:00:13. > :00:16.investigation into neglect of the elderly in nursing homes. The pain
:00:16. > :00:21.and suffering she must have gone through to be in that state. I don't
:00:21. > :00:25.know any other way to describe it other than a catalogue of failures.
:00:25. > :00:31.We speak to a former worker. There was a deliberate undercutting of
:00:31. > :00:36.staff to save money. Families whose hopes for justice lie in tatters.
:00:36. > :00:42.Somebody has to answer to all these failures. We examine the system that
:00:42. > :00:46.let them down. How do we prove those cases? That is incredibly difficult.
:00:46. > :00:56.What of the nursing homeowner who will probably never stand trial?
:00:56. > :01:13.
:01:13. > :01:17.can make complaint, but you have to years, all with failing health. They
:01:17. > :01:23.all required care in a nursing home. But what their families didn't know
:01:23. > :01:28.was that their loved ones were suffering behind closed doors. They
:01:28. > :01:33.were all victims of neglect. These empty offices were the base for a
:01:33. > :01:42.team from Gwent Police who investigated that neglect for
:01:42. > :01:47.seven-and-a-half years. Operation Jasmine identified 74 suspects and
:01:47. > :01:52.103 potential victims. The investigation into six nursing homes
:01:52. > :01:57.cost �11 million. It generated a huge amount of paperwork, but in
:01:57. > :02:06.court, earlier this year, the trial collapsed in dramatic fashion
:02:06. > :02:11.leaving families, like Evelyn Jones, with a host of unanswered questions.
:02:11. > :02:16.Nobody deserves an ending like this. We wanted this opportunity to be
:02:16. > :02:21.able to tell her story, what happened to her, so it is not swept
:02:21. > :02:27.under the carpet. This was Ruth's grandmother five years before she
:02:27. > :02:35.died. What happened to Evelyn became one of the key cases in the Gwent
:02:35. > :02:40.Police investigation. She was a very kind, very caring. She was quiet,
:02:40. > :02:45.she had a quiet way about her. She had a good social life. She was very
:02:45. > :02:49.popular and well thought about in her community. Evelyn developed
:02:49. > :02:53.dementia. Her family realised she needed full-time care and
:02:53. > :02:59.eventually, she was placed in a nursing home. It is now under new
:02:59. > :03:04.ownership. It used to be called Brithdir. When she went in, I went
:03:04. > :03:09.up to see her. She was sitting in a chair, had a tray, some lady was
:03:09. > :03:16.trying to take her food off her. She was fit enough to say, "That's mine!
:03:16. > :03:20.You will have yours in a minute." She was quite talkative and she
:03:20. > :03:24.would come to the door with us when we were going. Marina and her family
:03:24. > :03:28.went to Greece for two weeks for Ruth's wedding. When they returned,
:03:28. > :03:36.they noticed a big difference in Evelyn. They were shocked when they
:03:36. > :03:42.tried to lift her in her chair. son got one side of her. We tried to
:03:42. > :03:46.do the same as what the nurses, the way they handled, not to hurt her.
:03:46. > :03:52.We put our arms underneath her arms. Then we tried to lift her up. When
:03:52. > :03:57.he was lifting her up, she was going, "Oh!" She kept on like that
:03:57. > :04:03.all the time. I said, "You have to get up." I said, "What's the
:04:03. > :04:07.matter?" She looked at me and the tears were rolling down her face.
:04:07. > :04:12.Evelyn developed a chest infection and was admitted to Prince Charles
:04:13. > :04:20.Hospital in Merthyr Tydfil. When I arrived, I found my grandmother in
:04:20. > :04:28.an isolation room. We all went in as a family. But there was a really bad
:04:28. > :04:32.smell, a very pungent family. I recognised the smell of an ulcer.
