Safeguarding issues in NHS Reablement Care

Hi all, I hope this weekend sees you happy and healthy.

We’ve had a nightmare 10 days and I’m left in a bit of a quandry about what action to take. Apologies, it’s a long one…

Dad was discharged from hospital (after a fight) with a full time live in carer through NHS Reablement. We knew nothing about what to expect and what they should & shouldn’t do or how well they were trained etc. Initially it seemed fine but I quickly realised that the carer wasn’t giving Dad the care he deserved but assumed I was expecting too much. Then the District Nurses took issue with the care and the lack of paperwork / evidence keeping etc. She was on her phone most of the time, on loud speak, which meant that she couldn’t hear Dad if he called out and he couldn’t hear the 2 programmes he could follow since he totally lost his eyesight (within a couple of weeks, hence why he was in hospital). She was putting him to bed at 9pm even though we’d spoken about it being 10pm several times, and doing nothing with him all day other than meal prep & feeding, plus help in the shower. The social worker was also concerned about the lack of evidence / care plan etc and asked for it to be sent to her. The carer also said Dad shouldn’t be left on his own and was waking her up several times a night getting disoriented going to the loo, which wasn’t backed up by other opinions. She fell asleep during a visit by the sensory team and shut the door on the man from the fire service. She had no idea what to do in the event of a fire and knew nothing about diabetes or Parkinsons. She also refused to look at why my dad’s bottom was sore so she had no idea if it was pressure sores, piles etc. When I eventually saw the logs the carer was filling in it was clear she was doing it once a day rather than in real time, it was hugely inaccurate and lacked any narrative. The care plan had no medication details, no list of conditions (of which there are many) and they were working from the hospital discharge summary which had 3-4 huge errors on it. The care plan had also been dated the day after the social worker had asked where it was. I looked the agency up on CQQ & they were rated as “Requires Improvement” in every single area. Adult Services said they’d be working closely with the council on their improvements & it was probably an old report, not updated because of covid. I went back to the report, dated June last year, and was horrified that every point I had picked up was also in the report, plus an outstanding serious safeguarding investigation. That afternoon I witnessed my dad (newly blind, Parkinsons, talked of suicide) going off for a walk around his road by himself. The carer told me she was with him but he just didn’t know she was closely following him - she hadn’t realised I could see that he was well out of her eyeline (she was in the house) from the doorbell camera. I immediately asked the SW the following day to step in but they could only use the same agency as they are the only ones contracted to provide live-in D2A care. That afternoon the carer gave Dad his meds an hour late because she didn’t know what the time was. She put him to bed at 8.45 because she wouldn’t let him go back downstairs after his shower. He was absolutely broken & felt trapped in his own home and feeling like life was not worth living.

To give the agency their due, they replaced the carer the following day and they came out the day after to follow up. However the new carer had no knowledge of Parkinsons or Diabetes, and also didn’t know what to do in the event of a fire! I didn’t mention that I’d seen the CQC report but I did try and get the point across that this was an agency / training issue, not just one bad carer. I also mentioned the logs, which the manager had denied there was an issue with initially, and that I had since been restricted from viewing again. I asked the new carer if she knew my dad wanted to end his life, which he had talked about every day and should have been noted. She said she had no idea and the manager said “but you knew he was tearful” as if this is the same thing! He then revealed that they had spoken to the original carer 3 times during her stay about her not logging in often enough. Apparently the care plan gets updated which is why it had a more recent date on it but they don’t keep previous versions so I have no idea what the original one said. He briefly let me glance at the report on his phone that goes to the carer before they arrive at the client’s house.

The social worker didn’t seem too horrified by Dad wandering off on his own, or any of the other issues I raised, including that this agency clearly still has the same problems as they did last year. I expressed my concern that this agency is the only one they can use but she couldn’t escalate the issues because her boss and her boss’s boss were both off sick. I don’t know who should have been monitoring this situation but I feel like they have failed. The CQC had asked for an action plan back in June but I can’t see an update or a date when this should have been completed. The commissioning group for the council clearly knew there were problems but they haven’t found an alternative and / or monitored the situation effectively. The SW was aware of some of the issues 2 weeks ago but didn’t follow it up. The original carer is now in someone else’s home and the agency continues to send out untrained staff and don’t follow up when protocols are not being followed.

I was worried about going back to the CQC when the current carer leaves, theoretically on Friday. I thought they might close the agency down or at least remove the contract for D2A beds and then the hospital would have nobody to help and there might be a few good carers without a job. However, 2 days ago I saw on the news that a care home placed in Special Measures in May last year, was again found to be Inadequate in November. They intend to inspect again within 6 months. How can this be effective monitoring? What if you have no choice but to leave your loved ones in this situation? Surely a much closer eye should be kept on companies that fail to provide appropriate care? If this agency was the only one good enough to get a contract with the council, what on earth are the others like??

I’m so angry about all this and I can’t get it out of my head which is interfering with my ability to do the rest of my caring job.

Has it always been like this?

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Until about 2005/6 the homes were monitored by CSCI.
They investigated individual concerns, and were very good when I complained about something.
Then CQC was formed, didn’t investigate individual concerns like CSCI. A chocolate fireguard would be better!

I made a complaint about my son’s care about 4 years ago, they inspected his service and didn’t look at his file, and rated it good.
Later, the same company’s residential care home was inspected, 4 out of the 5 areas needed improvement, exactly the same issues I had been having.
My son was made to have this company for over 2 years, council in total denial, but soon after the residential CQC report he was moved, and the council in a later report said that they were unable to do certain things.
The situation is a disgrace, my son has learning disabilities and can’t stand up for himself.

Hi Henry’s Cat.

Your social worker is avoiding the problem. When someone is off sick, in a case like this, there is ALWAYS someone senior to go to. I strongly suggest you make contact with the Director of Adult Social Care directly to raise these issues - best in an email that you can copy in to the relevant councillor with the social care brief. Make it clear that this is a safeguarding concern and that your father is at risk with suicidal thoughts, not being supported when he goes out, etc. Make it clear how long this has gone on. Use your earlier emails to remind you of things so that you can give chapter and verse. Keep it polite but make it clear you are very worried about your father and the level of care he’s receiving. Which is appalling, frankly.

I don’t know about the “only company doing live-in”, that may be true. But if that’s the case, why haven’t they made arrangements with another company and dumped this one if they are as bad as this?

This is my issue (well one of them!) Is decent care so hard to come by that they have no choice but to use this company? Same with the poor people in that care home. My Dad has me fighting his corner but obviously I wasn’t there all the time so goodness knows what else went on. The new carer is more proactive but I’m a bit dubious about medication timings (honestly wish I hadn’t put the camera in now, it’s making me paranoid!!) Only a week to go (in theory…).

The SW has been dealing with hr Director because there wasn’t anyone in between. She said he hasn’t dealt with this sort of thing for a long time - I bet he hasn’t! BUT I need her on my side so I don’t want to rock the boat too much at the moment. They’re trying to source weekend care so we can do the weekdays but it’s proving impossible (it’s on another thread) and I know that as self funders they have a duty to ‘help’ but not an obligation to actually find it. Without her finding it, we won’t be able to look after him and I honestly don’t know how we will manage. I hate to put my Dad (and me) above the safety of other people but will keep fighting.

The thing is that although live-in care isn’t something that’s often needed - or, rather, offered - these days, as a social care department you are responsible for supporting the local care market, and that means identifying gaps and working to fill them. One agency with the sole brief for providing live-in care is a recipe for exactly what’s happening here.