Ms Carol Grogan:

As part of the regulation of nursing homes, the provider must set out their staffing and management structure in what is called a statement of purpose. That is reviewed as part of registration and is a condition of their registration.

On staffing, we can have the numbers but staff also need the proper training and competence to deliver safe, quality care. A fundamental review at every inspection concerns what staffing is available, how it compares to what they said they would have in place, and how those staff are delivering care. We observe the care practices. We have noticed over the last while that nursing homes are being bought as going concerns and, in some cases, it is the company that is being bought so the registered provider does not change but the directors change within that company. When we go back to do an inspection shortly after the takeover, in some cases we are finding that providers are reducing their staffing levels. We require them immediately to put them back in line with their statement of purpose. If they have difficulties, we will put a condition on their registration to reduce the number of beds they have or cease admissions until they are able to restabilise their resources. In some cases, providers have been quite innovative in looking at their skill mix and considering how they can shorten the gap in some areas. However, there is no substitute for having the clinical oversight of a nurse along with well trained and competent care staff.