Shocking Care Quality Commission report on Kent brain injury centre

I was shocked to read the CQC’s inspection report into the care provided to residents at the Hothfield Manor Acquired Brain Injury (ABI) Centre near Ashford in Kent.  The ABI specialist centre is part of the Huntercombe Group, and caters for up to 44 adults with complex neurological conditions and acquired brain injury.

The report, published on 22 February 2016 following an unannounced inspection in December 2015 stuck out like a sore thumb on the CQC website because it had been rated as ‘inadequate’ in relation to every single one of the 5 CQC inspection criteria questions:

• Was the service safe? No
• Was the service effective? No
• Was the service caring? No
• Was the service responsive? No
• Was the service well-led? No

The Centre has now been placed in “special measures” meaning that it will be kept under review by the CQC and inspected again in 6 months’ time. You can download the full CQC inspection report here.

The Huntercombe Group, who run 18 specialist brain injury rehabilitation centres market themselves as providing ‘the highest standards of person-centred care in specialist brain injury rehabilitation, complex disability management and neuropalliative care’. The standards at Hothfield Manor were clearly a far cry from this.

The major report findings were as follows:

• Residents’ health was not consistently monitored and staff did not know how long they would wait before contacting a GP – health appointments were frequently missed due to staff shortages.
• Medicines were not consistently managed safely, handled appropriately, stored safely and securely or disposed of in line with guidance – residents did not always receive their medicines safely and on time.
• Staff did not always treat residents with dignity and respect – they did not consistently act in the residents’ best interests.
• Management of safety risks was inadequate, putting residents at risk of avoidable harm and abuse.
• Accidents and incidents were not always recorded and were not regularly analysed to reduce the risk of further events.
• Care plans were often inadequate, out of date and were not designed to keep people safe – the residents and their families were often not involved in producing the care plans.
• There were severe staff shortages – staff reported that four members of care staff were needed during the day shift but this was not achieved at all in the week that was reviewed, with only one member of staff on one day, two members of staff on four days, and three on the remaining two days.
• Some members of staff were unskilled and untrained – only 40% had received training on the Mental Capacity Act and only 65% had received safeguarding vulnerable adults training.
• There was no registered manager and a lack of leadership. The team did not work closely or communicate well.
• Some areas of the premises were in need of re-decoration. Carpets had multiple spillages and some smelled of urine.

There were 31 vulnerable people in residence at the time of the inspection, many with complex health and rehabilitation needs requiring a high level of care and support. All of the residents required personal care, some requiring assistance with mobility and/or eating and drinking.

If you could like to find out more about rehabilitation after brain injury, please click here to see a helpful guide produced by Dr Howard Jackson and Dr. Andrew Bateman for the Encephalitis Society.

When I read into some of the specific failures identified during the two-day inspection it really brought to light the complete lack of care afforded to the residents. For example:

• One incident was recorded as follows: ‘I was cleaning apartment 1. One of the clients had been cooking but had left the area. I was aware that the hob was hot. And I was concerned for the safety of one of the clients as she was walking around the unit and I didn’t want her to come to any harm. I spoke to one of the therapists to let them know that the client may be in danger. Their reply was ‘shut the door then’.
• In another incident, an epileptic resident dropped one of their anticonvulsant tablets on the floor, but this went unnoticed, so it was signed on the medication record as having been taken when the person had not in fact received it.
• Another resident often went out early to go to the shops and didn’t let staff know they were going out. Staff said that if the person wasn’t there they ‘”presume he has gone to the shops”. There were no systems in place to check and monitor that this person was alright and returned safely.

The situation at Hothfield Manor reminds me of the atrocious level of care provided to the residents of the Orchid View Care Centre. I represented their relatives in civil claims against the care home provider, Southern Cross Healthcare, following a 6 week inquest in 2013. The Coroner who held the inquest into the deaths of residents of Orchid View attributed five of the deaths to neglect and institutionalised abuse.

You can find out more about the Orchid View cases here.

It is concerning to see that even following the Orchid View scandal, a specialist centre caring for some of the most vulnerable people in society can allow their standards of care to fall to such neglectful levels.

How do we prevent care getting to such poor levels in the first place?

Ensuring safe standards of care in rehabilitation centres and nursing homes is an important and topical issue that I won’t be able to explore fully here.

However, in terms of this case, the CQC inspected Hothfield Manor after they received some ‘information of concern’. I take this to mean that somebody, possibly a member of staff from the home, blew the whistle on the dangerous situation that residents were being placed in.

So, one of the possible ways of preventing nursing homes failing in future would be to encourage nursing home staff to feel empowered to whistleblow if they are concerned about the safety of their home’s residents. There are sadly many barriers to whistle blowing, with staff often feeling concerned about possible repercussions.

Another way of ensuring good standards of care is ensuring that when a Registered Manager is due to leave a residential care provider, another one is put in place immediately so that the service is seamless. Residential care providers who do not have a Registered Manager in place are unlikely, in my opinion, to have good quality leadership. This is another area in which the Orchid View Care Centre failed and was criticised.

Rigorous recruitment processes and mandatory training for care workers before they can be employed in a capacity where they are working with vulnerable people, is crucial. This helps to ensure that appropriate standards of care for vulnerable residents are maintained.