A care home in Oxford left one resident in pain and others were poorly-monitored, inspectors have found.

The Brookfield Christian Care Home failed in seven essential areas, a Care Quality Commission (CQC) report shows.

Bosses at the Southern Cross-owned home now have 14 days to improve service at the home ahead of further inspection.

"A number of improvements in care provision and changes to management have been made at the home," a spokesman for the home said.

CQC inspectors visited the home in Greater Leys in December 2010 and again in January this year.

As well as the resident being left in pain because they had not been given their medication, inspectors found that the well-being and nutrition of other residents had been inadequately monitored.

Of the seven areas of failings inspectors identified, four caused "major concerns" which were:

• Care and welfare of people who use their services
• Meeting nutritional needs
• Management of medicines

Inspectors also had concerns in the following areas:

• Respecting and involving people who use their services
• Safeguarding people who use services from abuse
• Supporting staff
• Assessing and monitoring the quality of service provision

In the most serious cases the CQC said it could suspend or cancel a service, but this is regarded as a last resort.

However, a spokesman said: "The right outcome is if we highlight failings in standards and then they are quickly rectified to improve conditions for the residents living in the home."

All practices will be expected to register with the watchdog from April 2012. Unless the fee is paid directly by the Treasury, the GPC plans to submit evidence to the Doctors' and Dentists' Review Body calling for funding to cover it.

Dentists were obliged to register from April this year, and pay a £1,000 annual fee.

The rate for GPs is expected to be similar.

Although dentists pay the fee directly, the GPC has argued that dentists can raise additional income in ways that GPs cannot. GPC chairman Dr Laurence Buckman described the registration cost as 'a tax on doctors'.

The CQC system, which requires GPs to meet essential standards of quality and safety, was recently trialled by NHS Derbyshire across 21 practices.

Derbyshire LMC secretary Dr John Grenville said a key problem faced by the pilot practices was limited time to prepare. 'When it becomes real, practices will be given a fortnight,' he said.

He urged practices to prepare for registration in advance and ensure that their practice managers were not away.

Practices should be aware that they 'don't have to present all evidence at time of registration', Dr Grenville said.

Once practices have made a 'self-declaration' the CQC may look into and discuss any plans.

Practices should have a written protocol to prove they are doing what they have claimed, he said.

Dr Grenville predicted GPs would have to pay a registration fee similar to the price for dentists, around £1,000.

Practices operating from more than one site can avoid additional registration fees by appointing a 'single officer' with legal responsibility for their registration, he said.

A CQC spokesman said that it would be holding a consultation over the summer to decide on how registration fees should be paid. The GPC plans to issue a CQC registration toolkit in late May.

News of the looming deadline came as the British Dental Association, whose members were registered last week, a year ahead of GPs, warned the process had been ‘shambolic’ and ‘lurched from one crisis to another’. It said it had ‘serious concerns over what our medical colleagues could be subjected to’.

Practices will start submitting evidence online in October this year, with a December deadline to demonstrate compliance in areas as diverse as equipment safety, record keeping and management structure, in order to be registered with the CQC from 1 April, 2012.

GPs will be required to adhere to CQC outcome standards already applied in other areas of health and social care, including respecting and involving people who use services, co-operating with other providers, safeguarding people who use services from abuse, medicines management and safety of premises (see box).

The CQC is still to consult on the thorny issue of GP registration fees – reduced from £1,500 to £800 per surgery for dentists following widespread revolt – but told Pulse it was likely to continue the policy it has adopted with hospitals and care homes of asking providers to register per location.

A spokesperson said: ‘We register care homes as individual instances of care. Even if a provider has two or three, it’s the locations that are registered. I would be very surprised if we broke from the model we’ve done for everyone else.’

But the spokesperson insisted the regulator would be flexible when setting fees, adding: ‘We will listen to the industry and we are flexible.’

The spokesperson said GPs would have to adhere to ‘a common set of standards’ already applied to hospitals and dental practices, also encompassing areas such as complaints handling, infection control and managerial issues such as ensuring all staff have had criminal record checks.

Three care homes in Exeter are not meeting quality and safety standards, a health watchdog has said.

The Care Quality Commission (CQC) told Devon County Council it was concerned about Alphin House, Arthur Roberts House and  Exebank Care Home.

The watchdog said delays in treatment could be putting people's health at risk while some practices undermined patient's dignity.

The council said it accepted there were problems and was working to fix them.

The residential homes cater for older people with a range of needs, including dementia and mental illness.

The CQC said that its inspectors, who visited the premises earlier in the year, found that not all staff showed residents respect.

Inadequate record keeping, staff arrangements and training for staff were also highlighted as concerns.

The council said that there could be no excuses and that it recognised the shortfalls, having identified many of them itself prior to inspections.

