BBC Documentary On Jonathan Aquino Shows Up Failings By Care Home & British Government Regulator
24 Apr 2012
Jailed carer Jonathan Aquino and entrance to the Ash Court care home at the center of the BBC documentary Panorama
The BBC documentary Panorama's expose of mistreatment of an elderly Alzheimers patient Maria Worroll by sociopath Jonathan Aquino, the Filipino carer/nurse jailed two weeks ago, has brought to public attention a catalog of failings of supervision and oversight.
With YouTube videos of the program and BBC IPlayer links for those in the UK
Rogue carer Aquino in action slapping 80 year old Maria Worroll
The Panorama program, "Undercover: Elderly Care", shown on BBC 1 Monday night (a link to see the program on I Player is below) showed shocking scenes of Aquino striking and slapping the 80 year old female patient. It also showed extremely poor care by 4 other carers, two Filipinas and two negros, all female.
The program also had as a consultant Paul Edwards, an expert in dementia care from Bradford University, who gave his views on the level of care (details published in full below).
The program and conviction of Aquino in London's Blackriars Crown Court, where he was sentenced to 18 months imprisonment, was only as a result of Maria's daughter, Jane Worroll, secretly installing a covert video camera in her mother's room at the Ash Court Care Home in north London.
The two and a half hours of footage led to the police investigation, the documentary and a denial of responsibility by both the care home operator, Forest Healthcare and the government regulator of care homes, the Care Quality Commission (CQC).
Jane Worroll moved her mother to another home immediately.
Left to right - presenter Fiona Phillips, Maria Worroll and her daughter Jane happier now at the new nursing home
The Director of External Affairs at the UK's Alzheimers Society is particularly scathing on this matter, stating:
"Despite the tremendous work done by a large number of care providers and care staff there still far too many examples of poor practice. It is time for a root and branch reform of how we provide care in this country".
His full personal statement as well as that of the official Alzheimers Society statement are reproduced in below.
The program presenter, BBC journalist Fiona Phillips, had an additional insight in that her mother also suffered from Alzheimers.
The covert camera was hidden in an alarm clock, and two sessions of filming were recorded. This covert camera was motion activated. The first was not really a success because of the positioning; it was the second that brought to Jane Worroll's attention the assault by basketball player Aquino as well as the uncaring attitude and attention shown by the other four female carers.
Detective Sergeant Trevor Plumb (above) stated in the program that Aquino did not seem to be aware of what he had done when he was being interviewed.
Sgt Plumb also stated that friends and colleagues of Aquino could offer no explanation for his actions, most relating that the Aquino on the footage was not the Aquino they knew. This gives rise to an indication of either a dual personality or that of a sociopath.
Worrall immediately approached the care home, but as was seen in the documentary, was not really satisfied with their response.
The care home in question, Ash Court Care Centre owned by Forest Heathlcare, in London's Kentish Town, eventually suspended all 5 carers who were filmed. Aquino was later dismissed when he was arrested and charged by the police over the assault.
However, in relation to the other 4 female carers there now comes some confusion. Jane Worroll said that they were reinstated after undergoing four days of "training".
Four and half months after Ash Court were informed of the film's existence, the chief executive of Forest Healthcare wrote to Jane Worroll and requested a look at the recording. It was then the four were also dismissed.
Letters from Forest have consistently downplayed the incidents.
Forest Healthcare in a statement (reproduced below) state that the four were never re-employed between their suspension and dismissal.
Forest Healthcare have never taken any responsibility for their lack of supervision or for allowing procedures on patient care or handling to be flouted. Their press office stated that that Aquino's being allowed to bathe Maria Worroll alone (totally against guidelines and Jane Worroll's expressed instructions to Ash Court) was an "isolated lapse".
Other procedures such as putting patients to bed at 5.30 in the afternoon appear to be standard, as is waking patients up at 6.30am and not giving refreshments until 2 hours later. This does not equate with the timetable shown on Ash Court's advertising on their website.
Patient handling was shown to be grossly at fault in the film, Forest's weak statements do not address these failings.
