conduct and competence committee - the nursing & … · mrs griffiths was not present or...

Conduct and Competence Committee Substantive Hearing

3, 4, 5, 6, 9 and 10 November 2015 Nursing and Midwifery Council, Temple Court, 13a Cathedral Road, Cardiff, CH11 9HA

Name of Registrant: Joy Daphne Griffiths NMC PIN: 91G0029W Part(s) of the register: Registered Nurse - Sub Part 1

Adult – 6 December 1994 Area of Registered Address: Wales Type of Case: Misconduct Panel Members: Cindy Barnett (Chair/Lay Member)

Alan Bridge (Lay Member) Alice Clarke (Registrant Member)

Legal Assessor: Juliet Gibbon Panel Secretary: Hailey Robinson Representation:

Nursing and Midwifery Council: Represented by Rory Mulchrone, Nursing and Midwifery Council Regulatory Legal Team. Mrs Griffiths: Not present and not represented in absence

Facts proved: 1 (in its entirety), 2, 3a, 3b, 3c, 3d, 3f, 4a, 4b,

4c, 4d. Facts not proved: 3e, 3g, 4e Fitness to practise: Impaired Sanction: Striking off order Interim Order: Interim suspension order – 18 months

Charges: That you, a Registered Nurse, whilst employed between 20 November 2012 and 28

March 2014 by Barchester Healthcare Limited (“Barchester”) at the Plas Y Dderwen

Nursing and Residential Home, Carmarthen (“the Home”):

1. On or around 30 - 31 January 2013, having become aware that Resident A was

suffering with chest pains and/or was unwell, did not:

a. Attend Resident A immediately, or, sufficiently promptly;

b. Carry out any, or any adequate, assessment of Resident A’s condition and

/ or record in the progress and evaluation records for resident A the results

of observations taken of Resident A’s condition;

c. Hand over to your colleague at the start of the day shift at around 08:00

that Resident A was suffering with chest pains and/or was unwell;

d. Contact a General Practitioner and/or an ambulance to assist Resident A;

2. On 4 February 2013, after Resident B informed you she needed to use the toilet,

told her to, words to the effect of, “pee in your pad”;

3. On unknown dates between 20 November 2012 and 11 March 2013, failed to

appropriately administer medication to residents in that you, on one or more

occasions:

a. Left the medication trolley unlocked;

b. Left the treatment room unlocked;

c. Left medication unattended in residents rooms including, but not limited to,

Resident E;

d. Administered medication to residents whilst they were lying down;

e. Told Resident E that you would “have it instead” or words to that effect,

when she refused paracetamol, and took Resident E’s prescribed

paracetamol yourself;

f. Disposed of medication in the normal waste bin;

g. Did not administer to residents all of the medication which they were due

to receive and which had been dispensed for them to take;

4. On unknown dates between 20 November 2012 and 11 March 2013, behaved

unprofessionally in that you, on one or more occasions:

a. Smoked in the doorway of the residents’ lounge causing smoke to be

blown into the residents’ lounge area;

b. Took for yourself tea / biscuits prepared for residents;

c. Slept whilst on duty;

d. Attended work whilst smelling of alcohol;

e. Asked care assistant Ms 1 to administer medication to residents when she

was not qualified to do so;

And in light of the above, your fitness to practise is impaired by reason of your

misconduct.

Decision on service of notice:

Mrs Griffiths was not present or represented at the hearing. The panel heard the

submissions made by Mr Mulchrone on behalf of the Nursing and Midwifery Council

(NMC) that the notice of hearing was sent to Mrs Griffiths in accordance with Rules 11

and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of

Council 2004 (The Rules) as amended on 6 February 2012.

11.(1) Where a hearing is to be held in accordance with rule 10(2), the Conduct and

Competence Committee or Health Committee shall send a notice of hearing to the

registrant.

(2) The notice of hearing shall be sent to the registrant

(b) in every case, no later than 28 days before the date fixed for the hearing.

34.(1) Any notice of hearing required to be served upon the registrant shall be delivered

by sending it by a postal service or other delivery service in which delivery or receipt is

recorded to, or by leaving it at—

(a) her address in the register; or

(b) where this differs from, and it appears to the Council more likely to reach her at, her

last known address, the registrant’s last known address.

Notice of this hearing was originally sent to Mrs Griffiths’ address on the NMC register

on 1 September 2015 by recorded delivery and first class post, over 28 days in advance

of this hearing. The panel is satisfied that the NMC has complied with the rules of

service.

Decision on proceeding in the absence: In deciding whether to proceed in the absence of Mrs Griffiths, the panel considered the

submissions of Mr Mulchrone on behalf of the NMC.

The panel heard and accepted the advice of the legal assessor. She advised that the

discretion to proceed in the absence of Mrs Griffiths must be handled with the utmost

care and caution. The panel must consider the nature and circumstances of Mrs

Griffiths absenting herself, in particular whether the decision was voluntary and if so,

whether she had waived her right to be present and represented; whether an

adjournment might result in her attendance; and the general public interest that a

hearing should take place within a reasonable time of the events to which it relates. The

panel had regard to Rule 21(2) that the panel may direct that the allegation should be

heard and determined notwithstanding the absence of the registrant; or may adjourn the

hearing.

In deciding whether to proceed in the absence of Mrs Griffiths, the panel weighed its

responsibilities for public protection and the expeditious disposal of the case with Mrs

Griffiths’ right to a fair hearing.

The panel noted the record of a telephone call between Mrs Griffiths and an NMC Case

Officer dated 22 October 2015 which stated “[NMC Case Officer] asked if she was

happy for the panel to proceed in her absence if she were not to attend the hearing. She

said she would be. I confirmed that she would not be attending and that she would be

happy for the panel to proceed in her absence.”

The panel further noted an email from Mrs Griffiths’ former representative, the Royal

College of Nursing to the NMC, dated 5 August 2015, in which it stated “I write to

confirm that we have received instructions from Ms Griffiths that she intends to

disengage from the NMC regulatory process. … Ms Griffiths has resolved not to attend

any future hearings of the NMC Conduct and Competence Committee and feels unable

to meaningfully engage with any NMC correspondence. We would respectfully request

on Ms Griffiths behalf that no further documentation be sent to her home address.” A

written statement confirming the same and signed by Mrs Griffiths was attached to the

email.

The panel was satisfied that Mrs Griffiths had voluntarily absented herself from the

hearing and it was unlikely that an adjournment would result in her attendance at a later

date. A number of witnesses are available to give evidence and the panel considered

that should the hearing adjourn it may have an adverse impact on the quality of

evidence provided by them. The panel concluded that Mrs Griffiths had waived her right

to attend the proceedings - it drew no adverse inference from her non-attendance. It

determined that there would be no injustice to Mrs Griffiths with proceeding in her

absence. In weighing Mrs Griffiths’ own interest with the public interest in the

expeditious disposal of this case the panel decided to proceed in Mrs Griffiths’ absence.

Reasons and decisions on finding of facts: In reaching its decisions on the facts, the panel has taken into account all the oral and

written evidence adduced and the submissions made by the case presenter, Mr

Mulchrone, on behalf of the NMC. The panel heard and accepted the advice of the legal

assessor. The panel was reminded that the burden of proof rests on the NMC, and that

the standard is the civil standard, namely the balance of probabilities. This means that

the facts would be proved if the panel was satisfied that it was more likely than not that

the incidents occurred as alleged.

Background

Between 20 November 2012 and 28 March 2014, Mrs Griffiths was employed by

Barchester Healthcare Limited (“Barchester”) as a Registered Nurse at the Plas Y

Dderwen Nursing and Residential Home, Carmarthen (“the Home”). During the time

that Mrs Griffiths worked at the Home, concerns were raised about the way that she

provided care to and interacted with residents at the Home, particularly in relation to

Residents A and B.

