dreadful consequences which can follow flouting regulations and disregarding the requisite standards.
The time and effort taken to devise policies and procedures may seem onerous to begin with but will save time, distress and possibly a criminal conviction.