:04:32. > :04:38.The smell was so bad that the children, well they couldn't stand
:04:38. > :04:43.it, basically. My husband said, "I'm going to take them out." Staff
:04:43. > :04:49.alerted Ruth to the wounds on her grandmother's back. There was a
:04:49. > :04:56.large bruise which was at least 12-and-a-half inches by 6 inches. It
:04:56. > :05:02.was massive. It looked like a really bad burn, it looked like a burn. It
:05:02. > :05:07.was black, blue and festering around the edges. It was sore.When I
:05:07. > :05:15.looked further down, it was horrific. What I saw next I wasn't
:05:15. > :05:22.expecting to see. She had two holes holes in the coccyx area, which was
:05:22. > :05:28.like a twopence piece. One slightly above it, a bit smaller, but it was
:05:28. > :05:38.so badly infected that I could see the bones of her back penetrating
:05:38. > :05:38.
:05:38. > :05:46.through these holes. Obviously, the smell was all this infection. It was
:05:46. > :05:56.black. It was absolutely horrific. The pain and suffering she must have
:05:56. > :05:58.
:05:58. > :06:03.gone through to be in that state doesn't bear thinking about.
:06:03. > :06:08.hospital staff were so appalled by what they had found that they called
:06:08. > :06:18.in social services and the police. By 2006, it became evident that
:06:18. > :06:19.
:06:19. > :06:22.there was a pattern across a number of homes in which we were seeing
:06:22. > :06:28.deaths in circumstances which appeared to be not natural causes.
:06:28. > :06:33.Tin vest gating team were shocked by what they were finding. -- the
:06:33. > :06:36.investigating team were shocked by what they were finding. When you are
:06:36. > :06:41.seeing people with pressure sores that are corroded down to the bone,
:06:41. > :06:47.where you have got people who are vomiting faeces because they are so
:06:47. > :06:54.constipated or where you have people who are so dehydrated that it's a
:06:54. > :07:04.significant cause of their death, then in 2006, now in 2013, surely
:07:04. > :07:07.
:07:07. > :07:15.nobody would expect anybody to live in those conditions. I went like
:07:15. > :07:20.that. This is how I liked to think of dad. Casual dress. Pam and
:07:20. > :07:25.Gaynor's father, Stanley Bradford, had also been in the Brithdir
:07:25. > :07:30.nursing home. On a number of occasions, I was there for four
:07:30. > :07:35.hours at a time, in all that time I never seen one career. We would go
:07:35. > :07:42.in, let ourselves out, that four hours I was there, we wouldn't see a
:07:42. > :07:47.career or nobody. On two occasions, one was for the evening meal and the
:07:47. > :07:54.other time was for the lunch time meal. I waited in his room. Nobody
:07:54. > :07:57.came with food. That was the same on both occasions. They had forgotten,
:07:57. > :08:03.that was their explanation. How many other times have they forgotten to
:08:03. > :08:07.feed my dad? When Stanley became unwell, and had to go to hospital,
:08:07. > :08:13.Gaynor was shocked by what she saw. When they took the gown off him to
:08:13. > :08:23.examine him, the state on him to me was like somebody out of a prisoner
:08:23. > :08:25.
:08:25. > :08:33.of war camp. His chest was sunk in. I ran out. It was a real shock to me
:08:33. > :08:39.the way I seen it. Stanley Bradford died later that year. He was 76. A
:08:40. > :08:44.few months later, the police called on his family. The first thought
:08:44. > :08:47.that come to my mind was that they had evidence that he had been
:08:47. > :08:53.starved to death because the way I seen him, that is what I thought
:08:53. > :09:00.they were coming to tell me, you know. It wasn't for that. Dad was
:09:00. > :09:09.one of the ones that was going to be looked at by medical experts that
:09:09. > :09:13.they were fetching in to deal with the case. We know he had severe
:09:13. > :09:22.pressure ulcers. Nobody had told us in the home that dad was suffering
:09:22. > :09:27.from pressure ulcers. Only the investigation through the police.
:09:27. > :09:31.People do get pressure sores. It is a fact. But not to this extent. I
:09:31. > :09:37.think would I want to put my family into a care home in those
:09:38. > :09:45.circumstances? Absolutely not. the time the police were
:09:45. > :09:52.investigating Brithdir, it was owned by this man, Dr Prana Das. He is a
:09:52. > :09:57.GP and ran a surgery with his wife in Bargoed. Dr Das has owned and run
:09:57. > :10:03.care homes across South Wales for more than 20 years. At its height,
:10:03. > :10:09.his empire consisted of 25 registered homes, which made it the
:10:09. > :10:15.largest business of its kind in Wales. Concerns about the care
:10:15. > :10:22.provided at Dr Das's nursing homes stretch back years. In 2005, we made
:10:22. > :10:25.a programme highlighting complaints from worried families. Complaint
:10:25. > :10:32.after complaint after complaint. Lack of consultation with the GP,
:10:32. > :10:36.upheld. Poor personal hygiene, inadequate wound care, upheld.
