SVA Report

Well the investigation took place yesterday and as I thought apart from a few minor points, we passed with flying colours. My insistence of my staff to ensure that everything they do is recorded has finally got through to them and our audit trail was complete in almost every area.

We are not perfect, there were as I said a few minor points, but we can deal with these very quickly and as I have a staff meeting this afternoon it will be great to be able to congratulate my staff on being so conscientious with their recording, then discuss the few small flaws.

The investigating social workers are aware that the home is an ongoing development, and that I have only been in post for 14 months and what we have achieved in that time is nothing short of remarkable.

It does make me have a wry smile on my face though as Lord Lang stated that he didn't want any common people to sit on one of his committees, yet a monkey could do his job as he so aptly proves, but Lord Lang couldn't do my job at all, even after 12 months training as it takes more than an arrogant, pompous, egotistical upper class twit to do what my staff and I do.

Safeguarding Vulnerable Adults Investigations and the Damage They Can Do.

Safeguarding Vulnerable Adults (SVA) is a very important part of care of the elderly and in fact all vulnerable adults, but in my opinion, working as a frontline Care Home Manager this has not been well thought through and it appears to me, that in this time of cut backs and reduction of services, an obscene amount of money, resources, time and heartache is caused by this important and very relevant law, being misused, and in some cases abused by certain people, whereas if common sense guidelines were introduced this may save a great deal of time, resources, money and in some cases heartache.

As usual my anti-politician stance has come to the forefront here, as at times I look at the laws and can see the flaws, usually in a very short space of time, purely by using commonsense. I feel that many of the people who influence our laws help to write up policies such as SVA are out of touch, or dare I say have never worked in frontline management positions and will draw on other ‘experts’ to help guide them, who themselves may have the university degree or the higher education, but lack the inner knowledge that only comes with experience.

I was also very concerned to read this week, that one poor baby had died because its alcoholic mother had left him in front of the gas fire, and that she had cancelled 17 YES 17 meetings to review her case. Now certain people are saying that children’s services should have unannounced inspections as a matter of course.

Wake up please!!!! Care homes for the elderly have had unannounced inspections for at least the last 6 – 7 years, and they can be very harsh. Again I can only assume that the ‘experts’ deemed this unnecessary for children at risk!

In the past 6 months I have had two SVA investigations at my home, with a third due on Wednesday 9^th February 2011. I am going to give examples of where this system is completely failing in being cost effective, best use of resources and time consuming by box ticking to protect departments as opposed to people.

Case 1

Last year my Nepalese night staff rang me up to say that she had called the ambulance for Mrs A. My night staff had a sore throat and was having difficulty in speaking clearly, she also has an accent, but in my opinion is one of the best night staff I have ever employed in 40 years.

Apparently Mrs. A. had demanded that an ambulance be called as she was in ‘terrible pain’. I was aware that she had been suffering from constipation and that I was taking her to a hospital appointment later on that morning. I asked my night staff if the ambulance crew were there and she said yes and I asked to speak to them. I thoroughly explained the situation to the crew, explained she also had a history of Angina and that under the Mental Capacity Act, as she had capacity we had no right to refuse to call an ambulance.

The next thing I know, the ambulance crew had made a SVA referral, stating that they could not understand the night staff, (failing to mention that they had spoken with the manager) and that the toilet door was broken (it wasn’t) no toilet paper (the roll had been placed by Mrs. A. on the floor) and that the room was in a disgusting mess (Mrs A. has mental health problems and we have to work around those problems!)

First an investigating social worker had to come out and inspect the home. She then returned at a later date to interview my night staff. Then there were two SVA meetings which had in total:

1 Senior Practitioner

1 Investigating Social Worker

1 Minute taker

1 Care home manager

Oh and the ambulance service were invited to attend but declined!

This investigating meeting lasted about 40 minutes and then closed with another meeting being arranged for the future.

The second meeting took place and the following people attended:

1 Senior Practitioner

1 Investigating Social Worker

1 Minute taker

1 Care home manager

Oh and the ambulance service were invited to attend but declined!

At the end of the meeting where the concerns were unfounded, I raised the question, why did the ambulance crew decide to leave an elderly lady in her 80’s with what were obviously severe stomach cramps due to constipation and not her sake take her to the A&E to be checked over, in particular as when I took her to her appointment later I the day she was immediately admitted to hospital which gave my staff the time to clean her room, the only time they usually get to do this as she is resistant to this being done.

