/ Health, Home & Energy

Is the care home sector working well?

elderly care

The Competition and Markets Authority is undertaking a thorough review of the care home sector to make sure it works in the best interests of those who rely on it, as Douglas Cooper of the CMA explains.

We launched our market study in December last year to look at issues affecting the 430,000 older people in care and nursing homes across the UK.

As part of this study, we’re looking at a range of issues including:

  • How people find the experience of choosing a care home
  • How care homes compete to attract residents
  • How well care homes are complying with their obligations under consumer law
  • Whether the current regulation and complaints systems give residents adequate protection

We want to be sure that the care homes sector is working well for residents and their families.

Home to care home

Care homes can provide a safe, warm and caring environment for older people to be looked after when they’re no longer able to cope at home.

But choosing a care home is a big decision, which often needs to be taken in stressful or upsetting circumstances, and can have a huge financial impact on families.

In particular, we want to know that residents and their families can get the information they need, when they need it, that they understand any contracts they sign once a home is chosen, and that they are treated fairly by the home during the time they need it.

We’re also looking very closely at reports of potentially unfair practices and contract terms being used by some care homes.

We will assess how widespread these concerns are, how they’re affecting residents, and whether they are likely to breach consumer law.

Playing fair

We’re now a few months into our study and have already received a wealth of useful information and well-informed opinions.

We’ve heard from consumer groups and charities about various concerns around potentially unfair practices and contract terms being used by some care homes, including:

  • Hidden charges where residents face additional fees for services they didn’t know weren’t covered within the weekly fees. Examples might include charges for accompanying residents to medical appointments or entertainment.
  • Fees being increased at very short notice and without clear explanation.
  • Care home residents being charged large deposits/upfront payments without being clear what these cover.
  • Unreasonably long notice periods to leave the home.
  • Residents in receipt of local authority funding being asked directly for top-up payments for additional services by the care home, but it may not always be clear what they are being charged for.

We’re also looking at complaints and redress systems to assess whether these work effectively for residents and their families or if they are difficult to use and deter people from complaining, for example through fear of retaliation against them.

We’re taking a detailed look into how common these practices are.

We haven’t yet formed any view about whether they break any consumer law or other regulations.

But if we do find there are problems, we can take action, including launching enforcement cases or making recommendations for changes in the rules that protect residents and their families.

Help needed

We want to gather further information and that’s why we welcome the launch of the Which? care home reporting tool, where your comments will be treated confidentially.

We want to hear about the experiences of residents and their families who feel they may have been treated unfairly by a care home.

This will feed into our study and help inform our conclusions when we publish our final report by the end of the year. We’ll also be ready to publish our interim report in May this year.

This is a guest contribution by Douglas Cooper of the CMA. All views expressed here are the CMA’s and not necessarily those shared by Which?.

What’s your experience of the care home sector? Have you or an older relative/friend ever been treated unfairly by a care home’s practice, contract or complaints procedure? Or, if you’ve ever worked in the sector, what sort of problems did you encounter?

If you’d like to share sensitive personal experiences in the comments below, please choose to do so using an alias, and omit anything identifiable.

Alan Smith says:
31 March 2017

In my opinion and observations . Care homes are only making vasts amount of money for very little care , I had arranged to take a person out , I had given plenty of notice and asked to have this person ready and shoes on due to an appointment time , I also phoned 30 mins before my arrival time , when I got there the person was waiting to be dressed and no shoes on , his medication had not been given , When I spoke with the manager she phoned my company to complain , Managers feel they are a power on themselves and staff are often scared to speak openly . This person told me that the staff was rude , refused a cup of tea and given a glass of water . Lunch consisted or soup and toast for breakfast with cerials and evening meals was mince .
People in care homes are often verbally abused if they ask for help and assistance . but always very nice to visitors and family , Personally I would rather die before I go into a care home ,

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care home, i am not sure what this means to me, it looks very much like wear housing’ pack um high sell um cheep, CQC again expensive organisation but a toothless tiger , politicisation just did not get it for many years , sold the dream to the electorate, cradle to grave we will be there, ?? now its time to pay the piper . BIG QUESTION HOW ?? . some families like to visit members of there family in care home if this becomes to often care home do not like it heavens forbid should you complain your family member is convicted , yes this is a care home . what is needed an open discussion about shared support a good look at profit and see if it meets value , it is an ugly subject but needs to be thoroughly arid,
this is my observation based on just visiting

