Sydney Heathcote v Lancashire County Council

It is a unanimous decision of the tribunal that the appeal be allowed.

Introduction

This is an appeal under Section 15 of the Registered Homes Act 1984 against the decision of the Special Cases Sub-Committee of the Social Services Committee of Lancashire County Council on the 6th of March 1998, to cancel the registration of Mr Sidney Heathcote in respect of Phoenix House, 9 Bairstow Street, Preston, Lancashire on the grounds that he is not a fit person to be carrying on a Residential Care Home within the meaning of Section 10(a) and Section 9(1)(a) of the Act.

The reasons given to support this decision were:-

We heard evidence from the following witnesses:-

For the Respondent:-

Mr Patrick Rooney of Lancashire Social Services Inspection Unit

For the Appellant:-

Mr Sydney Heathcote, the appellant and the owner of Phoenix House

Mrs Yvonne Constance Pickup, the housekeeper and live in careworker

Mr Frank Pickup, Yvonne Pickup's husband and a live in care worker and handyman

Mr Mark Bernard Charles Christie, Community Psychiatric nurse responsible for 4 of the 6 patients at Phoenix House

Mrs Pauline Nicholls, an approved social worker for Lancashire County Council with experience of Phoenix House for 3 years

Dr Graham Colin Wood, Consultant Psychiatrist at the Avondale Unit, Royal Preston Hospital and responsible for 3 of the residents at Phoenix House

Mrs Grace Margaret Abbott, Community Psychiatric nurse and a member of the team responsible for Phoenix House

Mr John Elwell whose brother is a resident in Phoenix House

We read the Affidavits of Theresa Bond, Paul Mansfield, Paul Cunningham, David Anthony Duncan and William David Chadwick.

Background

Phoenix House is a small care home accommodating 6 residents with various degrees of mental illness. Mr Sydney Heathcote, owns the home and runs it with the help of two live in carers, Mr and Mrs Pickup. Mr Heathcote is a man of 69 years whose left leg was amputated below the knee in 1991. He also suffers from minor circulatory problems for which he is receiving treatment but otherwise he appears to be mobile, active and in reasonable health. Neither Mr Heathcote nor Mr and Mrs Pickup have any formal qualifications, other than experience, for work with the mentally ill.

Problems arose in 1991 when Mr Heathcote was in hospital and when his partnership with Mrs Joan Smith, who was joint owner of Phoenix House, dissolved. A manager, Mrs Deaves, was appointed and the problems were resolved.

When she left in 1994 the authority encouraged Mr Heathcote to appoint a new manager and an indication was given that Mrs Pickup would not be a suitable candidate. After much discussion and further visits it was agreed in January 1996 that Mr Heathcote could fulfil the role of manager. The Authority become concerned about the administration of the home and about the continued involvement of Mr and Mrs Pickup. In March 1998 a decision was taken to remove Mr Heathcote's registration.

The Issues

Failure to employ suitably qualified staff in numbers which are adequate for the well being of the residents.

Mr Rooney suggested that there had been a constant and continuing failure to employ suitably qualified staff. This problem was compounded by a failure to obtain suitable references and a persistent failure to prepare accurate staff rotas. The Authority wanted Mr Heathcote to employ a manager who met with their approval and they did not approve of Mr and Mrs Pickup as carers or of Mr Heathcote's wish to have Mrs Pickup as a manager, although no formal application from Mrs Pickup to become the manager was submitted.

The response of the Authority to these perceived problems has been contradictory and inconsistent.

Mr Rooney first became involved in inspecting Phoenix House in 1976. Before this, in 1992, concerns had been expressed about the quality of staff, poor training and supervision, poor standards of facilities and equipment, the building being in an unsatisfactory condition, inadequate record keeping and an inadequate standard of care. Mr Heathcote had accepted these criticisms, relating them to his absence due to illness and his dispute with his former business partner. He had employed a registered manager and the situation had improved.

