Behind Closed Doors: Elderly Care Exposed Panorama

This programme contains some scenes which some viewers may find upsetting

A care home for the elderly.

But where's the care here?

And where are the words of comfort?

How often is this the experience

of those who are older and vulnerable?

CRYING:

We go undercover to discover what can take place

when relatives aren't there...

I'll come in a minute, I just need to help here first.

..the challenges for care workers...

I've lost count of the times

I've found people lying in urine-soaked sheets.

..and what happens when things go wrong...

No! No!

..when the caring stops.

Did she just slap her? She did!

I mean, that's assault. She's just assaulted that lady.

At this care home, eight staff suspended.

At another, grieving families whose relatives died after neglect.

As a society, we need to say, "This has got to stop."

We can't have this going on.

At a third home, secret filming by a family

that captured their grandmother's hours of distress...

..as she called for the toilet more than 300 times.

I'd go in and she'd start crying.

She'd say, "I just don't want to be here any more."

We're living longer

and our needs in old age are getting greater.

This is a problem no-one should ignore.

This is a challenge for the whole of society.

There should be no hiding place for poor care.

Night deepens across the capital

and at this nursing home in South Croydon,

the residents are settling in their rooms.

It's December 2012. The X Factor is on the TV.

'Tonight, it's the X factor final!'

98-year-old Yvonne Grant is finishing a cup of tea.

SONG ON TV: "Make You Feel My Love"

Just before 9:30, Yvonne needs the toilet.

She can no longer walk

but getting to the toilet is really important to her.

It's a matter of dignity. She needs help.

CRYING:

Yvonne started calling almost half an hour ago.

She doesn't know her family has left a secret camera in her room

to check on her care.

She's now desperate.

WAILING:

Yvonne is just a short distance from the nurses' station.

Staff should know she doesn't use her call bell,

she calls out instead.

But no-one is answering her.

Another 18 minutes tick by.

Still no help.

Yvonne Grant lived her whole life in south London.

She grew up not far from the care home.

She always used to talk fondly of when she was living at home

with her mum and dad, when she was younger, with her sisters.

It's the area where she raised her family and worked,

eventually becoming head of dress-making

at one of Croydon's large stores.

Always put her lippy on. She used to love looking smart.

We used to say she looked like the Queen Mum,

the way she used to have her hair and...

She was as young on her 90th as what she was on her 80th.

She just never seemed to age.

Her granddaughter Vanessa and her family lived nearby.

But when Yvonne required more medical help,

doctors said they needed to find a nursing home.

She was increasingly unable to walk.

So she moved to the 61-bed Oban House,

owned since 2011 by one of the country's biggest providers -

HC-One.

Soon, Vanessa began to feel things weren't quite right.

Almost every visit she pointed out problems

but felt things weren't changing.

On the surface, it did look smart.

But when you're in it for a while, you start to see the cracks.

I'd go in there and she'd start crying.

She'd say, "I just don't want to be here any more."

I knew that something wasn't right. But exactly what, I don't know.

Well, I didn't know until I put in the camera.

In Yvonne's room,

the unattended camera counts the minutes as she waits.

On that Saturday night...

..Yvonne calls out "nurse" 321 times.

She pleads for the toilet 45 times

and bangs her cup on 26 occasions.

Finally, after more than an hour, a care worker appears.

Her name is Sakovia.

Despite Yvonne's long wait,

Sakovia doesn't seem interested in helping her to the en-suite toilet.

Sakovia and a colleague

are telling her to defecate in her incontinence pad,

the last thing Yvonne wants.

She hated the fact that she couldn't walk to the toilet.

She used to say it was so undignified.

She would always make sure that she used the toilet.

She wouldn't, you know, as she'd say,

degrade herself with using a pad.

Again, Yvonne has to wait.

With that promise, Sakovia leaves.

15 minutes later, there's no help

and now, the light's switched off.

YVONNE:

Consultant nurse Lynne Phair is an expert on elderly care.

She's advised the Government on protecting vulnerable older people.