:10:36. > :10:43.Failure to call in a GP, upheld. Poor communication record keeping,
:10:44. > :10:48.upheld. Upheld. Privacy and dignity, not respected. You are a GP. Don't
:10:48. > :10:54.you care about this? You can make complaint, but you have to prove it.
:10:54. > :11:01.All those allegations were upheld by the Care Standards Inspectorate. And
:11:02. > :11:05.Dr Das's nursing home, Baybridge, was closed down. After we broadcast
:11:05. > :11:11.our programme in 2005, we were contacted by even more worried
:11:11. > :11:16.families. Like former staff nurse Jeanette and her brother Gareth.
:11:16. > :11:24.Their mother was also in Brithdir. At first, they had no complaints.
:11:24. > :11:28.seemed clean. Yeah, it was clean. The staff... The food was OK.
:11:28. > :11:33.one morning, they had a call to say their mother, Marion Barnes, had
:11:33. > :11:41.fallen. They rushed to the home. When we got up there, she was in the
:11:41. > :11:46.ambulance. There was a young career with my mum. I said to her what has
:11:47. > :11:54.happened and she said, "I came in to work this morning and found your
:11:54. > :12:01.mother on the floor." She was shaking. She said she couldn't move.
:12:01. > :12:06.The career called for help from a nurse. She said, just get Mrs Barnes
:12:06. > :12:11.dressed and bring her downstairs." The young girl said, "I'm not moving
:12:11. > :12:20.Mrs Barnes, she seems to be in a bad way. She needs to be seen." When I
:12:20. > :12:24.got there, it was clear to see a her femur had been broken. You could see
:12:24. > :12:29.where the bone was protruding. I don't need to be a doctor, or have
:12:29. > :12:33.medical knowledge to see the bone was broken. It was plain to see. How
:12:33. > :12:39.these people didn't see that, getting her dressed, beggars belief.
:12:39. > :12:46.They told me she had got up and walked, which was impossible. She
:12:46. > :12:52.couldn't stand up on her own, let alone walk. Her bed had a cot side
:12:52. > :12:56.to it, didn't it? It should have had a cot side. They hadn't attached the
:12:56. > :13:00.cot side that night. They said they had. They tried to make out that my
:13:00. > :13:05.mother crawled to the bottom of the bed. Marion's broken leg was treated
:13:05. > :13:12.in hospital but when she was well enough to be discharged, she didn't
:13:12. > :13:16.return to the Brithdir nursing home. We wouldn't let her go back there.
:13:16. > :13:20.You lost confidence in them? Definitely. All we wanted at the
:13:20. > :13:30.time was for them to close the place down. We were appalled by what had
:13:30. > :13:34.