It is alleged that on 31 January 2013, in the early hours of the morning, Mrs Griffiths

was told by two care assistants, Ms 2 and Mr 3, that they had discovered Resident A

suffering with chest pains and unwell. After some delay, Mrs Griffiths attended to

Resident A and also allegedly noted that she was suffering with pain, which she put

down to indigestion. It is alleged that Mrs Griffiths did not record in the Progress and

Evaluation Record for Resident A the results of observations that she took. It is then

further alleged that Mrs Griffiths did not handover to the nurse in charge of the day shift,

Ms 5, that Resident A was suffering with chest pains and was unwell. It is finally alleged

that Mrs Griffiths, knowing of Resident A’s pain and unwell state, did not gain assistance

for Resident A by contacting a General Practitioner (“GP”) and/or an ambulance.

On 4 February 2013, during the course of another night shift, it is alleged that Mrs

Griffiths used inappropriate language towards Resident B. When Resident B asked the

registrant to use the toilet, Mrs Griffiths allegedly replied with words to the effect of, “pee

in your pad”.

The Deputy Manager at the Home, Ms 11, conducted a brief investigation into the

allegations during March 2013, which led to Mrs Griffiths’ suspension on 11 March

2013. The matter was subsequently referred to Carmarthenshire County Council (“the

Council”) safeguarding team, in order for an investigation to take place.

A safeguarding investigation was conducted by social workers named Ms 9 and Ms 10,

both of whom concluded that Mrs Griffiths had neglected Resident A and acted

inappropriately towards Resident B.

As the safeguarding investigation had concluded, an investigation into the

circumstances surrounding Residents A and B was conducted by Ms 11 of the Home,

which directly led to Mrs Griffiths’ dismissal on 28 March 2014.

During the course of both the safeguarding and Home investigations, additional matters

arose about Mrs Griffiths’ nursing practice, particularly in relation to her practice in

administering medication to residents. These matters resulted in further allegations

being made concerning leaving the medication trolley and treatment room at the Home

unlocked, and leaving medication unattended in residents’ rooms. Further, allegations

involving unprofessional behaviour displayed by Mrs Griffiths whilst on duty were also

made by a number of staff members.

The panel heard from the following witnesses on behalf of the NMC; Ms 2, care

assistant at the Home; Mr 3, nightshift care assistant at the Home; Ms 1, care assistant

at the Home; Ms 4, carer at the Home; Ms 5, Staff Nurse at the Home; Ms 6, care

assistant at the Home; Ms 7, care assistant at the Home; Ms 8, senior carer at the

Home; Ms 9, employed by Carmarthenshire County Council in a joint role as

Designated Lead Manager and as a Safeguarding Investigating Officer; Ms 10, Social

Worker employed by Carmarthenshire County Council; and Ms 11, who at the material

time was employed as Deputy Manager at the Home.

The panel considered Ms 2, Ms 4, Ms 5, Ms 6, Ms 7 and Ms 8 to be straightforward,

reliable and credible. In particular, the panel considered Ms 2 and Ms 5 to be strong

witnesses who were professional and fair during their evidence. The panel considered

Ms 9, Ms 10 and Ms 11 to be credible and reliable, although noted that their evidence

related to their investigations, and that they did not have direct knowledge of the events

alleged.

In relation to Mr 3’s evidence, the panel noted that he had experienced a significant

personal event close to the time of the incident involving Resident A, during January

2013. The panel heard evidence from Mr 3 that he knew at the time of making his

statement to the NMC that his memory of these events was not accurate in relation to

times and dates of the alleged incidents. However, the panel considered that Mr 3 was

a good witness who was credible, reliable and doing his best to assist the panel. The

panel noted that Mr 3 frankly admitted when he did not know dates and times, but was

able to give a good recollection of the substance of events.

The panel noted, in relation to Ms 1’s evidence, that she appeared apprehensive and

nervous during her evidence. The panel noted that there were inconsistencies in her

evidence. During Ms 1’s investigation interview she had stated that “No one made me

aware that [Resident A] had been unwell in the night.” Ms 1 stated, in her witness

statement, that she could not recall why she had said this but the information she had

given during the investigation interview was “inaccurate”. Ms 1 stated that she had been

told by Ms 5 during handover on 31 January 2013 that Resident A had been reported as

unwell during the night shift of 30/31 January 2013. However, during Ms 1’s oral

evidence at this hearing, she stated that it was not Ms 5 who had told her that Resident

A was unwell, but it had actually been Mr 3.

Further, in her oral evidence, Ms 1 told the panel that after she had been informed by

Mr 3, she told Ms 5 that Resident A was unwell. Ms 5 denied that this had happened.

The panel preferred Ms 5’s evidence. The panel considered that Ms 1’s evidence had

changed a number of times, and therefore, it had doubts about her reliability and the

credibility of her evidence.

Charges: That you, a Registered Nurse, whilst employed between 20 November 2012 and 28

March 2014 by Barchester Healthcare Limited (“Barchester”) at the Plas Y Dderwen

Nursing and Residential Home, Carmarthen (“the Home”):

1. On or around 30 - 31 January 2013, having become aware that Resident A was

suffering with chest pains and/or was unwell, did not:

a. Attend Resident A immediately, or, sufficiently promptly;

Ms 2 gave evidence regarding this charge. She stated “On January 30

2013, at the start of the night shift, Joy Griffiths was present along with [Mr

3]. Ms Griffiths was the nurse in charge of the shift and therefore

responsible for the overall standard of care to be provided to the residents.

…

[Mr 3] and I next attended to [Resident A] at around 06:00 on the morning

of 31 January 2013. [Mr 3] and I went to [Resident A]’s bedroom in order

to assist her in waking up and getting dressed. At this point, I saw that

[Resident A] was not her usual self. [Resident A] is a resident that is

usually very eager to get up and out of bed and is usually in a talkative

state. That morning, [Resident A] was not very talkative. [Resident A] was

a fluent welsh speaker and she told me in welsh that she had, words to

the effect of ‘pain in her chest.’ [Resident A] was floppy and had no

interest in getting out of bed. Her complexion was very pale and her skin

was clammy to touch. All of these symptoms were different to her usual

condition. I did not notice any change in the way in which she breathed

from how she usually did. [Resident A] was responsive but much quieter

and subdued than normal.

I left [Mr 3] and [Resident A] in the room and located Joy Griffiths. I told

Ms Griffiths that [Resident A] had complained of having chest pains and

was not her usual self. Ms Griffiths’ reaction was that of someone who did

not appear to be too concerned. She said words to the effect of, ‘alright

love.’ Ms Griffiths did not then follow me back to [Resident A]’s room. [Mr

3] and I left [Resident A]’s room and continued to assist other residents in

waking up. I remained in the nearby proximity of [Resident A]’s room and

did not see Ms Griffiths go into the room. By approximately 06:30/06:45, I

did not believe that Ms Griffiths had been in to see [Resident A], so I again

went to find her in the nurses office on the Unit. I spoke with Ms Griffiths

and said that I needed her to come and see [Resident A] because of the

complaint of chest pains and she did not appear to be well. Ms Griffiths did

not explicitly say so, but the impression she gave me was that she had not

moved from the office in the nurses’ station since I had been in to see her.

Ms Griffiths remained in a disinterested state.

This time, Ms Griffiths did come with me to [Resident A]’s room. Ms

Griffiths leaned over [Resident A], who was still in her bed, and said words

to the effect of ‘indigestion is it love?’ [Resident A] did not respond.

