Most care homes are supporting residents with respect, but staff shortages in a minority are leaving residents malnourished, while homes supporting people with dementia are performing less well than other services.
That was the message from the Care Quality Commission from inspections of a sample of 500 care homes, designed to capture how dignified their services were and how well they were meeting residents’ nutritional needs.
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Overall, 63% of homes met all five standards they were inspected against – on respecting and involving service users, meeting nutritional needs, safeguarding people from abuse, having sufficient and suitably trained staff and keeping accurate and securely stored records; compliance was greatest on safeguarding (93%) and lowest on record-keeping (77%).
Good practice pointers
The CQC said homes meeting the standards tended to have effective systems in place for recording, assessing and responding to residents’ needs: for instance, 91% of homes that recorded people’s choices about their care were meeting the standard on respecting and involving people, compared with 41% who did not record needs; 85% of those who used a formal tool to identify people at risk of malnutrition were meeting the nutritional standard against 69% who did not use a formal tool.
Homes demonstrating good practice had enough staff to support people at mealtimes and used staff flexibly throughout the day. However, 14% if homes were not meeting the standard on staffing, with staff shortages, particularly during mealtimes, a key problem in these services.
Impact of staff shortages
Inspectors found cases where people were waiting a long time for their meals or for a member of staff to help them eat, often leading to their food going cold; also, staff were slow to respond to call bells in some homes.
These findings were mirrored in the assessment of homes against the nutritional standard: 14% of homes were not supporting people to eat and drink sufficient amounts, including because staff were not supporting or encouraging people who were struggling to eat or drink. The CQC said a lack of staff at mealtimes often made these “a chaotic, stressful part of the day”.
Dementia homes lagging behind others
The CQC also found that services supporting people with dementia were lagging behind other homes on four of the five standards assessed: among dementia care homes, 83% were meeting the standard on respecting and involving residents, compared with 92% of other homes, 82% the nutritional standard (86% for other homes), 85% the staffing standard (90% for other homes) and 92% the safeguarding standard (96% for other homes).
Inspectors observed staff not knowing how to communicate with people with dementia, while among homes not meeting the safeguarding standard, the CQC found that not all staff were aware of the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards (Dols). It voiced particular concerns where managers were not using the legislation appropriately to protect vulnerable people.
The CQC made the following recommendations:
- Individuals’ needs should be identified and documented on admission and regularly reviewed, with input from them and their relatives;
- Staffing levels and staff skills mix should reflect people’s identified needs and be reviewed on an ongoing basis;
- Staff caring for people with dementia must have appropriate skills, knowledge and experience, particularly in relation to the Mental Capacity Act and Dols;
- Records should be well-maintained and be made available to staff.
Care staff struggling to meet dementia needs, warns CQC