This lady, she probably, like most of us,

hasn't had an accident since we were two or three years old.

So you've got the dehumanisation, the emotional trauma,

the physical pain.

This is a type of assault.

But not the type of assault people understand.

After more than 20 minutes in the dark,

an hour and three quarters after Yvonne started calling out,

Sakovia returns with another care assistant.

In the darkness,

they try to make a desperate Yvonne, who hasn't walked for years,

walk to the toilet.

They should be using a hoist.

When they realise she can't walk, they sound disgusted.

GROANING

I know.

They drop her back on the bed

and complain they're short staffed.

That's not what Yvonne wants

and she still hasn't been to the toilet.

She's upset and again she's alone.

Two and a half hours after Yvonne first called out,

a different member of staff, a nurse,

finally takes her to the toilet.

The care worker that you see there,

the one who does all the talking,

she was prosecuted for common assault.

-And was she found guilty?

-She WAS found guilty.

Last July, Sakovia was given a suspended sentence

and community service.

She's currently appealing against the conviction.

The secret camera was in Yvonne's room

on three occasions over two weeks.

That night was by far the longest wait

that she had for the toilet.

Some care workers are also seen being kind.

Pardon?

GENTLY:

But there is other poor treatment.

There's nothing gentle about the way she's being handled here.

YVONNE GROANS

This care assistant was also convicted of common assault.

Lynne Phair is regularly called in to investigate concerns over care.

She says too often action isn't taken.

I am very relieved to hear the police took that so seriously

and the CPS took it seriously in that place.

Because it doesn't get taken seriously everywhere.

Sometimes in society we have to say enough is enough.

Things only change because society finally says,

"We will not tolerate this any more."

Croydon Council's safeguarding team concluded Yvonne's treatment

amounted to neglect and institutional abuse.

What was the reaction of the management

when you showed them the footage?

Horrified. Absolutely horrified.

HC-One, the company that owns Oban House, has told Panorama...

"The failings in care from that period were totally unacceptable.

"We apologised unreservedly to Mrs Grant and her family."

And...

"We always seek to deliver the kindest possible care."

The home now meets all necessary standards.

When Vanessa told her grandmother she'd put the camera in

and knew what had been happening, Yvonne was pleased.

She said, "Thank God for that.

"It's going to stop now, it's not going to happen to others."

The next afternoon was when her last days began.

It's like she was holding on for it to be found out.

Yvonne died in January 2013, aged 98,

surrounded by the family she loved.

Vanessa remains angry

that the earlier complaints she'd made

weren't listened to.

It left her grandmother vulnerable to poor care.

And she believes the secret camera was vital in getting heard.

I wish it were actually in every room in every care home.

That way maybe the care would just be given automatically

because people are aware that they're being watched.

She is part of a quiet revolution

where worried families are putting in their own cameras.

Many experts discourage the use of secret cameras

but accept that's what happens when families lose trust.

Putting in a secret camera does not sit comfortably with me.

Things are being filmed that are very intimate.

But I absolutely understand why the families are doing it,

because no-one is listening.

But how do you build trust so people don't put in cameras?

Here at the University of Worcester,

they believe better training for care staff is part of the answer.

Those fundamental aspects of care,

like the ability to maintain somebody's dignity...

The aim is to teach the skill and understanding

staff need when they move on to real people.

You've got to have very highly skilled care

but delivered in a kind and compassionate way.

The two have to go hand-in-hand.

Professor Dawn Brooker is a leading expert on dementia.

She says there are many good care workers

and in the best homes

the culture reinforces the right way to do things.

Everybody knows what good looks like.

Everybody in that home matters.

Most of the 17,300 residential and nursing homes in England

meet the regulator's basic standards.

Professor Brooker, who is against secret filming,

has done ground-breaking research

into the care of challenging residents with dementia.

She says far too many have limited quality of life.

30 years ago, it was relatively rare

to see anybody with dementia in a care home.

They were full of people who were pretty self-caring, really.

And yet we've continued that model.