Ms Griffiths did not undertake any observations of [Resident A]’s

condition. After Ms Griffiths had leant over [Resident A] and spoke to her,

Ms Griffiths left the room. Ms Griffiths did not give any instructions to [Mr

3] or myself as to what needed to be done. [Mr 3] and I then continued

with her [sic] work and Ms Griffiths left [Resident A]’s room at the same

time as we did.”

Mr 3 also gave evidence to the panel regarding this charge. He stated “At

approximately 20:00 on 30 January 2013, until 08:00 on 31 January 2013,

I completed a nightshift at the Home. The nurse in charge of the Unit that I

worked on during this nightshift was Ms Griffiths. Also present with me

during the nightshift was another care assistant named [Ms 2].

…

I next interacted with [Resident A] in the early hours of the morning, at a

time between 02:00 and 03:00. As part of the daily regime of turning

[Resident A] to mitigate against the risk of her developing pressure sores,

[Ms 2] and I went into [Resident A’s] bedroom and became concerned as

to her condition.

Usually when I went into [Resident A’s] room to change her position, I

would find that she would be upside down in bed, her bedding would be

dishevelled, and it would be likely that she would need to have her

incontinence pad changed. It would also be likely that there would be

faecal matter on the floor due to her suffering a bout of incontinence.

When [Ms 2] and I went into [Resident A’s] room at this time, we found

that she was pale and did not respond when we attempted to wake her.

Unusually we found [Resident A’s] bedding remained tidy and not

dishevelled and there was no sign of any mess on the floor. Given the

unusual condition that we found [Resident A] in, [Ms 2] said that she would

report the situation to Ms Griffiths, who, as the nurse in charge of the shift,

would be required to act as appropriate.

After a few moments, [Ms 2] returned to [Resident A’s] room and advised

me that she had told Ms Griffiths of our concerns. [Ms 2] told me that Ms

Griffiths had said she would come along in a few moments to see

[Resident A], but could not do so immediately as she was busy

administering medication to other residents. [Ms 2] and I then left

[Resident A’s] room.”

The panel noted a letter from Mrs Griffiths to Ms 8 dated 25 November

2013, in which she stated “One of the two carers informed me that

[Resident A] was ‘floppy’ and ‘not herself.’ I do not remember the actual

time of night that this occurred, as it was several months ago. The other

carer said [Resident A] had complained of chest pain.”

The panel noted that Ms 2 and Mr 3’s evidence both detail that Resident A

was not her usual self. The panel heard evidence that Resident A was

generally restless and wanted to be out of bed, but on this morning, she

was “floppy”, listless, pale and clammy. The panel accepted that Ms 2 and

Mr 3 noticed a significant deterioration from Resident A’s usual condition

and that this behaviour and presentation was out of character, as they had

provided care to Resident A on an almost daily basis.

The panel noted the discrepancy between Ms 2’s and Mr 3’s evidence in

relation to timings. Mr 3, when questioned about this, freely admitted that

his recollection was not good in relation to timing but he was very clear as

to the substance of events.

The panel accepted Ms 2’s evidence that she had sought out Mrs Griffiths

on more than one occasion to attend to Resident A as she was unwell and

experiencing chest pains. The panel was satisfied that Mrs Griffiths

accepted that she had been told by the carers that Resident A was unwell

and was experiencing chest pains.

The panel noted that Mrs Griffiths had to be asked twice to attend to

Resident A as she had not done so on the first occasion. The panel

considered that upon being told Resident A was unwell, Mrs Griffiths

should have attended Resident A. However, this did not occur

immediately, or, sufficiently promptly. The panel accepted the evidence of

Ms 2 and Mr 3, and therefore, found this charge proved.

b. Carry out any, or any adequate, assessment of Resident A’s condition and

/ or record in the progress and evaluation records for resident A the results

of observations taken of Resident A’s condition;

The panel had regard to the evidence of Ms 2 in relation to this charge. Ms

2 stated “Ms Griffiths did not undertake any observations of [Resident A’s]

condition. After Ms Griffiths had leant over [Resident A] and spoke to her,

Ms Griffiths left the room. Ms Griffiths did not give any instructions to [Mr

3] or myself as to what needed to be done. [Mr 3] and I then continued

with her [sic] work and Ms Griffiths left [Resident A’s] room at the same

time as we did.”

The panel also had regard to Mr 3’s evidence in this regard. Mr 3 stated “A

few moments later, Ms Griffiths appeared at the doorway of [Resident A’s]

room and then entered the room. Ms Griffiths said to [Resident A] words to

the effect of, “poor you, you’ve got indigestion have you?” I saw Ms

Griffiths check [Resident A’s] temperature. I do not know if Ms Griffiths

made a record of the temperature reading she obtained. Ms Griffiths then

said that she would handover to the nurse starting the day shift, at

approximately 08:00, that [Resident A] had been found unwell and that a

doctor would need to be called.”

The panel noted a letter from Mrs Griffiths to Ms 8 dated 25 November

2013, in which she stated “[Resident A] was definitely included in this

hand over and I would have told the nurse what I had observed and what

the carers had said but I cannot possibly remember the exact words I said

after so many months. I did tell the nurse that the observations were fine

although she was pale. I had written them on a piece of paper and left

them on the desk. I had not written the observations in her record as they

were within safe limits. My error was that I did not write down my actions

at the time and for this I am very sorry.”

The panel noted that during an interview between Mrs Griffiths and Ms 10

held on 24 September 2013, Mrs Griffiths stated that she carried out these

observations: “Pulse, blood pressure and temperature, which was not

raised.” Further, Mrs Griffiths stated “I wrote the observations down on a

bit of paper and I am sure I passed it on to the nurse at handover.”

The panel further noted from the record of the investigation interview that

Mrs Griffiths’ account of events contained inconsistencies. She began by

saying there was “Nothing significant or unusual” about that night before

further questions led to her giving the details noted above.

The panel also noted Ms 11’s oral evidence that Mrs Griffiths had

informed her that she had written Resident A’s observations down “on the

back of a cigarette packet”.

Mr 3 was questioned regarding these observations. Mr 3 stated that he

was familiar with a blood pressure cuff, and he confirmed that Mrs Griffiths

did not use one to undertake observations on Resident A.

The panel had regard to the evidence of Ms 5, who stated “There was no

documentation in the care records of [Resident A] indicating that there

were any concerns with her health during the night shift of 30/31 January

2013. Based on the lack of documentation and no verbal report of

concerns during handover from [Mrs Griffiths], I had no reason to believe

or to suspect that [Resident A] had been unwell during the night shift of

30/31 January 2013 and no action was taken.

A few days later, I cannot recall the exact date, [Ms 12] told me that the

night staff on shift on 30/31 January 2013 reported that [Resident A] was

unwell during the night shift and that they told [Mrs Griffiths]. I was

surprised that [Mrs Griffiths] was aware that [Resident A] was unwell and

she failed to seek medical assistance for her, document this in her care

notes and disclose the information to me during handover.”

Resident A’s Progress and Evaluation Record was produced in evidence.

The panel had regard to the record for the period of 30 and 31 January

2013, and noted that there was no record of any observations being

carried out until a record by Ms 5 at 08:30. Mrs Griffiths’ only entry for that

shift, written at 06:34, was that Resident A “settled at around 10pm. Needs

met. No new concerns…”.

The panel did not accept Mrs Griffiths’ explanation that she carried out

observations on Resident A and recorded them on a scrap of paper. This

explanation is not supported by any other account, and there was no

evidence of the scrap of paper she reports to have written the

observations on. Further, the panel considered that Resident A’s records

were readily available for her to document these observations in when she

wrote her evaluation of the care given, if indeed the observations had

been carried out.

