Care industry regulator the Care Quality Commission (CQC) has revealed it is seriously concerned about 4 services for people with learning disabilities run by Castlebeck, and that a further 7 do not fully comply with essential standards of quality and safety.

The CQC has called for the company to make "root and branch" improvements to its services and processes. This announcement came as the CQC released its findings from its review of all Castlebeck's 24 services. This review was launched in the wake of a BBC Panorama documentary that uncovered alleged abuse at the company's Winterbourne View residential hospital in Bristol.

This facility has since been closed. The services with most serious concerns are: Arden Vale in Meriden, Solihull; Cedar Vale in Nottingham; Croxton Lodge in Melton Mowbray and Rose Villa in Bristol. In these cases the CQC is taking enforcement action, but cannot reveal any more details for legal reasons. However, the CQC's chief executive, Cynthia Bower, stressed that the problems found were not on the same level as those discovered at Winterbourne View. The remaining 12 Castlebeck services were found to be compliant with the essential standards that were reviewed.

The unannounced inspections focused on safeguarding the care and welfare of the people who use the services. Where inspectors identified concerns, measures were put in place to address the problems and to ensure the safety of people using services. Where the CQC had any immediate concerns for people's safety action was taken to safeguard those people. Examples of the poor practice inspectors saw included:

  • Locking bedroom and other doors within the hospitals without explanation
  • Patients staying in rehabilitation services for long periods
  • In some services staffing levels dictated the activities that could be offered, so that for some only group activities could take place rather than activities based on an individual's assessed needs.

As well as findings failures in individual services, the CQC looked across those services to identify company-wide themes. These include:

  • Lack of training for staff
  • Inadequate staffing levels
  • Poor care planning
  • Failure to notify relevant authorities of safeguarding incidents
  • Failure to involve people in decisions about their own care.

The CQC has discussed these failings with Castlebeck and is taking action to address these problems. "Our inspections have found a range of problems, many of which are found in a number of different services," said Ms Bower. "This clearly suggests that there are problems that Castlebeck needs to address at a corporate level - the company needs to make root and branch improvements to its services and processes. "Where necessary, we have demanded improvements. Where we have had immediate concerns about people's safety we have taken action. In the case of Winterbourne View we took action which led to its closure. "Although our reports set out what Castlebeck and individual services need to do, there is a lesson here for all professionals who have contact with these services and those who commission care from them. You have a clear responsibility to stay alert for the signs of problems; take action if you can, and tell us if you have doubts about the safety and quality of care."

Ms Bower added that there will be a major review of learning disability services, and that the regulator will carry out 150 unannounced inspections of services.

In response, Castlebeck's chief executive Lee Reed again apologised for the failings at Winterbourne View and at other services. Reed added that the company-wide concerns the CQC highlighted had been identified as issues in need of addressing when he took over as chief executive in January 2011, since when they have been the subject of internal reviews and recommendations.  "Action has been taken as a result that will bring about positive change for all the people in our care," he said.  "Every other CQC concern that has been identified will be vigorously addressed, as we take all the steps necessary to re-establish confidence in our service. We believe that the issues identified can best be addressed by all stakeholders working together. A solution that comes through cooperation will also minimise disruption for the people in our care. "The safety and well-being of people in our care will always be of paramount importance to us and we will have a zero tolerance policy towards inappropriate behaviour directed against those who use our services."  

Alison Giraud-Saunders, co-director of the Foundation for People with Learning Disabilities, said the report provides lessons for all providers, but also raises questions of the NHS and local authorities that commission services. "The CQC report highlights a number of significant problems," she said. "A real lack of personalised care plans and risk management plans across the services is very troubling; these are fundamental tools to ensure that every individual with learning disabilities is being supported and treated properly. "Also evident in the report is a lack of consistent leadership from service managers. Many staff are said to be receiving poor supervision and the training offered is not matched with the needs of the people with learning disabilities that they are supporting. We know that good first-line management is critical to the quality of service delivery and the managerial deficiencies emerging from the report must pose a significant risk to the people in their care. " These are vital lessons for all providers of hospital and residential care services - it is important to note that these problems may not be restricted purely to Castlebeck services - and we need not wait for CQC's forthcoming inspection of other providers to act on them. "The report also raises serious questions for those in the NHS and local authorities who commission services. Why was there a lack of personalised plans when it is the responsibility of the NHS and local authorities to ensure that they understand and are acting on the needs of the people with learning disabilities living in their area and securing competent services to meet those needs?"