M J and C K Stent v Bedfordshire County Council

M J and C K STENT – Appellants and Bedfordshire County Council – Respondent Decision of the Tribunal sitting at Bedford on 20, 21 and 22 July 1987. Before:J C R Fieldsend, ChairmanMr R ColemanMiss M G Joynson Appeal against the decision of the Respondent to cancel the registration of the appellants in respect of the residential care home at Park House, 28 St Andrew's Road, Bedford. For the appellants:Mrs C K Stent For the Respondents:J Posnansky, of Counsel instructed by the County Solicitor. DECISION The Tribunal unanimously dismissed the appeal and confirms the decision of the respondent. REASONS Park House was first registered as a residential care home for the elderly under the old legislation in January 1984 with a Mr Ferretti as the registered proprietor. The registration was for 14 residents in one triple room, 4 double rooms and 3 single rooms. There was a shower on the ground floor for the 5 residents who could be accommodated in the 3 downstairs rooms, and 2 toilets. On the first floor there was a bathroom with a toilet in it, the room also housing the washing machine, and one separate toilet. No point has been made by the respondent in this appeal of the adequacy of the accommodation for 14 residents or of the adequacy of the bathing facilities or of the toilets. Under the new legislation and particularly under the guidelines in Home Life it may be that these points could arise, but we are not concerned with them in this appeal as the respondent has made no point of them. In May 1985 Mr and Mrs Stent bought the business from Mr Ferretti for £29,000 and agreed to lease the property for 3 years at a rent of £10,000 a year, payable quarterly in advance. The purchase price was met by a down payment of £7,000 and the balance by a mortgage repayable at £614 a month over 5 years. Mr Stent is an S.R.N. and Mrs Stent an S.E.N. They are both in their early thirty's and they have 3 young children including one born in September 1986. Their object was to establish a business where they could have their home and so not have to leave the children during their work. Mrs Stent feels that she has a bent towards working with old people, which she enjoyed. Mr Stent was to be the registered owner of the home and Mrs Stent the manager, as he was going to keep on his employment as an industrial nurse at Vauxhall's until the business of the home was properly established. On 1 May Miss Shant, the respondent's registration and inspection officer visited the Stents at Park House. Her initial impression was favourable and reports from the Fire and Health departments were favourable. The Stents made their formal application on 23 July 1985 and by October satisfactory references had been taken up. Following a formal inspection on 10 February 1986 by the Director of Nursing Services and the District Pharmaceutical Officer a registration certificate was signed on behalf of the Authority on 19 February 1986. This was not given to the Stents until 28 November 1986, the same day on which they were given formal notice that the Authority would consider a proposal, for the cancellation of registration. This was stated to be: a. for reasons connected with the state of repair, accommodation, staffing and equipment not being fit, for the purpose, and b. because the way in which it was intended to carry on the home was not such as to provide services or facilities reasonably required. The reasons for this delay was that some complaints had reached Miss Shant in about July 1985 which resulted in a number of inspections of the premises. No reliance was placed on the complaints themselves in the de-registration proceedings and none of them was canvassed before the tribunal. It is not proposed to go in detail through the various inspections and what was found on each occasion, but rather to consider what substance there is in the various categories of criticisms outlined by Mr Posnansky in his opening of the case for the respondent, though not in the order in which he gave them to us. DRUG PRECAUTIONS The initial inspection of 10 February 1985 revealed an inadequate system of storing and recording the administration of drugs. This had been taken over from the previous owner and in part complied with the requirements of earlier legislation. A follow-up visit on 15 April to provide assistance and guidance revealed that although there had been some improvement, standards were still not adequate. Advice was given and has apparently been heeded and followed. There may be occasional lapses, such as leaving the day's drugs in separate containers for the residents on a shelf in the office section of the hall, but, though undesirable, these occasional lapses would not be a ground for drastic action. SAFETY HAZARDS Fire Officers' inspections revealed an unsatisfactory situation concerning the washing, ironing and storage of laundry on the first floor. But these shortcomings had existed under, and had not proved fatal to the registration of, the previous owner. That they are not satisfactory we accept and they need to be attended to, but they are matters which could be met by imposing a condition on the registration. Mrs Stent was at fault in not having attended to the defective closing of the fire door at the top of the stairs, in not keeping a proper record of weekly testing of the alarm system and in failing to renew the extinguisher in the kitchen. We think also that despite advice the staff were allowed to wedge open fire doors between the lounge and the hall and the hall and dining room during the day when they should have been kept closed. Other hazards such as loose carpet tiles, toys left in the hall or passageway and the like are part of the other aspect of