Care homes now have become the home

of people with really, really very complex needs.

We are coping with some of the most challenging

and vulnerable people within our society.

But across the country,

even basic standards of care for older people

are not being met by a hard core of homes.

Exclusive figures released to Panorama by the regulator

show since 2011

1,260 homes have been given warning notices.

This is serious.

It means here, at the Care Quality Commission,

they have started legal action

because of failings in areas such as care, welfare and staffing.

More than one third of the 1,100 homes that remain open

still don't meet all standards.

That's 406 homes, with more than 15,500 beds.

The new Chief Inspector of Social Care wants change.

There are organisations who are running care homes,

they're getting paid to provide care and to provide support.

We are expecting people who are running services,

who are managing these services, to deliver.

People shouldn't be getting into this business if they don't care.

In the UK, more and more of us are living longer.

One third of the babies born last year will reach 100.

That is going to put care homes under even more pressure.

We're only as good, in a society,

as the poorest quality of care that we tolerate.

We have to admit that we do have a lot of shortfall

in quality of care

and that it causes people a lot of misery.

So unless we get care homes right

unless we really raise the bar,

actually all our futures are going to be really grim.

Frequently, it's staff with poor or minimal training providing the care.

And when that goes wrong,

the consequences couldn't be more serious.

'Next, elderly care home residents were left lying for hours...'

'Her family say she was treated worse than an animal

'in the care home she stayed in...'

'A cleaner says she saw one staff member slap a patient...'

Each of these cases

which were investigated or reached court in the past year

represented a failure to care for someone vulnerable.

A failure to change, even when there are warnings.

Lesley Lincoln is an experienced nurse

who made numerous complaints

about the nursing home where her mother lived.

Enid Trodden was denied even the most basic care.

She'd still be in bed, soaking wet, freezing cold.

She wouldn't have had her breakfast.

They would be lying on the table in her room.

Her 86-year-old mother

endured months of appalling care before she died.

I probably wrote about six letters,

possibly a dozen phone calls.

I was desperate, really, because I just thought,

I'm making all these complaints, nobody seems to be taking any notice.

That home was Orchid View in West Sussex.

'A coroner has ruled that neglect contributed to the deaths

'of five elderly people at a residential home in Sussex.

'Some residents were left dirty, distressed and unattended.'

Lesley's mother, Enid Trodden,

was one of the five whose death was hastened by neglect.

Last October, a coroner ruled that 19 Orchid View residents who died

had suffered poor care

in a home riddled with institutional abuse.

It just made me feel more guilty that...

How could I have left her there in amongst that?

How did I not know that this was more serious than what it was?

Of course, the place looked fantastic. It looked marvellous.

-We had no idea what was going on.

-None of us knew what was going on.

And all the families who had relatives there

now live with the distress of what happened.

Behind that facade of the new building,

there was hell on earth going on.

You're just thinking about your relative

and you're literally living on a day-by-day basis,

particularly there, because every day

there seemed to be some new catastrophe

or something that had happened.

Southern Cross, the company that owned Orchid View,

collapsed in 2011.

My mother was the last person to go into that care home

and I felt I was hoodwinked into her going into that place.

They knew they were in dire straits.

They just told you what you wanted to hear...

and take the money.

People died at Orchid View for lack of care.

We can put men on the moon, rockets in space, reach Mars

and we can't look after the elderly.

That's what I feel.

Lynne Phair was one of the investigators sent in.

Despite our best efforts,

we were unable to get the managers of that company

to see the neglect that their staff were administering.

It took an admin assistant turned whistle-blower

to expose the full extent of what was going on in Orchid View.

Morally I know that I did the right thing

but personally I have not worked for two years

and the case has had a huge impact on my life.

Eileen Chubb has first-hand experience

of just how difficult it can be to blow the whistle.

She was a care assistant at a different private-sector home.

She spoke out and lost her job as a result.

I've been a whistle-blower.

I've been there and I know the fear and, you know,

the distress that people are put through.

'I saw horrific abuse.