The panel accepted the evidence of Ms 2, Mr 3 and Ms 5, as well as the

documentary evidence before it. The panel noted that there was a slight

discrepancy between Ms 2’s and Mr 3’s evidence in relation to this charge,

in that Ms 2 stated that Mrs Griffiths did not undertake any observations,

whilst Mr 3 stated that Mrs Griffiths checked Resident A’s temperature.

However, the panel considered that even if Mrs Griffiths had checked

Resident A’s temperature, this did not amount to an adequate assessment

of Resident A, and, in any event, the temperature was not documented in

the records.

The panel concluded that Mrs Griffiths did not carry out any adequate

assessment of Resident A’s condition. Further, Mrs Griffiths did not record

in the progress and evaluation records for Resident A the results of

observations taken of Resident A’s condition. The panel, therefore, found

this charge proved in both alternatives.

c. Hand over to your colleague at the start of the day shift at around 08:00

that Resident A was suffering with chest pains and/or was unwell;

Ms 5 gave evidence regarding this charge. She stated “On 31 January

2013, I worked a shift from 08:00 until 20:00. I received a handover from

[Mrs Griffiths] as she worked the night shift on 30/31 January 2013. [Mrs

Griffiths] informed me of the care she provided to the residents on the

Unit. She did not report any concerns about a resident named [Resident

A]. If there are concerns regarding the welfare of a resident that requires

urgent attention or monitoring the nurse responsible for the care of that

resident during the shift is expected to handover this information to the

nurse on the preceding shift. As [Mrs Griffiths] had not said so, I had no

reason to believe there were any concerns regarding the welfare of

[Resident A].

The panel had regard to the submissions of Mr Mulchrone, who advised

that, in this case, a handover is “an oral exchange of information between

two registrants”. The panel accepted that Ms 5 did not receive a verbal

handover from Mrs Griffiths in relation to Resident A feeling unwell or

experiencing chest pains.

When questioned in respect of Mrs Griffiths’ assertion that she had

handed over the observations on a piece of paper, Ms 5 stated that Mrs

Griffiths did not handover any piece of paper, and therefore she had no

record of any of the observations that Mrs Griffiths said she had carried

out.

Ms 5, during her evidence, stated that “On 31 January 2013 I handed over

the information provided to me by [Mrs Griffiths] to the carers on shift.

There were five carers working that shift with me but I can only recall the

names of two of them, [Ms 4] and [Ms 13]. I allocated these two carers to

work on the corridor that [Resident A’s] bedroom was on. Shortly after the

start of the shift, I cannot recall the exact time, [Ms 13] came to tell me

while I was preparing to administer the morning medication to residents.

She said that [Resident A] was unwell and she needed me to assess her.

[Ms 13] told me that [Resident A] was in a collapsed state, gasping for

breath, restless and pale. I stopped administering medication to residents

and immediately followed [Ms 13] to [Resident A’s] room.”

The panel next considered the evidence of Ms 4, who stated “On 31

January 2013 I worked a day shift from 08:00 until 20:00. Nurse [Ms 5]

was in charge of my shift. I worked alongside Care Assistant [Ms 13] and

four other care assistants whose names I cannot recall. As is standard

practice in the Home, I received handover from [Ms 5] who received

handover from [Mrs Griffiths] the nurse in charge of the night shift on

30/31 January 2013. During handover, [Ms 5] did not mention that there

were any immediate concerns with the health of a resident named

[Resident A]. After handover, [Ms 13] and I were allocated to care for the

residents on the Unit, including [Resident A’s] room was on that corridor.”

The panel considered that if Mrs Griffiths had handed over Resident A’s

health concerns during her handover to Ms 5, it is likely that Ms 5 would

have handed over these concerns to Ms 4 and Ms 13. The panel accepted

that this was not done.

The panel accepted the evidence from Ms 5 and Ms 4 in relation to this

charge. The panel concluded that Mrs Griffiths did not hand over to her

colleague that Resident A was unwell or experiencing chest pains. The

panel therefore found this charge proved.

d. Contact a General Practitioner and/or an ambulance to assist Resident A;

The panel had regard to the notes of the investigation interview held by

Ms 9, Ms 10 and Mrs Griffiths on 29 September 2013. When asked what

she did in this situation, Mrs Griffiths replied “I took her observations. I

didn’t see any need to call a GP or ambulance - if the observation had

been slightly unusual, I would of done that.”

Further, the panel noted the letter from Mrs Griffiths dated 25 November

2013 to Ms 8, in which Mrs Griffiths stated “These observations did not

seem sufficient for me to call for an ambulance. Indeed, I am one of the

first people to call for an ambulance if anything indicates that a client

needs one.”

This is supported by Ms 10’s evidence. Ms 10 stated that “Ms Griffiths

accepted that she had not called an ambulance or a GP, but that this was

on the basis that she did not think [Resident A’s] condition warranted such

attention.”

The panel noted that the first time an ambulance was requested was when

Ms 5 called for one, after carrying out observations on Resident A. Ms 5

stated “The results of the observations were concerning but I cannot recall

what they were. I left the room and asked [Ms 4] to stay in the room with

[Resident A] while I went to contact the ambulance and her daughter.

I telephoned the ambulance and the paramedics arrived shortly after.

They administered oxygen to [Resident A] and took her to the hospital and

[Ms 4] accompanied her. I telephoned her daughter and informed her that

there were concerns with her mother’s health and told her that she had

been taken to the hospital….

At the time I assumed [Resident A] had deteriorated suddenly and put it

down to the chemotherapy treatment she was receiving. This was the first

time that I had seen her in this state. I had no reason to believe that [Mrs

Griffiths] would not have informed me that she was unwell. I would also

not have expected the night staff to have washed and dressed her ready

for the day if she was that unwell. I cannot comment on what happened

during the night shift of 30/31 January 2013 as I was not there. However, I

would not expect a nurse to see a resident in an unresponsive state and

not seek medical attention to [sic] for them. If [Resident A] was

unresponsive during [Mrs Griffiths’] shift, then I would expect [Mrs Griffiths]

to contact the ambulance or out of hours GP. If [Resident A] was unwell

but not unresponsive, [Mrs Griffiths] should have conducted observations

on her, monitored her regularly and informed me during handover to

continue to monitor her.”

The panel noted that Mrs Griffiths admitted that she had not called an

ambulance or the GP. The panel accepted Ms 5’s evidence in relation to

this charge. The panel therefore found this charge proved.

2. On 4 February 2013, after Resident B informed you she needed to use the toilet,

told her to, words to the effect of, “pee in your pad”;

Ms 6 gave evidence regarding this charge. Ms 6 stated “Whilst in the middle of

the task of cleaning and putting residents to bed, I entered the lounge, along with

[Ms 7] and [Ms 8]. I saw that Ms Griffiths was still sat by [Resident B]. I heard

[Resident B] say that she needed to use the toilet. I do not remember the exact

words that [Resident B] used to Ms Griffiths. … [Resident B] was in an agitated

state, in that she was unable to get to the toilet on her own. I heard Ms Griffiths

say to [Resident B], words to the effect of “you can piss in your pad”.

[Ms 7] and I told Ms Griffiths that we would take [Resident B] to the toilet once we

had completed our tasks. Ms Griffiths did not offer to take her to the toilet. Ms

Griffiths said that [Ms 7] and I could finish what we were doing and then take

[Resident B] to the toilet afterwards.”

Ms 7 also gave evidence regarding this charge. She stated “The night shift of 4

February 2013 started at approximately 20:00 and concluded at 08:00 on the

morning of 5 February 2013. The nurse in charge of the shift was Joy Griffiths.

