A more "robust" approach will be taken to failing care homes, according to the region’s inspector for the Care Quality Commission (CQC) - in a bid to re-build the public’s shattered confidence in its work.

Adrian Hughes, deputy chief inspector of the South for the CQC - the body charged with inspecting health and social care services across the country - was being interviewed at our offices last week when news broke that the watchdog had ordered Merok Park Nursing Home, in Park Road, Banstead, to close because its elderly residents were at a "significant risk of harm".

In light of this newspaper’s reports on Firtree House, another Banstead nursing home, which is currently under police investigation, Mr Hughes spoke about the changes which have taken place at the CQC in the last year.

Widely slammed as a toothless watchdog in the wake of the care crisis uncovered at Mid-Staffordshire NHS trust, Mr Hughes said the reforms it triggered have seen a shift away from assessing how ‘compliant’ a care home is to a ratings system - to get rid of any ambiguity and help people when they are choosing care services for loved-ones.

He said: "It would be disingenuous to say we have always been wonderful.

"We listened and over the last two years we have changed our whole methodology of inspecting our services.

"Having that gradient of judgement really helps people to choose care.

"They still need to look at the individual needs of their relatives but it’s a good starting point."

As of October 1, five key questions are now being asked of care homes - about its leadership and management, its safety, how responsive it is to individuals, its effectiveness and how caring it is.

An overall rating of Outstanding, Good, Requires Improvement or Inadequate is then given to the home.

Mr Hughes said the new system leaves much less "wriggle room" for homes to continue operating while not meeting standards.

"There will be no yo-yoing between complaint and non-compliant.

"We are much more robust about enforcement actions which are taken against providers," the inspector said.

If a home is not rated as Outstanding or Good, Mr Hughes said, "we will be all over them".

Another visit will be arranged within six months and a decision will be taken as to whether to shut a care home if the necessary changes have not been implemented.

"We can’t keep publishing reports saying a home is inadequate two or three times.

"We have to make a judgement and not let things languish around as inadequate because that’s not acceptable.

"There’s no middle ground.

"If the service is not good enough we have to take action to cancel it."

Mr Hughes said the ratings given to care homes will not simply be a "snapshot in time" but will reflect intelligence the CQC has gathered on them.

He said inspections can be brought forward according to intelligence, if necessary, and homes can be inspected "any time during the night or day".

In extreme cases the CQC can also cancel a provider’s registration requiring all the homes they run to close.

"It’s easy to say we’re on the side of people"

Mr Hughes said the CQC has not always succeeded in communicating effectively with worried residents who raise concerns.

"If someone takes the time to write to us, there’s an obligation to write back and say what we are doing," he said.

"Before [the changes] there was an obligation but we didn’t do it.

"If people tell you things and you don’t act on it, how can you be on their side?

"It doesn’t mean we run out every time someone tells us something but we need to ask how we can make a judgement about it.

"It can’t be that individuals write to us and it’s this black hole."

Mr Hughes said it is important to engage with relatives in a "timely fashion" to build a relationship of trust.

"We’ve got to get better at that," he added.

"It’s about engagement and communicating with them, listening and acting on what they say and giving them feedback on that."

When asked whether the CQC had a tough job on its hands in rebuilding people’s trust, Mr Hughes said: "It’s a really important job.

"We are convincing more people increasingly that we are getting it right.

"The difficulty is all we tend to talk about is the bad care. How do we help people to understand the good things?

"But when we get it wrong, it’s important to say we got it wrong very quickly."

Questioned on delays in the publication of CQC reports on the watchdog’s website, Mr Hughes said challenges to findings by providers sometimes hold up the process.

He said: "If we don’t publish the reports, there’s no point doing the inspections.

"We’ve got to have timely publication of the reports, as soon as possible after the inspection.

"If it’s your business you want to deflect. We need to ensure our processes are robust so when providers challenge us we have the evidence.

"The obligation is also on us to do our bit so the provider has got the report so we can get it out."

Mr Hughes said the CQC will also be publishing guidance on the use of covert surveillance by worried relatives in care homes.

He said it cannot legislate to stop people from doing it, but that the other options available to relatives in such situations must be highlighted: "There are individuals who are concerned and just don’t know what to do.

"How do people get information to make judgements?"

"Experts by experience"

The CQC has moved away from employing a "generic" workforce to specialist inspectors who have expertise in hospices, care homes and other service providers.

On top of this, there are special advisors and new "experts by experience" - people who have used or been involved with the types of social care services being assessing by the CQC.

A new Provider Handbook has been co-produced by providers and the people who use the services so those who run care homes understand what is required of them.

Next April will also see the introduction of a ‘special measures’ regime for adult social care, for establishments which receive an inadequate rating.

This will be alongside a ‘duty of candour’ and ‘fit and proper persons’ requirements for directors of health and care providers.

"Is the service run for the convenience of the staff or the people living there?"

Mr Hughes said that while the CQC recognises care homes are businesses which need to have financially viable models, there must be the understanding that human "citizens" are at the heart of them.

He said: "If homes develop good business acumen there is stability and homes don’t change hands.

"But one of the things we ask is: is the service run for the convenience of the staff or the people living there? For example is there time for staff to sit and chat with residents?

"How do we have the business consistency and how does that service become human for individuals on a day-to-day basis?

"The people who use these services are not commodities, but human, individual citizens."

The inspector said he disagrees with people who believe no care homes should be run by corporations.

"That’s just not going to happen," he said.

"The majority of services in England are provided by a variety of enterprises in the private sector - profit companies, not-for-profit companies, charities, community interest groups. There needs to be that pluracy."

When asked about beliefs that a cultural disconnect is created in care homes where staff are employed from abroad, Mr Hughes said ensuring that service is accessible to its users is key.

He said nurses speaking to each other in their mother tongue or a carer sitting and completing written work in front of residents fosters a perception that they should not be disturbed on the part of residents.

Mr Hughes added: "Accessibility is about the whole ambience of what happens there."