A judge has accused a care home of “systemic failings” over managing exposure to legionella following the death of a 95-year-old pensioner.
Reading Borough Council was this week fined £100,000 after an investigation into the death of Lewis Payne three years ago.
During the HSE prosecution, Reading Magistrates’ Court heard how Mr Payne arrived at RBC-operated care facility, The Willows having previously been in hospital with a broken leg.
During his stay at The Willows he began feeling unwell, complaining of aches and pains including tightness of the chest, shortness of breath and difficulty in breathing. He was also suffering from nausea.
Three weeks later, on 16 October 2012, he was re-admitted to hospital and a sample proved positive for the presence of Legionella. He underwent treatment for Legionnaire’s disease, but died on 1 November 2012 from pneumonia related to legionella.
The prosecution said the control and management arrangements needed to ensure the risk from legionella is minimised, need to be robust. The court was told, prior to November 2012, RBC’s arrangements were not robust enough in a number of areas.
The Legionella training for the key personnel at The Willows was significantly below the standard required. There were inadequate temperature checks and some of those done with respect to Thermostatic Mixer Valves (TMVs) were done incorrectly.
Showers were not descaled and disinfected quarterly as required; flushing of little used outlets was reliant on one member of staff and there was no procedure for this to be done in the absence of that member of staff.
HSE said the failings were systemic and continued over a period of time. There was a history of legionella problems at the home which was formerly known as Tanfield Care Home. The monitoring, checking and flushing tasks were given to the home’s handyman who was inadequately trained and supervised. There was no system in place to cover for him when he was away so that the requisite checks were not done.
Reading Borough Council, Civic Offices, Bridge Street, Reading admitted breaching Section 3(1) of Health and Safety at Work etc. Act 1974 and was fined £100,000 with £20,000 costs in Reading Crown Court.
After the hearing, HSE inspector Kelly Nichols said: “Reading Borough Council could and should have controlled the risk of exposure to legionella to the elderly and infirm as well as those receiving immediate care prior to returning home.
“RBC’s failings were systemic and continued over a period of time. There was a history of legionella problems at the home. The control and management arrangements were not robust and the legionella training of key personnel fell significantly below the required standard.”