Ash Court state in their promotional blurb that the CQC gave it a 3 star excellent review after the inspections.
The CQC have been extremely lacking any kind of credibility in their response to the Aquino/Ash Court failings.
The CQC blandly stated (statement published in full below) that they had interviewed staff and residents in the wake of Jane Worroll's film and found nothing wrong; as Maria Worrall suffered with dementia and had been unable to communicate to her daughter, other residents similarly afflicted would have been in the same situation.
The treatment, or lack of it, that Maria Worroll sustained was able to happen because she was not in full control of her mind. It is fairly obvious that if any residents who were just elderly and were able to tell relatives if they had been treated badly had endured what happened to her, these failings would have become apparent earlier.
The CQC also have a weak answer as to why they actually delayed a proper inspection, trying to pass that responsibility to the police and the local authority (Camden Council).
Intriguingly, the CQC state that Ash Court has "improved". As the CQC had previously graded it as 3 star Excellent, it does not explain how it is able to improve on excellence.
What also became apparent in the pieces of filming that were shown in the documentary was that staff there are not happy. The two Filipinas can be seen discussing some undisclosed problems within the care home, and the two negros are seen discussing their very low wages of £6.50 per hour.
The CQC and Forest Healthcare declined requests for an interview.
The abuse took place at a home passed as 'excellent' by the national regulator, the Care Quality Commission, and has led to one of the care workers, Jonathan Aquino, being sentenced last week to 18 months imprisonment for assault. Another four care workers at the home have now been sacked.
Paul Edwards said: "Cases like these are thankfully not frequent but we still have a society and staff in care homes who don't treat people with dementia as human beings. We have safeguards and checks in place, but we don't routinely look at the experience of people with dementia moment by moment and use that knowledge to make judgements about quality of care."
Following the abuse, the Care Quality Commission (CQC) is being criticised for failing to take appropriate action against the care home. The Relatives & Residents Association, a small national charity which helps families and friends of those in care, say that a report produced by the CQC four months after the incident does not warn the public about the abuse that took place at Ash Court at Kentish Town, north London.
Judy Downey, head of the charity says: "It doesn't say that a member of staff has been charged. It is not an honest document, it isn't a helpful document and it isn't a decent document. This is an area where the CQC can do so much if it uses its powers. They can actually cancel the provider's registration if they're shown not to be fit. We would suggest that the provider was very clearly shown not to be fit."
In Panorama Undercover: Elderly Care tonight at 8.30pm on BBC One, Fiona Phillips, whose mother died in a care home, investigates whether the regulator and care home provider did enough to prevent the abuse that took place and asks whether the system of elderly care itself can be trusted.
Maria Worroll was diagnosed with Alzheimer's in 2008 and had been living with her daughter Jane and her family until her condition became so bad that she required round the clock care. In March 2010, on the advice of Maria's hospital and social services, Jane Worroll began to search for a suitable care home for her mother.
Following visits to numerous homes in North London, Jane settled on Ash Court Care Centre. She made the decision after reading a report by the Care Quality Commission which gave the home an ‘excellent' rating. Jane's mother moved into Ash Court in July 2010.
Six weeks later Jane noticed that her mother had bruising on her hands and arms. She raised her concerns with the staff at Ash Court but was told her mother was bruising easily as a result of taking aspirin. However, Jane wasn't satisfied with the explanation and in the months that followed, she says there was a noticeable deterioration in her mum's condition.
In June 2011, she decided to place a secret camera in the bedroom to see for herself how her mother was being treated. On viewing the footage, Jane says she was horrified at the level of abuse her mother received at the hands of her carers.
She witnessed her mother being manhandled by carers, despite her severe arthritis, and put to bed at 5.30pm in the afternoon. On a number of occasions captured on film, Maria's carers would completely ignore her, never greeting her and sometimes only putting the television on when they entered the room and turning it off as they left.
Jane said: "I was horrified to see that was a day in the life of my mother."