'I reported it.

'From that moment on, we were basically driven out of our jobs.'

Yeah, I've got a copy of it, yeah.

Her experience led her to start a charity called Compassion In Care.

In the past 14 years,

she's had more than 1,600 calls from whistle-blowers working in care.

Across the country,

she finds some homes are complained about over and over.

Every day cases are coming in where there's been, you know,

sometimes up to 15 staff, 20 staff raising concerns.

Six years later, more staff raising the same concerns.

One call she received in March 2013 was from a woman called Karis.

She was really nervous.

Just said that she was a care worker

and there was a number of others, as well,

and that she'd blown the whistle.

Karis was upset

by how she'd seen elderly and vulnerable residents treated.

When people beg to go to the toilet

and then they're sitting in their own faeces

and people think it's fine...

This is the care home where she used to work.

The Old Deanery overlooks the Essex countryside.

It's a residential home

which sits alongside St Mary's Court nursing home.

Together they make a 183-bed care village,

set in beautiful gardens.

The brochure says, "Care is at the heart of everything we do."

But during more than two years as a housekeeper at the Old Deanery,

Karis says she saw care workers shout at, goad

and even pull some elderly residents about.

You get the people mocking them, winding them up...

..to being downright abusive, some of the shouting.

What went through your mind when you saw that happening?

It's shocking and really upsetting.

What makes you say those kind of things to people?

Karis and ten other staff put a long list of complaints

about pay, staffing levels and poor care

to their then bosses in August 2012.

Amy, a care assistant, was one of them.

Like the others, she was concerned

about not having enough time to do all that was needed

and people being left soaked in urine.

There were so many residents there.

How was you supposed to do all of them?

And with the amount of carers there were,

it was just physically impossible.

It was horrible.

There was one resident

and there'd be a massive puddle on the floor.

And the amount of times that people used to walk past

and shrug it off.

You wouldn't want to be treated like that,

so why do you treat them like that?

They also complained to the local authority

and the national regulator.

That September,

the Care Quality Commission made an unannounced inspection.

Staff levels at the Old Deanery that day

were described as woefully inadequate by an inspector.

And some residents were waiting too long

for call bells to be answered.

Essex council's safeguarding team

also stopped new residents moving into the home for three months.

It should have been a clear marker that things needed to change.

So did they?

Alex Lee is about to find out.

She will see what the inspectors don't see.

She's going undercover as a care assistant at the Old Deanery.

I am worried and I feel really daunted by it.

I just hope I can do a good job.

I really, really do.

Alex, an experienced journalist, has never worked in care before.

But Panorama arranged training

in addition to the three days mandatory training

the home provided before she started work.

She'll soon discover the pressures

that care assistants face for £7.16 an hour.

ALARM SOUNDS IN THE BACKGROUND

'Doors closing.'

Well, this is my first day.

I'm wearing the cameras at the Old Deanery and

I'm just going up to the first-floor care station to start my shift.

We've got pasta, tuna and cheese.

It's like a bake.

Like a maze!

This 93-bed residential home is one of the largest in the country.

Alex finds she's pitched straight into the job,

with limited guidance.

At first, it's a struggle.

Did you say through the middle?

She wants to go for a wee.

-Whereabouts do I need to take her?

-Um...

'Doors closing.'

Yeah, I'm just finding it slightly chaotic.

Nobody really tells you anything.

Nobody explains what's going on, you know.

It's frustrating to say the least

because the problem is you could make a mistake,

you could probably end up hurting someone.

The home says employees are well-supported.

It has told Panorama there are...

"A large number of staff on duty at any time

"who can provide guidance.

"Detailed care plans exist for every resident."

# Que sera sera!

# Whatever will be will be... #

Which star was the theme song from The Wizard Of Oz?

At the Old Deanery, Alex finds many good things,

like comfortable rooms, a cinema,

hair-dressing and these daily activities.

MAN CROONS

Would you like a cup of tea?

Most residents fund themselves.

Some pay roughly £700 a week.

