Dunedin rest-home that closed in September was using milk-bottle tops to dispense medication, apparently as a cost-saving measure, even though residual water in the tops damaged the medication, a surprise inspection initiated by the Southern District Health Board revealed.
The "issue-based" audit was carried out on Inlet View Rest Home in August in response to a complaint.
Following the audit, the DHB imposed a temporary management order, appointing a registered nurse to oversee it.
The audit report, released to the Otago Daily Times under the Official Information Act, noted that only one staff member had a current first-aid certificate; in one case, emergency first-aid instructions were issued over the phone to assist a male resident who died after choking on food.
The decision to close the Andersons Bay rest-home was made by the home's owners, Beth and Ian Sizemore, who cited financial viability, nearly a fortnight after the temporary management order was placed.
A second resident death was examined, with concerns raised that multiple staff reports of adverse health symptoms over a number of weeks were not addressed.
However, "it is questionable as to whether these contributed to the resident death at the time it occurred".
Staff had raised concerns about both deaths, which were the two most recent at the rest-home.
A "dysfunctional" relationship between management and the home's registered nurse had compromised the ability of the nurse to do her job properly, the report says.
"The workplace culture was deemed unhealthy with a degree of nepotism between management and staffing which also impacted negatively on encouraging a cohesive care team."
The report said cost-saving measures appeared to be in place, including using plastic milk-bottle tops as medication dispensers, and an outdated and inadequate supply of wound dressings.
"The bottle tops were unable to be dried completely after washing and therefore moisture leaked on to tablets impacting on the integrity of any enteric coating; these tops were also deemed to be an infection control risk and use was discontinued."
Other issues included "deficient" medication management, a strong smell of urine in some parts of the home, and concern that rubber mats on floors - probably used because of incontinence - had ingrained dirt and posed an infection risk.
Two residents were assessed as needing hospital-level care and were transferred to appropriate care at the end of August.
Mr and Mrs Sizemore told the ODT they strongly rejected the report, had engaged a lawyer, and would rebut it in detail.
They had had insufficient time to study the report after receiving it late last week, and were concerned it differed significantly from the draft.
They were particularly concerned by its discussion of the two residents' deaths, which the Sizemores believed wrongly implied the rest-home was at fault.
They reject the assertion only one staff member had a current first-aid certificate, saying seven or eight had valid certificates.
Of the first-aid instructions issued over the phone, Mrs Sizemore said it was reasonable to expect staff to follow to the letter instructions issued by emergency service call centres.
While the initial spot audit did identify areas that needed to be changed, issues were quickly remedied, the couple said.
Regarding the milk-bottle tops, these were used because the standard dispensers kept "disappearing".
As soon as it was pointed out, the practice stopped, Mrs Sizemore said.
They say the rest-home was a good business, they "loved" their residents, who were for the most part happy.
"We're not monsters," Mr Sizemore said.
Staff relations were mostly healthy, rather than dysfunctional, and they rejected the report's suggestion of nepotism, which they say reflected the fact Inlet View was a family business with a small number of extended and immediate family members working there.
SDHB funding and finance general manager Robert Mackway-Jones said there was no requirement for facilities to have a certain number of staff certified for first aid.
However, facilities were required to have a "qualification education programme" to upskill staff.
The report noted Inlet View's training programme "lacked evidence of implementation".
