Which? report highlights care home concerns

19 April 2011

Residents in some care homes are inadequately fed, under-stimulated and, in one extreme case, potentially abused by a member of staff, an undercover investigation from Which? has found.

In early 2011, the consumer champion sent undercover actors into four care homes* in England, posing as residents. While there were examples of good practice, areas of care in all four homes left a lot to be desired

• Food in two of the care homes was unappetising and inadequate – in one home, experts found evidence of sub-standard portion sizes and inadequate calories or protein**. One researcher reported a half stone (7lbs) weight loss in a single week. In three homes, residents sometimes had to wait 16 or 17 hours between dinner and breakfast without food, and in one, our actor noted that lunch was served at 11.30 am despite having had breakfast at 10 am.
  
• There was a worrying lack of activity in all four homes. In one home, residents constantly said they were bored, and in another, not one of the advertised daily activities took place***. A lack of stimulation is linked to a range of health problems, and can leave residents restless and agitated, or withdrawn and depressed.
  
• Which? even had concerns about basic health and safety in two homes, from damp and dirty facilities to exposed wires and a blocked fire escape.
  
• In the most extreme case, one researcher witnessed a member of staff dragging a resident towards the toilet by one arm, while another resident was pushed down into their chair repeatedly by the head and shoulder when trying to stand up. Which? reported this to the regulator, the Care Quality Commission (CQC), and admissions to the home were suspended immediately. The best course of action is now being considered for current residents.

Care for older people doesn’t have to be like this. Ashley House, Hampshire, was recommended to Which? by The National Association for Providers of Activities for its range of engaging and stimulating activities. As well as providing a range of activities, staff are encouraged to spend time talking to residents throughout the day.

Peter Vicary-Smith, Chief Executive of Which?, says:

“Old age comes to us all, and everyone living in a home has a right to expect their most basic needs to be met. Sadly, the homes we visited left a lot to be desired.

“The fact that the CQC had identified some of the same problems in previous inspections is a real issue**** – clearly, not all care homes take inspection reports as seriously as they should. We’d like the CQC to step up its enforcement activities to ensure homes can’t just pay lip-service when action is required.”

Which? will be meeting with Age UK, which is running a programme to improve care in homes, to explore the possibility of working together.

For more information, and advice on what to look for when choosing a care home, visit www.which.co.uk/carehome-checklist - live from 00.01 hrs Tuesday 19th April 2011.

Notes to Editor

The report, Care homes investigated, is from the May 2011 issue of Which? magazine. For more information, a copy of the report, or to speak to an expert, please contact Rebecca Leach on 020 7770 7561 / rebecca.leach@which.co.uk or Judith Adams on 020 7770 7565 / judith.adams@which.co.uk.

Video footage of interviews with the actors about their experiences is available upon request. It will be published on www.which.co.uk/carehomevideo at 00.01hrs on Tuesday 19 April 2011

Research Notes

Three actors stayed in four care homes in early 2011. They recorded their experiences and what they ate, drank and were offered. These diaries were analysed by a panel including an expert in inspection, an expert in activity and daily living, and a dietician.

* Which? selected two independent care homes and two homes belonging to care home chains at random. In their last inspections by the CQC, one home had been rated zero stars (meaning it considered the care the home provided to be poor), two had been rated one star (satisfactory) and one had been rated two stars (good). This ‘quality ratings system’ has now been replaced by a new regulation system.

Which? is not naming the care homes it visited. It has, however, passed all the findings on to the CQC, which has produced a report outlining the action taken at each of the homes.

** For dinner one researcher was served four dry, thin sandwich quarters along with a chocolate-covered ice cream. This is despite the researcher previously stating they didn’t eat chocolate. As well as concerns about calorie content and protein, the dietician was worried that no fruit or vegetables were served with this meal, and there were no omega-3 essential fatty acids. Regular meals lacking these essential elements can, over time, lead to muscle loss, increased mobility and a weakened immune system.

*** One home advertised activities every day of the week, including exercise, a quiz and a singing session. Not one activity took place.

An expert from the National Association for Providers of Activities explained that inactive residents are more likely to have urine infections or constipation, lose muscle strength and will be less likely to eat and sleep well. Prolonged inactivity is also more likely to leave a resident restless and agitated, or withdrawn and depressed, which staff may find challenging.

**** The CQC had previously identified an outstanding or ongoing statutory requirement to provide activities in one of the homes one year before the Which? investigation. The lack of activity in a second home was also picked up by an inspector as far back as 2009.

The CQC had previously identified hygiene concerns in another of the homes, but Which? found there were still problems.

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