A care home in Ellon has admitted that its response to a “serious” choking incident “could have been better” after staff failed to report the incident.
Auchtercrag House, located on Commercial Road, received an unannounced visit just days before Christmas, following concerns raised during an earlier inspection in November.
The Care Inspectorate has visited the home multiple times this year, with concerns identified during each visit.
In the most recent inspection on December 16, inspectors found that three of the seven requirements set for Auchtercrag had not been met.
The report also highlighted weak ratings for both the staff team and the support provided for residents’ well-being.
Serious incident at Ellon care home goes unreported
The inspectors highlighted an incident where proper practice was not taken after someone choked and needed medical intervention at Auchtercrag.
“A serious incident had occurred in the service. One person had choked and required medical intervention,” they said.
“The incident report had been signed off as no further action and not reportable to relevant agencies.
“It is important that a review of the event, the care plan and risk assessment takes place to ensure that managers can assess lessons learnt.
“This would help reduce the same thing happening again.”
Auchtercrag staffing given ‘weak’ rating
Staffing was also given a rating of two out of six, or ‘weak’.
The inspectors said that in certain instances staff were not available, meaning high-risk residents had periods without support.
The report reads: “This increased the risk of them mobilising without the necessary support and increased the risk of them falling.
“When staffing numbers were lower there was an increase of people falling.”
Several concerns about patients’ well-being were also raised, including the way people were dressed and their ‘access to fluids’.
The inspectors said: “Some people needed better support to help with their standards of dressing.
“One person’s dignity was impacted upon due to being inappropriately dressed.
“Some people had t-shirt style tops on and we felt more consideration should have been taken to their warmth and comfort.
“People’s access to fluids was variable. In some areas, people did not have access to drinks. This increased the risks of not being hydrated.”
Concerns over medication management
Medication management was also highlighted as an area in need of improvement.
“Staff had completed medication training, however there had been errors with people’s medications,” the inspection report said.
“This meant that the skills and knowledge of staff had not been fully implemented into staff’s medication practices.
“A review of one person’s prescribed medication was planned. However, their care notes lacked the information on clinical need.
“This meant that the decisions made by the practitioner when reviewing the medications would not be informed by need.”
Auchtercrag respond to report
A spokesperson for Auchtercrag Care Home said they wanted to “strongly reassure” relatives and friends of resident’s “safety, comfort and wellbeing”.
“We are working alongside the Health & Social Care Partnership and local multi-disciplinary partners to ensure we deliver positive outcomes for our service users and that the areas of concern are being addressed,” they said.
“We are confident that we have made good progress and are keeping in regular contact with friends and relatives of the home.
“As mentioned in the report, we have recently strengthened our management team, and we’re focused on making improvements and improving outcomes.
“We monitor our staffing levels very closely and have ensured at all times that our staffing is adequate to meet the needs of our residents.
“With regards to the serious incident referenced in the report, we recognise that our documenting and external reporting of this could have been better – and this has been addressed.
“However, there was no question over the quality of care provided at the time. The situation was fully dealt with by the team, with no harm to the resident.
“We can strongly reassure the relatives and friends of our residents that their safety, comfort and wellbeing is always our top priority, and we continue to focus on ensuring everyone at Auchtercrag receives the highest standards of personalised, quality care and support.”
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