:13:34. > :13:38.happened. Yeah. These events took place in 2004 and 2005. But we can
:13:38. > :13:44.reveal that concerns about the standard of care at Dr Das's nursing
:13:44. > :13:50.homes went back at least ten years earlier. Those underlined indicate
:13:50. > :13:54.the times that we were on our own. Not only is it not acceptable, it is
:13:54. > :13:59.dangerous for the staff and the patients. Dawn Goll worked nights as
:13:59. > :14:08.the sister in charge at one of Dr Das's nursing homes. It is now under
:14:08. > :14:12.new ownership. The moment he took over, everything changed. He
:14:12. > :14:16.wouldn't have agency nurses. He cut down on the quality and quantity of
:14:16. > :14:21.food. And also incontinent aids. If you are going to have a nursing
:14:21. > :14:25.home, and run a nursing home, these people are not units of money. You
:14:25. > :14:31.have to look after them. You have to give your staff the facilities to do
:14:31. > :14:35.it. If you are cutting back on staffing levels, and food, and
:14:35. > :14:43.incontinence aids, where is that money going? These people are paying
:14:43. > :14:48.for it. They are entitled to good care. Dawn was particularly worried
:14:48. > :14:53.about staffing levels. I worked five nights a week and very often I would
:14:53. > :14:57.work three on my own. I wasn't the only one. There were other nurses
:14:57. > :15:04.being made to work on their own. What would be the situation if you
:15:04. > :15:08.had one resident on that part of the hall, one resident and both
:15:08. > :15:11.simultaneously having a heart attack? Which one do you go to? It
:15:11. > :15:17.is not good Dr Das saying it happened if somebody didn't turn up,
:15:17. > :15:24.or it was a case of sickness. No, that was not the case. There was a
:15:24. > :15:29.deliberate undercutting of staff to save money. Dawn Goll wasn't
:15:29. > :15:33.prepared to tolerate the staffing levels at Hengoed Hall and she
:15:33. > :15:40.resigned. She had kept paperwork showing how often she was the only
:15:40. > :15:49.nurse on duty. And an employment tribunal accepted her claim that she
:15:49. > :15:53.had been constructively dismissed. Dr Das was now coming to the
:15:53. > :16:01.attention of the authorities in Wales and a new organisation had him
:16:01. > :16:06.in their sights. The care standard inspectorate for Wales now had
:16:06. > :16:12.responsibility for regulating nursing homes. Dr Das wasn't about
:16:12. > :16:18.to give up his empire without a fight. People can complain, this is
:16:18. > :16:28.what I am saying. We have no control over people complaining, but they
:16:28. > :16:29.
:16:29. > :16:33.have to prove it and if they prove it, how valid that proof is, how
:16:33. > :16:38.qualified that is. We can challenge them and we have to find out how
:16:38. > :16:43.genuine those complaints are. Following up major concerns, the
:16:43. > :16:46.authorities closed nine of Dr Das's homes. He was still permitted to
:16:46. > :16:56.continue running others, like the one at Brithdir. The families want
:16:56. > :17:00.
:17:00. > :17:07.to know why this was allowed to happen. How was he able to run these
:17:07. > :17:13.homes? I found out since that this goes back to 2001. Surely that is
:17:13. > :17:18.wrong? It is wrong. The Older People's Commissioner for Wales is
:17:18. > :17:22.concerned about how the system allowed such widespread neglect to
:17:22. > :17:27.go unchecked. 103 people over a considerable period of time, I don't
:17:27. > :17:32.know how to describe it other than systemic failure. We failed to
:17:32. > :17:36.protect those people when they needed our protection most. I do
:17:37. > :17:40.firmly think there should be a fitness to own test. I firmly
:17:40. > :17:44.believe that. I don't think older people would see that as being
:17:44. > :17:50.unreasonable either. There is a fitness test, but the Commissioner
:17:50. > :17:53.says it doesn't go far enough. you have a history of running or
:17:53. > :17:58.owning a home where older people have been the victims of abuse or
:17:58. > :18:04.neglect, I don't think you should be allowed to own a care home in the
:18:04. > :18:08.future. Holly House near Blackwood was the nursing home owned by Dr Das
:18:08. > :18:12.that we featured in 2005. It was eventually closed down due to a
:18:12. > :18:17.faulty gas supply. But the families we have spoken to said they didn't
:18:17. > :18:23.realise at the time that their loved ones were being moved from one Dr
:18:23. > :18:31.Das home to another at Brithdir. should have been told about this,
:18:31. > :18:36.that Dr Das owned that home, I mean the one previously, Holly House, I
:18:36. > :18:44.mean that was just shutting down. I mean, the authorities didn't tell
:18:44. > :18:54.us. We didn't know. If only we had known that Dr Das had run that home,
:18:54. > :18:55.
:18:55. > :19:00.Our Father wouldn't have been in there. Would we? Vulnerable, elderly
:19:00. > :19:05.people, we understand, were still being sent to homes which were under
:19:05. > :19:09.investigation. Can that be right? No. It is not. Is it? I'm very
:19:09. > :19:12.clear. Older people are very clear. The average man or lady in the
:19:12. > :19:22.street would be very clear. If it goes wrong, put it right. If you
:19:22. > :19:30.
