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Inside Out: Care home investigation - who can we trust?


A ´óÏó´«Ã½ investigation has uncovered serious failings in the system that's supposed to police care homes for the elderly – Inside Out, ´óÏó´«Ã½ One East Midlands, 7.30pm, tonight.

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A journalist working undercover in a Nottinghamshire care home discovered evidence of poor infection control and lapses in care – yet the Moorlands Nursing Home in Brinsley was passed as satisfactory by an official inspection and a council audit.

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It took the Commission for Social Care Inspection (CSCI) 54 days to act after the ´óÏó´«Ã½ highlighted its findings. It should have taken just 24 hours.

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The CSCI have now re-inspected the home and found significant problems. It has launched an enquiry to find out what when wrong.

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The ´óÏó´«Ã½'s undercover reporter worked inside Moorlands Nursing Home in Brinsley, Nottinghamshire.

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The home is owned by Regal Care Homes Ltd and offers both nursing and residential beds for up to 40 elderly people.

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The residents are particularly vulnerable to infection, making it crucial that staff follow procedures to protect them.

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Yet Inside Out found evidence that some staff were confused about who was infected by MRSA and sometimes neglected basic hygiene precautions.

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Superbug expert Professor Richard James from Nottingham University watched video footage of cleaners at Moorlands wandering out of the room where someone was believed to be carrying MRSA.

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"Cleaners... not wearing an apron, not taking their gloves off before they left that room, wandering along a corridor... it would be quite likely that any resident in the care home could become an MRSA carrier," says Professor James.

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Regal Care Homes says the resident was clear of MRSA when the filming took place. But, ´óÏó´«Ã½ evidence shows staff were unsure and were unable to clarify even when they checked the resident's notes.

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The Inside Out reporter also discovered that, at times, residents with dementia were left unsupervised and others had to wait unreasonable periods for basic care.

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He found one resident had been left sitting in urine-soaked clothing. The carer who treated his sore skin said he had not been fitted with the leg bag he required.

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Regal Care homes disputes what happened and says leg bags were available at the home.

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In another incident a resident left unsupervised in a lounge area had soiled herself and removed much of her clothing.

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Her relative Raymond Skelton, distressed by the ´óÏó´«Ã½'s footage, says: "It's quite obvious there could not have been anybody there for some considerable time because she would not have got into that state in a couple of minutes.

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"I want answers. my initial reaction is I need to take her out of there now."

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Regal Care Homes maintains the lounge was never left unattended that evening. But it says staff do have to leave residents alone occasionally. It says it is inevitable some will have accidents of this sort.

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While Inside Out's reporter was undercover he raised his concerns about care and hygiene with the home's management but saw little change.

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When Mike Rourke, CSCI's director of inspection, regulation and review, was questioned about the delay in responding to the call from the ´óÏó´«Ã½'s reporter, he says: "At this stage it looks as if there may have been a number of people who were involved and we want to understand what they did and why they didn't act as our procedures required.

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"But our view is that this is an exception, there are lessons I'm sure to be learned from this and we will do so."

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The commission is responsible for inspecting all 18,500 care homes in England.

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Last October one of its inspectors went into Moorlands. Its report suggested Moorlands had no significant failings.

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Part of the inspection regime is self-assessment. Moorlands' own management filled in a questionnaire before the inspector arrived. The inspector based his report on it – and the care notes of just four residents.

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Former inspector and nurse Ruth Poole spent more than six years inspecting care homes.

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She believes the inspection system is now not robust enough to protect residents.

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"It's has been watered down to such a degree that in my opinion inspection reports are nothing more than tick boxes."

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But the CSCI's Mike Rourke says: "We wouldn't accept that our inspections are tick box. We've tried very hard to make sure that our inspections really begin with the service users' experience.

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"We want to know what it's like to live in a home. We want to know what it's like in terms of dignity, independence, safety, all of the things that people who use services tell us are important."

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The CSCI stands by its October 2007 report and says it is perfectly possible that the problems highlighted by Inside Out had developed in the weeks after the inspection.

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The CSCI has subsequently re-inspected Moorlands and asked the home to act immediately to address a number of issues.

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Mike Rourke says: "It is a case that there are concerns around the management of medicine, infection, care planning, risk assessments, those sort of areas that we would expect to be addressed properly in a well-run home."

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During the ´óÏó´«Ã½ investigation, the home was also audited by Nottinghamshire County Council – its report showed nothing wrong.

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The council has now issued the following statement: "We are extremely concerned about the issues that have been raised about Moorlands Nursing Home and we have immediately acted to ensure the safety and wellbeing of the residents in partnership with the Commission for Social Care Inspection.

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"This year, we have introduced a quality audit process for the first time to look at aspects of care in independent care homes. These audits are pre-arranged and provide a snapshot of the arrangements in any home.

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"This audit at Moorlands was not an official inspection and it was carried out in addition to the regular inspections by CSCI, which is the regulator of adult social care in England.

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"The County Council is committed to improving the overall quality of care at residential and nursing homes in Nottinghamshire and we have been working with the Notts Care Home Association to do this.

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"We will continue to work with CSCI. and Moorlands to ensure the future improvement to the quality of service in the home."

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While inside Moorlands Inside Out's reporter also saw kindness and compassion from staff sometimes working in very difficult conditions.

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Most relatives who contacted the ´óÏó´«Ã½ were very supportive of the home and believed it was caring very well for their loved ones.

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Regal Care Homes say the home is now clear of MRSA, and it complies with NHS guidelines on infection control.

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But questions remain about how these homes are inspected – how standards are maintained.

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Former inspector Ruth Poole says unless inspections take place regularly and unannounced there is nothing to prevent conditions deteriorating behind closed doors.

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She says: "If you haven't got the inspectorate knocking on your door, coming in at any hour of the day or night then effectively you are left to your own devices."

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Inside Out, ´óÏó´«Ã½ One East Midlands 7.30pm, Friday 2 May 2008

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Notes to Editors

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Inside Out is also available at bbc.co.uk/insideout from 8.00pm, Friday 2 May.

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´óÏó´«Ã½ Birmingham Press Office

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Category: East Midlands TV
Date: 02.05.2008
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