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.
Thursday, 10 February 2011
Friday, 4 February 2011
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 9th 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.
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 9th 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.
Saturday, 29 January 2011
Cuts at a Cost to Peoples Health
I have to say I don't agree with everything David Cameron and his puppet government are saying and doing, in fact, I think that these people, many of whom have been brought up in a privileged way and have never had to struggle to make ends meet are completely out of touch with the ordinary people.
Last night, well really early this morning, my mobile which is always next to my bed went off. It was a call from my night staff, 'Bert has fallen, and cut his head open,'
'OK', I sighed, 'I shall come out' I have had to put a rule in place that I am called before any ambulance is called because there was a complaint that my Nepalese night staff cannot be understood by the ambulance call centre which had resulted in an adult protection alert by a ambulance crew attending in the past, unfounded but costing us a lot of money and me having to put very strong policies in place. My Nepalese night staff is brilliant, I couldn't ask for a more caring or more conscientiousness member of staff to be on at night.
So on went my clothes and off I went back to the home. Bert had got out of bed to go to the toilet and had got his foot tangled in a blanket and had fallen with hell of a bang. My night staff had done everything right, staunching the flow of blood by direct pressure, and had it almost completely under control. I took one look and called the ambulance as he had a deep cut about two inches long on the right hand side of his forehead. They came quickly and as I thought Bert was taken to hospital for treatment. I was told by the ambulance crew that they would not be able to transport him back when he was finished.
So back to bed for about two hours of broken sleep (ha ha) waiting for my mobile to go off again, which it did at about 4am. I went and got Bert and returned him back to the home, but gave up going back to bed myself as I know that as I normally do I will be back in work this morning as I have another resident who is 103 today and I have a cake on order, I want to make sure everything is arranged for this afternoon.
I can't believe that the ambulance cannot transport people back from hospital,which they did in the very recent past. There has been no communication by any official about this sudden change, so people like me who actually really care about elderly residents have to continually put ourselves out. My gripe about this is that for at least the past three weeks I haven't had one full day off. I have worked on average 10 - 11 hours Monday - Friday, been into work for up to three hours on Saturday, and receive phone calls or text messages from staff about being too sick to come into work, even though I am the oldest member of staff and I haven't had a day off sick for 13 months, and I have been on call for the majority of that time.
This government, no all politicians are completely out of touch, and some are still fiddling their expenses, others trying to find loopholes to abuse, and more complaining about how unfair the expenses system now is, but they are the ones who have abused the system, and they get paid a damn sight more than me or nurses, or carers, who continually work flat out to help others whilst these people tell us how hard they work on our behalf and they deserve everything they get - WHY?
Bercow to me is a complete biased fool led by his mouthy wife. Cameron, Clegg, Miliband, Balls, Harman, Cable and everyone else seems to be so far removed from what is really being felt by ordinary people, that they might as well be governing another country, on another planet, in another galaxy. I know we have to cut back, but politicians led us into this depression, but it is the ordinary person who hurts the most, whilst these silver spoon millionaires walk around almost telling us how good we have got it. GET REAL!!
Monday, 17 January 2011
At Last - Just Deserves For An Extremely Moral Less Man
I am sure the press will not want to miss this event and I am sure that they will soon be able to publish the name of the person I have been blogging about for at least the past year and finally his just deserves have been delivered to him, but before we go into the details of what has happened here is yet another warning to anyone who wants to work for this b'stard.
Today I found out that his staff in one home were having to work without even the most basic Personal Protective Equipment namely gloves. What makes this even more ironic is that this home has just completed Infection Control Training, I wonder what CQC and Health and Safety would say if they were informed? Maybe a quick telephone call should be made to them, after all it is important that both staff and residents should be protected, in particular as in dementia homes double incontinence is not unusual.
Not only that though, they do not even have any paper towels to dry their hands on, what a way to run a care home. The owner has had plans to become a millionaire care home magnate, what he really is is a woman abuser, a careless, moral less, stupid liar who will at the drop of a hat employ solicitors to protect his 'Good' name. The sooner this man is publicly humiliated the better, the only person I feel sorry for is his daughter as she will soon learn in the most cruel way really what her parents are like. Yes I have included his wife as she has covered up and tried to clean up and disguise what her husband has done and become.
