Records were error-ridden No specialist training for staff

RESIDENTS IGNORED Staff had become “desensitised” to residents’ calls for help, walking past rooms where people had been shouting for some time without offering words of comfort.

Some residents receiving palliative care called out for attention during the inspection but there were no staff within hearing distance.

On several occasions inspectors went to see people because there were no staff available. One person said they were sometimes left waiting for pain relief because staff were busy.

Another said: “I can wait and wait and sometimes be very uncomfortable, but they don’t come or say they’ll be back in a minute and never come back”.

FOOD ERRORS One person was served a cheese salad at lunchtime, but when inspectors visited them at 2.30pm they were asleep and the meal remained uneaten. The person’s food chart was later documented to say they had been served roast turkey and vegetables at 12.30pm and that all the meal had been eaten.

A full bowl of cereal was removed from another person’s room after breakfast as they were asleep. Their food chart the following day showed “Cornflakes 100% eaten”.

NO TRAINING None of the staff had received training in specialist subjects such as diabetes, end-of-life care, wound care or nutrition.

The inspection found that a lack of specific training in these areas affected the quality and safety of the care.

During one lunchtime staff discovered the blood sugar levels of a diabetic resident were high. With staff not planning to run another test until 4.30pm, inspectors were forced to step in to avoid an emergency situation. Staff did not know to take their temperature to check for signs of infection or to encourage drinking more when blood sugar levels are high. TOILET BREAKS Residents were repeatedly heard asking to go to the toilet, with many waiting for at least 20 minutes and one more than halfan-hour. One relative told inspectors: “Mum and other residents have to wait to go to the toilet, and that happens a lot. My main concern is about mum’s incontinence. Sometimes she smells of urine”. Another relative said staff could sometimes be “dismissive” of people who asked to be taken to the toilet, prioritising other tasks.