Tuesday, 2 March 2010


Becca asked about how to complain about a poor care home, or effect a change for the better.

A number of possibilities exist.

1) Talk to the Care Home manager

In my corner, it works out at less than 2% of care home managers want to be left alone. I've no authority or statutory powers to enter care homes or direct how things should be in care homes. Even so, all but one care home manager I've worked with has welcomed me in to work with the NHS to improve care. Most reasonable managers will listen to opinions, especially valid opinions of people who've been through their home. They may listen and take your views on board. They may listen politely but ignore everything. But the first port of call should be the manager since they're in a position to improve things markedly and turn a poor care home into a great care home.

2) Talk to Secondary Care

Some hospitals have specialist services that visit care homes. Care Home teams, Outreach Teams, Liaison Teams, names vary. But it's becoming more common for NHS prividers to have a specialist team that visit private and Council care homes to provide support. Our team knows which care homes are great and which are dreadful. We're involved in all the Safeguarding referrals and all investigations, simply because we can contribute information to the processes but equally can contribute solutions in both staff development/training and direct patient care. Care home teams can therefore take on board comments you have. One of our carer forums gave great feedback to us, resulting in us training a large number of care home staff. The carers were pleased since standards have improved. The care homes are pleased since they've had free specialist training (and forged close working relations for ongoing support).

3) Talk to the company

Care Homes mostly are run by massive companies. There's a tension in them. They want to maximise profits. But they also want good publicity and to be seen to have decent standards of care, holding a decent reputation. Care home managers may compromise too much, eroding care (through poor food, poor staffing, poor environment, poor recreational opportunities) to maximise profits and be seen to succeed for the company. The company likes a good balance sheet. But extra profit at the cost of 21 Safeguarding cases and the home closed for investigation is less attractive to them. Which is what heppened in one of my local care homes. The company had no idea it was so bad. It can be very worthwhile telling the parent organisation what you feel, since you sharing your views affects their reputation, which matters to them.

4) Talk to the Council

What if it's not an independent care home? If it's run by the Local Authority, then get on to the Council. Heck, even if it's a private care home, the Council have major influence.

The Council will have a contracts department for care homes. They will have details of what care homes are registered to provide (although this is changing) but critically they details what the Council, through social care funding, will pay care homes. If a care home is embargoed, no Council funding is given. Nobody's funded to go there. Councils therefore have enormous clout. If you've concerns about a care home, you can talk to the Contracts department and share this concern. They'll not be able to act on their own, usually, but it's healthy for them to have an awareness that all's not well in Home Blah since then they're obliged to do some digging.

5) Talk to the PCT

The PCT fund a lot of care home placements now, through Continuing Care funding. This NHS cash going into care homes is managed by the PCT. If a care home's doing a rubbish job, the PCT can intervene through different systems. They can investigate directly themselves, informally or formally. They can use resources (like PCT pharmacists, Community Matrons, Health Visitors) to provide surveillance or support. They can refuse Continuing Care funding and with with the Local Authority to embargo a care home, effectively closing it down until it sorts itself out.

6) Talk to the Care Quality Commission

The Care Quality Commission (CQC) will take your complaint. They've taken over CSCI and now oversee care homes. They helpfully detail what they'll do. They can direct homes to progress certain actions and have teeth, effectively being able to close them down until they pull their socks up to the CQC's satisfaction.

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