THE LEVEL of care of 72 elderly and frail residents under the roof of a Twickenham care home was disclosed in a lengthy and damning report last week, the publication of which has been long awaited by concerned friends and relatives.

The report on the Independent Investigation into Lynde House, which has been operating since 1996 was a result of an independent assessment by McLaren Consultancy Limited, following the complaints from residents' friends and relatives.

A presentation of the final written report was planned for the end of the investigation in November but the report was only made public last week by the South West London Health Authority.

Julie Dent the chief executive of South West London Health Authority said: "Since then Westminster Health Care has acted to address the issues raised by the report and the newly established National Care Standards Commission, which is now responsible for the registration, inspection and monitoring of care homes, has carried out its own inspections that confirm progress has been made and is, at present, broadly satisfied with the care now provided. We will be holding a public meeting in September which we hope residents and relatives will be able to discuss the report's findings with representatives of Westminster Health Care and the Commission."

Age Concern, Richmond upon Thames said that the disagreement by WHC over the findings in the report masked the real issues. Ryan Sampson, Age Concern RuT's chief officer said: "Progress is still required and we should remember that serious issues are not resolved by arguing about reports. They are resolved through interaction, co-operation and stringent enforcement of best practice."

The report's author outlines that registration and the legal right to operate a nursing home business is given to an individual or company who applies to be registered and that in the case of Lynde House. It states: "The registered person has not ensured that the person in charge undertook those delegated legal responsibilities and did not adequately monitor the performance of the person in charge in relation to those duties." This registered person is reported to have allowed insufficient levels of staff to operate on occasions which did not meet the high level of resident need and inadequately trained staff to undertake the care tasks and procedures required.

It was reported that the registered person allowed inadequate supervision of all staff to continue whilst failing to ensure that housekeeping and cleanliness standards were maintained at all times as domestic staff only worked until 2pm.

They provided responses to concerns and complaints that were inadequate or non-existent as far as relatives were concerned and were unable to correct the hostility as perceived and reported by relatives to be present between managers, managers and previous managers and managers and staff.

In addition they were also apparently unaware of actual activity on the units especially at night for example of hoists not being re-charged, routine checking of residents and security of the home.

With reference to the fitness of the building, the registered person was reported to have allowed unacceptable levels of maintenance of hoists, wheelchairs and other equipment putting the safety of residents at risk and to have allowed the provision of equipment which did not meet either Health and Safety Legislation or the care needs of individual residents. In addition they did not ensure that all residents had access to a call bell at all times.

With regards to the fitness of the organisation, the registered person was found to have allowed an Internal Complaints Management system which many of the residents found to be unacceptable and to make access to WHC seem impossible. They also failed to respond promptly to serious written complaints and visits to the WHC Head office by concerned relatives.

It was reported that an apparent climate of fear and intimidation as perceived by some relatives and residents (the examples of eviction notices and alleged restricting orders placed on individuals were quoted by relatives as a threat) was allowed to continue at the home by the registered person.

The latter was reported to allow an apparent closed organisation that did not encourage whistle blowing' by staff when some were very unhappy with certain situations. They also allowed claims of inadequate investigative and corrective procedures to continue and undertook a recruitment process for staff that allowed appointed care staff to undertake tasks without fully assessing their competence in a working knowledge of English.

The report states that the registered person did not always fully investigate incidents and accidents and untoward occurrences or reassure the relatives and keep them fully informed as evidenced by entries in individual nursing records and accident books. They also failed to respond to constant enquiries by certain relatives as evidenced by, among other things, the 27 responses to the commission's questionnaires. In addition, they failed to ensure that Lynde House met the changing mental health needs of some residents by providing the appropriate skills and environment.

Kingston and Richmond Health Authority's role in this was seen as their failure to implement a robust complaints system in relation to Lynde House which investigated in-depth, repeated concerns raised by residents and others when it was evident that according to the allegations the care was less than adequate. They also failed to provide a written investigation report for some complainants as a formal response to their complaints. They failed to recognise deficiencies during routine visits and inspections to Lynde House and to enforce compliance, for example, with the administration of medicines and record keeping and the level of nursing equipment.

Westminster Health Care maintain that they are providing excellent care' for their residents and say they believe the report by the McLaren Consultancy to be, in many places inaccurate and that some of its conclusions are simply wrong'. They also said that some of the evidence presented by WHC in an attempt to correct those errors' has not been referred to.

Their main bones of contention are with regard firstly to the inference that the care of residents was not safe and adequate' and they say there is clear evidence to counter this assertion. They also question the reference to the company as the fit person' in charge of the home failing to undertake and monitor its legal responsibilities. Referring to the reports attention to staff levels they said: "There is clear evidence that staff numbers were sufficient and Westminster demonstrated that the home operated at 37 hours per day in excess of the staffing levels set by the registration authority. These staffing levels have also been approved by the National Care Standards Commission." With regards to the report's inference of inadequate training and poor practice at Lynde House, they said: "There is evidence of proper training in all the procedures listed" and with regards to complaints they said: "We acknowledge that some residents and their relatives were unhappy with our responses, but every complaint was responded to." They concluded: "We now want to put these matters behind us and continue to provide excellent care for our residents."

The Lynde House Relatives Support Group have called the reaction of Westminster Health care to the report an illustration of an uncaring, cynical and arrogant company'. A spokesman for the group said: "It is no surprise to us that Westminster Health Care are blind to the facts contained within Mrs McLaren's independent, in-depth and totally impartial report commissioned by the NHS. This behaviour clearly illustrates what an uncaring, cynical and arrogant company this is. One wonders what the National Care Standards Commission makes of the company's response and if the commission considers that they are fit persons to lead a company that purports to care for the most helpless and vulnerable in our society. Westminster Health Care's reactions to the concerns which many of us raised over the years can now be seen in print - thanks to Mrs McLaren's report and the efforts of Dr Cable to release this report."

Commenting on the report this week Ryan Sampson the chief officer at Age Concern Richmond upon Thames pointed out the far reaching nature and impact upon the everyday lives of the residents at Lynde House of the essential but mundane care requirements which had been found lacking.

See letters pages.