Yeah!

'I really enjoy spending my time with the residents.

'Experiences they've had, what they've done with their lives.

'They've all had such a rich history

'and they've got so many stories to tell.'

Very good!

But there just never seems to be any time

to sit down and just listen to them.

THEY LAUGH

Alex's job is to help many residents to eat, drink, dress...

Let's get you to the toilet first.

..to clean them and help them wash.

It's also about being sensitive to their needs.

Let me just tuck that down.

That's brilliant.

Many residents only need a little support.

Others need a lot.

ALARM GOES OFF IN BACKGROUND

'Residents that are there just for residential needs have no problem.

'They've got a social life there,'

their food is provided, they can get around.

But there are also a lot of residents there

that have much more complex needs.

Those residents need a lot of skilled help.

And Alex does meet many care workers who are trying their best.

ALARM GOES OFF

But from day one,

Alex hears call bells ringing for a long time.

When a resident presses a button or pressure pad,

their room number flashes.

If no-one answers within six minutes,

the system goes into emergency mode.

The bell sounds so everyone can hear.

I'm just with somebody.

I can't come at the moment, I'm afraid.

Sometimes delays are because

care assistants are busy looking after other people.

'The alarm's going quite often

'cos the problem is there's just so much to do'

that you physically do not have the time

to go and get to all the buzzers that are sounding.

Sometimes staff are doing handovers or writing care notes.

ALARM SOUNDS

Whatever the reason,

there are several hours in most shifts

when Alex notices call bells sounding almost constantly.

ALARM SOUNDS Are you OK?

And some residents are clearly distressed

by how long they have to wait.

This woman was sadly in the final months of her life.

She rang her call bell a lot.

On this day, she called ten times,

twice the home's average.

WEAKLY:

You need the toilet?

Let me turn your buzzer off.

But without help, she couldn't go to the toilet safely.

She fell twice trying to get there on her own.

CRYING:

ALARM SOUNDS

Until a call bell is answered,

there is no way of knowing if the resident is wet, dirty

or more worryingly has had a fall.

Even so, this care worker called Lorna

is saying she put a call bell behind the back of a man

whose movement is so limited he has the button hung around his neck.

LAUGHTER

We can't know if she really moved the bell

but three times she says she did.

Lorna could be joking

but he can't do anything for himself

and that call bell is his lifeline.

The company which runs the home says while a bell does ring audibly

once a resident has waited six minutes...

"It does not at all follow that if a call is answered after six minutes

"there is a failure of care.

"The vast majority of calls are answered within minutes."

Alex also sees the consequences

of people not getting help when they need it.

She regularly sees people sitting in their own mess for lengthy periods.

Often it's the same three or four people.

THE MAN MOANS

'I've lost count of the times I've gone in'

and found people lying in urine-soaked sheets,

that have got pads with poo in

that, you know, they've been sitting in.

'It's stuff like that that I find really frustrating.'

Alex is heading to a resident's room

to move his possessions to a new room.

His serious medical condition means he relies on staff completely

and will need care for the rest of his life.

To respect his privacy, we're not using his voice.

He says he needs someone to clean him.

He's already rung his call bell twice

Two care workers have been in. Both cancelled the bell.

They went without helping him.

It seems that was being left to someone else.

He tells Alex he's been lying in his own faeces for more than an hour.

She cleans him.

Even so, he says it doesn't matter. He's not complaining.

This is one of the care workers, who left without helping him.

She was in the room just minutes before Alex.

Her name is Anita and a year earlier the whistle-blowers complained

she had a bad attitude.

She was later promoted and supervises some staff.

There were a number of care workers the whistle-blowers

complained about in 2012.

But they only made their written complaints after weekend pay

and hours were cut.

The home said that was to bring it in line with other

local care providers.

There was no morale left. You'd been pushed so far.

Pushed to the point where you break or you have to fight back.

And what did fighting back mean in your terms?

It was to stand up and say, "Things are going on and it's not acceptable

"and we can't deal with this."

