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Name:

Debra Lewis

Registration number:
W/5000324
Date:
28/07/2020 - 28/07/2020
Time:
9.30am
Domiciliary Care Manager
Immediate order pending removal on 31/08/2020
This is a remote hearing taking place by video conferencing. If you would like to attend, please contact us at hearings@socialcare.wales
Formerly Ty Draw Wentworth Lodge Ltd
Fitness to Practise panel

Allegations

That you, between 1 January 2016 and 7 January 2019, whilst registered as a Domiciliary Care Manager and employed by Ty Draw Wentworth Lodge Ltd as Registered Manager of ("the Home"):

1. On an unknown date in December 2018 you behaved inappropriately towards Resident A in that you:

(a) shouted at her;

(b) pointed or waved your finger at her;

(c) told the resident that she was 'out of here' or words to that effect;

(d) told the resident that you would phone her daughter to have her removed from the Home, or words to that effect;

(e) caused the resident to be distressed.

2. On an unknown date in December 2018 in relation to Resident B:

(a) you did not ensure that the resident was positioned correctly on the stairlift;

(b) your conduct in (a) resulted in bruising to the resident;

(c) you spoke to the resident in an aggressive and/or inappropriate manner;

(d) your conduct in (a) and/or (c) caused the resident to be distressed.

3. Gave instructions to limit the provision of and/or choice of food to residents, namely:

(a) to limit the breakfast to be given to Resident C;

(b) not to make biscuits available to residents with their tea;

(c) that fruit should not be available for residents in the dining room;

(d) to reduce the size of portions of food for residents;

(e) that residents should not be offered dessert in advance of the Christmas buffet;

(f) that Resident D should not be given dessert as she had not eaten her lunch;

4. You behaved in a bullying and/or inappropriate manner towards staff in that:

(a) on various unknown dates you spoke to members of staff in a rude and/or aggressive manner;

(b) on an unknown date in 2018, in relation to Colleague A, you:

(i) shouted at her;

(ii) swore at her;

(iii) displayed anger by throwing a file on the floor;

(iv) caused her to be distressed and/or upset.

(b) on an unknown date or dates, in relation to Colleague B, you:

(i) shouted at her;

(ii) caused her to be distressed and/or upset.

And your fitness to practise is impaired by reason of your serious misconduct.

Decision on facts

We have decided that the following Charges are proved:

Charge1 – all particulars

Charge 2 – particulars c) and d) only

Charge 3 – all particulars

Charge 4 – all particulars

Reasons

We have not heard oral evidence from any witnesses and have not heard from Ms Lewis but we have carefully scrutinised a bundle of evidence which runs to 57 pages. We have accepted the legal advice provided to us.

Ms Lewis registered with Social Care Wales as a Domiciliary Care Manager on 7

June 2012. She transferred within the company for which she worked to an Adult Care Home Manager role. It is not suggested that she was at fault for not being registered with Social Care Wales in that specific role.

The home in which she worked is registered to provide care for up to 16 individuals who may have a diagnosis of dementia. We will refer to it as “the Home”.

It appears that Ms Lewis was the manager of the Home from late 2014. In January 2019, staff at the Home raised various concerns with the Registered Manager of a nearby home in the same ownership (“the Registered Manager”). This led Ms Lewis’s employer to begin an investigation and to refer concerns to Social Care Wales. The investigation was led by the Registered Manager. Ms Lewis did not participate in the investigation and we have nothing from that source to indicate whether she accepted or denied any of the concerns about her practice.

We have before us seven witness statements which were prepared by Social Care Wales for this hearing. The first statement is that of the Registered Manager. The other six statements are from various members of the home’s staff who we have referred to as Colleagues A to F.

Colleagues A to F were interviewed by the Registered Manager as part of his investigation and, in each case, notes that he made of those interviews are exhibited.

