Accountability in care

Peter Cheney summarises how care home facilities are inspected and regulated.

The Regulation and Quality Improvement Authority (RQIA) is the independent regulator for health and social care services in Northern Ireland and has been operating since 2003. It is therefore responsible for registering, inspecting and encouraging improvement in residential and nursing homes, and nursing and domiciliary care agencies.

Any person who manages a facility or service must apply for registration to the RQIA. Once this is approved, the authority will issue a certificate of registration and add it to the relevant register.

The authority selects a variety of standards which it will inspect during a financial year. For 2014-2015, it has set down two minimum care standards for residential homes: an appropriate staff response to the behaviour of residents; and a programme of activities and events for residents.

On the first point, staff should understand each resident’s usual conduct, behaviour and means of communication and also seek to understand any reasons for unusual behaviour. Where staff or other professionals need to take a consistent approach or response, this must be detailed in the care plan. Staff should also receive the necessary training, guidance and support to deliver this assistance.

Where the staff response is not in line with the resident’s care plan, this should be recorded and reported (if appropriate) to his or her representative and to relevant professionals and services. Where necessary, this should be followed by a multi-disciplinary review of the care plan.

Restraint should only be used as a last resort by appropriately trained staff in order to protect the resident or other people. All instances of restraint should be recorded.

The programme of activities and events needs to be structured, varied and based on the needs and interests of residents. Residents, including those who generally stay in their own rooms, should have the chance to suggest ideas and the programme should be clearly displayed within the home.

For activities led by people outside the home, the manager is responsible for ensuring that they have the necessary skills and staff should also inform them if residents’ needs have changed since the last visit. The programme of activities should be reviewed regularly – at least twice a year – to ensure that it remains relevant.

Standards for nursing homes are understandably more detailed and refer to the management of wounds, pressure ulcers, nutritional needs, weight loss and dehydration. Domiciliary care standards for supported living cover the appropriate management and safeguarding of residents’ finances and property and responding appropriately to their needs.

Each inspection includes interviews with staff and residents and reviews of documents held by the home. Inspection reports and enforcement notices are available online at www.rqia.org.uk

The regulator has been asked to improve its performance after a highly critical review of how it inspected the Cherry Tree House nursing home in Carrickfergus.

A whistleblower who worked at the home claimed that her allegations, regarding patient safety, were repeatedly ignored. The RQIA has since apologised to the whisteblower and Jennifer Tracey, the current manager of Cherry Tree House, recognised that “there is much in the report we can learn from and it provides useful insight into our own shortcomings.”

RQIA Chief Executive Glenn Houston has also pointed out the organisation only has eight inspectors to cover 240 nursing homes and while it would like to recruit more, this is “unlikely” due to financial constraints. The report recommends the use of lay assessors, alongside inspectors, and the enforcement of proper employment controls to ensure that members of staff suspected of abuse and neglect cannot move between homes.

Health Minister Edwin Poots added that he wanted to ensure that RQIA had “the teeth to ensure the care provided in each situation is of a high quality and standard” and he expected the regulator to resolve the problems identified in the report by next summer.

Inspections (2012-2013)