A resident of an Aberdeenshire care home managed to slip out – twice – due to staff failing to recognise and address risks, inspectors have said.
The Care Inspectorate made an unannounced visit to Westbank Care Home in Oldmeldrum last month and have now raised “significant concerns” about resident safety and the cleanliness of the facility.
They rated the service weak, noting that the responses and recordings of falls were “ineffective”.
They also reported a “lack of ownership of responsibility” on recording incidents after being told by staff “that’s not my job”.
Inspectors described the home as “worn” and “dirty” and raised concern about its infection control standards.
A letter of serious concern has now been issued.
Failure to recognise risks – and learn from them
Run by Aberdeenshire Council, the Oldmeldrum care home in Lower Cowgate housed 22 residents at the time of the inspection.
Inspectors were unimpressed by staff failing to identify risks was noted throughout the report.
They state: “There was no learning from adverse events. These were events that had the potential to put the person at risk of harm to their health and safety.
“For example, one person left the home unsupported and this was unsafe for them to do this. Due to a lack of follow-up and learning, this incident re-occurred.”
Several residents also fell due to beds being too low on the floor.
The report goes on: “The failure to identify this risk and cause of some of the falls, meant that some people continued to fall when rising from their bed.
“There were inconsistencies in the recording of falls in the home.
“Where risk factors had been identified, this did not necessarily inform any change.”
The team also noted staff often failed to understand, recognise and reduce distress or “act appropriately” when people’s health worsened.
Unexplained bruising was not properly investigated and one resident had increased pain levels and reduced mobility for several days before medical help was sought.
Letter of serious concern issued over cleanliness
Some residents were seen to need more support with personal care from staff after one resident had “several days growth of facial hair” and a woman had “a lack of suitable underwear on”.
“Visibly dirty” areas of the home were also noted- prompting inspectors to issue a letter of serious concern.
The report stated: “This required the service to take immediate action to clean heavily contaminated shower traps.
“This increased the risk of cross contamination and did not demonstrate respectful or compassionate care.
“The condition of some furnishings was worn. This made it difficult to keep clean and it was also unsightly.
“We identified significant concerns with the leadership and management of the home and felt that this was a contributing factor in some poor outcomes and a failure in responding to failings.”
‘Not quite where we would like to be but we are well on the way’
A spokesman for the Aberdeenshire Health and Social Care Partnership, said staff have since been taking part in training and the service handyman has been working on improvements.
They said: “The team at Westbank has been working incredibly hard, with the support of our senior team, to turn things around and ensure that residents at Westbank live the best and most fulfilled lives.
“We have come a long way since the initial inspection and have already completed many actions against the concerns raised.
“We are not quite where we would like to be but we are well on the way and look forward to the return inspection so that we can demonstrate how far we have come.”
Conversation