This was the first occasion upon which I worked with Ms Griffiths and as I have

not worked with her since, I gained the impression that she did not usually work

on the Unit. Also on the shift that night was a Senior Carer named [Ms 8] and

another Care Assistant named [Ms 6].

On the night of 4 February 2013, the time of which I am unable to state, I was sat

in the lounge providing one to one supervision of [Resident B]. [Resident B] had

recently suffered an accident in which she had fractured her hip. Nonetheless,

[Resident B] was a very active resident who regularly wanted to get up and walk

around, so she needed constant supervision to ensure that when she did walk

she did so with the support and physical assistance of a member of staff.

[Resident B] was a resident who was able to identify when she needed the toilet

and, with assistance in travelling to the toilet, then use it.

The shift of 4 February 2013 was a particularly busy one in which a number of

tasks needed to be completed. Ms Griffiths started off by administering

medication to residents in the lounge, so that they would then be able to be put to

bed. After Ms Griffiths administered the medication to residents in the lounge, we

changed roles, whereby I then started to assist [Ms 8] and [Ms 6] in putting the

residents to bed and Ms Griffiths took over my position as providing one to one

supervision to [Resident B].

After we had put one of the residents to bed, whose name I am unable to

remember, [Ms 8] and I started to walk down the corridor back unto the lounge.

Just outside the main lounge, I heard [Resident B] ask Ms Griffiths if she could

go to the toilet. [Resident B] was a resident that I had regular contact with, so I

was able to clearly recognise the voice as hers. As we walked into the room we

were then able to see and hear Ms Griffiths reply to [Resident B]. I saw that

[Resident B] was attempting to get out of a recliner seat that she was sat in. Ms

Griffiths was stood in front of her. Ms Griffiths said to [Resident B], in response to

her request to go to the toilet, Ms Griffiths replied with words to the effect of “pee

in your pad”.”

In her oral evidence, Ms 7 said that the words used by Mrs Griffiths to Resident B

had in fact been “piss in your pad” not “pee in your pad”. Ms 7 stated that

Resident B did not use such language. Ms 7 stated that Resident B became quite

upset when Mrs Griffiths would not take her to the toilet.

Ms 8, in relation to this charge, stated “Shortly after 20:00, the precise time of

which I am unable to state, [Ms 7] and I were returning to the lounge having

assisted another resident when we heard Ms Griffiths and [Resident B] having a

conversation. [Resident B] said to Ms Griffiths that she needed to use the toilet.

As [Ms 7] and I walked through the entrance to the lounge, I heard Ms Griffiths

say ‘it’s alright now love, you can pee in your pad’.” Ms 8 stated that this

statement from Mrs Griffiths alarmed her and her colleagues as residents who

had capacity to do so must be taken to the toilet.

Mrs Griffiths, in a letter dated 25 November 2013, stated “… when sat with

[Resident B], in order for her to remain safe and not to fall; (so that the carers

could put others into bed,) I was not happy to escort her to the toilet without a

carer who knew her, present, as I was not used to her. I was told that [Resident

B] had already fallen, during the handover and also by the carers. When I was

actually sat by [Resident B], I would not go to get her file, in order to read it as

she would have been left on her own and may have fallen…. [Resident B] told

me a few times that she had, ‘pissed herself,’ and ‘pissed in the pad.’ I tried to

reassure her and eventually a carer did come to assistance [sic].”

The panel considered that each of the NMC’s witnesses had been consistent

during their evidence at the local investigatory proceedings, as well as during

their evidence at this hearing. When Ms 6 and Ms 7 were asked how sure they

were about what Mrs Griffiths had said to Resident B, they stated that they were

100% sure that they had heard her use words to the effect of “piss in your pad.”

Further, when Ms 8 was questioned, she was clear that she heard Resident B

request to use the toilet. The panel heard evidence from all three of these

witnesses that it was most unlikely that Resident B would use the type of

language attributed to her by Mrs Griffiths. In addition, the panel heard evidence

that as the witnesses had provided care to Resident B on quite a regular basis,

they knew the sound of her voice well.

The panel could not accept Mrs Griffiths’ assertion that it had been Resident B

who said that she had ‘pissed herself,’ and ‘pissed in the pad’, and not her. The

panel accepted the evidence of Ms 6, Ms 7 and Ms 8 in respect of this charge,

and therefore, found this charge proved.

3. On unknown dates between 20 November 2012 and 11 March 2013, failed to

appropriately administer medication to residents in that you, on one or more

occasions:

a. Left the medication trolley unlocked;

The panel had regard to the evidence of Ms 2, who stated “I was also

generally concerned about the way Ms Griffiths administered medication

at the Home. … I also noted on a number of occasions, dates of which I

cannot specify, that Ms Griffiths would leave the treatment room on the

Unit, which contains the medication trolley and the cupboards of

medication stock, unlocked, which caused me great concern as it would

be possible for a resident or an unauthorised person to enter and have

access to the medication.”

During Ms 2’s oral evidence, she confirmed that Mrs Griffiths would leave

the trolley open and unlocked.

Ms 1, in relation to this charge, stated “… [Mrs Griffiths] also left the drug

trolley and the treatment room doors wide open and unlocked when

unattended.” The panel also noted that Ms 1, during an investigation

meeting held on 1 March 2013, stated, in response to the question “is [sic]

the doors on the med trolley open or closed?” Ms 1 stated “I have seen

them open once or twice”.

The panel accepted Ms 2’s evidence. The panel noted that Ms 1 had

made a similar allegation on more than one occasion. The panel

concluded, on the balance of probabilities, that Mrs Griffiths left the

medication trolley unlocked, and that amounted to a failure to

appropriately administer medication. Therefore, the panel found this

charge proved.

b. Left the treatment room unlocked;

The panel had regard to the evidence of Ms 2, who stated “I was also

generally concerned about the way Ms Griffiths administered medication

at the Home. … I also noted on a number of occasions, dates of which I

cannot specify, that Ms Griffiths would leave the treatment room on the

Unit, which contains the medication trolley and the cupboards of

medication stock, unlocked, which caused me great concern as it would

be possible for a resident or an unauthorised person to enter and have

access to the medication.”

Ms 2, during her oral evidence to this panel, stated that she would see the

treatment room “door wide open”.

The panel also had regard to the evidence of Mr 3, who stated “…On a

number of occasion, Ms Griffiths would leave the treatment room,

containing the controlled drugs cupboard and the other medications

lockers, unlocked and open, which gave me the concern that residents or

any other unauthorised person could have access to the medication.”

The panel also noted Ms 1’s evidence in relation to this charge. She

stated “…[Mrs Griffiths] also left the drug trolley and treatment room doors

wide open and unlocked when unattended. This was unsafe and could

have resulted in a resident or another unauthorised persons having

access to the drugs.”

The panel accepted the evidence of Ms 2 and Mr 3. The panel also noted

the evidence of Ms 1. The panel concluded that Mrs Griffiths did leave the

treatment room unlocked, and accordingly found this charge proved.

c. Left medication unattended in residents rooms including, but not limited to,

Resident E;

Ms 2, in relation to this charge, stated “Ms Griffiths did also not seem to

ensure that medication was consumed once she had dispensed and

delivered it to residents. An example of this relates to a resident named

[Resident E]. Although I am unable to be specific as to a date upon which

such an incident took place, on more than one occasion I would enter

[Resident E’s] room and see that her medication tablets were located on

her table. As [Resident E] was a resident I had a lot of experience in

providing care to, I recognised the tablets as the medication that she

would be given every night. My experience of how other nurses

administered medication was that they would wait with the residents and

watch them consume the tablets given to them to ensure that they were

taken and also to ensure that the tablets were not left for an unauthorised

person, such as another resident, to pick up and consume.”

