One in five nursing homes too short-staffed to ensure safe care, finds watchdog

One in five nursing homes does not have enough staff on duty to provide safe care, the Care Quality Commission has found.

The watchdog’s State of Care report for 2013-14 found that a shortage of nurses in adult social care is compounding longstanding concerns that the quality of care in nursing homes is lagging behind other care settings.

The CQC said recruitment of nurses to social care should be a ‘priority’ and pointed to figures from Skills for Care showing that nurses in social care had the highest turnover rate (32%) of all social care roles.

The regulator said there was ‘no clear evidence’ on the cause of the nursing shortage. However, it said that fewer long-term career development opportunities for nurses in social care and the push to boost nurse numbers in the NHS in the wake of the Francis report on the Mid-Staffordshire hospital scandal may have exacerbated the issue.

“This issue is now impacting on the quality of care, and is a pressure that is likely to increase as many of the current registered nurses working in social care are approaching retirement age. Around 29% of these registered nurses are likely to retire within 10 years,” the CQC report said.

A screengrab from the report

The CQC report also found that:

• The corporate care sector is expanding: Corporate firms owned 39% of care home beds in 2013-14, up from 37% in 2012-13. The CQC found that corporate-owned homes had better processes for recruiting and training staff but more problems with overall staffing levels. Wary of the impact the collapse of care provider Southern Cross had on the sector in 2011, the CQC has identified up to 60 ‘difficult to replace’ providers whose financial sustainability will be assessed by the regulator under new powers being introduced under the Care Act from April 2015.
• Smaller care homes performed better: Among care homes, the CQC found that homes with fewer beds tended to perform better than larger units. For specialist learning disability homes, small homes (those with up to 10 beds) met 94% of standards, whereas large homes (those with more than 50 beds) met 85% of standards. For homes without a learning disability specialism, small homes hit 90% of standards while the figure for large homes was 82%.
• Shared Lives services were the best performers: Shared Lives services had the highest proportion of services compliant against each of the five sets of standards measured, with 100% compliance in providing dignity and respect in care, and at least 93% compliance in the four other areas (care and welfare;suitability of staffing; safeguarding and safety and monitoring quality).
• Homes without a registered manager performed worse: Inspectors found that care homes with a registered care manager performed better than those who had been lacking a manager for six months or more. In November last year the CQC launched a drive to address the fact that 2,439 homes had not had a manager for at least six months. By April 2014, 1,395 of the homes had a manager in place and a further 470 were in the process of appointing one.
• There was significant variation in care standards: The CQC found that there was general improvement in the quality of adult social care but the percentage of care providers meeting all quality standards ranged from 70% in some local authority areas to 100% in others.

David Behan, the CQC’s chief executive, said: “The findings from our inspections over the last year clearly show there is too much variation in quality and safety between services and within services. People need to have confidence that they will get good care.

“Our role is to identify what works well and why, and what doesn’t work, and use this information to drive improvement and close the gap.”

Janet Morrisson, chief executive of charity Independent Age, said: “The CQC report rightly highlights the wide variance in the quality of care homes, often even within a single geographical area. While it is right to call on people to become more active ‘consumers’, in reality – as the CQC itself acknowledges – most decisions about care are made at a time of crisis and with little opportunity to test the market for the best possible care.

“The CQC must maintain a focus on driving out the very worst examples of care – the abuse and neglect we see on our TV sets and in our newspapers – so that people can be sure that all care is safe and protects dignity.”