East Midlands

Personal visits to care homes can only offer a snapshot and websites may not tell the full story either.

So we depend on official inspections to keep the vulnerable safe.

Inside Out has uncovered serious failings in the system that's supposed to police our care homes.

Undercover investigation

Working undercover we discovered evidence from inside one home of poor infection control and lapses in care - yet the home was passed as satisfactory by an official inspection and a council audit.

Our undercover reporter worked inside Moorlands Nursing Home in Brinsley, Nottinghamshire.

The home is owned by Regal Care Homes Ltd and offers both nursing and residential beds for up to 40 elderly people.

Professor James - MRSA fears.

These residents are particularly vulnerable to infection which means it's crucial that staff follow procedures to protect them.

Yet we found evidence that some staff were confused about who was infected by MRSA and sometimes neglected basic hygiene precautions.

Superbug expert Professor Richard James from Nottingham University watched video of cleaners at Moorlands wandering out of the room where someone was believed to be carrying MRSA.

"Cleaners… not wearing an apron, not taking their gloves off before they left that room, wandering along a corridor… it would be quite likely that any resident in the care home could become an MRSA carrier."

Unsupervised?

Regal Care Homes says the resident was clear of MRSA when we filmed.

But, our evidence shows staff were unsure and weren't able to clarify even when they checked the resident's notes.

Our reporter also discovered that, at times, residents with dementia were left unsupervised and others had to wait unreasonable periods for basic care.

Inside the care home - secret filming.

We found one resident had been left sitting in urine soaked clothing.

The carer who treated his sore skin told us his carer hadn't fitted the leg bag he required.

Regal Care homes disputes what happened and says leg bags were available at the home.

In another incident a resident who'd been left unsupervised in a lounge area had soiled herself and removed much of her clothing.

Her relative Raymond Skelton asked to see our footage and was distressed by what he saw.

"It's quite obvious there could not have been anybody there for some considerable time because she would not have got into that state in a couple of minutes.

"I want answers… my initial reaction is I need to take her out of there now."

Caring for the elderly

Regal Care Homes maintains the lounge was never left unattended that evening.

But it says occasionally staff do have to leave residents alone.

It says it's inevitable some residents will have accidents of this sort.

While our reporter was undercover he raised his concerns about care and hygiene with the home's management but saw little change.

Moorlands care home - under scrutiny.

Then we phoned a hotline number for the Commission for Social Care Inspection (CSCI) and told them our concerns as an employee of the home.

It took 54 days for them to take any action.

CSCI has now started an inquiry into what went wrong - to find out why it took so long to respond to our concerns.

Mike Rourke, CSCI's director of inspection, regulation and review, told us that inspectors should have acted within 24 hours:

"At this stage it looks as if there may have been a number of people who were involved and we want to understand what they did and why they didn't act as our procedures required.

"But our view is that this is an exception, there are lessons I'm sure to be learned from this and we will do so."

Inspecting care homes

The commission is responsible for inspecting 18,500 care homes in England.

In October 2007 one of its inspectors went into Moorlands. Its report suggested Moorlands had no significant failings.

Care concerns - the CSCI report.

Part of the inspection regime involves self-assessment.

Moorlands' own management filled in a questionnaire before the inspector turned up.

He based his report on it together with the care notes of just four residents.

Former inspector and nurse, Ruth Poole, spent more than six years inspecting care homes.

She believes the inspection system is now not robust enough to protect residents.

"I’m extremely critical of the standard of inspection. It has been watered down to such a degree that in my opinion inspection reports are nothing more than tick boxes," she says.

Robust sytems?

But Mike Rourke from CSCI says:

"We wouldn't accept that our inspections are tick box. We've tried very hard to make sure that our inspections really begin with the service users' experience.

"We want to know what it's like to live in a home. We want to know what it's like in terms of dignity, independence, safety, all of the things that people who use services tell us are important."

CSCI stand by their October 2007 report and say it's perfectly possible that the problems we witnessed had developed in the weeks after the inspection.

Addressing concerns - Mike Rourke.

The Commission has now re-inspected Moorlands and asked the home to act immediately to address a number of issues.

Mike Rourke told us: "It is a case that there are concerns around the management of medicine, infection, care planning, risk assessments, those sort of areas that we would expect to be addressed properly in a well run home".

While our reporter worked undercover at the home it was also audited by Nottinghamshire County Council - their report showed nothing wrong. The council has now issued the following statement.

"We are extremely concerned about the issues that have been raised about Moorlands Nursing Home and we have immediately acted to ensure the safety and well-being of the residents in partnership with the Commission for Social Care Inspection (CSCI).

Ruth Poole - regular inspections vital.

"This year, we have introduced a quality audit process for the first time to look at aspects of care in independent care homes. These audits are pre-arranged and provide a snapshot of the arrangements in any home.

"This audit at Moorlands was not an official inspection and it was carried out in addition to the regular inspections by CSCI, which is the regulator of adult social care in England.

"The County Council is committed to improving the overall quality of care at residential and nursing homes in Nottinghamshire and we have been working with the Notts Care Home Association to do this.

"We will continue to work with CSCI, health and Moorlands to ensure the future improvement to the quality of service in the home."

Kindness and compassion

While inside Moorlands, our reporter also saw kindness and compassion from staff sometimes working in very difficult conditions.

Most relatives who contacted us were very supportive of the home and believed it was caring very well for their loved ones.

Regal Care Home says the home is now clear of MRSA, and it complies with NHS guidelines on infection control.

But questions remain about how these homes are inspected and how standards are maintained.

Former inspector Ruth Poole says unless inspections take place regularly and unannounced there's nothing to prevent conditions deteriorating behind closed doors:

"If you haven't got the inspectorate knocking on your door, coming in at any hour of the day or night, then effectively you are left to your own devices."

How we care for our vulnerable elderly relatives and the quality of care services continues to be a cause for concern...