Inspection observations within first three months of Miss Teal's admission

While inspecting in the specialist unit for people with dementia, which is locked, I observe Miss Teal, a well dressed healthy looking lady, leaving on four occasions through alarmed fire escapes. The first three times she is escorted back despite her firm protests that she did not wish to return. The fourth time she becomes very distressed and shouts for help, that she is being held against her will, she becomes aggressive and tells them she'll call the police. Staff respond by giving "as required" sedation. Miss Teal sleeps and misses morning coffee and lunch.

I check care plans and daily notes. It is clear that Miss Teal regularly leaves the unit via fire doors and often becomes distressed, crying and shouting out when escorted back. I check "as required" sedation which is regularly used each day. I ask staff about her care needs and I am shocked at what they say...

"She nearly killed someone you know. She's completely demented. Take her for a walk!? No point, she'd forget within five minutes and want to go again, her memory is like a goldfish's you know."

Inspection observations within six months of Miss Teal's admission

She's looking frailer now, her clothes are crushed and hair is lank. She's sitting dozing in a chair. I chat with her and she engages, she was a piano teacher and she loves classical music (Radio 1 is playing in the background). She used to walk every day, enjoy lunch out, and she doesn't like this hotel. The food is poor, service terrible and there's nothing to do. She's going to leave and find a better hotel when she can find the energy.

I check care plans and daily notes. They do not reflect any of what she has told me. She is reported as "settled", "slept well" ... she's fitting in with the unit's routine.

I check "as required" sedation. It's now used around two times a week when she tries to leave and gets distressed. I ask staff about her care needs and I am shocked at what they say...

"She nearly killed someone you know. She's completely demented. Take her to play the grand piano in the other unit? No, she needs to be in this specialist dementia care unit, she can't go out you know."

Inspection observations within fifteen months of Miss Teal's admission

I don't recognise her. She is slumped in a chair. She has significant weight loss. She has a black eye. I sit beside her and touch her hand. She opens her eyes and looks through me. I smile and ask her how she is. Her teeth fall forward as she tries to reply. I check care plans and daily notes. They note her weight loss, (encourage fluids and good diet), her continence difficulties (ensure pads applied), and her falls (she needs help of one person to walk).

I check "as required" sedation which is now rarely used. I ask staff about her care needs and I am shocked at what they say...

"She nearly killed someone you know. She's completely demented. Can she move to the other unit? Well, she's really settled here now you know."