Care home regulator didn't probe thousands of complaints

Investigations by the regulator into complaints against care homes in Scotland were significantly reduced during the period when Covid-19 was taking a devastating toll on the sector.

Only one in 20, or 5%, of complaints made by relatives, carers and staff about the quality of care being received by older people in homes were fully investigated by the Care Inspectorate.

Of the 2316 complaints received by the regulator from relatives in the 2020/21 period, just 122 were the subject of a full investigation. This compares with more than 600 in previous years.

The Care Inspectorate said that it had “rapidly adapted” to the situation last year and had reduced the number of on-site inspections it carried out to avoid spreading the virus.

The data has been revealed as part of a collaborative project by STV News, The Scotsman, The Herald, The Press and Journal and The Courier.

The Scottish Government has committed to a public inquiry into its handling of the pandemic but some relatives are now calling for the Care Inspectorate’s role in regulating the sector to be subject to similar scrutiny.

Highland councillor John Gordon lost his father, John Angus Gordon, to Covid while he was being cared for at Home Farm in Portree. He believes staff did their best but were part of a system “that failed them and failed us as families but most importantly failed the residents”.

Home Farm was operated by care provider HC-One before being taken over by NHS Highland. HC-One declined to comment.

John said: “Our elderly population deserve the best care possible and if there are complaints they should be addressed and dealt with in a timely and professional manner.

“I think that a lot of the problems that care homes are facing and what we have experienced during the pandemic in terms of some of the reports that have come out and the complaints that we’re now hearing about ultimately is at the door of the Care Inspectorate.”

More than 3300 people died of Covid-19 related causes in Scottish care homes.

The information about complaints emerged as part of an ongoing collaborative investigation by Scotland’s leading media companies, including STV News. Previous freedom of information requests resulted in the National Records of Scotland being ordered to release data on deaths in every care home in Scotland.

Now, the Care Inspectorate has responded to a FOI request by releasing data on the number of complaints lodged about individual care homes for older people.

The data reveals that three quarters of Scotland’s 806 care homes were complained about in 2020/21. The total number of complaints was 2316 – a slight reduction from the previous period, which is thought to be linked to fewer visits from relatives and carers.

It has also emerged that the regulator made a number of changes to how it dealt with complaints in a bid to reduce the level of visits to care homes during the pandemic.

It adopted a system that relied on “more dialogue and mediation” at the earlier stages of complaints. Under this approach, the number of completed investigations fell from a monthly average of 52 in 2019/20 to just ten per month during the last financial year.

Rather than be subject to detailed investigations, half of all complaints were noted for “intelligence” and for possible future inspection work – a rate almost double that of the previous period.

Additionally, the number of cases dealt with by “direct service action” – where the regulator asks the care provider to engage directly with the complainer – increased from an average of 13 per month to 27.

A report from the Care Inspectorate board meeting in June notes that the regulator was “keen to learn the lessons from our work on complaints in the last year” and that an internal review has been commissioned.

The data released under FOI shows the regulator has dealt with 10,481 complaints about care homes for older people in the past five years.

At the height of the pandemic in April last year, 295 complaints were recorded.

Of the 20 facilities with the most complaints last year, 18 were privately run.

The Care Inspectorate received at least one complaint about 82% of private sector care homes for older people last financial year. It upheld the complaint in about one in eight cases.

Of the complaints made in 2020/21 about care homes for older people, 40% came from relatives and carers and more than 25% were lodged by staff at the homes.

The focus of the complaints were healthcare (38%), communication (17.8%) and wellbeing (8.3%).

A spokesperson for the Care Inspectorate said: “ In March 2020, in line with guidance from directors of public health and after consultation with the Scottish Government, we rapidly adapted the way we worked because it was critical to minimise the spread of the virus, to keep people safe.

“Part of this meant on-site complaint investigations had to be limited to those that were deemed essential following an enhanced risk assessment. At that time we also significantly increased our contact with services and made use of technology where appropriate.

“The pandemic caused changes to how services operated. Some closed and others restricted non-essential visitors.

“As a result, the trends and patterns in complaints noted in previous years were disrupted with falls in complaints received in the past year.

“Complaint investigation is one important part of our scrutiny work. Complaints inform our wider work, which includes intelligence gathering about care services and subsequently unannounced inspections of care services as required.

“Where we have serious concerns about a care service we do not hesitate to take action to keep people safe, and we lay a summary report of all our inspections every two weeks before the Scottish Parliament.”

Kevin Stewart, the Scottish Government minister for mental wellbeing and social care, said: “The safety, protection and wellbeing of residents and staff in care homes is a priority, and we have met regularly with the Care Inspectorate throughout the pandemic as they adapted to the challenges of inspecting and supporting care homes.

“Complaint investigations have continued throughout the pandemic as part of a multi-agency approach, which also involves Health and Social Care Partnerships and local public health teams.

“We mourn every death from Covid-19 and express our sympathy for all those who have lost loved ones.

“We have confirmed there will be a public inquiry into all aspects of the impact and handling of Covid-19, including care homes, and our immediate focus is on continuing to do everything necessary to save lives for the remainder of this pandemic.

“In addition, the First Minister announced an independent review into how adult social care can be most effectively reformed to deliver a national approach to care and support services.”

Karen Hedge, national director at Scottish Care, said: “The delivery of safe high quality care and support is our first priority.

“Whilst we understand the need to reduce footfall as a result of the pandemic, the sector is now in a safer position with the introduction of double vaccinations and other IPC (infection protection and control) measures.

“In situations where a local resolution cannot be found, we would welcome Care Inspectorate intervention as a way to investigate and respond to complaints.

“This is a necessary part of the improvement process offering assurance to those accessing care and support and their families as well as to care providers and staff.”

‘There still feels like there is no closure in this‘

Highland councillor John Gordon lost his father, John Angus Gordon, to Covid while he was being cared for at Home Farm in Portree.

John’s father was diagnosed with dementia in the final years of his life and lived close to his daughter, Mary MacCaskill, and his grandchildren.

“Getting dementia in the last six years of his life wasn’t easy. My mum cared for him, sadly two years into it she passed away with cancer,” John explained.

“He was settled in Home Farm by then and, yeah, I always say my dad loved reaching out his hand to give you a handshake, he would always shake your hand whenever he met you and even if you went to his house for a cup of tea, even if I went to his house for a cup of tea, you would always get a handshake as he greeted you at the door or even when you went into the sitting room.

“It was something he did, he just liked shaking hands. For us, it was very poignant the day he died and we said our goodbyes. I don’t know if he recognised our voices but certainly when my sister and I spoke he reached out his hand but it was the carer with her blue gloves on, for us it was very poignant because our dad always shook our hand and there he is coming to the end of his life and the hand that’s grabbing his hand is somebody that has to wear a blue glove because of the pandemic that we are in and that was our last time with our dad.

“It was obviously on FaceTime and it’s not been an easy year and as I said there still feels like there is no closure in this. It’s such a cliche but answers have to be given and these issues have to be addressed.”