In 2012, Anglia Retirement Homes Ltd, the company that

runs the Old Deanery, was owned by a local property developer.

He insists it was properly run, delivering good care,

and the behaviour of the complainants during negotiations

showed the dispute was about money, not care.

After a messy argument, six of the care workers were suspended,

including Karis, partly for not raising concerns earlier.

Amy was among three who left.

Just two continued to work at the Old Deanery.

The home says the complaints were investigated, but...

"The allegations were, in the vast majority of cases,

"denied by the accused.

"The incidents were old

"and no verifying evidence could be obtained."

Whatever the motivations behind the dispute, investigations by

the CQC and the local authority that followed

identified problems around staffing, answering calls,

training and the treatment of some residents.

A year later, when Alex is working at the home, there is change

of a different kind.

Anglia Retirement Homes, which runs the Old Deanery and St Mary's Court

next door, is sold to a private equity firm - August Equity.

And it's noticed.

So you say this place is being sold, then?

Yeah? On what?

Oh! LAUGHTER

Providing care for the UK's ageing population is an expanding business.

And it's attracting private investment companies,

like August Equity.

In the last financial report, the two homes made more than £1 million

in trading profits pre-tax.

CALL BELL RINGS

At the Old Deanery, the new owners and new chief executive seem

to be trying to deal with call bells not being answered.

care workers are given pagers, which tell them who's ringing for help.

But Alex doesn't notice much change.

And now she finds some call bells unplugged.

She finds the bells of three different residents

unplugged on five occasions.

The three are known for asking for help a lot.

Alex can't know who left it unplugged,

but she hadn't noticed it happening before.

Call bells for residents are a lifeline.

Without those call bells they're imprisoned.

They have no way of communicating with the outside world.

It could be that there's not enough staff, it could be that the staff

do not appreciate the importance of the call bell to that resident.

Anglia Retirement Homes say they take allegations of call bells

left unplugged or not answered extremely seriously.

They continue...

"Frequent audits of the call bell log are carried out

"and any such incidents are examined and investigated."

But Alex is also seeing the sort of rough treatment of some residents

the whistle-blowers complained about more than a year before.

Here, Lorna, the care worker we saw earlier,

has showered this elderly lady.

She appears to be rushing to dress her.

Pulling on her nightie whilst she's still wet.

The resident's not impressed.

And another lady is clearly upset by how she's treated

by a different care worker.

She's already made it clear who she's talking about.

She's talking about Anita.

The care worker who earlier walked away from a man

who needed to be cleaned.

Separately, Alex sees some residents, like this woman,

with large bruises.

Older people can bruise easily,

so it doesn't necessarily mean anything sinister.

But this should be recorded on a body map, to keep a check

on what may be happening. It isn't.

Another lady is clear in her own mind how she got her bruises.

We can't know how they were caused or why they weren't documented,

but with an incomplete record, there's no way to keep a check

on what's going on.

Over 36 shifts with cameras, Alex saw at least seven large bruises.

Only two were recorded.

What I've been shown in the training that I've been given

is that with old people, you do it like that.

Paws not claws. So why has she got almost like a grab mark?

During her time at the home, as well as worries over how people

are handled, Alex sees some care workers who mock

and goad residents.

The sort of behaviour the whistle-blowers

warned about a year before.

Remember Lorna, who gestured she'd taken a call bell away from one

resident and was rough with another.

The man she's lifting in a hoist swears at some staff,

usually when he's agitated.

He seems better when people explain what's happening.

Here his private parts are being washed,

but Lorna gives him no warning.

This is really intimate care

and the way it's done here clearly upsets him.

Then Lorna has her say.

KNOCKING

The test of any home and its staff is how

they look after residents with the most complex needs.

People like Joan Maddison.

Alex is told she is one of the Old Deanery's

more challenging residents.

I didn't quite know what to make out in terms of the personality

and how they treat this woman. Cos I see this lady, you know,

and she's very quiet going around the care home in her electric wheelchair.

I think he's been naughty, don't you?

