A Serious Case Review (SCR) into a care home run by Southern Cross has made more than 30 recommendations in a bid to prevent the "institutional abuse" that coroners found contributed to the death of five elderly residents.
The SCR, commissioned by West Sussex Adult Safeguarding Board, made 34 recommendations in its answers to a series of questions asked by the family members of those who died at Orchard View, and how regulations can be improved. Key recommendations include:
- It should be a requirement for care businesses to prove they can recruit and sustained skilled staff
- Relatives should have a named point of contact within homes
- Concerns over safeguarding should be escalated outside the care home, if not dealt with promptly and properly
- Emergency services should have named contacts so they can access care home more easily
- Care providers should be contractually required to hold open meeting with residents and their relatives on a regular basis - a local authority representative should be invited to this and minutes should be shared
Health and social care inspectorate body the Care Quality Commission said they were "appalled" by the Serious Case Review into the deaths of five residents of Orchard View care home, and admitted they did not act quickly enough.
They were criticised by the coroners report into the death for giving the home a "good" rating a year before shutting it down.
Chief Inspector Andrea Sutcliffe said the blame for the "sub-optimal" care lay with those working in the home.
I was appalled by the descriptions of what had happened at Orchid View. Today’s Serious Case Review once again shows what a truly tragic situation this was and my thoughts remain with the people who suffered such awful care and with their families.
The Serious Case Review shows the primary responsibility for these failings rests with the people providing services at Orchid View, together with their owners Southern Cross.
Ms Sutcliffe admitted the Care Quality Commission missed early warning signs, and did not act quickly or strongly enough. She said:
At CQC we made a commitment to take a long, hard look at our role, make sure lessons were learned - and most importantly - turn those lessons into action.
We know from our own review that we did not fulfil our purpose of making sure Orchid View provided services to people that were safe, compassionate and high quality.
The bereaved relatives of those who died at a Southern Cross run care home are calling for "dramatic changes" to improve care standards across the UK.
Linzi Collings, whose mother Jean Halfpenny died whilst living at the £3,000-a-month home said she was appalled and baffled by the findings of the coroner's inquest and called for home owners to be more accountable.
Speaking ahead of the Serious Case review into her death due to be published this afternoon, she said:
"How the corporate failings of Southern Cross could create these events and how such terrible standards could go unnoticed by the authorities for so long has left us baffled.
"In this day and age you expect measures to be in place to protect vulnerable members of society from being subjected to such horrendously poor care.
"We believe dramatic changes are needed to the current care system, starting firstly with greater accountability for care home owners if they are found to be making unnecessary mistakes and offering substandard services."
A serious case review (SCR) into the deaths of five people in a care home in Copthorne has identified a number of failings that contributed to their neglect.
Staff and managers at Orchid View care home, run by Southern Cross, "turned a blind eye" to errors, and were criticised for the following:
- A lack of respect for residents
- Poor nutrition
- Poor hydration
- Mismanagement of medication
- A lack of staff
The coroner at the inquest into the deaths last October said all residents suffered "sub-optimal" care, but five people, Wilfred Gardner, Margaret Tucker, Enid Trodden, John Holmes, and Jean Halfpenny, died from natural causes "which had been attributed to by neglect". She said:
There was institutionalised abuse throughout the home and it started, in my view, at a very early stage, and nobody did anything about it.
This, to me, was from the top down. It was completely mismanaged and understaffed and failed to provide a safe environment for residents.
A Serious Case Review (SCR) will be published today into the deaths of five elderly people who died after suffering neglect at a Southern Cross-run care home in Copthorne.
The review into the now-defunct Orchard View care home, will say the home was riddled with "institutionalised abuse".
Following a five-week inquest last October, coroner Penelope Schofield heavily criticised the quality of care at the home, and questioned why the Care Quality Commission inspection a year before it was shut gave it a "good" rating.
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