I worked in the NHS for 40 yrs and heard many horror stories from nurses who had worked in “care” homes. Your case is, sadly, typical of many of these homes, but the government is uncaring as well.
My sister and I care for our 101 yr old mother ourselves, and will never subject her to the abuse (physical and verbal) meted out in many of these homes. It costs a lot and retricts our freedom, but she cared for us when we were babies, and now the role is reversed – it’s our turn to care.
Naturally, if my mum was “cared for” by the local authority, it would cost far, far more than the laughable allowance paid for her care by her family. My sister and I have only our state pensions, and we just about manage. Meanwhile the owners of these places are raking in the takings.
My sister and I are childless and the future is bleak.

I have worked in Adult Social Care for over 35 years, over this time I have seen many very well run care home’s and met many very compassionate care staff, I have of course seen many poorly run home’s and met some dubious staff.
In my view there are some key issues that are very wrong with the care sector at this point in time.
* We have a growing population of older people and severe cuts to public spending
* Over the last 30 years the sector has gone from one mainly run by council’s and the voluntary (not for profit) sectors to one where care is either privately purchased or commissioned by councils from the independent for profit sector. This makes old and vulnerable people a commodity. Many of these companies very genuinely want to provide good quality care but many are run for the sole purpose of making a profit for their owners of share holders.
* Due to the above, the wages, terms and conditions of the workforce have been eroded, staff are working long hours, doing very demanding work, with minimal numbers of staff, often 2 or 3 staff having to care for 20 to 30 vulnerable people. Most care staff are on minimum wage.
* The knock on effect of all this is that the care sector now has such a poor reputation that who would want to work in it, when the pay is so bad and the work so undervalued.

Very good summary, Vexed.

I would agree with all that you say and add, that the independant ‘not for profit’ charities are positively encourage, for tax purposes, to become limited companies. And of course it was only a short step before the charity became ‘for profit’ organisation.

The question comes down to whether money is governoring us or if we are governing money. By that I mean, there is a moral and social question regarding how ‘we’ as a society is going to address this major issue of the numbers of elderly people. That is the social and moral situation. So we find the money to address that situation.

Or we can do what is usually the case, declare it’s going to cost too much money so ‘we’ as a society we do nothing.

I have a cousin who has been sectioned and lives in a ‘care’ home. Throughout her stay there, they have treated her appallingly. They are literally punishing her for being mentally disabled. They use methods which prison guards are not permitted to use on convicted murderers. Why is it that there are laws to protect murderers but no laws to protect residents in ‘care’ homes ? There should be at least the same protection. Whenever she complains, they order her to withdraw the complaint or else they will have her locked up in a mental hospital. The appalling food has caused her (and some of the other residents) to become diabetic – but they won’t provide a diabetic diet for them. They are continually robbing her – they help themselves to money from her account. For example – although she has a free bus pass covering herself and carer, the carer calls for a taxi and takes money from her account to pay for it. They have got all of them hooked onto nasty addictive drugs which mean they spend most of their time doped like zombies. They do experiments on the residents – e.g. give them a drug which makes them thirsty, refuse to allow them a drink and watch what they are driven to do by the thirst. Then punish them for doing it.

John Wigglesworth says:
1 April 2017

Last year over 250000 people lost their homes to provide care for their partners. It is licensed robbery!
It is also grossly unfair as only the middle class pay for this (Home owners) If you rent your property you get away free. I would advise anyone of buying a home if you have to go without many other things in life because when you get older you can never be certain you will not lose what you have strived and worked hard to pay for and your children will have nothing to gain when you die. Even now the Government have slapped death charges / Law charges to snatch away what you have strived for.
My wife has just died and we found out all the care workers are paid different sums and also different mileage charges in expenses> It is a license to make fortune. No wonder it is growing bigger.

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Part of the issue is the ‘paper chase’ which is suppose to give quality, in this case, care. The fact that you have ticked the boxes and written down what has been done, means these companies pass the relevant inspection. But it is very easy to fill out paper without any care being done.