We first engaged in a careful consideration of the credibility of each of the witnesses and we reached the following conclusions:

The Registered Manager seems to us to be very fair in how he presented his evidence. He gives credit to Ms Lewis for the positive elements of her practice and does not show any bias against her. He completed a referral form known as a “VA1” and expressly acknowledged that some of what he was told about the issue which was the subject of the referral may have been exaggerated by the family of the resident concerned because of how upset they were.

He had only met with Ms Lewis once or twice and his evidence is therefore based in the main on what he was told by others. We find his written evidence to be credible.

Colleague C was at the Home for a few days only. He was one of the first to approach the Registered Manager with concerns. We judge his evidence to be that of someone who is caring and credible, particularly in his account of the existence of an atmosphere of fear in the Home. We have decided that we should give weight to his account.

Colleague D was briefly employed as the Home’s Chef. He had 10 years’ experience in care homes and was trained in a care role. He corroborates a number of the aspects of the evidence of Colleague C and we regard his evidence as being credible and consistent.

Colleague B gives a clear account of an incident in which she was shouted at and threatened with criminal prosecution by Ms Lewis. She alleges that Ms Lewis was temperamental and we are satisfied that her account is credible and is supported by the evidence of other witnesses.

Colleague E suggests that she did not have the same degree of difficulty with Ms Lewis as others experienced. She states that she could engage in banter with Ms Lewis on occasions but also said that she could be moody, sharp with residents and staff and tended not to do much with the residents. We regard her evidence as being credible and we noted that Colleague E was less critical of Ms Lewis than others. She says that she was not scared of Ms Lewis but her statement supports the evidence that Ms Lewis could be a bullying presence within the Home.

Colleague A provides very limited evidence. She describes Ms Lewis throwing files and swearing at her. She does not mention an incident involving the stair-lift despite being one of two carers involved. Her statement is very short. We regard it as deserving some weight as reinforcing the evidence of others about Ms Lewis’s alleged tendency to be aggressive with staff and residents.

Colleague F is a care worker who moved on to be a cook at the Home after the chef left. We concluded that her statement contained an open and honest account in respect of the incident involving the stair-lift even though she might be subject to personal criticism in respect of that. Her evidence tallies with other’s statements in relation to Ms Lewis being unapproachable, and the existence of an unusually large staff turnover. She said that she felt that Ms Lewis was in the wrong job. We decided that we should give weight to this statement.

We then went on to address each of the Charges against Ms Lewis in turn.

Charge 1

On an unknown date in December 2018 you behaved inappropriately towards

Resident A in that you:

(a) shouted at her;

(b) pointed or waved your finger at her;

(c) told the resident that she was 'out of here' or words to that effect;

(d) told the resident that you would phone her daughter to have her removed

(e) caused the resident to be distressed.

We were satisfied on the basis of the evidence of Colleague C in particular that this incident occurred. We noted that a number of the witnesses provided consistent accounts which corroborated one another. Only Colleague C refers to Ms Lewis pointing or waving a finger but this description was in keeping with the behaviour described by the other witnesses.

We find Charge 1 proved in each particular.

Charge 2

On an unknown date in December 2018 in relation to Resident B:

(a) you did not ensure that the resident was positioned correctly on the stairlift;

(b) your conduct in (a) resulted in bruising to the resident;

(c) you spoke to the resident in an aggressive and/or inappropriate manner;

(d) your conduct in (a) and/or (c) caused the resident to be distressed.

Colleague C provides detailed evidence about an occasion on which he intervened to assist a resident to descend the stairs on the stair-lift. He says in effect that there was a stand-off between staff and a resident who was unwilling to use the stair-lift on three consecutive days and that, on the fourth day, he took over and was able to encourage and reassure the person concerned to descend safely. He alleges that Ms Lewis and others were approaching the issue in an aggressive and inflexible way and that they had not turned the chair of the stair-lift so as to make it more easily accessible by the resident. He states that Ms Lewis said forcefully to the resident that she must sit in the chair. Colleague C describes Ms Lewis as being clearly annoyed and he says that the resident was shaking.