Mr Rooney's visit on 30th October 1996 was, he said, a positive one. It was a visit which purported to evaluate the quality of care in respect of rights for the residents. No mention was made, on this occasion, of a lack of staff records but the report said that urgent attention should be paid to employing a registered manager for the Home.

Although the Authority has expressed a constant concern about the absence of a registered manager, except during the period between 1992 ad 1994 when Mrs Deaves was employed, it was agreed, following an administrative inspection of the Home on 7th January 1997, to allow Mr Heathcote to operate without a registered manager.

The visit on 7th January 1997 revealed that a current rota was available and showed that the required hours of cover were provided by the home. Mr and Mrs Pickup were resident at the home and were available on call in addition to their rota hours. However there was still no evidence of employment application forms being completed by current staff and no references were available.

There was no suggestion in this report that staffing was inadequate.

The Authority was prepared to accept Mr and Mrs Pickup as carers and Mr Heathcote as a manager in January 1997. No concern was expressed about the suitability of Mr and Mrs Pickup or about Mr Heathcote's age or health.

In August 1997 as a result of a phone call from a senior social worker concerning Mrs Pickup's mother, a further visit was made to the home.

This alleged complaint was based on a suggestion that Mrs Pickup was physically abusing her mother who lives in sheltered accommodation in the Morecambe area. It was suggested that there were grip marks on her mother's arms and that Mrs Pickup had said that she was under stress as a result of having to run Phoenix House alone. Mrs Pickup categorically denied that she had abused her mother in any way. No complaint had been made by her mother and the matter had not been pursued.

We heard no other evidence about this and we were concerned that Mrs Pickup had suffered serious injustice as a result of an assessment of her character based on an unsubstantiated allegation.

Mr Heathcote was not present when Mr Rooney visited on 12th August and Mr Rooney believed that Mr Heathcote had been absent for a number of weeks because of illness. Mr Heathcote's evidence was that he had spent 1 week in hospital and had attended the out-patients department on 3 or 4 days in each of the following 2 weeks. One of the weeks he spent in hospital was covered by an experienced agency manager.

It was suggested that because Mrs Pickup had completed a pre inspection questionnaire this was evidence that she was acting as manager. Her evidence was that she completed it because she was in a position to. She did not complete it in the capacity of a manager. We felt that the fact that she took it upon herself to complete one piece of paperwork did not indicate that she was acting as a manager.

Mr Rooney said that there were no rotas available on 12th August or on 26th August when another visit took place. Mr and Mrs Pickup disputed this in their evidence.

Finally a care inspection was carried out on 16th October 1997 when the issue of incomplete staff records was raised again.

The Authority criticised the lack of staff training but Mr Rooney was completely unaware of the training and advice which Mr Christie provided for the staff. The Authority were unable to suggest any appropriate courses and indeed did not regard it as their function to do so.

Failure to complete records specified in Schedule 2

This failure seems to relate to the staff record sheet referred to at appendix B6 of Lancashire County Council information booklet 2. Sections 4 and 5, qualifications and experience, provide no explanation or guidance about what us required. Mr Rooney and the other inspection staff did not see it as their role to provide such guidance or support.

Mr Heathcote does not like keeping records ("My job is to look after mentally ill persons not be a secretary") and he accepted that from time to time the record sheets were not kept up to date. He insisted that he could not obtain references for Mr and Mrs Pickup because his former business partner Mrs Smith would not provide them. He felt that he had known the Pickups for a number of years, he had every confidence in them and he knew what their track record was like. So far as other members of staff were concerned. Mr Heathcote said that he did keep records and references were available for Sandra Duncan, a person he employed to be on call, and he produced a staff record sheet and a reference. Mr Rooney felt that these records were still not adequate because the details of experience were sparse ('4 years experience as a care worker with the elderly infirm and young people with mental health problems').

So far as staff rotas were concerned there seemed to be some difficulty in completing the rotas a month in advance as Mr Rooney required. As there were only 3 regular members of staff and Mr and Mrs Pickup lived in there was always someone 'on duty'.