So the care job is all to do with filling out the paperwork, and little to do with the care. My issue will be that if the government steps in, it will require yet more paperwork in a vain attempt to impose controls on the industry. And of course what does more paperwork mean? Less time for care …

My wife is principal carer for a close relative – this also has effect upon family life. The situations now commented upon are historical in the last say ten years, but still rankle with me. Care respite – local – elderly male. The smell in care home (1) was obnoxious. When later committed to care home (2) it was far superior however it did not seem able to cope with with a self imposed isolationism, accepting declining health as a contributing problem. Care respite 7 days; at a distance – elderly female. care home (3). no known problems. Care home (4) 7 days – very rich to the nostrils, On returning home found to have Florid Eczema – this had to be treated privately and took over two years to clear up. and every piece of clothing, including outer clothes had to be thoroughly cleaned from stale odor. Regrettably I was not allowed to report this and being out of area probably was not officially notified. Care home (5) local 7/10 days – following NHS treatment – cannot comment on physical care; taken as ok, however, the allocated room had seen far better dickensian days. The local authorities should never have consented to hire such a dreadful room. The last care home (6) under the auspices of the NHS – 7 days – a fairly recent built complex appeared to a high standard – probably ÂŁ600.00 plus fee.

I propose a new competition for local authority care home placement managers. First prize: a week in whichever home they have purchased the most placements at. Second prize: two weeks ditto. Third prize: dinner on four consecutive days in four different care homes. Fourth prize : a day in the lounge at any care home. Entry compulsory. All entrants get a clothes peg and shades.

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Mary says:
1 April 2017

I worked for 2 hrs per week in a number of different care homes for elderly. In general, most of the caring was reasonable and some was very good. However one of the things I was most disturbed about was seeing just how much staff time went into completing written reports, and records for official purposes like use for Care Comission Reports, Local Government Departments etc,as opposed to having this same amount of time be dedicated to better client care and in particular empowering the older people to do things to contribute to their own wellbeing and self worth as well as to the community of the home e.g., helping change a bed, grow a plant, help handing out biscuits. when Care Commision visits were due all sorts of things were done to prepare and even less time was available for clients, and it seems to me that some things would really make a difference to their role and make them really useful. 1) stop almost all the paperwork, 2) have visits be random and not planned, and 3) just send a couple of people in rather than a whole team, and the people coming could be rotated over time, and the ;4) the emphasis should be on supporting the homes to do better, so maybe the type of People chosen to be members should be considered with this role in mind.

chandra maharaj-ng says:
3 April 2017

You have made some very valid points, pressure is put on skeleton staff to do additional paperwork there is no recognition that something has to give and people suffer and are not given the opportunity to experience any decent standard of living ,no occupation,no stimulation,being taken out seldom probably never,the cheapest food.The lists go on often we see residents sitting aimlessly round a very loud television set
I used to work for a charity which dealt with issues around elder abuse and we often had to gather evidence regarding neglect,abuse physical,emotional,financial etc

And those residents sitting in that room with the overloud TV will no doubt be the ones who have been wheeled there.

Unfortunately (in a way) many residents choose to stay in their own rooms and this causes isolation. This has been exacerbated by everyone having their own TV! When the staff are minimal they may not have enough time to persuade residents to come to any activities that may have been organised. Volunteers playing music can be an absolute Godsend. Sing-songs are wonderful for those with problematic memory.

There is so much that should be done to make care homes better places. Relatives caring at home need respite. One of the reasons for this is that the elderly and ill can nap during the day so want to get up really early and go to bed really late whilst the caring relative can’t! This can mean that visiting carers whose remit is to wash, change and put to bed – ie something that can hopefully be delegated – arrive far too early as far as the cared-for is concerned and so the service is pretty much useless if a relative is around. We have found that care homes allowed a later bedtime than visiting carers but there were other drawbacks. Although the en suite shower rooms were available the staff weren’t for help with a shower. There were just not enough staff to get everyone washed other than a quick flannel wash and dressed and down to the dining room for breakfast all at the same time. Obvious when you think about it – but we felt guilty because we had been sold – and sold as part of the persuasion for a week’s respite the idea of being able to have a shower. Unfortunately it was just that – an idea. Things like this are very important.