That evidence is not entirely consistent with the evidence of Colleague F who gives a different account of the use of the stair-lift. Colleague F refers in her evidence to there being an allegation that the resident sustained bruising, that an investigation into this followed and that she was required to undertake re-training as a result. She denies that the seat was not turned.

Taking all of the evidence into account, we were not satisfied that Ms Lewis was responsible for failing to ensure that Resident B was positioned correctly on the stair-lift.

We saw the VA1 referral form completed by the Registered Manager who met with a family member who described bruising that the Registered Manager thought could be in keeping with poor manual-handling. It is said that photographs of bruising were taken but we have no direct evidence of how that bruising was caused. It is not clear how, if bruising occurred, that can be attributed to the actions or omissions of Ms Lewis.

We were however satisfied that there was consistent and credible evidence that Ms Lewis dealt with the use of the stair-lift by Resident B in an unacceptable way and specifically that she spoke to her aggressively, causing her distress.

We find Charge 2 proved on the basis on sub-paragraphs c) and d) only.

Charge 3

Gave instructions to limit the provision of and/or choice of food to residents,

namely:

(a) to limit the breakfast to be given to Resident C;

(b) not to make biscuits available to residents with their tea;

(c) that fruit should not be available for residents in the dining room;

(d) to reduce the size of portions of food for residents;

(e) that residents should not be offered dessert in advance of the Christmas

buffet;

(f) that Resident D should not be given dessert as she had not eaten her

lunch;

There is consistent evidence across the witness statements that Ms Lewis adopted a rigid approach to the provision of food to the residents. We have taken into account the possibility that it may have been necessary, for example, to ensure that some residents did not put on too much weight but particular dietary needs should have been reflected in the relevant care plans. Concerns about nutritional needs would not justify a blanket approach to what food was offered and would not allow residents to exercise individual choice.

We find Charge 3 proved in each particular.

Charge 4

You behaved in a bullying and/or inappropriate manner towards staff in that:

(a) on various unknown dates you spoke to members of staff in a rude and/or

aggressive manner;

All of the witnesses describe a tense atmosphere within the Home which they state was attributable to Ms Lewis’s management and personal style. We are satisfied that there is more than sufficient evidence before us to prove that Ms Lewis spoke to staff members in a rude and aggressive manner. We find that there was an overriding sense of people being scared of Ms Lewis, who was intimidating and bullying. The two specific incidents referred to below exemplify that.

(b) on an unknown date in 2018, in relation to Colleague A, you:

(i) shouted at her;

(ii) swore at her;

(iii) displayed anger by throwing a file on the floor;

(iv) caused her to be distressed and/or upset.

We gave careful consideration to the fact that Colleague A’s account was not supported by other witnesses. However, we have no evidence to put against Colleague A’s account and it is in keeping with the descriptions of Ms Lewis’s behaviour provided by all of the other witnesses.

(c) on an unknown date or dates, in relation to Colleague B, you:

(i) shouted at her;

(ii) caused her to be distressed and/or upset.

Colleague B describes a sustained period of bullying behaviour which involved a threat of criminal prosecution and her account is supported by Colleague E.

We find Charge 4 proved in each particular.

We also find that this conduct towards staff members had the potential to cause harm to residents. Colleague B said she was happy to learn from mistakes but that the culture in the Home did not encourage that. The staff were afraid of the repercussions of any errors and the culture was not one in which they could share learning, rather it was one of blame and bullying.

We accept the evidence of Colleagues E and F that Ms Lewis shouted at staff in front of residents.

Treating staff poorly was bound to have an indirect impact on residents through the creation of a negative atmosphere in the Home. We accept the evidence that, after Ms Lewis left, the atmosphere and culture improved, there were more activities and the residents were happier.

Decision on impairment

We have accepted legal advice and we have had regard to the Code of Professional Practice for Social Care (“the Code”).

