I’ve been reporting on the care services that CQC have found to be inadequate routinely for five months now and one of the providers that come up time and again are Achieve Together.
If you were to pop over to their website right now you could be mistaken for thinking you were at the wrong place. Their lead news story is about their award wining services:
We were delighted to be awarded this accolade in recognition of the incredible work our teams have done and continue to do day in and day out, supporting people across England and Wales. Emma Pearson, Chief Executive Officer, and Garry Fitton, Chief Financial Officer accepted the award on behalf of Achieve together.
I’ve been talking about the scam that is health and social care awards for years now. There’s a very old blog post from 2014 here, where I FOI’d every NHS Trust in the country and was aghast at the amounts of money some of them spent on entering and attending awards, whilst of course on more than one occasion delivering poor care at the very same time. There’s a short video I recorded and shared on Twitter last year below, that covers some of my concerns in 2mins, and it’s almost identical to my concerns about this latest award that Achieve Together have ‘won’.
My main issue with awards are how utterly subjective and meaningless they are, that its only those who are self promoting and applying that win (and the good providers are far more focused on delivering good care and support for people, rather than marketing and spin) and that they’re all just a money maker for whoever is hosting them. A quick squizz at the cost of tickets for attending suggest that’s the same for the Laing Buisson Awards too.
Achieve Together spent at least £948 for their CEO and CFO to attend and pick up these ‘awards’. No evidence from their news article that they took any of the people actually delivering care and support with them, never mind failing to take any of the people who they support, for whom their salaries, profits and awards rely, with them.
Anyway, back to CQC’s latest findings of their award winning provision. First up Inglewood House in Camberley, Surrey.
This was a targeted inspection of Inglewood House which has been in Special Measures and rated inadequate since May 2022. It considered safeguarding, infection control, staff training and how information is shared. Targeted inspections don’t change ratings, so Inglewood House remains inadequate in every domain.
Inglewood House is a residential care home providing personal care to up to 12 people. The service provides support to people with a range of learning disabilities including people living with autism. At the time of our inspection there were nine people using the service. The home supported all people in one adapted building.
So what prompted the targeted inspection I hear you ask?
The inspection was prompted in part by notification of an incident following which a person using the service sustained harm. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of safeguarding, reporting and training. This inspection examined those risks.
Award winning specialist care in 2022.
In May, Inglewood House was in breach of Regulation 13 (safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection was to check whether they remained in breach, and also for CQC to:
…check on a concern we had about a delay in action and reporting of a serious safeguarding concern.
There was no registered manager in place. The absence of one creates a gap in accountability, and no doubt contributes to the inadequate care provided.
The registered manager position is important because they have to register with CQC to say that they are managing the service. They are then in turn, alongside providers, legally responsible for how the service is run and for the quality and safety of care and support provided.
Back in May there was a registered manager in post but CQC discovered that they’d been working remotely from the service since April 2020. Couple of snippets from May 2022 report relating to the safeguarding breaches:
The registered manager and provider had failed to investigate concerns relating to people being abused at the service. This was despite evidence that indicated poor staff culture. Although this has now been addressed by them the failure to have robust oversight of the poor culture had a direct impact on the people living at Inglewood. A member of staff told us, “The oversight now is to hone in on the closed culture which I think exists here.”
Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The registered manager had not informed the CQC of significant events including incidents and safeguarding concerns.
As an aside, this is what a relative said about care provided by Achieve Together at Inglewood House when CQC spoke to them in May 2022. Not sure how this squares with Laing Buisson considering them award winning:
Relatives told us they felt the service had deteriorated and the registered manager not being at the service had impacted on care for their loved ones. Comments included, “Since [registered manager’s] absence it’s gone downhill”, “Nobody gives you straight answers anymore” and “Recently I don’t think it’s been a pleasant place to live.”
Concerns raised on audits in 2021 that were received from relatives were not acted upon. We saw from one audit a relative stated they wanted more regular contact from the provider and an increase in activities for their loved one. They stated on the survey, ‘We’ve been trying to get people to listen to us for over a year and nobody has taken any action’.
Do any of these awards ever do any due diligence, or do they just take the self promoted propaganda at face value?