It said it had been in the early stages of putting new structures in place during the inspections.

Devon County Council said it accepted the inspectors' reports and analysis of the services.

Malcolm Vede, assistant director for adult and community services, said the council was "determined to do better" for residents.

It added: "We have agreed robust improvement plans for each home with CQC, and we will be commissioning our own independent forensic inspection of the homes in the near future to make sure we're getting it right."

As the standard is to have 19 during the 12 months up to the end of March, they are set to be over the annual figure too.

Ms Dailly said they were likely to fail or underachieve that indicator, which is set locally.

Only one MRSA case is allowed per month so it is likely the fine, which is levied by health service commissioning body NHS Leeds, will be even higher.

Hospitals trust non-executive director Mark Abrahams told a meeting of directors: “It’s a bit of a warning sign – take your eye off the ball for a very short period of time and something bad happens.”

The organisation, which has an annual budget of nearly £1bn, had previously been threatened with multi-million pound penalties for failing to cut superbug numbers.

For years it consistently missed national targets on MRSA and Clostridium difficile (C.diff). In the past there have been hundreds of MRSA cases every year.

That problem was successfully tackled and cases have fallen dramatically as the issue was made a top priority by managers.

MRSA screening has been introduced for all acute patients and an analysis of the cause of each infection is done. Any lessons learned are passed on to all hospital staff.

However out of six similarly sized hospital trusts, Leeds still has the highest rate of MRSA infection compared to the number of overnight beds it has.

In 2009 the YEP revealed that the hospitals trust faced a penalty of up to £20m over its superbug problem.

That money would not be taken away from funding but would have to be spent on tackling MRSA and C.diff.

Currently Leeds hospitals are on course to meet their aim over the number of C.diff cases, with 200 reported in the financial year-to-January, compared to a target of 200.

Unannounced visits were made to Hazelhurst, where up to 10 people stay, on 16 and 30 December last year, after the commission was "alerted of serious concerns by Bristol City Council and South Gloucestershire Council".

It was found the home was failing to meet six essential standards.

Findings detailed in a report published on Monday included that staff were not adequately trained to prevent abuse, or to respond appropriately when it is suspected.

It was also found that the home was dirty, having not had a cleaner for two years.

The report said care staff were expected to clean, which mean they could not support residents.

The report said St David's Lodge was a care home for 11 people with learning disabilities, and 10 are aged over 50.

Unannounced visits were made to St David's Lodge on 7, 8 and 30 December last year.

The report said it was failing to meet 10 standards.

Its findings included noting that "people cannot be assured that they have their privacy, dignity and independence respected".

It also found proper steps to ensure all residents were "protected against the risks of receiving care that is inappropriate or unsafe" were not taken.

The CQC spokesman said Clive and Hazel Pryce-Jones, the registered providers of both homes, were required to "take immediate action to protect residents of St David's Lodge from the cold".

At Hazelhurst, inspectors said they must take immediate action to ensure that there were enough staff.

Both homes have been in the hands of administrators since January.

The spokesman said both have stopped taking new residents and have produced plans to comply with the regulations.

Under new plans published by the Department of Health, which have been backed by the RCGP, the NHS Alliance, the NAPC and the Family Doctor Association, consortia will be expected to run regular reviews of the quality of services offered by every practice in their organisation

Consortia will use local league tables to monitor practice performance in areas such as referrals and take on whole chunks of contract management, including clinical governance and clinical audit to ensure ‘continuous improvement’. They will have a duty to ‘identify poor performance’ and call in the NHS Commissioning Board, the GMC or the Care Quality Commission to investigate or order remedial action.

Consortia boards will also be put in charge of tens of millions of pounds of enhanced services funding for practices, as for the first time some GPs take control over their colleagues’ income.

GPC negotiator Beth McCarron-Nash said: 'This is the first time someone else will have control over your pay. It will be other GPs but I don't think that will make it easier. In some ways it may make it harder.’

GPC deputy chair Dr Richard Vautrey said negotiators had pushed the Government to give consortia powers over enhanced services.

'The trouble in the past has been that despite the plans for services coming out of hospital there has been no extra funding for the services in primary care. This gives consortia the power to direct that money,’ he said.

But he admitted the move could effectively force consortia to divert the funding to private providers.

'The Government's has any willing provider as a key part of its policy and this could lead to private firms being awarded enhanced services because they are offering the cheapest price. What you could end up with is a very fragmented service.'

Dr Kambiz Boomla, chair of City and Hackney LMC, said: ‘The problem with devolving performance management to consortia is that when patients demonstrate against the cuts, they are going to be demonstrating outside GP practices. It takes responsibility away from the Government who were happy to take the credit in the period of growth.’