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Complaints received by the nursing home

The Commission has been notified of many complaints made to the nursing home by
the families of former residents. However, whereas the Commission understands that
it has been provided with details of all complaints made to the Health Board / HSE, in
the case of complaints to the nursing home the Commission has information only
from those families who came forward voluntarily to give evidence. Less than one in
five families of former Leas Cross residents provided the Commission with
information, so any statistics derived from this information are of limited value.

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See chapter 15.

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The complaints of which the Commission is aware were made in a variety of formats.
In a minority of cases, written complaints were made to the matron or the proprietor.
However, most of the complaints were made orally. In some cases, the complainants
sought out the matron to lodge their complaints at managerial level. In other cases,
complaints were made to nurses or care workers and it is impossible to know for
certain whether those complaints were passed on to the matron or the proprietor. For
all these reasons, and in the absence of a comprehensive written record of complaints
to the home, it is impossible to state with any accuracy how many complaints were
made during the seven years Leas Cross was in operation.

Complaints in writing

The documents disclosed to the Commission by the owners of Leas Cross Nursing
Home contain two letters of complaint written by the families of residents in 2004.
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The first, dated the 8 January 2004, is addressed to the matron, Grainne Conway and
concerns the removal of sweets and biscuits from a resident’s locker, and the apparent
disappearance of clothes belonging to the resident. It is not clear whether this letter
received a response.
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The second letter, dated the 11 November 2004, is addressed to Mr John Aherne,
and contains a complaint about the designated smoking room for residents at the
home, which the author of the letter considered to be poorly situated and badly
ventilated. A handwritten note on the face of the letter indicates that Mr Aherne
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telephoned the author of the letter on the 17 November and informed him that Leas
Cross was “looking into the situation”.

From information provided by the families of residents, the Commission is aware of a


further five written complaints to Leas Cross made while the residents in question
were in the home and prior to the Prime Time documentary. Only one of those letters
yielded a substantive written response, while another resulted in a meeting with the
proprietor at which the complaint was resolved. The letters are not amongst the
documents disclosed to the Commission by the owners of Leas Cross Nursing Home.
The substance of these letters is summarised below, according to the resident to whom
they relate.

Kathleen Reilly

Ms Reilly, who suffered from Alzheimer’s disease, was admitted to Leas Cross in
July 1999. In September 2000, members of her family found her wandering around
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the area in Swords where she used to live. On the 6 September her niece wrote a
letter of complaint to the owner of Leas Cross in relation to the incident.
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The letter of complaint was replied to by the matron Grainne Conway on the 11
September. The matron expressed regret on behalf of the nursing home for the
incident and explained that that the transport section of the Eastern Health Board had
sent a taxi instead of an ambulance to take Ms Reilly to Beaumont, and asked the taxi
driver to bring her to the x-ray department. They informed him that her details were in
an envelope in the resident’s pocket. When Ms Reilly left Beaumont, she was brought

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to the taxi by a porter, but on hearing the price of the taxi, she told the porter that she
would take the bus. The letter concluded:

“It seems to me that it was unfortunate that the taxi driver did not inform
Beaumont staff that [the resident] was an Eastern Health Board Transport
patient. I accept that we are responsible for [her] care and safety and I am not
retracting from that………….I apologise for the distress caused and by this
incident and I have assured your mother that [she] will attend her future
appointments in a taxi booked privately by us and with an escort.”

The matter was also investigated and reported on by the Northern Area Health Board,
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to whom the family had also complained.

Catherine Mullins

Ms Mullins was admitted to Leas Cross in June 2003. According to a statement


provided to the Commission by her daughter, Ms Mullins and her family were
initially happy with the nursing home but found that care standards “deteriorated
significantly” as the number of patients in the home increased. The family state that
they made several verbal complaints to the matron, but their concerns about the care
being received by their mother at the nursing home remained unresolved.
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By a letter dated the 13 January 2004 the family informed the matron that they had
decided to remove their mother from Leas Cross as they were “…very unhappy with
the nursing care and management of our mother’s welfare at Leas Cross in recent
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times…” On the 15 January 2004 the family wrote again to the matron setting out
detailed complaints regarding Ms Mullins’s care. Copies of this letter were also sent
to the owner of the nursing home, the Northern Area Health Board and a consultant
physician at Beaumont Hospital. The matter was subsequently taken up by the
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Northern Area Health Board.