CQC took action after their last inspection, placing conditions on the provider’s registration and cancelling the manager’s registration.
They’ve clearly failed to recruit a replacement since, although CQC did speak to the acting manager, alongside a number of other staff on this recent inspection. Inglewood House remains in breach of regulations relating to safeguarding, and people remain at risk of abuse and neglect.
Not enough improvement had been made at this inspection and the provider was still in breach of
People were not always protected from abuse and neglect. There had been a recent incident where a serious safeguarding concern had been identified by staff and this had not been reported in a timely way. This meant police and other professionals did not know about the concern immediately to take action to safeguard the person.
Staff did not always document the sharing of information with each other. For example, the handover between staff shifts were verbal and not always written. This meant that pertinent information about people could be forgotten or misplaced and placed people at risk of neglect.
People continued to be at risk of abuse and neglect. This was a breach of regulation 13 (safeguarding service users from abuse and improper treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This is gut churning stuff. The April inspection, reported in May, was conducted in part because CQC received concerns about people not being protected from abuse and unsafe care being delivered to people.
Their inspection laid bare how bad those were. Achieve Together promised they’d sort it out. See the optimistic comment from inspectors in the May report above “The registered manager and provider had failed to investigate concerns relating to people being abused at the service. This was despite evidence that indicated poor staff culture. Although this has now been addressed by them the failure to have robust oversight of the poor culture had a direct impact on the people living at Inglewood”.
Well what do you know. They hadn’t addressed things. People were not only remaining at risk of abuse and neglect, they were abused and neglected. A serious safeguarding concern was identified, and not reported. AGAIN.
Award winning specialist care in 2022.
Nearly every inquest I’ve covered following a death in social care services the same issues arise. Poor recording keeping, collective remembering when after the event a manager from the provider starts asking questions and getting people to ‘remember’ what happened. Then by the time the police, CQC or the coroner are investigating there’s a version of events, with no evidential basis, but a sort of apathetic shrug.
To be clear I’m not saying someone died at Inglewood House. I wouldn’t be surprised if they had, but the point is about the institutional cover up that occurs when there’s poor recording, late or non reporting to safeguarding etc. As there had been in April and May.
Yet again the CQC inspectors seem to think that Achieve Together have it all in hand:
The provider responded immediately during and after the inspection. They confirmed a written handover was introduced and completed twice daily to ensure staff shared all important information in a safe way. Following the recent concerns senior management took immediate action, and notifications were made. Senior management engaged with the Police and local authority safeguarding professionals and continue to work with them.
This just seems such a strange statement to make given they’d been inspected a handful of months earlier where apparently they’d also responded immediately. Time will tell I guess.
CQC comment that staff had received safeguarding training following the most recent incident, it’s not noted why it wasn’t provided following the last report and breach relating to safeguarding.
Since the recent serious safeguarding incident staff had received additional training and discussions with the management team. Staff were confident they would be able to report any safeguarding concerns in a timely way.
What is unclear is why if they’re so confident, that they didn’t take action.
In relation to whether the home is well-led, CQC again found continued breaches:
At our last inspection the provider had failed to ensure staff received appropriate training and supervision. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Not enough improvement had been made at this inspection and the provider was still in breach of regulation 18.
Following a recent serious incident, staff had not followed directions detailed in training courses. They had failed to effectively use their experience to immediately alert other professionals to an incident that had occurred in the home. This meant that the training had not been effective for staff to understand and act accordingly.
Staff had failed to show their skills and experience when faced with a serious concern. There had been a delay in sharing important and essential information with professionals who could effectively support people through a serious incident. This was a continued breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
I am so pleased to see CQC picking up on this. Simply attending training is not enough to change behaviour, despite the demands for mandatory training in social care, it is not a panacea. Training is an easy tick box, training transfer and improving practice is a whole other ball game.
One of the final comments in the report I find pretty demoralising too. I can’t help but wonder whether it speaks to an apathy that’s endemic across the social care system:
Since the incident the provider had been working closely with the local authority. A social care professional said, “There have been major failings, however, it is how they respond now. And it honestly appears as they are responding well and doing everything to make positive changes for the home and the people living there.”
I wonder where the social care professionals were when people were being abused and neglected.