cleanliness and tidiness. LACK OF CLEANLINESS AND TIDNESS We accept that on a number of occasions the respondent's officers found the home to be shabby and unkempt and unacceptably dirty though it was accepted that there had been improvement in these respects. Certainly on our visit to the Home – of which there was overnight notice – we did not find such signs. The dining room was not an attractively furnished or appointed room, but otherwise the home appeared to be cared for reasonably well. It is apparent that a house of this size and age needs considerable daily care to keep it in good condition as well as constant maintenance and re-decoration. This is particularly so when it is used as a home for elderly people who cannot do much for themselves and who suffer in many instances from varying degrees of infirmity and incontinence. There is no dispute that during their time the Stents have done a considerable amount of re-decorating and re-carpeting in the public rooms and a number of the bedrooms. They have renewed the kitchen floor following a recommendation of the health authority and installed or repaired items such as a cooker, a dishwasher, water boilers and radiators. None the less we are satisfied on the evidence as a whole that there have been occasions when there have been unacceptable shortcomings in the cleanliness and tidiness. The reasons for this we deal with later. STAFFING AND SUPERVISION Only two of the Stents' staff gave evidence before us. Both appeared to be competent and caring persons, though one had limited experience. We think that so far as cleaning is concerned this was beyond the single person employed to do both this and the washing in conditions that were by no means ideal. There was little evidence led about the competence of the staff, save that two undesirable assistants were employed which could probably have been avoided if Mrs Stent had, as advised she should do, consulted the registration authority about them. It was clear, however, from Mrs Stent's evidence that their financial and cash flow problems resulted in an absolute minimum of staff being employed. Mrs Stent's personal situation with two young children to care for at first and a third child being born in September 1986 resulted in a lack of sufficient supervision of the staff from time to time. This explains too the untidiness noted by the authority's officers and such things as a child's cycle being left in a downstairs passageway. LACK OF ATTENTION TO RESIDENTS We were told of two serious instances of lack of attention to residents, the one related to an elderly woman, the other to a severely handicapped man. Without going into the facts in detail we can say that we are satisfied that the care given to the man did deteriorate from about June 1986 and that there was justification for his relatives' criticism. This was during the later stages of Mrs Stent's pregnancy and was undoubtedly due to lack of supervision. So far as the woman is concerned the complaints were not so serious. They related more to general standards of cleanliness, and to such things as the residents spectacles being mislaid. The condition of this resident was deteriorating due to the ageing process and this may in part have distressed her relative and friend. As against this evidence we heard from the nephew of another resident who was incontinent and had a colostomy bag how satisfied he was with her treatment. He was a straightforward and impressive witness whose evidence was entirely acceptable. It is also noteworthy that on at least two of the formal inspections it was specifically noted that the residents appeared to be clean and well cared for, happy and relaxed and that there was a good rapport between them and Mrs Stent. CONCLUSIONS The decision has been a difficult one, made more complex by the fact that the Stents are actively trying to sell the business with the intention of moving elsewhere and starting a very much smaller home. They are naturally concerned that an adverse decision in this case will prejudice their plans. Having seen and heard Mrs Stent over three days, conducting her own case and giving evidence, we are satisfied that she is a caring person of ability who genuinely has the welfare of her residents at heart. The separate heads of complaint taken individually would not in our view be sufficient grounds for de-registering the home. But taken together with the additional feature that we think that the Stents were too ambitious, particularly in the light of their own family responsibilities, in embarking upon a project of this magnitude, we think on balance that we cannot allow the appeal. There are still aspects of the home which require improvement which will involve capital expense, such as the provision of proper laundry facilities, a situation inherited from the previous owners. These will be matters for a new owner and it would not be right for us to impose such conditions on the Stents. Finally we must stress that this has not been a case where it has been alleged that the Stents or either of them are not fit persons to run a residential home. The fact that their appeal has by a narrow margin had to be dismissed flows from the circumstances we have already noted that they took on too great a financial burden, and too large a home as a first venture, particularly in the light of their family circumstances. There were, too, features of the home which though previously accepted under the earlier registration needed under the new Act to be rectified. An added difficulty was that they were not allowed pending registration, notified to them only in November 1986 to take a full complement of residents to make the enterprise viable. Signed J C R FIELDSEND, ChairmanR COLEMANM G JOYNSON