Elizabeth Fleming

In February 2004 Ms Fleming, a resident of Leas Cross Nursing Home, discovered


that a wallet containing €900 had been taken from her handbag. She reported this to
staff in the morning and her family was informed when they visited that evening. The
family subsequently wrote to Mr John Aherne seeking a meeting to discuss the issue.
A meeting was held and the family accepted an offer by the management of Leas
Cross to replace the missing €900. Ms Fleming was happy to accept the offer and the
matter was considered closed by the family.

Resident P.S.

31
See chapter 15.
32
See chapter 15.

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This resident arrived in Leas Cross in April 2004. Three months after his arrival, his
daughter discovered that the majority of her father’s clothes were missing. She stated
to the Commission:

“Dad had been involved in the clothing industry for much of his career and
had some very nice clothes; He took great pride in his appearance and was
always impeccably dressed. On investigation I was told that his clothes could
not be found and that my father had probably thrown them away into a skip
outside in the grounds of the nursing home. I was shocked at this explanation
as my father could hardly hold a cup not to mention move ‘unnoticed’ 30 kgs
of his belongings to a skip. His clothes were never found despite my many
searches and repeated enquiries.”

The resident’s daughter wrote a letter of complaint to Mr John Aherne, the owner of
Leas Cross:

“My letter was never acknowledged. Eventually after four months of phone
calls. I was handed a personal cheque from Mr. Aherne by one of his staff for
€300 but neither he nor Grainne Conway offered any form of apology to my
father or our family.”

Resident J.B.

The family of this resident, who had been admitted to Leas Cross in April 2004, also
found reason to complain in writing. They have chosen to remain anonymous in this
report. Over a number of months, the family grew concerned about various aspects of
their father’s care. The family told the Commission that they raised these concerns
verbally on a number of occasions with staff at Leas Cross but received no response.

As the family were getting no response to their verbal complaints, the resident’s
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daughter wrote to the matron on the 26 October 2004. The letter detailed serious
concerns regarding her father’s continuous diarrhoea, drastic weight loss and a lack of
communication between the nursing home doctor and the family. The letter also
raised questions concerning the use of physical restraint on the resident. The family
delivered the letter personally:

“My brother and I handed this letter to Grainne Conway in her office. Ms
Conway spoke to us about our concerns and said that she would reply to the
letter. I asked Ms Conway whether the staff had training in dealing with
patients with dementia. Ms Conway said that her nurses were extremely
capable and well qualified. I did not receive any response from Grainne
Conway to this letter.”

Patrick Crowley

Mr Crowley, who arrived at Leas Cross in May 2004 for two week’s respite following
an operation at Beaumont Hospital, decided after one day at the nursing home that he
did not want to stay there. He informed the matron and asked for the return of the

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money paid by him which covered the remaining days of his respite booking.
According to Mr Crowley’s statement to the Commission, the matron told him that
she had no money with which to reimburse him. After he left the nursing home, he
wrote to Mr John Aherne on two occasions looking for a refund, but received no
answer. He also got the Citizen’s Advice Bureau to write to Mr Aherne, but again no
response was received.

Complaints in person

The oral complaints made by families covered a wide variety of issues, of which the
following is a representative sample. The quotations are taken from statements
provided to the Commission by the families of various residents.

 Rough handling of residents by care staff:

“My father complained that the man who showered him was very
rough…”

“On one occasion my mother complained of rough treatment by the


staff, saying “I was bashed”. When I questioned the Matron … about
this incident, she passed it off as my mother not wanting to dress
herself.”

 Unnecessary sedation of residents:

“Prior to [my sister’s] transfer to Leas Cross, she was capable of


speaking coherently and making intelligent conversation. During her
time in Leas Cross, her speech was often slurred and she was unable
to participate in conversation. I believe that this was due to an
increased use of sedatives, and I would question whether this was
warranted or appropriate…”

“Our main concern was that my father seemed to be very sleepy and
sedated when he was in Leas Cross. This regularly seemed to be the
case and he was in this condition for long periods of time and at
different times of the day, even in the morning…”

“My mother was very often asleep or drowsy when we visited her, and
my family and I are concerned that she may have been sedated
unnecessarily…”

“[Our mother] always seemed to be drowsy, as if sedated. Her family


were not told what medication she was on…”

 Inadequate supervision of residents’ food / fluid intake:

“During her later years at St. Ita’s Hospital [my sister] had problems
with weight gain. She was placed on a special diet which involved
close, daily monitoring of her eating and fluid intake. This diet
continued up until the time of her transfer to Leas Cross… A short time

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after [my sister’s] transfer to Leas Cross, her family noted that she had
started to put on weight. [Her family] mentioned this on a number of
occasions to the Matron, Gráinne Conway… I believe that [my
sister’s] diet and fluid intake were not properly supervised.”

