CQC Inspection Reveals Multiple Failings at Marlborough House Nursing Home After Woman Choked On Food

The family of an elderly resident who choked to death at a care home in Fleet, Hampshire, which has since been criticised by the Care Quality Commission, are taking legal action as they seek to find out more about her death.

Margaret Humphreys died aged 84 after choking on food at the Marlborough House (Nursing Home) in August 2014. It is understood the police are investigating the incident and that there is likely to be a Coroner’s Inquest next year.

Mrs Humphreys’ devastated family have instructed specialist medical negligence lawyers at Irwin Mitchell’s Southampton office to investigate her death as they have concerns about the way she was fed.

Following Mrs Humphreys’ death and other issues that had been raised at the care home, the Care Quality Commission (CQC) has taken enforcement action and issued a number of warning notices following an unannounced inspection in September 2014.

A number of serious issues were identified at the home and it was found that the service provided was not safe, effective, responsive or well led. The main issues identified were:

• Medicines were not always handled safely and records of medicine administration were not always completed
• Repositioning charts for those at risk of developing pressure sores were not fully completed
• Records were not always kept securely
• People receiving respite care did not have nutritional care plans in place to meet their identified needs
• There were not sufficiently robust arrangements to manage identified nutritional risks to all people – a specific example is given in the report of a resident whose care plan stated that they needed their meat to be cut up. This resident advised that they had to specifically ask staff to do this for them at mealtimes.
• People who received respite care did not have care plans in place to meet their identified care needs.
• Following identified incidents, measures which had been taken were insufficiently robust to ensure risks to people had been effectively identified and managed

Rebecca Brown, a specialist medical negligence lawyer at Irwin Mitchell’s Southampton office representing the family, said:

Expert Opinion

The CQC has identified serious failings which, as has been seen in Mrs Humphreys’ case, can lead to catastrophic outcomes. These types of failings would have left residents at the care home at risk of suffering malnutrition, pressure sores and falls.

“Mrs Humphreys’ family have been left distraught by her death and want answers as to exactly what happened. While nothing will bring her back, it is some relief to see that the CQC has taken enforcement action against the care home as this will hopefully mean that sufficient action will be taken to rectify these failings and prevent serious incidents happening to other residents in future.

“Sadly we continue to receive instructions from families of loved ones who have received sub-standard care in homes all across the country. More must be done to learn lessons from all incidents and improve standards for the vulnerable people who need the high level of support that a nursing home should be providing.” Rebecca Brown - Partner

Gayle Gunner, Mrs Humphreys’ daughter, from Surrey, said: “It is a difficult decision for a relative to go into a care home, but when this happens you expect that they will be properly looked after. It was devastating to hear how my mother died and we feel betrayed by the care home.

“We gave very clear instructions on how she should be fed and to know that she died from choking on her food has raised many issues and questions which we hope the legal process will help answer.

“The CQC report is extremely worrying to us and we hope that the home takes urgent steps to ensure no other families suffer as we have.”

Read more about Irwin Mitchell's expertise relating to Medical Negligence Claims and Pressure Sore Claims.