Saturday 6 July 2019

Who cares?

UPDATED 30 October 2021: 
I originally wrote a blog about the Apthorp Care Centre back in July 2019 (see below) setting out the failure of the operator to deliver a safe service to residents. This is a centre that was contracted out yet when the service failed it was simply handed back. Since then Barnet Council's 100% owned Arms Length Management Organisation, Barnet Group have been running the centre. In recent months the centre has been found to have a number of building problems (even though the building is less than 20 years old) and so the Council has decided to close the building indefinitely while building works are undertaken and make all of the care staff redundant. I have just been to a demonstration outside the centre where some of the redundant care workers were present. 

This whole situation seems mad. NHS trusts up and down the country are saying that the cannot discharge elderly people out of hospital because of the lack of care workers either to provide in-home care or into care homes that are short staffed. From what I understand Barnet Group are saying they cannot upgrade Apthorp in phases, for example, doing one wing at a time so have to close the entire care home, all 120 beds. Something just doesn't seem right here. It smells very badly and makes we wonder what the long term use of this building is planned. It is also important to note that Barnet do not own this building that they are spending so much money repairing - it is owned by Catalyst the company to whom the care homes were outsourced. Back in 2019 I was asking why the operator was not being more closely monitored and it seems Barnet Council weren't monitoring the building either. When they took the contract back from Fremantle in 2019 they should have also reviewed the state of repair and held Fremantle responsible for any failings to maintain it properly but apparently did not happen. Questions need to be asked how such a disastrous position could have been reached in such a modern building.

 Staff today were calling for a Public Inquiry into what has happened at Apthorp Care Centre and they are absolutely right. Something here stinks. 93 care workers have been made redundant at a time of care worker shortages and very frail and elderly residents have been moved out of their home and the people they know and who care for them removed. At the same time Barnet residents are being landed with a massive repair bill for a building we don't own. We need answers.

Post from 2019:
Back in January the Care Quality Commission (CQC) published a damning report about a local care home, Apthorp Care Centre which is located near the bottom of Oakhill Park in East Barnet. The CQC gave the home an inadequate rating and a number of the specific details were quite shocking, including:
  • No Registered Manager in post;
  • Bathrooms were dirty and this exposed people to the risk of harm due to poor infection control practice;
  • All the showers were out of use due to legionella in the water system and yet five of the seven baths were being used for equipment storage;
  • Breaches of five regulations relating to person-centre care, safe care and treatment, premises and equipment, staffing and governance;
  • Medicines were not administered in a systemic manner and not managed in a safe way;
  • Risks to people were not appropriately mitigated and risk assessments were not always followed.
A quote from the Report:

"We  found bathrooms and toilets were dirty and being used inappropriately for storage. We saw two shared toilets had faeces visible on the outside of the toilet bowls. The flooring in some bathrooms was damaged meaning that they could not be effectively cleaned and posed an infection control risk. Where they were not damaged the floors were dirty and water stained. The showers in the home were currently out of use as they were being refitted following legionella being found in the water systems. The manager told us people were being supported to have washes and baths until the shower heads were replaced. Seven of the baths checked were dry and dusty. They were all dirty and one contained a dry, stained tissue underneath the bath chair. Five of the baths were being used to store equipment, some of which were Christmas decorations which staff told us had been brought down from the loft two days before our inspection. However, other items stored in bathrooms included clothing, bed linen, shopping trollies, people's clothing and wheelchairs. The cluttered nature of bathrooms meant they could not be effectively cleaned."

What is also important to understand is that this care home is run for Barnet Council by Fremantle and in 2018/19 Barnet paid Fremantle £3.99 million to provide care for Barnet residents. I was aware that Barnet has a system that is supposed to monitor these contracts so on 25 February I submitted the following questions in a Freedom of Information (FOI) request:

  • In the years 2017 and 2018 how many time did Barnet Councils' Care Quality Advisors visit Apthorp Care Centre (Nurserymans Road, London N11 1EQ)?
  • Please provide me with copies of the monitoring reports of all the visits to Apthorp Care Centre in 2017 and 2018.
  • Please provide me with copies of all the monthly reports setting out provider risks and concerns which are circulated to the DASS and to the DU's Leadership team for 2017 and 2018.
  • Please provide me with details of the support Care Quality Advisors provided to Apthorp Care Centre through best practice support and supporting staff development in 2017 and 2018.

After just over a month, the initial response to my FOI was for Barnet to refuse to answer any of the questions, something which I found astonishing and so I immediately requested an internal review. That was on the 28 March. The deadline came and went and no review was forthcoming. Trying to speak to anyone at Barnet Council proved incredibly difficult and after 11 calls I eventually got through to someone. I had also spoken to my local councillor, Felix Byers, who had emailed the FOI department, but when I spoke with them they said they had no record of his email. Barnet said they would fast track the internal review but again that was an empty promise. Eventually on 20 June, after threats to go to the Information Commissioner, I received  a response. Two questions were answered and two were again refused. What the answers did reveal was that:

There was no log of visits from Care Quality Advisors in 2017: "We do not maintain an accurate records of all visits by Care Quality Advisors to Apthorp Care Centre as far back as 2017 but we have a record of 21 care reviews of residents that were carried out in 2017". They speak as if 2017 was a long time ago which again I find staggering.

In 2018: "there were 2 Contract Monitoring visits, 16 visits from Care Quality Advisors, 12 resident care reviews and 21 visits from the Enhanced Care Homes Team. The Enhanced Care Homes Team is commissioned by Barnet CCG and works in partnership with the Care Quality Team in the Adults and Health Directorate to support care homes in the borough." 

