Nursing homes still worst performing social care sector despite improvements, says CQC

Regulator issued substantially more warning notices against care providers in 2012-13 than 2011-12, says annual State of Care report

Nursing homes continue to lag behind other services on safeguarding and care quality despite improvements in the past year, the Care Quality Commission said today in its annual State of Care report.

While the proportion of CQC safeguarding standards met by nursing homes during inspections rose from 76% to 82% from 2011-12 to 2012-13, the sector was out-performed by community services such as Shared Lives, home care agencies (both 92%)and residential care (87%).

Levels of failure were also greatest in nursing homes; 55% of all safeguarding concerns identified by the CQC in nursing homes had a major or moderate impact on service users, compared with 50% for community services and residential homes, and 46% for home care agencies.

Common problems across nursing and residential homes included failures to give out medicines correctly, not maintaining adequate medication records and staff not receiving guidance on how to give medicines prescribed to be used as and when the person needs them.

There was a similar trend on care quality, where the proportion of standards met by nursing homes rose from 74% to 83% but performance still lagged behind residential care (89%), home care (90%) and community services (92%). Again 55% of concerns identified by the CQC had a major or moderate impact on service users, compared with less than half for the other three service sectors.

Responding to the report, the Registered Nursing Home Association admitted providers had “room for improvement” but said the CQC had been unfair in its criticism of the sector.

“All of these findings are signs that nursing home performance is moving in the right direction,” said RNHA chief executive Frank Ursell. “Nationally, compliance with standards in these five areas is recorded at between 82% and 88%.  Whilst there is clearly still room for further improvement, I would have expected some acknowledgement from the CQC that measurable progress had been achieved, rather than the doom and gloom story painted in its press release.”

More warning notices issued against failing providers

Despite all four sectors improving their performance, the CQC issued almost 40% more warning notices for care failures against providers in 2012-13, with 818 issued compared with 598 in 2011-12.

The CQC also raised concerns about staffing levels. Despite improvements since 2011-12 social care providers met 87% of standards on staffing suitability in inspections in 2012-13. The regulator is conducting a thematic probe into staffing levels in social care on the back of its concerns.

It also suggested practice in care homes had contributed to a rise in avoidable hospital admissions among older people. The CQC said these rose from 48 to 62 per 1,000 people aged over 65, and from 74 to 99 per 1,000 people aged over 75, from 2007-8 to 2012-13.

It linked this to a lack of integrated health and social care and to failings in care homes to manage residents’ nutritional needs. The CQC also said that, among care home residents, avoidable admissions were 30% higher for people with dementia than for those without the condition.

Support in managing medication needs in care homes

Draft practice guidance on managing medication needs in care homes was published this week by the National Institute for Health and Care Excellence. Its key recommendations include that:

  • Residents should be supported to self-administer their medication, where possible, and to be actively involved in decisions about their medication;
  • Information about residents’ medication should be accurately recorded and transferred when a person moves between settings;
  • Care home staff should report all suspected adverse effects from medicines to the prescriber as soon as possible and record these in the resident’s care plan;
  • Care homes and other organisations should ensure that systems are in place for identifying, recording, reviewing and learning from medication errors;
  • Care homes should notify regulators of any medicines-related safeguarding incidents.

Improve your safeguarding practice

Community Care is holding a conference on improving safeguarding in care homes and hospitals in Birmingham on 4 December. Register before 29 November for a discounted place.

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