Case 2

Miss B. was admitted to my care home initially for respite and assessment due to severe personal neglect. Her toe nails were so long it took the chiropodist almost an hour to cut them, under her breasts were red raw and no one was certain the last time she had eaten, or even gone to bed.

Miss B. suffers from depression and has an unrealistic view of her being able to cope at home. The Social services took Miss B. home with the help of Occupational Therapists to see if she could safely reheat a pre-packet and cooked meal. She failed even that simple test. She was then made a full time resident at my home for her own safety and well being.

We were concerned one day that her cycle of depression was taking rather longer than we had experienced in the past to lift and that it was affecting her appetite. The GP was called and he prescribed an anti-depressant, at no time did he come and talk to the manager, me!

The next thing I know we are having another SVA investigation because the GP thought that we were failing to meet her needs! So here we go again. A senior practitioner attended with another social worker, the manager of the care home and Miss. B’s brother and best friend who was also her next door neighbour.

Miss. B. was interviewed and her brother and next door neighbour stated how they felt being placed in the care home was in her best interests and she would fail if she went home.

Again after at least another 40 minutes of having another meeting the concern was unfounded.

In case 1 & 2 professionals had been involved, in case 1 the ambulance crew did speak to myself, but didn’t ask any questions of the me relating to the room, or their concerns, had they had done so the cost of the investigation, which no one from the ambulance service attended would have been saved.

In case 2 the GP another professional should have spoken to the manager and then looked at his notes and possibly spoken with the Social Services and Miss B’s Psychiatrist, this would have prevented another huge waste of time and resources, by the way the GP  didn’t attend the investigation!

Case 3

This is different and has led to a level 4 investigation of my home!

I very reluctantly took in a homeless woman,  Mrs C. early in December 2010 when we had the very bad weather. This was at the request of the Social Services for one weeks respite. At the end of the week I contacted the Social worker who had placed this woman and I was told to ask her to leave. Then later I received another phone call to state that due to the extremely cold weather another weeks respite had been granted.  At this time I raised concerns that this woman was not needing residential care, she was under age (under 60) and was self sufficient, I also had concerns for my vulnerable residents as she was smoking in room and was asking for money and cigarettes from my elderly residents.

This woman had a personality disorder which was very apparent. The respite kept getting extended until about 9^th January 2011, where a bed and breakfast was found for her, but true to form, she managed to be very rude to a person at the B&B and effectively made herself homeless again, leaving the majority of her belongings cluttering up our front hall.

Once she had left, Mrs C tried to return claiming that she had left a kettle in the room she had occupied and I went to check with another member of staff as a witness. No kettle was found and I asked Mrs C to leave the grounds.

The next thing I know, I have a level 4 investigation because this woman had telephoned the Care Quality Commission and made a complaint that we were not meeting the needs of our residents and that they were in danger.

This woman can barely string together cohesive thoughts to the end of the subject without digressing to make out she is always a victim! When I realised that she would stay with us over Christmas, despite my vocal reluctance expressed to her Social Worker, I went out and purchased her a Christmas present so that she wasn’t the only one in the home without a present.

The level 4 investigation is going to take:

2 Social Workers

The Care Home Manager

The Deputy for the care home.

To me all of these cases have one thing in common, misuse of a system designed to help vulnerable people. Common sense is needed, in particular with the professionals who have expressed their concern, but on both occasions have declined to attend meetings or even in one case even talk to the manager who knows every resident extremely well.

CQC are at fault as well, I know we have to take complaints seriously otherwise it is easy for vulnerable people to fall through the net, but knowing Mrs. C and her inability to make a cohesive statement without going off at tangents should have sent alarm bells ringing, so as not to waste time and resources a quick call to the local Social Services offices could have put this to bed without costing another huge amount of cost and resources.

This is the fault of politicians, not just the current crop, but Labour were in power for 13 years. Ticking boxes has become obsessive and I think that this takes place of common sense and the actual care required. This is just one care homes experience, what if 10% of all care homes in East Sussex experienced this, has anyone worked out the cost?

Then to get even more frightening, multiply that 10% across the whole country and see what figure is arrived at. There has to be a simple effective way of filtering these alerts.

For professionals a simple questionnaire before progressing, e.g. have you raised your concerns with the manager and did you get an acceptable response? If they still wish to progress make sure they attend the meetings and not hide away.

For people like Mrs. C. ring the local office, if this person is known and has a history of being difficult or evasive then maybe a more casual approach should be taken involving a brief drop in unannounced visit by a social worker.

The savings for using a common sense approach rather than how many boxes have we ticked, could save this country a huge amount of time, money and resources.