Today I found out that his staff in one home were having to work without even the most basic Personal Protective Equipment namely gloves. What makes this even more ironic is that this home has just completed Infection Control Training, I wonder what CQC and Health and Safety would say if they were informed? Maybe a quick telephone call should be made to them, after all it is important that both staff and residents should be protected, in particular as in dementia homes double incontinence is not unusual.
Not only that though, they do not even have any paper towels to dry their hands on, what a way to run a care home. The owner has had plans to become a millionaire care home magnate, what he really is is a woman abuser, a careless, moral less, stupid liar who will at the drop of a hat employ solicitors to protect his 'Good' name. The sooner this man is publicly humiliated the better, the only person I feel sorry for is his daughter as she will soon learn in the most cruel way really what her parents are like. Yes I have included his wife as she has covered up and tried to clean up and disguise what her husband has done and become.
Thursday, 16 December 2010
Has He Been Banned?
That wonderful ex-employer of mine who is such a nasty human being, who I have named Dog Breath (becuause of his foul breath) hasn't been seen in the Eastbourne home for quite a while now, instead his wife is doing the visits.
I actually wonder why his wife (Mrs Dog Breath)has stood by him after having had her world fall through the floor when hearing about what her husband was accused of, but then she is cut from the same cloth. No morals, no interest in any one other than herself, unfair, a liar and totally delusional.
It makes you wonder have things finally caught up with him? The case that has been brought against him is still ongoing, because the slimy toad is wriggling at every turn, telling lies, but getting caught out. Still the judge seems to have his measure as she isn't leaving any room for him to lodge an appeal over some slight mishandling, so she has afforded him yet another stay of execution. I just feel so sorry for the person who is still waiting for justice as this nasty, slimy creep still tries to squirm his way out of trouble.
The home itself is failing to hold onto staff still, and the reports going around are of a very unhappy home with staffing issues, mainly because good staff now avoid this home like the plague. One resident managed to fall down the stairs and survived, what I have been informed, was a broken neck. This was a lovely resident always chatting, now in pain and apparently just sitting in the lounge without saying much apart form appearing to be in pain, which is heart wrenching for those who are still there and knew her before.
I still haven't heard anybody from the Social Services have a good word to say about the home or its owners, and the word is that they are trying to wind up the company, it is thought as both the company and Mr Dog Breath were being taken to court over the accusations. I heard that when informed of this the judge turned to Mr. Dog Breath and said it wasn't just about the company, but about him so he would still be liable.
Next instalment when I get enough news to pass on.
I actually wonder why his wife (Mrs Dog Breath)has stood by him after having had her world fall through the floor when hearing about what her husband was accused of, but then she is cut from the same cloth. No morals, no interest in any one other than herself, unfair, a liar and totally delusional.
It makes you wonder have things finally caught up with him? The case that has been brought against him is still ongoing, because the slimy toad is wriggling at every turn, telling lies, but getting caught out. Still the judge seems to have his measure as she isn't leaving any room for him to lodge an appeal over some slight mishandling, so she has afforded him yet another stay of execution. I just feel so sorry for the person who is still waiting for justice as this nasty, slimy creep still tries to squirm his way out of trouble.
The home itself is failing to hold onto staff still, and the reports going around are of a very unhappy home with staffing issues, mainly because good staff now avoid this home like the plague. One resident managed to fall down the stairs and survived, what I have been informed, was a broken neck. This was a lovely resident always chatting, now in pain and apparently just sitting in the lounge without saying much apart form appearing to be in pain, which is heart wrenching for those who are still there and knew her before.
I still haven't heard anybody from the Social Services have a good word to say about the home or its owners, and the word is that they are trying to wind up the company, it is thought as both the company and Mr Dog Breath were being taken to court over the accusations. I heard that when informed of this the judge turned to Mr. Dog Breath and said it wasn't just about the company, but about him so he would still be liable.
Next instalment when I get enough news to pass on.