My best friend died in a care home in Thamesmead 3 years ago . It was a dull anonymous room , not very comfortable & not enough staff especially at night .

Whilst later life care is an underrepresented need that society fails to cater for. why is this being looked at separate from the needs of any other group all themselves underrepresented.
No standards of daily living other than basic care or an at times all too patronising social activity people in care are easily forgotten cast aside but the truth is if you are in care aged anywhere between under say 30 or over 100 the issues are surely the same.
Are there enough staff trained and willing to have enough time to make each day a quality homely experience. Carers are the life blood of the person in care if they are expected to work like slaves for a pittance without the skills or time to actually care then we fail those who need care.

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Twelve years ago and following a heart attack, my mother lost all confidence and a once very independent 94 year old went into a care home. It was selected after visiting many in the local area. The reason being, it was close to family members so Mum could have daily visits, it was comfortable and the food was freshly cooked on a daily basis. We were promised that when she became afraid during the night she would be sat with and comforted. She wanted a shared room and got on well with the other lady. However, after being concerned by her low mood and withdrawal from the social activities, we discovered that when she called at night staff became annoyed with her and gave her medication in the form of strong sleeping tablets which she had never taken before. When I asked to see her medication which in the past I had always organised for her, I was appalled to see where it was kept. i.e.in an unlocked cupboard under the stairs. It was all muddled and the care worker was unable to tell me exactly what Mum should have been taking. This I believe was largely the reason for the change in her presentation. This resulted in her falling and we were horrified when we visited her after a second fall because her face was black and blue. We made an immediate decision to move her when there was no apology or indeed a satisfactory explanation as to her very severe bruising. She went to a lovely home, a convent run by nuns. They were so kind to her and she was much happier. They sat with her and did reminiscence work with her, took her into the garden, settled her at night without drugs and gave her lovely home cooked food of her choice. Sadly she was there for only two weeks and died just three months short of her 95th birthday. I would warn anybody thinking of entering a care home or arranging for a relative to go into one, to be very very careful. Speak to other residents before committing and if this is not allowed give the place a wide birth. My Mum was a very sociable person and easy to get on with but some of the staff were abrupt and impatient with her. I believe much of the above was due to lack of appropriate training and staff on low wages with little interest in the job they were doing.

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Celia says:
3 April 2017

I cared for my mum at home for 8 years and could write a journal about the fight for every penny that she received, from 23 page assessment forms whose boxes were valued per box. The form was clearly aimed at under 65 year olds and therefore very difficult for the right answers to be given if you were not under 65 and therefore impossible to obtain a fair montary outcome. .

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I only have experience with one home in Kent dealing exclusively with dementia patients. The problem I noticed more than anything was the lack of training of staff. The carers pay is basic, they have a hard job and need lots of patience, but because they are always short staffed, anyone appeared to be taken on. Apart from finances, the basic needs of the patients were ignored as they weren’t able to communicate. Clothes were boiled, shrunk and distributed between anyone, regardless of name tags on clothes. Their excuse was that because of incontinence everything needed to be boiled. Because of cost cuts, incontienence pads were kept in cupboards, not bathrooms. Therefore, patients were left uncomfortably on the toilet whilst the carers wandered off for 10 minutes to fetch a pad. Cleaning of bathrooms and shortage of staff at weekends when most families visited was glaring. The hopelessness of the patients was obvious especially when they were able to ‘grumble’ but do nothing. The managers changed practically every two months, usually keeping to their office and not managing the staff. The whole running of these homes depends on good management. When I queried anything at all I was continually lied to. When being able to prove my point, I was stared at in silence. Notes were not kept up to date. Medication notes unavailable if there was a query. We paid for care initially until funds ran out and social services financial help stepped in. My mother’s own bed disappeared leaving her with a terrible metal contraption. Bedding was basic and far too light, even though the home was heated well. Dressing was diabolical with shrunk, ill fitting jumpers or extremely tight waisted trousers which caused pain when sitting all day. My family spent hundreds on replacement clothes which usually disappeared, being told this was ‘soiled’, left somewhere by the patient, or never seen. I understand the difficulty in looking after dementia patients. It is devastating and hard work, but even though they cannot communicate properly, if spoken to clearly and quietly without shouting in their faces – which is very common – it is possible to know how they feel and it is this that makes one feel so guilty and helpless, having to leave them there because you work full time and unable to look after 24 hours a day. There were a few carers with insight, usually foreign ironically, who treated the patients with dignity and quietly helped them for which you could see the patient’s gratefulness. I despair at the treatment my mother received and still feel guilty two years after her death, which itself was traumatic for which the care home was totally unhelpful. One thing I did notice was that the older the carer the better care – perhaps tolerance and patience and understanding of dementia comes with age and experience of life. I wish mostly anyone under 30 years was banned from dementia care homes. The most important however is finding good managers.