Decision

We find that Ms Lewis’s fitness to practice is currently impaired.

Reasons

We have found that Ms Lewis behaved in an aggressive and uncompromising way to staff and residents and that she presided over an unhealthy culture within the Home.

We noted that Ms Lewis appears to have been managing the Home from 2014 until 2019. The evidence that we have presents a snapshot within that longer period and a number of the witnesses knew Ms Lewis for a very short period only. We questioned, therefore, whether Ms Lewis’s misconduct could have occurred for a short period within her longer career. We decided, however, that the evidence suggested long-standing and deep-seated problems in Ms Lewis’s personal and management style. We noted that the Registered Manager was asked to try to mediate between Ms Lewis and Home’s staff and that she was not open to this. In our view, it is not the case that Ms Lewis’s misconduct can be seen as isolated.

We are satisfied that Ms Lewis failed to meet the expectations of the Code in numerous significant ways. Her failure to behave respectfully to residents and staff constituted a breach or numerous sections, most notably sections 1.2, 1.3, 1.4, 2.2, 2.3, 5.1, 6.6 and 7.2. These sections encompass expectations such as appropriate communication, upholding residents’ rights to control over their choices, ensuring that residents are not directly or indirectly harmed by your actions and the creation as a manager of a learning culture in the workplace.

We have concluded that Ms Lewis breached the fundamental tenets of social care by failing to model caring behaviour to her staff and by treating the Home’s residents in a way which on occasions upset them or failed to respect their dignity.

We find that she also risked undermining public confidence in social care. Members of the public are entitled to expect that their family members are being treated with respect and accorded choice in a warm and caring environment.

There is no doubt in our view that this amounts to serious misconduct.

There is no evidence before us to suggest that Ms Lewis has remedied any of these problems in the period since she left the Home and they would not in our view be easily remedied because they represent defects in attitude and a lack of a compassionate approach.

We find that Ms Lewis’s fitness to practise is currently impaired.

Decision on disposal

We have accepted further legal advice and have had regard to the Social Care Wales Indicative Disposals Guidance. We have been advised that Ms Lewis is currently subject to an interim Suspension Order.

Decision

We impose a Removal Order and we order that this is applied immediately.

Reasons

Ms Lewis’s lack of participation in this process has meant that there is very little mitigating evidence before us. We noted that the Registered Manager identified within his statement some positive aspects of Ms Lewis’s practice, in particular in her paperwork. We decided that this was far outweighed by the aggravating features which include harm being caused to residents. Ms Lewis abused the power her position as a manager gave her and failed to meet the responsibility it carried resulting in an unhealthy environment for staff and carers.

We decided that imposition of a Warning is not sufficient. Ms Lewis has not shown any insight. She did not take up the opportunity to reflect on how she managed the Home when she had the chance and she has chosen not to participate in this process. A Warning would not be adequate to protect the public.

We do not believe that imposition of a Conditional Registration Order is practical because Ms Lewis is not in current regulated social care employment has not participated in this process and we do not therefore have any basis for confidence that she would meet any conditions imposed.

We considered imposition of a Suspension Order but questioned what a suspension even of the maximum length would achieve. We could have no confidence that Ms Lewis would work to ensure that her practice was safe and appropriate at the end of any suspension and there is no indication that she is likely to participate in a review. There is no reasonable prospect that she would conduct herself differently if she were to return to practise after suspension.

We have decided that a Removal Order is necessary, appropriate and proportionate. We have found that Ms Lewis demonstrated long-standing and deep-seated attitudinal defects which resulted in harm to residents. We agree with the views of some of her colleagues that Ms Lewis was in the wrong job. She would be no better suited in her registered role of Domiciliary Care Manager. The need to protect the public and the public interest means that a Removal Order must be imposed in this case.

We discharge the interim order but impose an Immediate Order so that this Removal takes place as soon as Ms Lewis is notified of it. We do so on the grounds that imposition of an immediate order is necessary to protect the public and to protect public confidence.