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THE care assistant fixed her eyes on me and warned: “What you saw just then,
if anyone asks you, you did not see it.” We were standing in a lounge, still
panting after hauling Florence from the floor where she fell.
It was early October and my first day at the Arden Valley Christian nursing
home, in Bearley Cross, near Stratford-upon-Avon. Already I was being asked
to turn a blind eye to malpractice.
When I had walked into the lounge, the care assistant and a male colleague had
been struggling to pick up the woman. It appeared that she had fallen while
they had been moving her from her chair. Florence (not her real name), who
suffers from dementia, was quietly murmuring to herself. When I reassured
her, she began to whistle.
The astonishing thing about the scene I had just witnessed was that only hours
earlier I had been told that manually moving residents in this way was
straightforward “abuse”.
Brian Goodhew, the home’s manager, had said during my “training” – a two-hour
talk followed by a multiple choice test – that lifting residents under the
arm was a “drag lift”.
It might not seem serious to those unused to caring for the frail elderly, but
drag lifts are a condemned practice. “I could fracture your shoulder . . .
or pull your arm out of its socket,” a staff member explained. There was
also the risk of dropping someone, especially someone as heavy as Florence.
Over the next three weeks I lost count of the number of times I saw care
assistants using drag lifts. It was one of several areas of concern I was to
witness over the next three weeks.
Many of the problems seemed to spring from the fact that the home appeared
under-resourced and understaffed. Yet it belongs to Southern Cross
Healthcare Group, the biggest supplier of beds to the elderly in Britain,
which has made huge profits for its directors and former private equity
owners.
Arden Valley was chosen for the undercover investigation after reviewing its
“poor” inspection reports. In its April report, the Commission for Social
Care Inspection outlines complaints about the mistreatment of residents: two
alleged they had been physically abused by a staff member and another was
said to have been in a “poor physical state”.
Posing as an office worker looking to change careers, I was accepted for the
job after one interview. There was not much competition: the pay was £6.35
an hour which is 7p more than stacking shelves at a local Tesco.
The home, which charges up to £752 a week, has two floors containing 24
bedrooms with the upstairs devoted to caring for people with dementia.
My task was looking after one of the floors along with a qualified nurse and
two, or sometimes three or four, other carers.
Before entering the red-brick building – dressed in blue surgical smock and
black trousers – I passed a sign seeking recruits. The home had difficulty
hiring local people and many of the recruits came from countries such as
India and Bulgaria.
Indeed, language turned out to be a big problem. I saw several care assistants
struggling to give basic instructions in pidgin English and being met with
blank incomprehension by the residents.
One carer claimed that she was the only person on duty last Christmas speaking
fluent English. “They can’t get enough people whose first language is
English,” she said. “The only way they would do that is to pay a lot more
and they are not going to do that.”
Goodhew was candid about his foreign staff. “They have no idea about
accountability, whatsoever . . . they don’t seem to think things are wrong,”
he complained.
The job was demanding. There was always someone who required washing, moving,
taking to the lavatory or feeding. Residents would sometimes hit out at you
in confusion, or spit.
Many of the carers coped by cutting corners. After witnessing the scene with
Florence on my first afternoon, I saw most of my other colleagues resorting
to “drag lifts”. They should have used a mechanical hoist or other
specialist equipment, but they were often too busy.
Similarly, residents were often pulled across their beds when they should have
used a “slide sheet” to reduce the friction. I saw one resident cry out in
pain as she was yanked onto her pillow. One carer, however, stood out. She
told me it was “totally unacceptable” to lift the residents by hand.
The inspection report in April had highlighted the fact that there were
insufficient staff to deal with the residents, especially at meal times.
Little seemed to have changed. Many of the residents could not feed
themselves and had to wait for a carer to spoon-feed them. This was vitally
important as patients with dementia can soon become seriously ill if they
are not properly attended to at meals.
Meal times were always a nightmare. One senior carer said that it took 15
minutes to feed one person but most carers had only five minutes at best.
One of the Bulgarian carers said he felt that he was on a “race track”
because he had to feed nine people one evening.
We were not helped by the fact that the hot lunches would be served together
at 12.30pm. One day it was almost 2pm before I was able to get to Tom (not
his real name). After taking one spoonful of the pureed pea and mince, he
spat it out. The food was stone cold.
Many of the residents required soft food, which is difficult to make look
appealing. But more could have been done to stop some of the dishes looking
like an unappetising mush. The liquidised cheese and tomato omelette was a
low point.
One afternoon I spoke to the the husband of one of the residents as I cut his
wife’s finger-nails. He told me he had raised concerns that the residents
were often not getting sufficient food or hydration. “There aren’t enough
carers,” he said. “[The carers] are all dashing about trying to give this
one a bit there, that one a bit there . . . it’s difficult to get some of
them to eat . . . it needs time and perseverance and they haven’t all got it
here.”
His wife, he claimed, had lost 2½ stone since she had been admitted to the
home. Southern Cross, however, later said there had been no fluctuations in
the weight of residents at the home in the past three months.
Another concern was hygiene. In their hurry, many of the carers seemed to rush
from resident to resident without washing their hands or changing their
gloves and aprons as they were instructed to do by the manager. Careful
hygiene is essential because superbugs such as clostridium difficile and
MRSA can easily be brought into nursing homes, especially after hospital
visits.
However, I saw carers changing a soiled incontinence pad one minute, and then
handling another resident with the same gloves. I conducted a series of swab
tests on the carpets and floors and two of the samples detected pathogens:
one for MRSA and the other for C diff.
We did not have time to check the residents’ incontinence pads regularly,
which meant that some could go for hours without being cleaned. When I was
changing one woman’s pad, I noticed two flies crawling inside.
It was impossible to say how well funded the home was because I never saw the
books. But one analyst estimated that it might make between £70,000 to
£100,000 profit a year based on its current full occupancy. Margins in the
industry are tight and this profit would soon disappear if they failed to
fill a few beds.
Many of my fellow carers complained about small cost savings such as rationing
in the amount of cleaning foam we could use.
There were also frequent shortages in towels and sheets, which grew worse in
my third week when one of the two washing machines broke down. I saw one
member of staff attempting to clean a soiled sheet as it lay on the bed
because there was no replacement available.
Sometimes there were no clean clothes available either. One morning a man, who
had been sitting in wet trousers for three hours, asked me when he was going
to be changed. I had to tell him that he wouldn’t be.
Despite this, Goodhew called a staff meeting to outline bold plans for the
home. “This is now going to be run as a five-star hotel,” he said. “People
eating in their rooms will be now be given trays with doilies.”
My colleagues were not impressed. One told me: “They are always on about how
they’re going to turn it into a five-star hotel, with all this posh Italian
wallpaper and flat-screen tele-visions, but we haven’t got any bloody
sheets.”
Bosses make millions
For a former hospital nurse, Philip Scott has come a long way. The 43-year-old
will quit as chief executive of Southern Cross Healthcare at New Year with
plenty to celebrate.
He is now a nursing home multi-millionaire who last year earned £600,000 plus
bonus. After six years at the helm, he is sitting on shares worth £12m.
The rewards for restructuring the company under private equity and turning it
into a successful plc have also been shared by his fellow board members:
Bill Colvin, the chairman, has £7.1m of shares; John Murphy, chief operating
officer, £11m; and Graham Sizer, chief financial officer, £8.5m.
A company spokesman said the directors had been rewarded for investing their
own money in the company several years ago.