The notion that we just have to judge people on how they respond now, when they’ve already been in known breach since April this year sums up how little concern is given to the human rights abuses inflicted on learning disabled and autistic people in this country.
In my opinion the focus shouldn’t simply be on how they respond now, it’s how they got there, while others in the organisation were busy filling out applications for ‘awards’.
In case anyone thinks I’m being too hard on Achieve Together, this is the 6th report of inadequate care of theirs I’ve covered in the past five months. There were 5 reports of services that required improvement in July alone. When the next CQC data set comes out in a few days I’ll do an overview of their provision, given its award winning, worth a closer look.
There’s another inspection report published this month, the 7th inadequate report… which is actually an update on the action CQC have taken since Rosebank Lodge was found to be inadequate in August.
This was another Achieve Together service where CQC were prompted to inspect due to concerns raised about people.
The inspection was prompted in part due to concerns received about people being unlawfully deprived of their liberty.
Concerns that CQC found that to be substantiated.
Staff did not support people to have the maximum control over their own lives. Staff did not do everything they could to avoid restraining people. The service failed to record when staff restrained people, and staff did not learn from those incidents and how they might be avoided or reduced. Governance processes were not always effective in providing good quality care and support.
Staff did not always understand how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse, however, did not always apply it. Staff spoke positively about the people they supported.
People experienced harm because of a lack of protection, they experienced or were at risk of abuse, including unnecessary restraint, segregation and seclusion. The service had a closed culture whereby people were not supported to live safely and free from unwarranted restrictions because the service failed to adequately assess, monitor and manage safety well. Staff did not respect people’s rights. There is a lack of visible leadership, staff were reluctant to report incidents, and management failed to act on known issues.
Award winning specialist care in 2022.
This updated report reflects that CQC have issued Warning Notices. I hope there is more going on that they’re not able to report yet. I have discussed the report on Twitter here already, but a few lowlights follow.
An inspection in February 2022 saw CQC rate everything as good, except well-led which they considered required improvement. Inspectors considered that the registered manager was aware of their duties under the Duty of Candour, however they noted that they received mixed feedback from relatives.
One astute relative told inspectors:
“There tends to be excuses for things rather than put his hands up and admit things went wrong and I’ll make sure it doesn’t happen again.”
The unannounced July 2022 inspection saw the domains of safe and well-led rated inadequate, with an inadequate rating overall.
People were being deprived of their liberty unlawfully.
Prior to the inspection we were informed of incidents whereby staff were locking people in their bedrooms without the necessary skills to open the door independently; and staff turned off people’s water supplies in their room to ensure they could not flush items down the toilet or cause a flood.
Staff told us that people were locked in their bedrooms so that they did not walk into other people’s rooms causing distress. Deprivation of Liberty Safeguards (DoLS) written authorisations in place did not authorise the use of such restrictive practices.
They were locking people in their bedrooms. Imprisoning them. And then turning off the water supply to their rooms.
Award winning specialist care in 2022.
There are similarities to the non-care provided at Inglewood House in relation to safeguarding.
People were at risk of abuse as the service had an embedded culture whereby staff members were unable to identify, escalate and report poor practice.
On the first day of the inspection we observed staff unlawfully restraining one person. The staff member had failed to use de-escalation techniques and used physical restraint as a first response instead of a last resort. The staff member was unclear on how to safely support the person who was attempting to leave the service without direct support from staff.
Incidents of physical restraint were not documented, which meant healthcare professionals were unable to accurately assess their needs as they did not have a clear evidential history of the behaviours people engaged in.
On the second day of the inspection, the area manager informed us that she had located 53 incident and body map documents which had not been reported to the local authority nor thoroughly investigated to minimise repeat incidents. The incident forms were not completed appropriately and had not all been reviewed by senior staff to identify patterns and trends in order to prevent reoccurrence.
Unlawful, undocumented restraint. In full sight of CQC inspectors.
An area manager apparently uncovering 53 incidents not reported to safeguarding on day two of the inspection. Why does it take CQC turning up at an Achieve Together home for them to notice that their staff are breaching people’s human rights?
Maybe if they spent more time focusing on the care they were delivering, rather than the propaganda marketing and awards, people might actually have better lives.