The panel, during Ms 2’s evidence, heard that Resident E was allowed to

take medication herself. However, the panel accepted that Resident E

should have been supervised taking her medication and it should not have

been left unattended.

Mr 3 also gave evidence regarding this charge. He stated “On a number of

occasions, the dates of which I cannot confirm, Ms Griffiths would leave

medication in a pot in a resident’s room and would not then wait with the

resident to ensure that they consumed it. I cannot remember the names of

any of the residents upon which this took place and cannot provide any

further specific details on this practice.”

The panel accepted the evidence of Ms 2 and Mr 3 in this regard. The

panel concluded that Mrs Griffiths had left medication unattended in

resident’s room, including Resident E’s. Accordingly, the panel found this

charge proved.

d. Administered medication to residents whilst they were lying down;

The panel had regard to the evidence of Ms 7 in respect of this charge.

She stated “I was also concerned at the way in which Ms Griffiths

administered medication to a resident named [Resident F]. When we went

into [Resident F’s] room he was lying down flat on his bed. [Resident F]

had been diagnosed with dementia and I had seen other nurses

administer medication to him by sitting him up in his bed. I believe that the

reason why medication should not be administered to a person lying flat is

that there is a risk of choking.

[Resident F] needed to consume a type of medication that came as a red

liquid. I do not know the name or dose of the medication. Ms Griffiths went

over to [Resident F] and although he was lying flat on the bed, she poured

the red liquid medication into [Resident F’s] mouth. [Resident F] did not

swallow the medication, which overflowed out of his mouth all over his

face and chin and down his pyjamas.”

Ms 1 also gave evidence regarding this charge. She stated “During shifts

that I worked with [Mrs Griffiths] from December 2012 to February 2013

she often administered medication to residents while they lay flat on their

backs in bed. [Mrs Griffiths] would just tilt the head of the residents up a bit

but did not put them in full sitting positions like other nurses in the Home

did. This was unsafe and she put residents at risk of choking from the

tablets or drinks. On more than one occasion I offered to assist with

repositioning the residents into sitting positions before she administered

medication but [Mrs Griffiths] ignored me.”

The panel noted the record of the investigation interview between Ms 9,

Ms 10 and Mrs Griffiths, held on 24 September 2013. During this interview

Mrs Griffiths was asked whether she administered liquid medication and to

describe how. Mrs Griffiths answered “Yes, often. I prop their heads up

with a pillow if they can’t sit up.” In response to the question “have you

ever given medication flat”, Mrs Griffiths stated “No.”

The panel accepted the evidence of Ms 7. The panel considered that Ms

7’s evidence in relation to this charge was detailed, and this incident would

have been quite memorable to her. The panel noted that Ms 1 gave

similar evidence. The panel preferred the evidence of Ms 7 to the

explanation Mrs Griffiths provided to the investigating officers. The panel

concluded that Mrs Griffiths had administered medication to at least one

resident whilst the resident was lying down, and as such, found this

charge proved.

e. Told Resident E that you would “have it instead” or words to that effect,

when she refused paracetamol, and took Resident E’s prescribed

paracetamol yourself;

Ms 1 gave evidence about this charge. She stated “One night shift

between December 2012 and February 2013, I was in the lounge assisting

residents to their bedrooms while [Mrs Griffiths] was administering

medication. She came to the lounge, pulled out a medicine pot with

dispensed medication from her tunic pocket and said a resident named

[Resident E] refused to take her paracetamol. [Mrs Griffiths] then said “so I

will have it instead.” This was not acceptable. If a resident did not want

their medication [Mrs Griffiths] should have disposed of it and not taken it

herself. Before I could tell [Mrs Griffiths] this, she swallowed the tablets

from the medicine pot. I told [Mrs Griffiths] she was not supposed to take

residents’ medication but she ignored me and continued with her tasks.”

The panel considered that it could not rely on the sole evidence of Ms 1 in

relation to this charge. As the panel had no other corroborative evidence

before it to support this charge, the panel found this charge not proved.

f. Disposed of medication in the normal waste bin;

The panel had regard to the Home’s Medicines Policy, issued in

September 2010, which states:

“Where medication is refused and is set aside for disposal, a record of this

should be made at the earliest opportunity, including –

• Name of the person the medication is prescribed to;

• Date of disposal / return to pharmacy;

• Name, form, strength of medication;

• Quantity of medication for disposal;

• Signature of two members of staff – designated person and witness.

Medication awaiting disposal should be stored securely within appropriate

containers provided by the waste disposal service or pharmacy service

provided.

Waste medication must not be disposed of in “sharps bins”, in clinical or

household waste bags or into the sewage system – i.e., down sinks.”

The panel also had regard to the evidence of Ms 5, who explained the

appropriate disposal process for nurses at the Home to follow.

The panel noted the evidence of Mr 3. He stated “Within the treatment

room is a medication disposal box that is usually used by the other nurses

to dispose of medication. There is also an accompanying medication

disposal record book that is completed by the nurse to confirm what

medication is disposed of. On a number of occasions, the date of which I

cannot remember, I remember seeing Ms Griffiths dispose of medication

in the waste bin in the treatment room, rather than the medication disposal

box.”

The panel also noted the evidence of Ms 1, who stated “During one of the

shifts I worked with [Mrs Griffiths] between December 2012 and February

2013 I saw her emptying dispensed medication from a medicine pot into a

normal waste bin in the treatment room. Medicines should be disposed of

in a separate bin to the usual waste bin. I cannot recall the colour of the

bin but they are kept in the treatment room. I do not know whose

medication it and did not speak to [Mrs Griffiths] about this matter. It was

the only time I worked with [Mrs Griffiths] that I saw her dispose of a

resident’s medication.”

Mrs Griffiths, in the investigation meeting held on 24 September 2013,

stated that “sometimes patients will refuse medication and if they don’t

take it I put it in the medication bin.”

The panel accepted the evidence of Mr 3, and noted Ms 1’s evidence in

relation to this charge. The panel preferred the oral evidence of Mr 3 to

that of the account given by Mrs Griffiths which could not be explored at

the hearing. Accordingly, the panel found this charge proved.

g. Did not administer to residents all of the medication which they were due

to receive and which had been dispensed for them to take;

Ms 7, whilst giving evidence, stated that “As the shift progressed and

because Ms Griffiths was inexperienced in treating the residents on the

Unit, I assisted her with the medication round that took place later that

night. I went around the rooms with Ms Griffiths in order to help her to

ensure that the identity of the residents that she needed to administer

medication to was correct. As Ms Griffiths and I walked around the Home,

I considered there to be a number of unusual aspects to her medication

practise that I had not seen when I had viewed other nurses administer

medication on the Unit. For example, for one or two of the residents, Ms

Griffiths did not administer all of the tablets that had been dispensed by

her into the medication pot for the resident. Ms Griffiths instead gave

some of the tablets but placed the remainder in a pot in her pocket.

There was sometimes residents who took three or four different types of

medication but Ms Griffiths said that residents did not need so much

medication and this was why she did not administer all of it. I did not see

what happened to the medication that she placed in the pot in her pocket,

I thought it was extremely unusual as to why she simply did not administer

all of the tablets that had been dispensed for the residents in question. I

do not know the identity of the residents for whom this happened and

cannot give any information as to the name or type of medication

involved.”

In oral evidence, Ms 5 confirmed that sometimes residents would not

receive all of their medication due to their condition at that particular time.

The panel had regard to the record of an interview between Ms 12 and Mr

3 dated 1 March 2013. Mr 3, when questioned about a complaint from two

residents regarding not receiving medication, stated that one resident had

told him “that [Mrs Griffiths] did not give him his medication”. Further, the

panel had regard to the notes of an investigation interview held on 19

September 2013. Mr 3 stated “Sometimes she walks into the residents

rooms with the medication in the pots. Sometimes I’ve heard [Mrs Griffiths]

say that the residents don’t need the medication and she puts them in the

waste bin – not the meds bin and signed that they were given.”