“My family and I were concerned that my father was losing a lot of
weight and becoming depressed and dejected during his time in the
nursing home… I raised these concerns with the matron, Ms Conway,
who told me that she would have a doctor look at my father. So far as
I am aware, this was never followed up…”

“[my sister and I] sought an appointment to see the Matron of Leas


Cross (Grainne Conway) to express our concerns regarding our
mother’s treatment at Leas Cross. She responded to our concerns
about our mother’s food and fluid intake by saying ‘Don’t forget, your
mother is very old.’ She said she would look into it, and that was
that…”

 Lack of regard for residents’ hygiene and other personal care issues:

“One day when I… visited our mother, she was wincing with pain and
I could see that her foot was hurting her. I took off her sock and saw
that a toenail was badly infected. I was astounded that the staff, when
dressing my mother each morning and undressing her each evening,
would not have treated this infection. I went up to the nurses’ station to
complain and found out that a chiropodist was in the nursing home
that day. I asked the chiropodist would he take care of our mother,
which he did…”

“I noticed over time that my father was deteriorating in his physical


appearance and I had to repeatedly request visits to the chiropodist
and also the optician. On another visit I had found Dad walking with
difficulty and when I decided to change his shoes I found a very
infected big toe, as the nail had been badly cut. On questioning the
staff nobody knew anything about this, yet I was told he had a daily
supervised shower…”

“The standard of hygiene in my mother’s room dropped dramatically.


The room became dirty and there was often food from previous meals
left under the bed...”

“On many occasions whilst visiting our father we would have to ask
that his incontinence wear be changed. He would be (either alone in
his room or on the corridor/landing outside his room) sitting in a very
wet or soiled ones. As he had developed a very deep intensive bed sore
on one of his buttocks we knew that it would not be good for him to sit
in very damp wear for long periods...”

 Failure to check on residents or to respond to calls for assistance:

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“We would sit with our father for hours and nobody would come to
check in on him whilst we were there. Many times when we visited our
father he would be isolated and alone in a buxton chair on the corridor
with sun beaming in on his face and in a sweat…”

“One evening [a family member] heard cries coming from the elevator
and it was going on for some time. When she went to investigate there
was a man stuck in a wheelchair in the lift she had to go and get help
to get him out…”

“On one occasion I visited my mother and when I got to the door of
her room, which was open, I found her sitting on the floor beside her
chair. She was in a dazed state and was not sure how she had fallen
out of the chair. She was not sure what had happened. I called the staff
and it took them some time to get my mother back into the chair. I
asked how she could have been sitting in the room on her own, on the
floor, with the door open, yet nobody had seen or heard her? The staff
could not provide any answers….”

 Loss or mishandling of residents’ clothes;

“[My husband’s] clothes started to go missing bit by bit and he often


had other people’s clothes on him. I was upset at this as I had put his
name on all of his clothes. I spoke to the Matron and to staff about this
a number of times. I also searched the laundry several times for his
clothes, but to no avail. Most of the clothes in the laundry room were
wet and damp. Eventually I spend over €100.00 on a set of new clothes
to be bought for him but these also went missing…”

“After a number of weeks we noticed that the new clothes we had


bought for [my mother] were starting to disappear. We raised the
matter with staff at Leas Cross, but nobody seemed to know anything
about the clothes…”

The Commission has been informed by a number of families that they encountered
difficulties making complaints because the nurses station was frequently unattended,
the matron was unavailable or because the available nurses or care staff did not speak
fluent English.

Response of nursing home to complaints

Documentary record

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Between 1999 and 2005, as a matter of both policy and practice, Leas Cross
management and staff failed to keep a record of:

i) the complaints made to them by residents or residents’ families; and

ii) the response of the nursing home to those complaints.