Three days later, Jane filmed her mother for a second night hoping that the first night had been an unfortunate one-off. But the footage she captured revealed an even more shocking level of abuse.
Despite the home's policy that male carers shouldn't provide personal care for female residents - and Jane Worroll's strict instructions that her mother should only be cared for by female carers - the camera footage shows a lone male carer enter Maria's room to give her a night bath. He then proceeds to strike the elderly woman six times on the face, arms and abdomen.
"I screamed when I first saw it," says Jane. "She was just so vulnerable. She can't get up, she can't call for help, it's just totally sadistic."
Jane immediately drove to the care home to show the manager the footage. All five of the main carers Jane filmed were suspended and the male carer, 30 year old Jonathan Aquino, was arrested. He has now been sentenced to 18 months imprisonment for assault. Aquino qualified as a nurse in the Philippines and came to the UK after being hired by Ash Court.
A month after the assault, Peter J. Curtis, then Chief Executive of Forest Healthcare, which owns Ash Court, wrote to Jane Worroll to say that now was a "good opportunity to move forward positively" - even though Aquino had been arrested and the other four female carers were still employed by Ash Court and due to return to work.
Jane felt that the home wasn't taking action and went to The Relatives & Residents Association. Judy Downey, the head of the charity, said: "How could five workers not know that she had to be moved gently? You could hear the poor lady cry out in pain at the way she was being moved. That doesn't suggest a one-off problem, it suggests a deep cultural problem in that home where people were being treated with less respect than slabs of meat."
Five and a half months later, Forest Healthcare finally sacked the other four care workers. Panorama asked Forest Healthcare why this abuse was allowed to happen in the first place.
Forest Healthcare says the assault was an isolated incident, and that although their manager had seen the footage in June, they requested to see it a second time, "to complete the disciplinary process." The company says that immediately after viewing it again "we completed proceedings and all four were dismissed".
The company says Ash Court is "committed to working closely with all families and residents" and that they receive positive feedback on their care which is subject to "continual improvement."
The Care Quality Commission, the national regulator who had rated the home as 'excellent', produced a report three months after Jane filmed her mother being abused which concluded: "Ash Court ensures that people who use the service are protected from abuse, or the risk of abuse, and their rights are respected and upheld."
Jane Worroll is angry that the report doesn't warn the public more explicitly that abuse has taken place at the care home - saying instead the local council and police had been informed of "safeguarding concerns" - and that staff were suspended, an investigation was ongoing and that an action plan was in place.
"When I read it, it was another slap around the face. It makes me worry for other people who are potentially about to put a relative into a care home."
The Care Quality Commission says that it inspected the home within four days of learning what had happened to Maria Worroll but "did not find any new evidence of poor practice or abuse". It says: "If we had done so we would have taken action."
The CQC says that inspectors recently returned to the home again unannounced and found "improvements". It told Panorama: "CQC is confident it has acted swiftly and correctly in light of the evidence it has available."
Maria Worroll is now in a different home where she is happier but Ash Court remains open.
A spokesperson for Ash Court/Forest Healthcare said:
"We are pleased justice has been done in the case of the male former carer and that the prompt actions taken by the home have been validated by the Court's decision. This matter caused great distress to residents and staff alike. We apologised both verbally and in writing to the family as soon as the incident came to light.
This was an isolated incident, as demonstrated by thorough investigations by the police, London Borough of Camden and the Care Quality Commission alike, and it is an important reminder that an individual who has been provided with all the appropriate training may still commit a criminal act even in the most professionally run and highly regulated environment."
When the male carer was arrested the four female carers were also immediately suspended. We made several requests to the family to view the footage in order to complete the disciplinary process, which they agreed to in November 2011. Immediately subsequent to that we completed proceedings and all four were dismissed. From the time the allegations were made until their dismissal these individuals did not work again for the company.
The wider staff team at Ash Court have provided many years of excellent care and were shocked by the truly unacceptable behaviour of these individuals. It is important to note that every member of staff at Ash Court receives comprehensive training, including Moving and Handling and Communications training and this was also the case for the individuals identified in the footage, which makes their actions doubly distressing. It is also important to note that the family had not raised concerns with the home manager prior to showing her the video footage on 22nd June 2011.