The panel was satisfied that Mrs Griffiths did not administer all of the

medication which they were due to receive to some residents. However,

the panel could not be satisfied, without further evidence, including

documentary evidence (for example: MAR charts), indicating which

medications were withheld and why they were withheld, that the non-

administration of this medication was inappropriate. The panel therefore

found this charge not proved.

4. On unknown dates between 20 November 2012 and 11 March 2013, behaved

unprofessionally in that you, on one or more occasions:

a. Smoked in the doorway of the residents’ lounge causing smoke to be

blown into the residents’ lounge area;

Mr 3, in relation to this charge, stated that “At the Home, the agreement

between members of staff is that if one wishes to have a cigarette, then

you have to go into the smoking area in the car park outside the Home.

However, whenever Ms Griffiths smoked at the Home, she would do so by

opening the fire door located in the residents lounge, and would then

stand in the doorway facing outside having a cigarette. Because Ms

Griffiths was stood in such close proximity to the lounge, it would be

common for smoke to be blown into the lounge area meaning that

members of staff and residents would have to experience it.”

The panel also noted in the investigation interview of Mr 3 dated 19

September 2013, Mr 3 stated “[Mrs Griffiths] use to smoke outside the fire

exit door and not in the smoking area. She’d leave the door open and the

smoke would come in to us.”

The panel had regard to Ms 8’s evidence, who stated “During the course

of the night shift of 4 February 2013 I remember Ms Griffiths took a

number of cigarette breaks. She would take her break by the fire door to

the lounge of the Home standing on the doorstep. On a night shift the

doorstep of the lounge is the only place really where you are able to go for

a cigarette break, as you are unable to leave the Unit as the nurse in

charge of the shift. I do not remember smelling smoke inside the lounge

after Ms Griffiths had taken a cigarette break.” Ms 8 clarified, in her oral

evidence to the panel, that the fire doors were patio doors which lead from

the residents’ lounge to the outdoor courtyard. Ms 8 stated, that whilst she

could not smell the smoke inside the Home, she did remember seeing the

smoke being blown back into the lounge.

Ms 1 also gave evidence in relation to this charge. She stated “[Mrs

Griffiths] was a smoker and instead of going outside the building to smoke,

she smoked in the lounge. [Mrs Griffiths] would open the patio doors in the

lounge of the Unit which opened onto the garden and instead of going

outside and shutting the doors, she stood in the lounge blowing smoke

outside the open patio doors. This did not make any difference because

the smoke was blown into the lounge by the wind and the Unit smelt of

smoke which lingered until the morning staff came on shift. Each time I

saw [Mrs Griffiths] I would tell her to go outside and smoke but she would

ignore me and carry on with what she was doing. [Mrs Griffiths] did not

respect or have any consideration for the welfare of the residents or the

staff who she subjected to passive smoking and the offensive smell of

stale cigarettes.”

The panel had regard to the notes on the investigation meeting dated 24

September 2013, during which Mrs Griffiths was asked where she

smoked. Mrs Griffiths replied “Outside the fire exit door by the lounge. This

is where people would smoke in the night, because it was easier to hear

patients and people could just call you if they needed you.”

The panel accepted the evidence of Mr 3 and Ms 8, and noted the

evidence of Ms 1. The panel concluded that Mrs Griffiths had smoked in

the doorway of the fire doors, and by leaving the doors open, allowed

smoke to be blown back into the lounge. The panel considered that this

behaviour was unprofessional as it presented a health risk to others

(residents and staff), and was generally unpleasant. The panel considered

that smoke would have been blown into the residents’ home, and the

residents had no choice as to whether this occurred or not.

The panel, therefore, found this charge proved.

b. Took for yourself tea / biscuits prepared for residents;

Mr 3, in relation to this charge, stated “Ms Griffiths would also behave in

an unprofessional manner during shifts. For example, when I prepared tea

and biscuits for the residents to have, Ms Griffiths would often take a

biscuit and a cup of tea for herself.” Mr 3 stated that other members of

staff did not take tea from the trolley, and that this was not the normal

practice.

At an investigation interview held on 19 September 2013, Mr 3 stated

“[Mrs Griffiths] would always drink and eat the biscuits from the resident’s

trolley and I had to make more for the residents.”

The panel accepted Mr 3’s evidence in relation to this charge, and was

satisfied that Mrs Griffiths had taken the tea and biscuits that was meant

for the residents. The panel was also satisfied that this was not

professional behaviour, and therefore, found this charge proved.

c. Slept whilst on duty;

Mr 3, in relation to this charge, stated that “I found Ms Griffiths to be a very

lazy member of staff to work with. One example of her laziness would be

that she would regularly take a sleep during a night shift. At any point in

the early hours of the morning of a nightshift, I would regularly find Ms

Griffiths on a chair in either the lounge or nurses office, with her feet

propped up, and a blanket wrapped around her. Ms Griffiths in such

instances could be heard to be snoring with her eyes closed. On such

occasions that I saw this behaviour, I quickly would conclude that she was

asleep. It was so often that Ms Griffiths would sleep whilst on duty but it is

impossible for me to give a specific example of a date upon which an

incident took place.”

In another statement by Mr 3, he stated “I was in the Residents lounge

doing some paper work when I noticed that [Mrs Griffiths], who was on

duty as the registered nurse, was fast asleep in a chair. I took a

photograph of [Mrs Griffiths] asleep using the camera on my IPad, which I

produce and exhibit… At this time [Mrs Griffiths] should have been in the

office writing out care plans. I transferred this photograph to my laptop

where it is currently stored. I did not mention this in my previous statement

as I thought I would get into trouble, taking a photograph without her

permission.”

The panel had regard to the photographs produced by Mr 3 in relation to

this charge.

Mr 3, during his investigation interview dated 19 September 2013 stated

“[Mrs Griffiths] would often sleep all night on the chair with a blanket; she

worked four nights a week and would always sleep when she was

supposed to be awake. She didn’t seem to care we were there and would

wake up and say “sorry love”.”

Ms 1 also gave evidence in relation to this charge. She stated “During all

the nights shifts I worked with [Mrs Griffiths] between December 2012 and

February 2013, [Mrs Griffiths] slept for at least four hours. After

administering medication to residents between 20:30 and 23:00 [Mrs

Griffiths] would sit in the lounge with other carers and myself. She sat in

one of the armchairs with her shoes off and her feet up on a stool in front

of her. [Mrs Griffiths] would cover herself with a blanket and within minutes

she would be asleep and be snoring loudly. [Ms Griffiths] did not wake up

to respond to buzzers when residents called for assistance. She also did

not assist with checks at 02:00 and 06:00. [Mrs Griffiths] would not wake

up until 06:30. After this [Mrs Griffiths] would administer the morning

medication due at that time and complete any documentation expected of

her about the shift. Although [Mrs Griffiths] is not supposed to provide care

to residents during the 02:00 check she should have assisted with

buzzers. She was the most senior person on shift and had overall

responsibility for the safety of residents. [Mrs Griffiths] should have been

awake so she is alert to deal with any emergency situations.”

Mrs Griffiths, during an interview on 27 September 2013, was asked

whether she had ever slept on night duty. Mrs Griffiths replied stating “No,

we all get dozy but we were there for each other. No I am not a sleeper.”

