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Monday, 30 January 2017

Care homes need minimum staffing levels to tackle risk of abuse

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

(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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