Ash Court is committed to working closely with all families and residents and we continue to receive positive support and feedback on the quality of care we provide, which is subject to a process of continual improvement.
We remain grateful for the vigilance of our dedicated staff and the professional scrutiny from the Care Quality Commission and London Borough of Camden."
CQC statement on the Panorama documentary
23 April 2012
"CQC carries out an unannounced inspection of every care and nursing home in England every year - more often if we believe people may be at risk. This system of regulation can and does identify poor care which CQC then takes action to tackle.
However, what it cannot do is to identify and stamp out deliberately concealed abuse. By its very nature, concealed abuse takes place away from the eyes of managers and inspectors and can even take place, as in this case, in a well run care home. Abuse of vulnerable people is a criminal matter, and is rightly handled by the police and the courts.
CQC has taken action against a number of providers where a current risk to people has been identified. In this case, the risk had been dealt with by the removal of the care staff involved by the home. CQC's role was to make sure residents were protected once police and social services had acted to deal with the abuse shown in the hidden camera footage. CQC acted quickly and appropriately in this regard.
It is the responsibility of the people who run and work in care homes to make sure they meet essential standards of care and to deliver good, safe care. CQC's role is to check this through unannounced inspections and take action where we see poor care. Care staff, homes, councils, police and other stakeholders all have a part to play in the prevention of elder abuse. CQC also relies heavily on information from people who receive care and their families and friends. Anyone who sees evidence of abuse should call our whistleblower hotline.
None of this detracts in any way from the appalling experience Maria Worroll had at this home. CQC welcomes the custodial sentence handed down to Jonathan Aquino. His behaviour was criminal abuse, and as such has rightly been handled robustly by the police and the courts. The sentence sends a strong message that it is unacceptable to abuse an elderly person in your care. We hope it will act as a powerful deterrent to others."
Notes to editors
The report on Ash Court Care Centre published on the CQC's website in October 2011 details the findings of two unannounced inspections (in June 2011 and August 2011) which took place following information received by CQC from Camden Council about the incident involving Maria Worroll.
The first unannounced inspection took place within four days of the CQC receiving information about this incident. On the day the information was received, CQC contacted the social services department at the council and was told that one member of staff had already been arrested and four suspended. CQC was advised that the police and a team of social workers were already in the home, so we held back our inspection by several days in order to allow the criminal incident to be investigated.
During this first inspection, CQC spoke to more than 30 people - residents of the home and their families and friends - about the care they received. Two inspectors spent more than six hours in the home talking to people, observing care taking place, and checking records. CQC inspectors chose not to speak to Jane Worroll as they did not want to risk any interference with the ongoing police investigation.
Feedback given by people at the home was positive, with no residents or their families raising any concerns. Inspectors were satisfied that, based on the evidence they heard and saw, the risk to people's safety had been dealt with by the immediate removal from the home of the staff concerned. CQC did not find any new evidence of poor practice or abuse that indicated a current risk to people living at the home. If we had done so, CQC would have taken action to protect people - as has happened in many other cases.
No other agency, nor any resident, family member or carer at Ash Court has provided us with any evidence of abuse or poor care that has not been dealt with through this criminal prosecution or through the suspension and dismissal of the other four staff. As a result, CQC is confident it has acted swiftly and correctly in light of the evidence it has available.
CQC does not have a legal remit to investigate individual complaints, but if we receive information of concern, we may carry out an unannounced inspection - as we did in this case. Our inspection report includes considerable detail about the safeguarding alert, explaining that our inspection took place as a result, and also references the involvement of the police. The fact that a serious incident has taken place at the home is made very clear.
However, our inspection reports do not as a matter of course name individuals or make these individuals identifiable.
CQC did require that the home made minor improvements with regard to training and formal supervision of staff. The home provided an action plan detailing how these improvements would be made. We recently returned to the home, again unannounced, to check the improvements had been made and found that they had. CQC will continue to monitor Ash Court Care Centre closely to make sure that it continues to meet the essential standards for care and safety - and will take action if it does not.
