Letter to Gillian Baranski, Chief Inspector, Care Inspectorate Wales 

Dear Gillian,

Re: Protecting Care Home Residents 

I am writing to you as the Director of the Royal College of Nursing in Wales regarding your function to provide assurance on the quality and safety of care homes for older people in Wales during the outbreak of COVID-19 virus.

Our members providing nursing service in care homes in Wales are deeply concerned and alarmed by the impact of the COVID-19 virus on the quality, safety and provision of care. Many care home residents are over the age of 75 and have chronic and complex needs, these individuals are vulnerable and require shielding through additional measures.

In order to protect residents, and nursing staff in care homes, there should be access to and the use of correct Personal Protective Equipment (PPE). 

Care home staff should also be able to promptly access testing facilities. This will allow for the timely identification of potential cases and reduce the negative impact of staff absences on the care provided. I can see from your website that you require all confirmed and suspected cases of both staff and residents to be notified to you. I am therefore inquiring as to whether testing of COVID-19 infection has begun on care home residents?

Care home residents should be tested in their home, to identify potential cases and limit the spread. It would not be appropriate to move vulnerable patients often with a chronic condition and suspected COVID-19 symptoms into a hospital setting for testing. Regulation 38 of the Care Homes (Wales) Regulations 2002 places a duty on registered persons to notify Care and Social Services Inspectorate Wales without delay if there is an occurrence of the following; ‘a death of any service user and the circumstance of their death and any outbreak in a care home of any infectious diseases’. I would be grateful if you could share this information with the Royal College of Nursing.

Your website states that you are not undertaking routine inspections at the moment. While this is an understandable and sensible decision in the circumstances of the social isolation guidance, I am concerned by the statement “when the pandemic is over and we resume inspections, we will not be considering retrospectively actions taken in the best interests of people who use services. We would only take action where we identify wilful neglect or deliberate harm.” I would welcome clarification of the thinking behind this statement and how it will be applied in practice.

There are actions from Welsh Government, local authorities, health boards, care home owners and care home staff that are being taken and will be taken to mitigate the negative impact of COVID-19. There will also be actions that are sadly not being taken which could potentially constitute ‘wilful neglect and deliberate harm”. How is this being identified in the absence of inspections and residents protected?

Most importantly, I ask that the Care Inspectorate Wales launches a review into the actions taken and not taken. A retrospective account will undoubtedly identify significant lessons for us all about best practice, best policy and avoidable harm. This seems to be a very appropriate exercise to be undertaken considering the remit of your organisation and your strategic ambition to be an “expert voice to influence and drive improvement”.

The safety of our members in the community is very important, and it is vital that our nursing staff feel safe to care for residents in a hygienic environment, having followed the appropriate guidance. This is also true for care home residents. Residents should feel safe and protected and comfortable in their home environment.

I would be grateful for a reply to this letter.

Yours sincerely,

Helen Whyley, RN, MA
Director, RCN Wales

cc: Vaughan Gething AM, Minister for Health and Social Services
Heléna Herklots CBE, Older People’s Commissioner for Wales
Angela Burns AM
Rhun ap Iorweth AM