Scandal of the ‘let me die’ note at Halifax care home

Birks 7 4 AB Birkshall Mews Nursing Home, Pellon Lane, Halifax. -wbrkab1-3-
Birks 7 4 AB Birkshall Mews Nursing Home, Pellon Lane, Halifax. -wbrkab1-3-

STAFF at a Halifax care home would have left a resident to die – because an out-of-date document saying “do not resuscitate” was left on the patient’s file.

The shocking blunder was uncovered when inspectors visited Birkshall Mews, the dementia nursing unit at Pellon Care Centre, Halifax.

Care watchdogs had been alerted after concerns over care and staffing. Inspectors from the Care Quality Commission discovered patients’ care plans were up to three years out of date.

In one resident’s notes, they found the “do not resuscitate” document, which had been brought with the person from hospital.

Such a note from a hospital is not active in a care home, unless the decision has been reviewed with the patient’s GP and family.

The inspectors said: “When we showed it to the nurse she said she would not perform resuscitation on this person.

“She hadn’t noticed the DNR document was invalid.

“This means resuscitation may not be given when required.”

Since the inspection, Calderdale Council has suspended sending residents to Birkshall Mews.

In their report, inspectors also told of major concerns with cleanliness, including faeces smeared over furniture.

In May 2010, Pellon care’s weekly charges ranged from £392 to £590. Hairdressing, chiropody and newspapers were extra.

The inspectors’ review states a “strong smell of stale urine” and “faeces smeared over furniture, grab rails, doors, walls, door frames, toiletries and light switches” in two of the bedrooms.

It went on: “In the shower room, the shower curtain had faeces on it, the shower chair was dirty.”

“We saw beds made with dirty pillowcases and sheets, a dirty mattress and a dirty headboard.”

Only one bedrooms had a bar of soap – and that was unused.

Inspectors found clothes crumpled at the bottom of wardrobes and drawers crammed with clothing.

Rotas showed that sometimes only one nurse was available to cover both floors – a total of 26 people.

Pellon Care Centre includes Brackenbed View and Pellon Manor.

The centre has been the subject of scandal in the past after the deaths of Gladys Broadbent, 73, and Stephanie Crowther, 75.

Gladys suffered a black eye, bruising, lacerations and bedsores after a two-week stay at the home.

In 2008, council inspectors told Brackenbed View to take action after upholding complaints on the lack of care given to stroke victim Stephanie, 75, who spent 10 days at the home before she died.

Birkshall Mews is owned by Four Seasons Homes, which is in crisis talks with new investors after racking up massive debts.

A spokeswoman said: “We deeply regret the quality of care at Pellon Care Centre fell a long way short of the standards we usually deliver.”

She said an experienced manager had now been brought in, supported by the regional manager, to oversee improvements and staffing levels had increased.

She added: “We have tightened up procedures and documentation, including closer involvement of relatives in care plans.

“We have undertaken refresher training for staff, particularly in infection control.”

She said there would be investment in facilities and decor and spot checks by senior management.”

She went on: “We believe there has been substantial improvement since the inspection in March, but we will continue to work to ensure Pellon provides the excellent standards of care we expect of our homes.”

The Care Quality Commission will monitor the centre and if improvements are not made they may take enforcement action.