Inspectors and care planning

 I go to various homes up and down the country visiting care homes that CQC inspectors have judged to be ‘failing’. I am never surprised that one area that is always quoted on their reports is that of care planning. However, what is surprising (although not to many home owners and managers) is the lack of consistency of CQC inspectors in their interpretation of what constitutes a care plan that meets the regulatory requirements. This may be due to the fact CQC inspectors are generally drawn from two different disciplines namely nursing and social work. Both professions have widely different perspective to care and the delivery of that care. To exemplify this, nurses will approach the care plan from a medical paradigm with greater emphasis on the health care needs of residents e.g., prevention of cross infection, fluid balance chart etc. Social workers on the other hand, will approach the plan from a psychosocial perspective. This is an exaggeration to some extent, there is however, often a bias by inspectors for the care plans  to reflect their particular area of interest; such as dementia. A home owner that was not registered for dementia was asked that she provide training for her staff in dementia care.A small care home in Dorset following a change of inspectors, was correctly criticized for not having demonstrated (in the care plan) residents ability to exercise choice with regards to the time the resident wanted to go bed or get up in the morning. This, along some minor administrative errors with medication moved the home’s rating from ‘good’ to poor ( during CSI rating of homes) and a ban of admission. The style of the care plans had not changed over a number of years and had previously been inspected and deemed to be meeting the needs of the residents. In contrast a Care Home in the Midlands had no written documentation about a resident’s diabetes, there were no risk assessment, and care plans had clearly not been drawn up with the collaboration of the resident. They had not been reviewed for a number of months. The inspector had raised some of the issues highlighted over a number of inspections but continued to grade this area as a minor concern  for care planning. This is interpreted to mean that the standard was almost met! Needless to say, the home also had administrative issues with medication. I accept that there is likely to be a degree of variability from inspector to inspector, however, the fluctuation in the sanctions far too great. CQC must ensure the approach that they take when inspecting is consistent, transparent and reflective of the essential standards of quality and safety. The publication of the inspection guidance has gone a long way in helping homeowners to have a better understanding of the criteria used by inspectors when assessing particular standards. Nevertheless, a number of areas such as care planning still require further clarification.