CQC case reveals ‘degrading’ conditions in England care home as Covid hit

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The depth of suffering in care homes in England as Covid hit has been laid bare in a court case exposing “degrading” treatment with residents being “catastrophically let down”.

Care levels at the Temple Court care home in Kettering collapsed so badly in April 2020, when ministers rushed to free up NHS capacity by discharging thousands of people, that residents were left lying in their own faeces, dehydrated, malnourished and suffering necrotic, infected wounds, the Care Quality Commission found. Fifteen of its residents died with Covid in the first weeks of the pandemic.

The case foreshadows the UK Covid-19 public inquiry module on the care sector, which next year will test Matt Hancock’s claim to have thrown “a protective ring around social care”.

The prosecution resulted in a ?120,000 fine handed down at Northampton magistrates court last week. The operator, Amicura, apologised but said it had been “acting in the national interest and supporting the NHS by accepting patients discharged from hospitals into care homes under government policy”.

The Northamptonshire home was one of hundreds across England put under unprecedented pressure after Hancock, then health secretary, ordered a wave of discharges into care homes amid fears Covid would overwhelm hospitals.

“They [staff] were overrun, they were short-staffed, and then with the influx of people they couldn’t cope,” a relative told inspectors. One said that their loved one was always thirsty when they visited and “gulped down” water when offered it. When community nurses were finally deployed they found people left in soiled bedding and made a large number of safeguarding referrals.

The high court has already ruled that the government’s discharge policy was illegal and the failure to isolate people who were being discharged without testing was “irrational” and “failed to take into account the risk to elderly and vulnerable residents from non-symptomatic transmission”.

More than a quarter of all deaths among care home residents in March and April 2020 involved Covid-19 – more than 12,500 people.

Temple Court’s population doubled in a few weeks when Amicura accepted 26 new residents, including 15 from hospital, while senior staff were struck down with the virus.

The CQC brought the prosecution, which concluded last week, and said residents were “catastrophically let down by the care provider’s poor systems and processes”. The care company was also hit with a ?80,000 costs order.

But Amicura said the discharges placed “incredible strain on our team – leaving many of them overwhelmed, exhausted and themselves ill with the virus … This, together with the rapid rate of discharges from hospitals to the home, had a significant and detrimental effect … on the care provided.”

Before the pandemic struck, the CQC was already concerned about the quality of care at Temple Court, rating it “requires improvement”. Between late February and early April 2020 the care home accepted the new residents without “properly assessing the impact that such an increase would have on the health and safety of everyone living there”, CQC said.

By the time inspectors visited Temple Court in early May 2020, a relative said, “it was chaos”.

The registered manager and the senior care team had been absent for about a month and the clinical lead was on prolonged leave. There weren’t enough staff with the skills needed and people suffering with blood clots, strokes, heart conditions and seizures were not getting essential medicines. Treatment was described as “degrading”.

Ros Sanderson, the CQC’s deputy director of enforcement, said the provider “failed in its specific legal duty to protect residents from being exposed to a significant risk of harm”.

Amicura said: “We fully accept the court’s sentence and apologise unreservedly to everyone affected by the failures of our systems and processes in the early stages of the Covid-19 pandemic. Following these events, we immediately set about learning lessons about what went wrong and committed to making significant improvements across the company to ensure that our residents are always safe, supported and well cared for.”

Experts have warned that the care sector has not recovered from the pandemic, with about 165,000 staff posts still vacant – more than one in 10 – despite rising need among an ageing population.

Earlier this month, a two-year study by the Nuffield Trust health thinktank and the London School of Economics concluded that distress in care homes at the start of the pandemic had been a consequence of “letting one of our most important public services languish in constant crisis for years”. It found ministers had failed to appreciate the sector’s fragility when sending patients into ill-prepared care homes.

Skills for Care, a government-funded agency, has predicted that the UK may need an extra 480,000 workers in social care by 2035 to keep pace with demand. Meanwhile, 430,000 carers could be lost in the next 10 years if those aged 55 and over decide to retire.

In one week this month, the CQC published 146 reports on care homes that it had previously assessed and it downgraded the quality rating of one in five homes. Overall, almost half of those assessed on issues such as safety, leadership and how caring a home is were “inadequate” or “requires improvement”. Fewer than 2% were “outstanding” and the rest were rated “good”.