Saturday, 6 November 2010
Saw an Advert Today
Well Mr Dog Breath is running out of carers in his home in Eastbourne. Great big advert in the Friday Ad, but the homes name wasn't mentioned, could it be because if the home is named there would be little or no response to the advert, well at least from the best carers?
I would have loved to have run an advert next to it saying.
"If you get a job in this home expect to be abused and used, and when you decide you have had enough and want to leave, expect your final pay packet to be raided so this evil home owner can claw back every penny for himself, Oh and if you're female, WATCH OUT!"
Unfortunately don't think the Friday Ad would that though.
On a more upbeat note my home now has 18 residents and had 3 emergency admissions in under a week, came through Adult Protection Investigation with flying colours (see this link) and I am helping another home owner find a good manager.
Mr Dog Breath doesn't know what he lost when he messed with me!!
Lastly Mr Dog Breath was on Facebook, left him open to get reminders from me about new Blogs about him and his business, he has suddenly disappeared, I am so upset (Ha Ha Ha) mind you he only had about three friends and one of those was his daughter!
I would have loved to have run an advert next to it saying.
"If you get a job in this home expect to be abused and used, and when you decide you have had enough and want to leave, expect your final pay packet to be raided so this evil home owner can claw back every penny for himself, Oh and if you're female, WATCH OUT!"
Unfortunately don't think the Friday Ad would that though.
On a more upbeat note my home now has 18 residents and had 3 emergency admissions in under a week, came through Adult Protection Investigation with flying colours (see this link) and I am helping another home owner find a good manager.
Mr Dog Breath doesn't know what he lost when he messed with me!!
Lastly Mr Dog Breath was on Facebook, left him open to get reminders from me about new Blogs about him and his business, he has suddenly disappeared, I am so upset (Ha Ha Ha) mind you he only had about three friends and one of those was his daughter!
Wednesday, 3 November 2010
Double Standards by an Ambulance Crew!
Last Thursday 28th October my night staff rang me and left a message on my answerphone to say that she was ringing 999 to call an ambulance as one of my residents had asked for an ambulance to be called as she was in so much pain, and had used the words, ‘I’m dying’. The call to my phone was at 5.51am, before 6am I rang her back and after a very brief discussion I was handed over to the attending ambulance crew.
I gave this crew member full information including what I knew to be wrong with this resident, (Chronic constipation), the fact that we had called the GP the day before and requested a home visit, which was refused! And that I was taking her to a hospital appointment later that morning.
I thought that that would be the end of it, but boy was I wrong!!!
This ambulance crew member despite talking to me, the manager, decided to call Social Services and place an adult protection alert. When I found out I was furious, a few simple questions and everything could have been made clear, but this spineless individual decided to let others do his work for him, and when the investigation took place I found out what the complaint involved and I was even more angry and made it known to the investigating officer.
It appears that they thought that my night staff didn’t have good enough spoken English for them!! Yet she communicates with the staff including accurate handovers, and the residents and they can all understand her. I also found out that it was stated that the residents toilet door was broken and there was no toilet roll in the toilet and they had concerns about this residents living conditions.
As I said earlier whilst he had me on the phone a few well placed questions would have sorted all this out. My night staff can make decisions and acted appropriately, she made the correct legible entry in the day notes and contacted the on call phone. Whereas the ambulance crew did nothing, here was a lady with chronic constipation who had only recently been released from hospital, and they walked away.
This resident has mental capacity although some short term memory loss, but knows when she is in pain. She also has mental health problems and cleaning here room to the homes satisfaction has to be organised with military precision, getting her agreement in writing with day and date, even then she is resistant, this is all well recorded. Also whenever she is admitted to hospital her room is cleaned as quickly and as thoroughly as possible including washing all her clothes.
Her toilet door wasn’t broken as reported and there was toilet paper in the toilet, but the toilet roll holder was broken (now replaced) as most people know that the elderly will use anything to help themselves get up, even if there is a grab rail in place, and by its very nature of where it is placed, a toilet roll holder is a handy aid to get up!