-No, never naughty.

-Don't you?

Joan's brought up five children, including her daughter Gill.

That's Mum at about 15. That's her at 17. Beautiful.

-She is stunning.

-They're how I think of my mum.

I'm very aware of how different she is these days.

She also looked after others as a social worker.

But now she has early-stage dementia

and is paralysed down her right side from a stroke in her 50s.

She's got this fierce independence.

She thinks she still gets herself up and gets herself washed

and gets herself dressed.

She cannot do any of those things, though in her mind she thinks

she still can.

In the behaviour notes written by staff,

Joan is often described as aggressive.

She can lash out if frustrated, and Gill has been increasingly worried.

There are definitely ways of dealing with her where she's a pussycat,

and ways of doing it wrong and all hell breaks loose.

I'd had the home ring me to say they'd been experiencing problems

with Mum being very difficult, quite obstructive with her care

and kicking out and hurting staff.

And I said, "Well, that's very unlike my mum."

She can kick off, but it's usually when she's been hurt

and I'm saying you need to look at the reasons why.

It was Lorna who first took Alex in to help with Joan's morning care.

Joan needs to be washed and dressed.

Lorna is physically restraining Joan and asks Alex to help.

Lorna should be defusing the situation.

Instead she's winding Joan up.

Alex doesn't know what to think.

Lorna asked me to hold her arms or her hands

to stop her from hurting her.

I didn't feel very comfortable doing it.

I think because Lorna was taunting her almost, reciprocating

the insults that she was throwing at her, it was just escalating things.

We asked consultant nurse Lynne Phair to review Joan's care.

They didn't talk to this lady, they didn't tell her what was going on,

they didn't anticipate what her problems were,

and all that lady's got is to resist what they're doing to her.

The home told Panorama...

"These incidents involved a small number of staff

"and are not reflective of the high standards of care

"which we expect and demand from all of our team."

But increasingly, staff need the skills to cope with residents

who can no longer explain what's wrong.

On 28 mornings, our unattended camera in Joan's room

shows how care assistants start her day.

Joan's paralysed right side is painful.

But on too many days, she's pulled roughly and she reacts.

Joan's a determined woman who's overcome disability,

but she's treated like a child.

Treated spitefully.

Her knuckles rapped.

She's told she smells.

Joan can be difficult, but this shouldn't be happening.

Hello. Nice to meet you, Gill.

After reviewing Joan's care, consultant nurse Lynne Phair

is meeting her daughter Gill.

She says the home should've been asking questions

about the reactions different care workers get.

The organisation have not been looking at the evidence that they've

actually got. The evidence would be there.

I say there's obviously something going on because of when she

expresses her dissatisfaction through aggression. At what times

and who were the care staff that were involved?

And there is a clear difference in the way Joan behaves

when she's with care assistants who show more understanding.

As requested in the family's care plan detailing her needs,

they involve her...

..chat to her...

..and she is much more relaxed.

But with Lorna and Anita the battle with Joan is predictable.

Lorna throws the bag strap at Joan's head...

..and she's left to struggle on her own.

We needed to show Gill what the secret camera had picked up.

It's an insight into what can happen when she's not there.

I've had inklings, gut feelings. I'm bitterly disappointed.

I spent two years with my sister looking for somewhere for Mum to go.

I've let her go there and have that happen to her.

This type of abuse is very insidious.

This is hidden, this is like psychological domestic abuse.

Panorama hasn't shown the undercover film to the Old Deanery,

but has provided it with details.

It says...

"We are shocked and saddened by allegations made by

"the BBC's Panorama programme of inappropriate behaviour

"by some staff at the Old Deanery Care Home

"and apologise unreservedly for the failings.

"We care passionately about our residents

"and will not tolerate this kind of behaviour."

Last November, CQC inspectors gave the Old Deanery Residential Home

a clean bill of health for the first time in 18 months.

But 11 days later, Alex is on shift.

She sees the senior care worker, Anita, with another assistant

about to get Joan up.