Charity demands action on broken care exposed by Panorama
Alzheimer's Society has today (Monday, 23 April 2012) set out five areas that require urgent reform to end abuse in care homes. The call comes ahead of shocking footage to be shown on BBC's Panorama tonight, which shows serious abuse of a vulnerable person with dementia at a care home previously rated excellent by the CQC.
Andrew Chidgey, Director of External Affairs at Alzheimer's Society said:
‘The case of abuse that happened at Ash Court Care Centre is a disgrace and must never be allowed to happen again. It is absolutely right that the person at the centre of the abuse has been sent to jail. Despite the tremendous work by a large number of care providers and care staff there are still far too many examples of poor practice. It is time for a root and branch reform of how we provide care in this country.'
‘Today we are issuing a call for immediate reform. The new dementia champion group on health and care formed last month must work quickly to stamp out abuse.'
The action that is being demanded by the charity is:
1. The government must respond to the care funding crisis 2. All care homes should sign up to the Prime Minister's Dementia Challenge 3. Local authorities must set stronger requirements for dementia training and quality 4. The Care Quality Commission should re-introduce public ratings for homes and enforce greater transparency of performance 5. The government should investigate strengthening the role of lay inspectors
Andrew Chidgey continued:
‘People with dementia, their carers and families deserve the best care possible. It's a tragedy that the news today will have made it harder for people with dementia and carers to consider care as a good option when in many cases it can be a positive experience.'
Personal statement by Andrew Chidgey of the Alzheimers Society
The case of abuse of a woman with Alzheimer's featured on last night's Panorama programme was truly abhorrent. Despite great work by a large number of care homes we are hearing about the abuse of people with dementia in care all too often. The problem lies not just with a few bad carers or a mistake by the regulator but systematic problems. Our care system in the UK is broken and underfunded. The only way to fix it is to introduce urgent reform.
Alzheimer's Society is calling for specific areas of action:
A serious government response to care funding crisis
The government must respond to the care funding crisis. We know what there is currently not enough money in the system but the answer is to invest now and not cut corners. Many care home staff are poorly paid and have little or no training. We can only attract the best staff if we improve their career opportunities. If this doesn't happen we are bound to continue to hear about examples of poor practice.
Dementia training and quality
All care home staff need to be trained in how to provide good quality dementia care. It can make all the difference. We regularly hear from people who say that their loved ones were not helped to eat or drink and subsequently became malnourished and dehydrated. This meant their dementia and general health worsened. Local authorities must set stronger requirements for dementia training to ensure that care homes tackle this problem.
Public ratings and lay inspectors
The current system of regulation is not working. We need the general public to be able to see which are the best care homes in their area. We need a more comprehensive scoring system, such as star ratings, to be reintroduced by the Care Quality Commission. Only then can carers be assured that their loved ones are getting the care they deserve. Lay inspectors could also have a role to play and we would encourage the government to look at this option.
Prime Minister's Dementia Challenge
Last month, David Cameron issued the first ever Prime Ministerial challenge on dementia. As part of this challenge, Alzheimer's Society is calling on all care homes to sign up and pledge to improve the quality of dementia care in their homes.
People with dementia, their carers and families deserve the best care possible. It's a tragedy that this story may put people off moving their loved one into care when it can be a positive experience. We just need to make sure that this becomes the norm rather than an exception to the rule.
Andrew Chidgey Director of External Affairs Alzheimer's Society
"The Panorama program, "Undercover: Elderly Care", shown on BBC 1 Monday night (a link to see the program on I Player is below) showed shocking scenes of Aquino striking and slapping the 80 year old female patient. It also showed extremely poor care by 4 other carers, two Filipinas and two Negros , all female."
With all the sensibilities surrounding the use of the word "Negro", why is it that Balita Pinoy still chose to use the word to describe 2 African-descended nurses? I would have thought Balita Pinoy knew more than that.