The absence of such records fatally compromises any attempt to assess the
performance of the nursing home management in dealing with the complaints of
residents and their families. In the Commission’s view, however, the failure to keep
proper records is, in itself, a sign that the management of Leas Cross did not treat
residents’ grievances with the seriousness they deserved.

Not having any nursing home record of complaints, the Commission has had to rely
principally on information supplied voluntarily by the families of former Leas Cross
residents. As set out earlier in this chapter, the Commission has received information
from a number of families concerning complaints made by them at various times
during the history of Leas Cross. But the failure of Leas Cross to keep a record of
complaints received makes it impossible to say whether the complaints of which the
Commission is aware represent a majority or just a small portion of the complaints
made to the nursing home over its lifetime.

The Commission is also aware that in circumstances where members of the public
with varying experiences of Leas Cross are asked to volunteer information, the result
may not be an entirely balanced picture: people who found no cause for complaint
with Leas Cross, or whose complaints were heard and addressed by the nursing home,
are less likely to contact the Commission than those who feel their complaints were
never properly dealt with. When the Commission has been told of complaints that
were satisfactorily resolved, those stories have generally come from people who
contacted the Commission because of other, unresolved grievances.

The situation is further complicated by the fact that, owing to the passage of time,
families who told the Commission of specific grievances were often unable to recall
whether they had made a complaint to Leas Cross at the time; and if so, when and to
whom their complaint was made.

Responses to the Commission

Where information has been given to the Commission about a complaint made to a
named person (usually the matron or the owner of the nursing home), the Commission
has put the substance of that complaint to the relevant person and sought information
from them as to what, if anything, was done in relation to that complaint.

In oral evidence the owner of the nursing home, Mr Aherne, responded to the
Commission’s questions by stating that as a rule, any complaints received by him
were passed directly to the matron:

“…if a family member met me going down through the corridors in Leas
Cross and made a complaint, I would go straight and inform the matron of the

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complaint and ask the person to wait there while the matron came to see her
or him.”

Mr Aherne did recall one complaint, regarding a problem with drains and sewage,
which he himself addressed, “because I was responsible for the structure of the
building.”

The response of the matrons to complaints which the Commission brought to their
attention varied. In some instances, the matron in question said she had no memory of
the complaint, or denied that any such complaint had been made to her. In other
instances, she claimed that the complaint in question had been addressed
satisfactorily. In the absence of any documentary evidence however, it is impossible
for the Commission to test such statements.

Some observations on Leas Cross Nursing Home’s response to complaints

Notwithstanding the difficulties caused by (a) lack of documentation and (b)


unresolved conflicts of evidence between complainants and nursing home staff, the
Commission considers that, having regard to the information available to it, the
following, limited observations can be made:

1. Residents and visitors who wished to make complaints were frequently frustrated
in their attempts to do so by the fact that key staff members, such as the matron or
the duty nurse, could not be located.

2. Some complainants experienced difficulties in communicating with staff who


lacked fluency in English. This left them uncertain as to whether their complaint
would be understood or acted upon.

3. The difficulties experienced by people who attempted to complain were


compounded by the fact that Leas Cross had no procedure for keeping written
records of verbal complaints, or of the response to such complaints.

4. Three of the five written complaints of which the Commission is aware appear to
have generated no response from the management of Leas Cross.

5. Most of the complaints of which the Commission is aware relate to an eighteen-


month period beginning in late 2003, when the population of the nursing home
had increased substantially following the intake of a large number of high /
maximum dependency patients from St Ita’s Hospital, Beaumont Hospital and
elsewhere. Whilst this might not be unexpected – even in the best of
circumstances one might expect an increase in resident numbers to bring an
increase in complaints – when combined with other evidence it suggests that the
nursing home was not equipped to deal with the number and dependency level of
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residents in its care from September 2003 until June 2005.

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On the concerns expressed by nursing home inspectors see chapters 8 and 13. On the concerns
expressed by the Psychiatry of Old Age service see chapter 17.

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6. A significant number of the complaints made during that period contain
allegations which imply a lack of adequately skilled staff in the nursing home at
that time. Those allegations include inadequate supervision of residents,
unwarranted use of physical or chemical restraints, and lack of regard for
residents’ hygiene and personal care.

7. If complaints received by the nursing home had been systematically recorded and
available for inspection, it would have been much easier for both the nursing
home management and the relevant health authorities to identify and deal with
emerging patterns of inadequate care.

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