Mr Rooney felt that the residents lived in little more than a bedsit situation and that the care did not really go beyond the provision of basis accommodation and some food.

It was difficult to reconcile this view with the need for full staff records.

Failure to make arrangements for the Home to be conducted so as to make proper provision for the welfare, care, treatment and supervision of the residents.

As well as the criticisms about inadequate staffing and staff training much was made of the absence of what Mr Rooney described as care plans. He suggested that a care plan should identify things which needed to be worked on. The plan should provide stated aims and objectives. He also suggested that the stated aim of the home was not being achieved because there were no attempts at rehabilitation. He suggested that rehabilitation involved preparing the residents to live more independently. He took no account of the views of Dr Wood that many of these residents had gone as far as they could into the community. They would always need the sort of sheltered accommodation which Phoenix House provided.

He was unaware that detailed care plans existed and that these plans were discussed with Mr Heathcote. We heard evidence from Dr Wood and Mr Christie that the provision and maintenance of a care plan is the responsibility the patient's key worker and the community staff. There is also a risk assessment which is an on going process. It was accepted by all parties that it would be a good idea for copies of some of this information to be kept in the home so that it could be available for staff if necessary in Mr Heathcote's absence.

It was clear from the evidence that the home was involved in rehabilitation where appropriate. We heard evidence from Mrs Nicholls that over recent years 2 of the residents had been introduced to independent living in the community, with mixed results. M, one of the current residents was being prepared to move to a sheltered housing scheme. Mr Heathcote gave evidence that he had taken M shopping, that he had offered advice about living in the community, how he should try to control his drinking and how to ensure that no one took advantage of him. When M left Phoenix House Mr Heathcote said that he would continue to visit and support him.

We were satisfied that the evidence of the medical staff painted a true picture of how the residents were care for. Dr Wood described in detail the care which his patients receive from Mr Heathcote and his staff.

In T's case Dr Wood says "The Staff have coped extremely well in successfully managing someone with a mental illness at the severe end of the scale. This man has improved markedly whilst in the care of those at Phoenix House". Of another patient he says "He is very difficult to care for and he has an exacerbating feature in that he abuses alcohol which has a destabilising effect on his medication. Staff have managed this individual very sensibly---there is a difficult balance to be struck. If a regime is too prescriptive he would become frustrated and aggressive and yet a too relaxed approach would not give him the focus he requires and he would drift and this would exacerbate his symptoms and illness. Sydney Heathcote and his staff have been skilled in achieving this balance of care and control".

He says that the support provided by the staff outside the home has been crucial and invaluable. Patients have always been accompanied to appointments and staff have provided invaluable information. In short Dr Wood felt that the patients at Phoenix House received the best support and facilities available in the area.

Mark Bernard Charles Christie, the Community psychiatric nurse is responsible for 4 of the residents, J, E, D and T. He also assists with the care of V. His evidence was that "the level of care afforded by Sydney Heathcote and his staff to residents is exceptional - I cannot think of anywhere better for my clients and believe that Phoenix House offers a unique and valuable service".

Further he says "I must express my deep regret and concern at these allegations levelled against Mr Heathcote and his staff which I feel are at best very misguided. Sydney Heathcote's involvement goes beyond that expected of a registered person. He ensures that his residents attend all their appointments. He goes out of his way to take them out for the day and he takes them shopping and generally caters for their every need".

Failure to maintain the home on the basis of good personal and professional relationships between the persons employed at the home and the residents.

The concerns of the Authority here were that Mrs, and to a lesser extent Mr Pickup, were unsuitable carers. This view seemed to be based on the unsubstantiated report about Mrs Pickup's mother, an incident where Mrs Pickup's son Gavin broke a window, an allegation by V, one of the residents, that Mrs Pickup spoke to her like a dog, an expressed lack of confidence in the Pickups in the absence of Mr Heathcote and an inappropriate attitude to the residents.