I wonder how many other people are, like me and my wife, thinking – with considerable dread – about what the future holds as we enter that phase of life when the body, or mind, or both, start to fail. Who will need professional care first? Where shall we live? Who will die first? What happens after that? The one thing neither of us want to do is go into a home of the sort described so frequently here, but only the very wealthy can afford to buy a place in a satisfactory establishment that will provide nursing care when needed as well as accommodation. Even selling everything up would only provide a few years [if we’re lucky] of residential care. With no available family to do anything we shall be at the mercy of social services, whose mercy is sorely strained I should think. Looking ahead, cost pressures can only increase.

There’s a lot of emphasis on dignity in death, and undertakers go on about it all the time with their financial schemes and funereal accoutrements, but we need a lot more thought about dignity in old age, and for those younger people with terminal conditions or severe dementia, who need almost constant help from a caring state and a compassionate profession.

You are not alone John. I dread getting to the stage where I or my husband are alone or can no longer cope in our own home especially with no relatives likely to give a damn.

I am not suicidal, but if there was a choice later in life to end it peacefully or live in conditions described by many here, I know what I would choose.

I share your approach at the end of your comment. I just hope I shall not be too feeble to exercise the option.

Helen says:
4 April 2017

Having read the previous comments, there seems to be a difference between Nursing Homes and Residential Care Homes. My brother (70) has been in a Bupa nursing home since 2013 which caters for adults of all ages with physical disabilities and diseases. All the rooms are spacious and comfortable, where residents spend the day as they please. The sitting rooms are normally empty and used for group activities like chair exercising etc.

The carers are from various countries as are most of the nurses. Unfortunately nurses are hard to recruit so the home has to depend on nurses from agencies quite a lot. They do their best though. The Manager checks on over 70 residents most days by walking around and notices everything and gets things put right in a friendly way. Whenever my brother or I have asked about things, the staff always respond well. I have never felt hesitant to approach them. The food is well prepared and always brought to the room piping hot.

I agree that there is a lot of time when carers are writing up their notes, when they could be interacting with the residents perhaps. I asked why they don’t use lap tops or computer stations, but apparently this is not allowed yet, although it is allowed in NHS hospitals. For carers new to the UK, the spell check would help them to finish their notes more quickly if they were on computers. Many residents have very elderly or no relatives at all to visit them, and although I have no first hand evidence from them, some look very lonely. There is not much money for Activities like outings or Activities Managers. My brother has only been out twice to a local museum and a park. The other times have been for appointments in NHS transport All the doors of the rooms are left open unless personal care is going on, and only people who have passed the Disclosure and Barring Check ( DBS checks) can enter a room, unless they are related. People’s surnames are not on the doors either.

The personal care and dispensing of medication is always done on time and with dignity in my brother’s case. Laundry is done every day and like most homes things get into wrong rooms and take a long time to surface again. My brother’s remarks about the home to us privately are: that he would like to be told when someone he may have known has died; and he would like to be introduced to new men once they have settled in. He hardly knows any of the 74 people. One plus thing about this home is that people with dementia in Alzheimer’s are not accepted and as most people are not mobile there are very few people moving about without assistance. There is no herding of residents into sitting rooms either. All residents are checked on every hour in their own rooms day and night.

To sum up we have only had a very positive experience in this home and I put it down to the leadership of the Manager in setting the ethos in a quiet but assertive way. Staff co-operate and things get sorted out. His office door is always open and he always answers his phone and emails.

