Tywardreath care home at fault for handling of resident's falls

Coral Skingsley broke her hip in a fall that required surgery, after which she remained in hospital until she died the following month

A woman whose aunt died following two falls says investigations of care homes need to be faster and easier to find.

Coral Skingsley suffered two falls in her nine days at Trecarrel Care Home in Cornwall, the second one causing a broken hip that put her in hospital. She died six weeks later.

Yvonne Robertson went to the Local Government and Social Care Ombudsman who ordered the home to admit fault.

The home said it had a good rating.

Ms Robertson said: "Although the ombudsman's report has been published, unless you knew exactly where it was on the internet you would have trouble finding it.

"As a member of the public you need that information if you are going to make a decision about where to send your relative."

The ombudsman found fault in the way the home assessed 79-year-old Miss Skingsley's risk of falls, its care planning and its actions after the two incidents.

The home was rated as Good in November 2019 and has retained the same overall rating in two subsequent inspections.

Having been rated as Inadequate in 2018 and placed in special measures, the home was re-inspected and upgraded to Good in November 2019, a few weeks before Miss Skingsley moved in.

Ms Robertson made a formal complaint to the care home after the falls in December 2019 and then to the CQC, which said it was unable to investigate incidents.

She then took the case to the Local Government and Social Care Ombudsman (LGO) which investigated and published its findings in June 2021 - which was 18 months after the falls.

The LGO said it was the first public ombudsman to publish every decision on its website and send them out weekly to subscribers.

Decisions are listed against the company or local authority and they are named where possible where fault is found, it added.

An LGO spokesperson said: "Where we have found fault with an independent provider, we might often issue the decision against the umbrella company if a home is part of a larger chain."

Yvonne Robertson had a close relationship with her aunt Coral Skingsley

The LGO also shares its findings with the CQC to help the inspection process.

The CQC said "it is not in the remit of CQC to investigate individual complaints" but "information such as we received from Miss Skingsley's family feeds in to our inspection process".

Cornwallis Care Services, which runs the care home, said "Trecarrel has had a continuous 'Good' rating from November 2019 until the present day" from the Care Quality Commission (CQC).

At an inquest in October 2020, the Cornwall coroner recorded Ms Skingsley's primary cause of death as old age, with immobility due to fractured left neck of femur and dementia mentioned as factors on the death certificate.

The ombudsman instructed the care company to write a letter to Ms Robertson apologising and acknowledging its findings, and to send a £350 payment for the distress caused.