Care homes should be required to meet standards on minimum staffing
levels that would be monitored by regulators to help tackle the risks of abuse
and neglect of residents. But currently
this is not enforceable.
In advanced dementia, there
are normally 2 carers per 6 residents during the day, I've spoken to a couple
of care home managers and can confirm that there are 'recommendations' and
'guidelines' and these unfortunately vary. Not much help to the end user.
Currently, care homes, like
other registered health and social care providers in England, must “ensure they
have sufficient numbers of suitably qualified staff”, to meet the relevant CQC standards.
However, while the CQC did begin a “thematic probe” into adult social care
staffing after receiving evidence that
insufficient staffing levels were leading to poor care in some settings,
particularly services supporting adults with learning disabilities or dementia.
However, Andrea Sutcliffe, chief inspector of adult social care at the
CQC, has said this would “not involve proposing staffing ratios but examining
whether staffing levels were contributing to poor care”.
Personally, I think it is easy
to conceive the idea that in fact staffing levels were contributing to poor
care.
And worse still in England the
CQC do not inspect or assess councils commissioning function – despite strong
calls from providers and charities for the government to ensure it does so. Instead, from April 2015, under the Care
Bill, the CQC will be able to inspect a council, with government approval, when
there is evidence of serious failing or where poor commissioning is leading to
poor provision – talk about working with both hands tied behind your back!
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 18
18.—
(1) Sufficient numbers of suitably qualified, competent, skilled and
experienced persons must be deployed in order to meet the requirements of this
Part.
(2) Persons employed by the service provider in the provision of a
regulated activity must -
(a) receive such appropriate support, training, professional
development, supervision and appraisal as is necessary to enable them to carry
out the duties they are employed to perform,
(b) be enabled where appropriate to obtain further qualifications
appropriate to the work they perform, and
(c) where such persons are health care professionals, social workers or
other professionals registered with a health care or social care regulator, be
enabled to provide evidence to the regulator in question demonstrating, where
it is possible to do so, that they continue to meet the professional standards
which are a condition of their ability to practise or a requirement of their
role.
The quality of life which
residents experience will depend to a great extent on the calibre of the staff
caring for them. A trained and experienced staff team, which is well managed
and adequately paid, is likely to provide high quality care in a responsive and
understanding atmosphere. People living in residential and nursing homes are
often vulnerable, both physically and emotionally. Staff will be required to
carry out personal and potentially embarrassing intimate services for residents
and will need special qualities to do this sensitively and tactfully. Such
qualities will include personal warmth, patience and responsiveness to and
respect for the individual. They should be able to provide competent and
tactful care whilst supporting residents in maintaining and extending skills
and self-care abilities.
If residents are to receive a
satisfactory standard of care, it is important that the staff see themselves as
part of a team which is consistent in its shared aims, with members fulfilling
complementary roles. A balance of staff will therefore need to be appointed to
match the residents' needs.
There have long been
concerns about a lack of national guidance on staffing levels, nurse:patient
ratios and skill mix in care homes. The
Edith Ellen Foundation calls for a 'national
guidance on staffing levels and ratios for care homes, determined and applied
locally according to the dependency and needs of residents in a home’s care and
to the demands of the home’s day (early and late) and night time shifts'.
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