We have already made our views about the allegation against Mrs Pickup clear. No criticism was made against Mr Pickup except that both he and Mrs Pickup had an inappropriate attitude to residents. This view seems to have been formed following a discussion with Mr Rooney about Gavin's behaviour.

It was suggested by Mr Rooney that on or about 9th October 1997 Gavin had been involved in a drunken argument with his parents and had smashed a window. This had frightened and upset two of the residents. Mr and Mrs Pickup gave evidence that their son had not been drunk but he had an argument with his girlfriend and in a fit of frustration he had shouted and smashed the window. They denied that any of the residents had been disturbed or upset.

During a discussion about this incident Mr Rooney suggested that the Pickups had said that it was all right for Gavin to behave like this because this was the way residents behaved. Mr Rooney felt that this was an unprofessional attitude, Mr and Mrs Pickup denied making this comment. None of the witnesses for the appellant were aware that any of the residents were upset by this incident.

We felt that there was nothing special or disturbing about this incident and it was of no consequence so far as the welfare of the residents or the running of the home was concerned.

Mr Heathcote dealt with the matter firmly and decisively by dismissing Gavin, who was also employed as a care worker, and requiring him to find accommodation away from Phoenix House.

Mrs Pickup denied that she had spoken to V like a dog and V made no complaint to any one else except Mr Rooney. Dr Wood described V in this way, "V does not say much. I cannot comment on her veracity but there are limits to her version of reality. She suffers from a chronic mental illness which means that she is at times isolated and very withdrawn but she has been treated very sympathetically by Mr Heathcote and the staff which has required a great understanding of her condition, her needs and requirements".

Had Mr Rooney spoken to Dr Wood he may have been in a better position to assess this allegation. We did not take it seriously.

Finally the comments attributed to Mrs Pickup about the behaviour of residents, if made at all, were made in the context of an isolated and irrelevant family upset.

Miscellaneous matters

The Respondent suggested that there had been a recurring problem over the storage of drugs. It was suggested that they were at times kept in a flimsy plastic cabinet and at other times in Mr and Mrs Pickup's bedroom on top of a wardrobe. The medical staff had no cause for concern about this situation and we accepted the evidence of

Mr Heathcote that the drugs are now locked away in a desk drawer in the private quarters of Mr and Mrs Pickup.

It was further suggested that Drug administration records were not accurate because the record had been completed in advance and on one occasion one of the residents was shown as having been given his drugs when in fact they were withheld from him because he had had too much to drink. We accepted that in the case of one the residents, J, who worked, his daily dose of medication was given to him in advance so that he could take it whilst he was at work. In this case the drugs administration sheet was completed in advance. It is difficult to see how these things could amount to a failure to administer drugs properly or to keep proper records.

A suggestion was made that one of the resident's rooms was dirty. This room was occupied by D who, according to Mr Christie's evidence, has serious alcohol dependency problems. He was very unhygienic and exhibited all manner of anti social behaviour. We accepted Mr Heathcote's evidence that his room had to be cleaned and his bedding replaced frequently.

Finally it was suggested at one stage that there was a problem with the fabric of the building. There was no evidence to support this allegation save that a minor amount of painting and redecoration may have been necessary from time to time.

The consequences of the closure of Phoenix House

The evidence pointed to Phoenix House and its staff providing a much needed and appreciated facility for the care in the community of a number of patients with serious mental health problems.

Dr Wood suggested that if his patients were unable to continue living at Phoenix House he had his staff would be left with having to find homes for very difficult persons with very serious mental illnesses. He felt that there was no other facility in Preston which could provide the same level of support and care. He felt that his patients would be caused considerable distress which would be detrimental to their health.

Mr Christie felt that his clients' mental health would be profoundly affected by the closure of Phoenix House and that one client would become a danger to himself and the public.

