How CQC is going to monitor closed cultures during COVID?
"When I was a patient in a closed culture on a psychiatric ward, I felt completely vulnerable. The staff had all the power and I felt that whatever I did or said I was completely powerless. Some of the senior staff were so arrogant that they controlled everything. I could tell that some of the more junior staff disagreed with what was happening, but even they didn’t feel able to speak up for the patients’ rights (and presumably for their own working environment too). Even when I did try to say that things weren’t safe, I was ignored. It felt like all my experiences, past education, training and work counted for nothing because I was the one who was mentally ill and they were the ‘professionals’. I may have been unwell, but I still knew that what was happening was wrong and was rejected when I tried to articulate this to the ‘powers’ in the organisation. This happened to me as someone who is articulate and confident to speak up. We now need to stand up for those people who are in similar situations but are unable to make their voices heard"
It is unfortunate that we idenitfy closed cultures only when it has caused irriversible damages. Such examples are abuse stories in Whorlton Hall and Midstaffordhire hospital.
Right culture in a care home
The biggest success factor for any care home is the 'culture'. In simple terms, culture means how your employees behave when not being watched. Behaviour is a combination of learned and taught actions which can be good or bad. You culture produces the "feel" of the care home. The "feel" can be good or bad. It is very subjective to the individual who is receiving the care. It is never perfect in any care home, but your employees should always be on a mission to make it perfect.
Closed culture happens when leaders act without integrity. It happens where there is no direct action taken in response to poor behaviours and ethical caring. Our organisational standards develop around what we accept or not notice. If you fail to take action against an employee who behaved in a bad way to one of your clients, tomorrow a person observing this would do the same without any fear of repercussions.
Effect of COVID in developing closed cultures
Due to the nature of the pandemic, all the non-essential visits inside any care home is stopped. This is a perfect breeding ground of developing poor behaviours. It gets worse when the clients are unable to speak up for themselves or there is a lack of supervision from the management.
How CQC is going to collect evidence
When there is a risk of closed culture is identified within your care home CQC can request the following:
CQC will request to speak to the clients using video call or by interviewing them onsite.
CQC will request a list of contact details for the family and friends.
CQC will analyse the pattern from safeguarding notifications, whistleblowing and other complaints.
CQC assess the leadership and other subjective "feel" of the home during ESF calls.
CQC will work with external agencies such as local authorities, CCG, NHS and Healthwatch to collect information.
It would be advisable to pick up the signs of closed culture as soon as possible to prevent any avoidable harm. Provider visits are the best opportunity to identify any poor culture within your care home.