I was able to show the investigating officer, daily notes, GP proforma, Care Plans, Risk Assessments, Night staff file, New Emergency file if ambulance has to be called, Training matrix, letters to residents solicitor, hospital transfer letters. Copies of many of these were taken and it was obvious that our audit trail was very complete, I was asked to complete a risk assessment for this residents health and this was done within the next 24 hours and the emergency file was completely updated and improved.
Why am I complaining so bitterly?
I saw this as a moral-less, spineless attack on my night staff, almost racial discrimination, also an attack on the home, in particular as the crew member who I believe made the complaint actually spoke to the manager of the home (me) and raised no concerns at the time, but had to do it in such a way that resources have been squandered, in particular as the home has just had three emergency admissions and I have been deflected away from writing the care plans for these people.
It seems to me that certain ambulance crew members see themselves as judge and jury without full knowledge, are not prepared to ask questions before acting like a bull in a china shop, but they can walk away from an elderly vulnerable resident in pain, without taking any action and get away scot free.
There are real double standards here, but bet if I made a complaint to the ambulance service now, it would be seen as getting revenge rather than trying to ensure that my residents get fair treatment and the home is dealt with in a fair and unbiased manner including its staff.
I gave this crew member full information including what I knew to be wrong with this resident, (Chronic constipation), the fact that we had called the GP the day before and requested a home visit, which was refused! And that I was taking her to a hospital appointment later that morning.
I thought that that would be the end of it, but boy was I wrong!!!
This ambulance crew member despite talking to me, the manager, decided to call Social Services and place an adult protection alert. When I found out I was furious, a few simple questions and everything could have been made clear, but this spineless individual decided to let others do his work for him, and when the investigation took place I found out what the complaint involved and I was even more angry and made it known to the investigating officer.
It appears that they thought that my night staff didn’t have good enough spoken English for them!! Yet she communicates with the staff including accurate handovers, and the residents and they can all understand her. I also found out that it was stated that the residents toilet door was broken and there was no toilet roll in the toilet and they had concerns about this residents living conditions.
As I said earlier whilst he had me on the phone a few well placed questions would have sorted all this out. My night staff can make decisions and acted appropriately, she made the correct legible entry in the day notes and contacted the on call phone. Whereas the ambulance crew did nothing, here was a lady with chronic constipation who had only recently been released from hospital, and they walked away.
This resident has mental capacity although some short term memory loss, but knows when she is in pain. She also has mental health problems and cleaning here room to the homes satisfaction has to be organised with military precision, getting her agreement in writing with day and date, even then she is resistant, this is all well recorded. Also whenever she is admitted to hospital her room is cleaned as quickly and as thoroughly as possible including washing all her clothes.
Her toilet door wasn’t broken as reported and there was toilet paper in the toilet, but the toilet roll holder was broken (now replaced) as most people know that the elderly will use anything to help themselves get up, even if there is a grab rail in place, and by its very nature of where it is placed, a toilet roll holder is a handy aid to get up!
I was able to show the investigating officer, daily notes, GP proforma, Care Plans, Risk Assessments, Night staff file, New Emergency file if ambulance has to be called, Training matrix, letters to residents solicitor, hospital transfer letters. Copies of many of these were taken and it was obvious that our audit trail was very complete, I was asked to complete a risk assessment for this residents health and this was done within the next 24 hours and the emergency file was completely updated and improved.
Why am I complaining so bitterly?
I saw this as a moral-less, spineless attack on my night staff, almost racial discrimination, also an attack on the home, in particular as the crew member who I believe made the complaint actually spoke to the manager of the home (me) and raised no concerns at the time, but had to do it in such a way that resources have been squandered, in particular as the home has just had three emergency admissions and I have been deflected away from writing the care plans for these people.
It seems to me that certain ambulance crew members see themselves as judge and jury without full knowledge, are not prepared to ask questions before acting like a bull in a china shop, but they can walk away from an elderly vulnerable resident in pain, without taking any action and get away scot free.
There are real double standards here, but bet if I made a complaint to the ambulance service now, it would be seen as getting revenge rather than trying to ensure that my residents get fair treatment and the home is dealt with in a fair and unbiased manner including its staff.
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