Even though there were a large number of visits (51) to this care home the shortcomings they indicate were clearly still present when the CQC made their inspection, suggesting little or no remedial action had been taken. There is absolutely no point in having monitoring regime if no actions or changes in behaviour and performance are forthcoming. Given that Barnet were paying Fremantle a shade under £4 million per annum, why didn't Barnet bang the table and demand improvements with the threat of withdrawing the contract to ensure problems were remedied.

Another quote from the report:
"When people were permanent residents at the home their medicines were supplied by a local pharmacist with printed medicine administration records (MAR). The files where MAR were stored were chaotic and held information that was not relevant to the administration of medicines, for example, reminders to put menus out were also in this file. The files also contained old information and some MAR were loose and not kept with the other MAR for that person. Staff had not recorded incoming medicines on the MAR. Furthermore, some entries were handwritten by care workers into MAR charts and this was not always legible or easy to read. The detail of how to support people to take their medicines was not always completed, which meant people did not always get the support they needed. For example, we saw a care worker gave one person a tablet then walked away before checking the person had actually swallowed their medicine. There was no information to inform this care worker about how to support this person to take their medicines properly."

The other question they answered were the details of care support provided by Care Quality Advisors in 2018 (as they don't have records for 2017). This included:
  • The Care Quality Advisors undertook regular visits to the home which included updating of risk assessment as well as supporting and monitoring the homes improvement plan. Once the provider concerns process has been invoked full risk assessments are completed and mitigating actions monitored through a regular action plan including staff support and development.
  • The Care Quality Advisors reviewed and recommended improvements in regard to the homes policies, procedures, care plans and fluid charts.
  • Workshops were provided by the Care Quality Advisors on effective care planning and evaluation.
  • Care Quality advisors liaised with Environmental Health colleagues in regard to Legionella issues at the home.
  • There were 12 care reviews of residents to ensure their care needs are being met by the home.
  • Contract monitoring visits were undertaken to monitor performance.
  • Joint work was carried out with NHS colleagues including pharmacists to improve medicines management
  • The Enhanced Health in Care Homes team delivered seven "Significant 7" programme training sessions, with 24 follow up visits reviewing and case tracking residents to monitor the success of the intervention. Significant 7 is a programme which supports staff to identify signs of deterioration in a resident at an early stage, allowing preventive action to be taken and reduce hospital admissions. The team also supported Apthorp to adopt the use of a ‘red bag’ to support smoother hospital discharges.
This reinforces the impression that although the problems were identified and some support was provided, the situation had still not changed by the time the CQC carried out their unannounced visit on 11 December. This suggests that there were no sanctions or effective enforcement in place, especially from the Contract Monitoring staff. I specifically wanted to see copies of the Care Quality Advisor reports so that I could understand how these concerns were being portrayed and what follow up actions were required.

If this was a restaurant that received a zero hygiene rating there would be a report which sets out the issues for immediate remedy, a clearly defined timetable for remedial action to take place and a deadline for a follow up inspection. All logical steps to ensure a problem is resolved. If the matters are not resolved there is the ultimate sanction of a closure notice. This suggests that while our local takeaways are adequately regulated to ensure our health is safeguarded, the care our elderly friends and relatives receive is at the mercy of a more passive, lax monitoring regime. I am continuing to pursue Barnet for the disclosure of these reports as without them we have no clear idea how the monitoring regime is managed and that means residents in any of the other 100+ care homes in Barnet could also be at risk.

Since the appalling CQC report Fremantle have decided to hand back the management of the three homes they managed on behalf of Barnet. The Barnet Group (which is 100% owned by Barnet Council) will take over the management of the homes and I understand the staff are in the process of being TUPE'd back to Barnet. It is good that the management of these homes will now be much more closely regulated but yet again it is a case of the public sector picking up an outsourcer's failure.

On the final item in my FOI request, copies of  monthly reports setting out provider risks and concerns which is circulated to the DASS (Director of Adult Social Services) and to the DU's (Delivery Unit's) Leadership team, Barnet are still refusing. I have reluctantly agreed to drop this request as I suspect it is devastatingly bad, flagging up the potential risk of other care home providers going bust. In April this year Four Seasons, one of Britain's largest care home providers, went into administration affecting 17,000 residents and patients. Between January 2016 and April 2019 there was a net reduction of 901 care homes in the UK with consolidation of beds into larger homes. A recent report in The Gazette suggest 1 in 4 care homes are financially unstable. In Barnet we have over 100 care homes and as such it is vital that we understand the risks of collapse.

While accepting the refusal I have asked that Councillors on the Adults & Safeguarding Committee be given copies of the reports under "Blue Papers" (not available to the public) so that they can understand the risks if they have not already been made aware of them.

This is a shocking story which has taken months and a great deal of persistence to uncover. It also highlights the shortcomings of the FOI system where often the first response is to refuse and how, even when councillors are involved, it still does not guarantee the answers will be forthcoming in a timely manner. Barnet are planning to close down questioning in committees and stop residents from making public comments in person. Residents provide an invaluable level of scrutiny yet it is something Barnet believes can be resolved through FOI's and talking to councillors.My own experience suggests that is a false assumption.  I will be pushing for this tragic case to be discussed at the next Adults & Safeguarding Committee and I will be asking to speak.

Mr Reasonable will not be gagged. If you believe Barnet are stifling public scrutiny please sign this petition

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