The Care Quality Commission (CQC) today publishes a further 20 reports from a targeted programme of 150 unannounced inspections of hospitals and care homes that care for people with learning disabilities.
The programme is looking at whether people experience safe and appropriate care, treatment and support and whether they are protected from abuse. A national report into the findings of the programme will be published in the Spring.
An area of concern to emerge from an initial analysis of the first 40 reports is that many services are failing to provide patient-centred care – that is, care that is based on the individual needs of people using the services.
Bernadette Hanney, National project lead for the learning disability review said: “People must be placed at the centre of their care. We have found that too often people are not involved in the development of their care plans. And often those care plans lack detail about the person’s preferences, which can have an adverse impact on the quality of care provided.
“Our inspection teams have found that often people don’t get enough activities. A varied range of activities that people enjoy and that meet their needs promotes and supports independence and is vital to the well being of people using the services. In some cases we have found there have not been enough staff to deliver activities that have been planned.”
The 20 inspections covered locations that provided a range of services including assessment and treatment, rehabilitation and longer term care.
Inspections were focused on two outcomes relating to the government’s essential standards of quality and safety: the care and welfare of people who use services, and safeguarding people who use services from abuse.
One location, Beech House in Newmarket, run by Four Seasons (Granby One Ltd) was found to have major concerns with both outcomes. Because of the seriousness of our concerns about the care and welfare of people using the service, we served a warning notice on the provider. We have been back to inspect again and found that Beech House is now compliant.
A lack of patient-centred care featured among our concerns at Beech House. For example, we reviewed five care plans during the inspection and found they were disorganised and difficult to locate. Care plans were not person-centred and the terminology reflected what staff would do for the patient rather than focussing on the patient’s desires, wishes and choices.
We also found major concerns in relation to the care and welfare of people using the service at North Lodge (Calderstones Partnership NHS Foundation Trust) and Langdon Hospital (Owen House) (Devon Partnership NHS Trust).
At North Lodge, while some areas of the care records were person-centred and involved people in their care, other care records were inaccessible to people. Restrictive and institutional rules and practices did not promote person-centred care and affected how fully people were involved in planning their daily lives.
And at Langdon Hospital (Owen House) evidence showed that some care plans were not person centred, were not written in plain English and in the majority of cases did not identify a goal. We found no evidence of patient involvement in developing the care plans and found nine instances where care plans had not been reviewed in 12 months.
Overall, of the 20 locations inspected:
· one location had major concerns with both outcomes, two locations with one major and one moderate concern, and five locations with moderate concerns with both outcomes
Specifically for outcome 4 (care and welfare):
· four locations were compliant, three had major concerns, eight had moderate concerns
Specifically for outcome 7 (safeguarding):
· seven locations were compliant, one had a major concern, eight had moderate concerns
Thirteen locations were from the NHS and seven from independent healthcare.
CQC inspectors were joined by ‘experts by experience’ – people who have first hand experience of care or as a family carer and who can provide the patient or carer perspective as well as professional experts in our learning disability inspections.
Where inspectors identified concerns, they raised these immediately with the providers and managers of services.
All the services where concerns are identified must tell the CQC how and when they will improve. Those failing to meet essential standards could face enforcement action by the regulator if improvements are not made.
The national report will be based on the findings from all the 150 inspections and will make conclusions about the overall state of this type of service.