'Very dirty and unkempt' care home resident died after nurses warned he showed signs of 'prolonged neglect'

-Credit:Copyright Unknown
-Credit:Copyright Unknown


Hospital nurses raised the alarm after fearing a 'very dirty and unkempt' care home resident showed 'signs of prolonged neglect'.

Peter Good was taken to Stepping Hill Hospital on Boxing Day 2023 with a 'blocked gastrostomy tube'. But, an inquest at Stockport coroners' court heard, nurses raised a safeguarding alert after finding him to be in 'poor condition' and showing signs of 'prolonged neglect'.

Mr Good, who suffered from Parkinson's disease and was bedridden due to a previous stroke, was said to be 'very dirty and unkempt' with some of his wounds 'looking and smelling infected'. The 64-year-old, a resident at Hilltop Hall Nursing Home, in Heaton Norris, Stockport, was also said to have 'poor oral hygiene, with calculus-covered teeth'.

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Despite treatment with antibiotics the 64-year-old's condition deteriorated further and he died on January 9, 2024. A postmortem gave the cause of death as pneumonia, cerebral infarction, Parkinson's disease and skin ulceration.

Coroner Chris Morris recorded a narrative conclusion saying Mr Good 'died as a consequence of complications arising from a previous cerebral infarction, Parkinson’s disease and skin ulceration which had significantly deteriorated whilst at the nursing home from which he was admitted to hospital for the final time'.

And now the coroner has written to the chief executive of Harbour Healthcare Ltd, the company which runs the nursing home, warning there is a 'risk that future deaths will occur unless action is taken'.

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In a prevention of future deaths report he wrote: "The court heard evidence that a safeguarding alert was raised by nursing staff at Stepping Hill Hospital shortly after admission on the basis that Mr Good appeared to them very dirty and unkempt with some of his wounds looking and smelling infected. It was further suggested that on admission, Mr Good was noted to exhibit poor oral hygiene, with calculus-covered teeth which the hospital safeguarding nurse regarded as indicative of prolonged neglect.

"Whilst the nursing home's deputy manager gave evidence to the effect that she did not recognise this description of Mr Good, she accepted she had last provided care to him several weeks prior to his admission to hospital. I am concerned in the light of this description that Harbour Healthcare as the owner and operator of Hilltop Hall has not instigated its own investigation into the way which Mr Good was cared for, with a view to considering any ongoing risk of harm to other residents and whether any learning can be derived for staff and managers of the home."

Hilltop Hall was given a rating of 'requires improvement' after its latest Care Quality Commission assessment in September. In a report inspectors said there were 'significant shortfalls' in the service provided and that the home had 'failed to take the action needed in the last two inspections to ensure people received safe care and treatment'.

Harbour Healthcare did not respond to repeated requests to comment.