A summary of our findings

We were satisfied on balance that:-

Although Mr and Mrs Pickup were not formally qualified, the evidence of the professional witnesses indicated that they were well able to care for the residents and that a good quality of care was provided in the Home.

Because of the nature of the Home and the somewhat independent lifestyles of the residents staff numbers were more than adequate.

The standard of record keeping was not acceptable but the Inspection Unit could and should have given positive guidance to put this right. This failure had no direct effect upon the quality of care provided for the residents.

Mr Heathcote did not relinquish the role of manager to Mrs Pickup.

There was some staff training although, with the help of the Inspection Unit, more could have been provided.

Staff records were incomplete but Mrs Smith, the previous employer of the Pickups, had a policy of not providing any references and the Pickups were well known to and trusted by Mr Heathcote. When Mr Heathcote sought to provide this information in respect of another employee, Mrs Duncan, he was given no indication of why the information was inadequate or how he should put it right. This lack of information had no effect upon the quality of care provided for the residents.

We did not believe that Mrs Pickup abused Residents or that the Pickups had an inappropriate attitude to those in their care.

Care plans were available and the care and treatment of the residents was discussed with the appropriate professionals.

Although many of the residents were, of necessity, in long term occupation, serious attempts were made at rehabilitation where appropriate.

The incident with Gavin was an isolated family incident and had little or no effect on the residents.

On one or two occasions mistakes were made in recording the administration of drugs. These lapses were of little significance and had no effect upon the welfare or safety of the residents.

There was some slackness in the care and control of drugs but they were always kept away from the residents and there was no danger that they would be stolen or misused.

Conditions of cleanliness and repair in the Home were of an adequate standard.

Mr Heathcote and his staff provided a high standard of care for the residents of Phoenix House.

Conclusions

The paramount consideration for Inspection Units when dealing with registration is the welfare of the residents and the quality of care provided for them. In the present case the Unit seems to have lost sight of this.

On balance we were satisfied that the evidence of the experience professionals; the consultant psychiatrist, the psychiatric nurses and the social workers showed that the appellant and his staff were the mainstay of support for highly vulnerable people. The evidence clearly attested to the good quality of the service and the personal commitment of the proprietor in supporting people, some of whom were very difficult to maintain outside a psychiatric hospital setting. It was a valued and valuable service.

The Tribunal was concerned that the Authority did not consult with professionals responsible for the care of the 6 residents at Phoenix House, nor even with its own social workers. Had it done so it is likely that the hearing would have been unnecessary.

The Tribunal accepts that an independent view by the Inspection Unit is necessary but an 'arms length' approach should not mean that the Unit operates in a vacuum.

It is important for Registration and Inspection Units to recognise their unique position as a catalyst for the development of the quality of service as well as carrying out their regulatory role. The provision of clear and expert guidance on a personal level should help to achieve compliance with the regulations and should be an integral part of the inspection process.

Mr Heathcote's attitude to the keeping of records under the regulations was a problem for the Inspection Unit. He should have made more of an effort but he could have been offered more advice and assistance in view of the good work of the Home in caring for its residents.

The keeping of appropriate records is an important part of the good administration of a residential home and a poorly administered home may mean that the residents are put at risk. This is clearly not the case here, as the inspection unit would have discovered if the residents and the professionals responsible for their care been consulted properly.

Mr Heathcote's lack of record keeping did not, by itself, make him unfit to run Phoenix House.

The ambivalent and inconsistent attitude of the Authority to the management of Phoenix House meant that it was unjust of the Authority to remove Mr Heathcote's registration on the basis of irritating failures in administration which had been condoned for a number of years.

The evidence of Dr Woods and the Psychiatric nurses Mr Christie and Mrs Abbott was virtually unchallenged and gave us a picture of a much needed facility in Preston.

All those who gave evidence had nothing but praise for Mr Heathcote's work with the mentally ill.

For all these reasons we have no hesitation in allowing Mr Heathcote's appeal.

This is the unanimous decision of the tribunal.