Residents at Covid-hit Midlothian nursing home experienced 'unnecessary harm and suffering’ due to 'neglect' of health needs
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The Care Inspectorate deemed Thornlea Nursing Home in Loanhead to be ‘unsatisfactory’ - the worst rating on a six point scale - in all areas of inspection to evaluate how well people were being supported during the pandemic.
A total of 15 people with Covid-19 died at the home, which had its registration suspended a few days after the inspection on December 14. Operator Thornlea Nursing Homes Ltd has since gone into liquidation and the nursing home has been permanently closed.
Thornlea is one of at least 474 care homes in Scotland being investigated by a Crown Office unit set up to probe Covid-linked deaths in care homes.
The Care Inspectorate report, published this week, said people’s health and welfare at the nursing home was “not being appropriately supported or safeguarded.”
It said: “We were very concerned that people who were unwell and nearing the end of their life were not being given appropriate palliative care. The nurses had not ensured that end of life medication to help people stay comfortable was available.”
Inspectors said there were failures to undertake essential observations including temperature checks, pulse rates and oxygen saturation checks, and that medication was not being reviewed and the need for end of life care not being recognised.
The report also said people’s oral health was not being monitored - essential for comfort when eating and drinking.
It added: “We concluded that people were at significant risk of harm due to the failure of staff to manage and care and support appropriately.”
Inspectors also identified “very serious concerns” with infection prevention and control practices at Thornlea.
Although they noted adequate and correct PPE supplies, they said it was incorrectly stored beside cleaning equipment and products that were in use - and PPE was also found on a trolley with an open bag of clinical waste attached, risking further spread of infection.
Inspectors said they did not see staff cleaning their hands after each episode of care or after removing PPE.
Clinical waste was also seen in overflowing waste bins that were not locked, and bags of waste were seen on a path next to the main building. Clinical waste bags were also seen being stored in a bath in a room which was not secure.
The report said: “This showed a fundamental lack of knowledge and practice in the management of clinical waste and presented a serious risk to people’s health.
“People should experience an environment which is well looked after with a clean, tidy, and well maintained premises, furnishings, and equipment. The lack of an effective cleaning regime and not using the right cleaning products increased the risk of infection spreading.
“The service had not implemented the enhanced Covid-19 cleaning guidance and therefore the environment presented a serious risk to people.”
Nurse competency concerns
Inspectors found “significant concerns” with the competency of the home’s nursing staff, particularly with failures to recognise when people were becoming unwell or dying and not reacting quickly enough to manage pain or symptoms.
The report cited one example that it was not until a local Health and Social Care Partnership palliative care nurse was on site that sufficient end of life medication was ordered.
A number of staff were also self-isolating after positive Covid-19 results, and inspectors said employees told them some had returned afterwards and were struggling with fatigue. They were also told there had been unsuccessful attempts to source staff from agencies and that this revealed no staffing contingency plan to deal with an outbreak in the team.
Their report said management support for the staff team was lacking which had a “very negative impact” on residents’ care and support, essential during an emergency event like an outbreak of Covid-19.
The report said: “Extremely poor support and communication given to the staff team had resulted in care practices that did not always follow the relevant guidance and best practice.
“This had resulted in people experiencing unnecessary harm and suffering due to their health needs being neglected, including at the end of life.”
Thornlea Nursing Home closed on January 18 after its remaining residents had been moved to alternative accommodation by Midlothian Health and Social Care Partnership.
The privately run home had its registration suspended at Edinburgh Sheriff Court after the Care Inspectorate applied for its removal.
At a court hearing in December, it was revealed that 15 of the home’s 29 residents, some of whom had dementia, had died following an outbreak of the virus.