:19:30. > :19:33.can't put it right, help me to live somewhere where I am safe. Don't
:19:33. > :19:41.can't put it right, help me to live somewhere where I am safe. Don't to
:19:41. > :19:48.somewhere where I'm not safe. council declined to tell us if
:19:48. > :19:51.families were ever warned that Brithdir was under investigation.
:19:51. > :19:58.What Gwent Police began in 2005 became the biggest investigation
:19:58. > :20:02.they had ever carried out. They called it Operation Jasmine. And
:20:02. > :20:05.these shelves contained just part of a mountain of evidence, 12 tonnes in
:20:06. > :20:13.all, which followed their investigation into six care homes,
:20:13. > :20:18.two of which were owned by Dr Das. But despite all this work, their
:20:18. > :20:22.enquiry was to receive a major setback. The Crown Prosecution
:20:22. > :20:28.Service decided the evidence didn't reach the required threshold to
:20:28. > :20:32.bring charges of gross negligence, manslaughter and wilful neglect. The
:20:32. > :20:37.police were bitterly disappointed. After gathering all this evidence,
:20:37. > :20:40.the Chief Constable at the time asked for a meeting with the
:20:40. > :20:47.Director of Public Prosecutions to press their case. But the answer was
:20:47. > :20:52.still no. If we haven't met the threshold test, there is a question
:20:52. > :20:59.- what have I got to do next time to meet that threshold test when I have
:20:59. > :21:03.put 75 detectives on an inquiry for the last six years? To prosecute Dr
:21:03. > :21:09.Das, they tried a different route. And the Health and Safety Executive
:21:09. > :21:14.took over the lead. They charged Dr Das, Chief Executive fall black and
:21:14. > :21:17.their company Puretruce with offences under health and safety
:21:17. > :21:24.laws, relating to Brithdir and a second nursing home called The
:21:24. > :21:30.Beeches. Dr Das was accused of theft and false accounting. But then came
:21:30. > :21:34.another and decisive setback. Last September, Dr Das and his wife
:21:35. > :21:40.Nishebita were asleep at their home here when they were attacked by
:21:40. > :21:45.burglars. Dr Das was repeatedly beaten about the head with a hammer
:21:45. > :21:49.suffering what were later described as severe and traumatic brain
:21:50. > :21:55.injuries. In March, Cardiff Crown Court was told that Dr Das was
:21:55. > :22:00.highly unlikely to ever recover enough to stand trial. The CPS
:22:00. > :22:06.decided not to proceed with the charges against Chief Executive Paul
:22:06. > :22:12.Black or their company Puretruce. The families were devastated.
:22:12. > :22:16.cheated, didn't we, that we were not going to see justice be done? After
:22:16. > :22:21.all this time of waiting... You are not talking about one person caring
:22:22. > :22:28.for somebody, you are talking about teams of people here, teams of
:22:28. > :22:34.people, not one of them stood up and said, "I have a concern about Mrs
:22:34. > :22:39.Jones." Maybe they did. But what happened? We will never know. There
:22:39. > :22:43.is no closure for the family. Somebody has to answer for these
:22:43. > :22:48.failures that have happened. In my eyes, up till now, there's been no
:22:48. > :22:51.answers for us, nothing. The MP for Blaenau Gwent, Nick Smith, has taken
:22:51. > :22:58.up the family's cause and he challenged the Prime Minister in
:22:58. > :23:02.Parliament. The wilful neglect of residents in care homes is a crime.