I needed the hoist so I went to look for it in Joan Maddison's room.

The hoist was in there and Anita and another care assistant were trying

to get her ready.

I could tell there was a lot of aggression in the room at that stage

and I couldn't stay, so I decided to leave a secret camera in the room

before I left.

Anita seems increasingly exasperated by Joan as they start to dress her.

And Joan appears to have scratched her.

The situation is escalating.

She threatens Joan.

Then Anita does this.

She slaps Joan.

Did she just slap her? Can I see that bit again?

She did. I mean, that's assault.

She's just assaulted that lady, but who would believe Joan?

Because Joan is labelled, by everybody that I've seen so far,

as someone who's aggressive, she's nasty, she's an alley cat.

I feel like I've let her down, I've let everybody down that trusted me.

I begged, I pleaded, I fought like a tiger to get the funding

to get her in there.

The care home says that Anita...

"Has been summarily dismissed

"and other disciplinary proceedings will be completed shortly

"after the Panorama broadcast."

The home told Panorama as soon as they were informed of our evidence

they took immediate action.

They suspended eight staff and...

"Hired an independent law firm to carry out a full investigation.

"Our priority remains the health and well-being of our residents

"and we have more than 200 dedicated members of staff

"who remain committed to the highest standards of care."

Gill visits her mother at the Old Deanery several times a week.

If things aren't going to change,

I'll have to look for somewhere else for her.

Where will my mum end up?

But the Old Deanery is her mother's home.

There's an element of hope, because I have to have hope.

I don't want to move her, Alison.

I believe that they could change things.

They've got some amazing staff that need good, strong leadership.

It isn't adjustment needed, it's fundamental change.

The Old Deanery emphasises the good care it provides.

Its new owners say they've increased the number of senior staff

on shift and introduced an independent whistle-blowing service.

The home told Panorama it's...

"Very concerned that any broadcast of what is likely to be

"highly-emotive material will give a wholly false view of the home."

And they told us to consider...

"The many positive views that have been expressed about the home."

However, two months ago, after we informed it of our findings,

the CQC carried out an early-morning inspection.

This time it found too few staff.

And some residents waiting too long for call bells to be answered.

They discovered one person "crying and distressed" because

they couldn't find a care worker to help them to the toilet.

In less than two years, the CQC has visited the home six times.

We have inspected the Old Deanery, we have identified concerns that

we've had, we've issued a warning notice.

They improve but then they fall back on other areas,

and particularly because of the issues around staffing,

that's where you get the problems.

The CQC gets eight serious legal challenges a week

from places unhappy with inspection reports.

It finds some homes seem to resist change.

But it's introducing ratings to make it clear which homes are doing well.

And new legislation will mean company directors could be

prosecuted for failings in care.

But as Alex finishes her time at the Old Deanery,

she knows inspectors won't see all that happens in homes.

I've just come off my last night shift at the Old Deanery.

I'm absolutely shattered, if I'm honest.

What these residents are getting is just the basic level of care,

and sometimes even that's not happening

and it's just not good enough.

For too many people like Joan, we aren't getting the basics right.

So what will it take to change that?

At the Department of Health, the minister with responsibility

for care in England agrees there's a problem.

There's a stubborn minority of care providers who do not meet

acceptable standards and those are the ones that we have to tackle.

We have to send out the message that there should be no place

in our care services for providers of that sort.

With pressure on funding and growing need,

he accepts change will take more than fine words.

This has to be a big collaboration between Government,

the regulators, local authorities and providers.

I think collectively we can drive up standards and ensure that

our loved ones get access to the best possible care that's available.

The families who've experienced poor care say that means all homes

need to measure up to the best.

For Lesley Lincoln that's the only way to protect others

from the neglect her mother suffered at Orchid View.

As a society we need to say, "This has got to stop."

All the basics are basics.

You shouldn't have to be complaining about that sort of thing.

It should be top-notch.

And each time the cries of someone like Yvonne Grant go unheeded,

the question for us all is,

do we have the will to stop this happening?