A Tauranga rest home has been criticised by the Health and Disability Commissioner for failing to pick up on a patient's fractured hip six days after a fall.
An 81-year-old woman with advanced dementia injured her hip at Killarney Rest Home in August 2011 but was assessed as having no injury and staff were told to treat her as able.
Six days later, when she still could not stand up, the rest home's clinical manager ordered x-rays which showed the woman's hip was fractured.
She said she sent the woman to hospital under protest from the rest home manager and owner, who noted the cost of an ambulance and said she did not need to go.
The woman had surgery but never returned to the rest home because her family were not happy with its care.
Deputy Health and Disability Commissioner Rose Wall said Killarney Rest Home did not provide safe care for the woman and failed to make sure staff were complying with its policies and procedures.
She said the woman had a history of falls and the home should have had a care plan in place for her.
The rest home, its manager and clinical manager have all been referred to the Director of Proceedings to decide whether further action should be taken. The rest home has since been sold.
The two staff have also been referred to the Nursing Council for their competency to be tested.