:23:02. > :23:08.But too often the victims and the victims' families don't get any
:23:08. > :23:10.justice. Given it is your third anniversary, when will we have a law
:23:10. > :23:14.that is fit for purpose? If you are a company director and you run a
:23:14. > :23:18.care home, you make sure you have the best possible care for the
:23:18. > :23:24.people that you are looking after. If you don't, you will be held
:23:24. > :23:27.accountable under the law. In the end, Dr Das was going to be pursued
:23:27. > :23:32.through health and safety and financial maladministration. That
:23:32. > :23:36.can't be right. We should be pursuing these people for poor care
:23:36. > :23:41.and if they do provide poor care, they should face the full force of
:23:41. > :23:46.the law and they should be prosecuted and made to go to prison
:23:46. > :23:51.for any criminal activity. Mr Smith wants to introduce a Private
:23:51. > :23:56.Members' Bill later in the year. Its aim - to lower the threshold in
:23:56. > :24:05.cases of wilful neglect and place greater corporate responsibility on
:24:05. > :24:10.nursing homeowners. How do we prove admissions? If I had a child who was
:24:11. > :24:15.three, and I left them in a room and I didn't feed them or care for them,
:24:15. > :24:19.or if I had an elderly person and I left them lying in bed watching the
:24:19. > :24:24.television, what is different? The Director of Public Prosecutions,
:24:24. > :24:29.Keir Starmer, declined to give us an interview. He has agreed to meet
:24:29. > :24:34.with families. The CPS acknowledges it could have x plained more clearly
:24:34. > :24:36.to them and the police what the legal requirements are for a
:24:36. > :24:42.successful prosecution -- explained. As well as cause for a change in the
:24:42. > :24:46.law, there is growing pressure for a public inquiry. As Gwent Police
:24:46. > :24:51.carried out their investigation, they identified what they said were
:24:51. > :24:56.weaknesses within the system and they produced this document with 10
:24:56. > :25:01.#6 recommendations for change. What we don't know is how many of these
:25:01. > :25:06.have since been implemented. -- 106 recommendations. What concerns me
:25:06. > :25:09.most is that we still don't know what happened to those individuals
:25:09. > :25:12.who was responsible and we don't know whether we have yet learnt the
:25:12. > :25:17.lessons to make sure it can't happen again across Wales. That is why I
:25:17. > :25:20.have been very clear, I have called on the Welsh Government to undertake
:25:20. > :25:25.a public inquiry into what happened, who was responsible and to provide
:25:25. > :25:34.the reassurance that I think the public is looking for that it
:25:34. > :25:38.couldn't happen again in Wales. Despite the fact that all this
:25:38. > :25:44.evidence and much more has been gathered, it may never see the light
:25:44. > :25:50.of day. And many of the agencies at the heart of this case have refused
:25:50. > :25:54.to take part in our programme. That includes the regulator, the Care and
:25:54. > :25:59.Social Services Inspectorate for Wales and Caerphilly Council which
:25:59. > :26:03.paid for some elderly residents' care. The Welsh Government also
:26:03. > :26:06.declined our invitation to take part, but a spokesman did say it is
:26:07. > :26:12.considering calls for a public inquiry and legislation is planned
:26:12. > :26:17.that is aimed at further protecting vulnerable adults. I do have to ask
:26:17. > :26:27.the question so in future, if we have an elderly person, who is
:26:27. > :26:29.
:26:29. > :26:36.brought into a care home, who is not turned or fed adequately, how do we
:26:36. > :26:42.prove those cases? That is incredibly difficult.
:26:42. > :26:52.Dr Das's empire of nursing homes lies in ruins. Some were ordered to
:26:52. > :26:54.
:26:54. > :27:01.close down, like this one, or sold to other companies. All that remains
:27:01. > :27:06.is one nursing home in the Rhymney Valley. We invited his wife,
:27:06. > :27:13.Nishebita Das, to take part in our programme, or a representative of Dr
:27:13. > :27:20.Das's. They failed to respond to our request for an interview. As has
:27:20. > :27:26.company Chief Executive Paul Black. With a court case very unlikely, the
:27:26. > :27:30.families are left wondering if they will ever get justice. For Gaynor
:27:31. > :27:37.and Pam, the home where they have been told their father suffered
:27:37. > :27:46.neglect brings back memories they have tried to forget. It holds so
:27:46. > :27:51.many bad memories. To see your dad lying there and to think we didn't
:27:51. > :27:56.have proof. We thought he was in good hands. Look at my dad's photo
:27:56. > :28:06.every night and I say, squt sorry if we have let you down." Every night
:28:06. > :28:10.you say that? Every night. Something has to be done. I want something
:28:10. > :28:14.done. We hear that all the time. mother went down to hell and thank
:28:14. > :28:18.goodness she is at peace now. I wouldn't want to see anybody going
:28:18. > :28:22.through what she went through. She was vulnerable, she was trusting,