I hope there are more reports of good nursing homes in this survey soon.

Good to hear.

I have no personal experience of care homes but would like to make 2 points.
Many years ago, in a mock interview for medical school, I asked the candidate why he wanted to study in the UK since there were med schools in his own country. His response? ‘I want to learn in a country where human life has a value. ‘ What is the life experience of the staff in the homes?
A colleague has placed her mother in a Catholic care home. It is expensive, but the overriding impression is one of CARE. I have visited there – guests are welcomed at meal times (albeit not for free) and can honestly say that I have been impressed. (However a friend had a very different experience in another Christian care home.)

Week by week, with every visit, another piece of my Mother’s jewellery had disappeared. When she died, she just had her wedding ring left.

Kelly Oliver says:
6 April 2017

I worked for a domiciliary care agency for four years first on the business side to enhance communication between patients and the service provider, then training as a carer so I could understand the patient needs better.

Unfortunately – even when someone’s using a friendly care service like the one I worked for – there seems a fear culture to not rock the boat or care provision may be affected.

This biggest concern I had during this period of my working life was learning that the CQC can give advance notice of an inspection.

Though not an issue for the company I was employed by, this did make me wonder how many care home and home care providers were altering the service they provided solely for the day the CQC inspector visited.

If CQC are going to undertake surprise inspections to ascertain the level and quality and care being provided then it need to exactly be a surprise check. I heard of other companies who would fill in days worth of care notes which should have been done after each session to correctly raise any issues to the next carer/nurse on shift. They’d also scramble around to ensure workers were compliant with mandatory training and CRB checks which should have been completed before they went anywhere near a patient.

On the whole, the experience has cemented that should my parents be in a position where they need extra care, I’ll try to undertake it myself or make sure we have a living arrangement where outside carers can be monitored. There are many, many wonderful carers out there, but my folks are too precious to risk a broken hip because mandatory manual handling training hasn’t been enforced until CQC deliver the advance warning of a visit.

Andrew says:
6 April 2017

I am pleased to say that the care home in which my 91 years old father-in-law resides (Jubilee Court in Stevenage) offers a good and attentive service. It’s not cheap at ÂŁ3,600 per month, but the staffing levels are high and they are very attentive to the needs of the residents. Meals are good quality and varied and there are numerous activities and trips organised for residents. No complaints from me.

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I looked after my mother at home because she had dementia and I knew she would only survive a few short months in one of these places. She succumbed to a water infection and was taken into hospital. I fully expected her to come home after a few days. Although the water infection cleared up, she then caught norovirus and was considerably weakened by this, then was moved to a small elderly care unit still in hospital, they were extremely good to her there, but, they refused to let her home as by this time she had become incontinent, unable to walk, and in general unable to do anything for herself, although she still tried to get out of bed they would not let her. They then insisted I get her a place in a care home, even though I was willing to look after her at home with the right help.

I refused, from what I had seen and heard it was not the place for my mum, as with the right help I could have done a better job. There was no help available, the best place was a care home according to them. I was away on holiday and they moved her into a home without my permission.

What happened to my mother in the first care home still haunts me to this day, the bruises, legs, face, the police were involved but they did nothing. She had no rights any more and no dignity. I still have some photographs of the bruising, but like a lot of these places the care home is now closed, and they were not willing to own up to what was deliberate abuse. All this happened in 2006-7. When I have the time I intend to write about it. Mother only lasted 9 months in a care home, and died in hospital from phneumonia.

The second care home was ok, but the manager disappeared after destroying all the medical information on the patients, never found out why, it all happened after mother died. The cost of these places were about ÂŁ700 a week. The first manager of the second home had a very nice BMW with a personal number plate, so I agree they are a licence to print money on the backs of vulnerable people.

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Steve Jones says:
6 April 2017

I worked in a care home back in 2004 (as a handyman) and the staff their were so blase about the care they gave. I was a good friend to one of the people there and her care plan said she needed help standing up as she had little power in her hands to hold on to things. One morning two carers went to get her up and they told her to hold onto a rail so they could get things (?) ready for her ablutions. She immediately fell down hard. The care home manager basically said to me they would deal with it internally and not to say anything. (Dismissal with no proof)

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