The panel accepted Mr 3’s evidence in relation to this charge. The panel

noted the evidence of Ms 1. The panel was satisfied that Mrs Griffiths

slept whilst on shift, and that this was not acceptable, and thus,

unprofessional. The panel found this charge proved.

d. Attended work whilst smelling of alcohol;

Mr 3 also gave evidence towards this charge. He stated “I was also

concerned during a number of shifts, when I came into close proximity of

Ms Griffiths, I would be able to smell alcohol about her person. Whilst I did

not ever witness Ms Griffiths consume alcohol during working hours, she

would often conclude her shifts in the morning by stating that she would

now go and consume some vodka.”

At an investigation interview held on 19 September 2013, Mr 3 stated

“Sometimes [Mrs Griffiths] would come in smelling of alcohol, I didn’t tell

anyone.”

Ms 1 gave evidence towards this charge. She stated “When [Mrs Griffiths]

arrived for her shifts her breath smelt very strongly of alcohol but I did not

mention this to her. She did not act out of character to make me suspect

that she was drunk and that she was not capable of performing her

role…”.

Mrs Griffiths, during an interview on 27 September 2013, was asked

whether she had ever attended work smelling of alcohol. Mrs Griffiths

replied stating “Categorically not. I am too open about myself. I did lose

my licence a long time ago for drink/driving. But this makes me realise

someone is trying to get me out of Plas Y Dderwen.”

The panel accepted the evidence of Mr 3, and noted the evidence of Ms 1.

The panel preferred Mr 3’s evidence to the untested statement made by

Mrs Griffiths in this regard. The panel considered attending work whilst

smelling of alcohol was unprofessional. Further, a resident, their family or

even a colleague may have called into question Mrs Griffiths’ ability to

safely perform her duties. The panel found this charge proved.

e. Asked care assistant Ms 1 to administer medication to residents when she

was not qualified to do so;

Ms 1, in her witness statement, stated “During shifts [Mrs Griffiths] asked

me to administer medication to residents but I refused. It is not my

responsibility as a care assistant to administer medication to residents

because I am not qualified to do so. I have not been asked by any other

nurse in the Home to administer medication to residents. [Mrs Griffiths]

often asked me to administer medication to residents when I assisted

them with personal hygiene care. in that situation [Mrs Griffiths] had two

choices, she could have asked that I stop what I was doing so that she

could administer the medication or she could return to the resident after I

had finished giving them personal hygiene care. Instead [Mrs Griffiths]

would leave the medicine pot with the dispensed medication on the table

by the resident’s bed and say that she would return later to administer the

medication to the resident. I cannot recall any more specific details of such

incidents”.

The panel could not rely on the sole evidence of Ms 1. Without other

corroborative evidence to support this charge, the panel found this charge

not proved.

Determination on impaired fitness to practise Having announced the facts, the panel considered whether on the basis of the facts

found proved, Mrs Griffiths’ fitness to practise is currently impaired. This is a two stage

process. The panel must first determine if Mrs Griffiths’ actions and omissions amount

to misconduct. If misconduct is found, the panel must consider whether that misconduct

amounts to current impairment of Mrs Griffiths’ fitness to practise.

In coming to its decision, the panel has taken into account all of the facts found proved.

It has taken account of all the evidence before it, including the records of Mrs Griffiths’

investigatory interviews and her letters to the investigating officers. The panel had

regard to Mr Mulchrone’s submissions on behalf of the NMC, and has heard and

accepted the legal assessor’s advice.

The panel had regard to the public interest matters to be considered. Those matters

included the protection of the public, the need to maintain proper professional standards

and whether, in the particular circumstances of this case, public confidence in the

profession and in the NMC as a regulatory body would be undermined if a finding of

impairment were not made.

Misconduct:

When determining whether the facts found proved amount to misconduct the panel had

regard to the Code: Standards of conduct, performance and ethics for nurses and

midwives 2008 (the Code).

The panel accepted that not all breaches of the Code automatically result in a finding of

misconduct. In particular, the panel considered Charges 3(f), 4(a), 4(b) and 4(d). In

relation to charge 3(f), the panel considered that it did not have sufficient information

before it to allow it to determine which medications were disposed of in the waste bin.

The panel also noted that the evidence before it suggested that the medications were

disposed of in a waste bin which was in the treatment room, and not in patient areas.

Whilst the panel determined the facts found proved in relation to charges 3(f), 4(a), 4(b)

and 4(d) were not best practice and were unprofessional, the panel considered that

these actions were not sufficiently serious to amount to serious professional

misconduct.

In relation to Charge 1, the panel noted that it took two requests by a night shift care

assistant before Mrs Griffiths attended a vulnerable resident after concerns had been

raised about a deterioration in her condition. The panel noted that despite these

concerns, Mrs Griffiths stated that she did not consider Resident A’s condition to be

particularly serious. The panel found as a fact that Mrs Griffiths failed to carry out

adequate observations, did not document any observations she may have made, failed

to call for medical assistance and did not hand over the information on to the day shift

nurse, Ms 5.

Resident A’s deteriorated condition was subsequently identified by two care assistants

on the day shift, who asked Ms 5 to attend to Resident A. It was only then that an

ambulance was called. The panel considered that Mrs Griffiths’ failures to respond

appropriately to Resident A’s deteriorating condition as set out in Charge 1(a), 1(b), 1(c)

and 1(d), were each serious and amounted to serious professional misconduct.

The panel considered Mrs Griffiths’ behaviour as set out in Charge 2 was serious and

amounted to serious professional misconduct. Mrs Griffiths failed to respect Resident

B’s dignity by telling her words to the effect of “pee in your pad”, and did not respect the

contribution that Resident B was trying to make to her own care and wellbeing.

In relation to Charges 3(a), 3(b) and 3(c), the panel considered that Mrs Griffiths’

actions led to a risk of vulnerable residents accessing prescription medication. This

could have resulted in significant harm to a resident if such medication had been

consumed. Further, the inappropriate administration of medication, either by failing to

supervise its administration or administering it whilst the resident was lying flat, was

unsafe and could have led to a risk of harm to residents. The panel concluded that the

conduct as set out in Charge 3(a), 3(b), 3(c) and 3(d) was in each case serious and

amounted to serious professional misconduct.

The panel considered, in relation to charge 4(c), that it appeared that Mrs Griffiths

displayed a pattern of behaviour, in that, she would go to sleep at the Home for hours at

a time, and was clearly not contributing to the safe running of the Home at such times.

The panel considered this to be unsafe practice on her part, as she would not have

been alert to any issues which may have arisen. The panel concluded that the conduct

set out in Charge 4(c) was sufficiently serious to amount to serious professional

misconduct.

Given the misconduct found proved, the panel considered that there had been a serious

departure from the standards expected of a registered nurse, and as such, Mrs Griffiths

had not upheld the reputation of the profession at the relevant time.

The panel was satisfied that Mrs Griffiths had breached the following parts of the

preamble and the Code:

The people in your care must be able to trust you with their health and wellbeing

To justify that trust, you must:

• make the care of people your first concern, treating them as individuals and

respecting their dignity

• work with others to protect and promote the health and wellbeing of those in your

care, their families and carers, and the wider community

• provide a high standard of practice and care at all times

• ….

As a professional, you are personally accountable for actions and omissions in your

practice, and must always be able to justify your decisions.

1 You must treat people as individuals and respect their dignity.

3 You must treat people kindly and considerately.

8 You must listen to the people in your care and respond to their concerns and

preferences.

10 You must recognise and respect the contribution that people make to their own care

and wellbeing.

15 You must uphold people’s rights to be fully involved in decisions about their care.

21 You must keep your colleagues informed when you are sharing the care of others.

22 You must work with colleagues to monitor the quality of your work and maintain the

safety of those in your care.

24 You must work cooperatively within teams and respect the skills, expertise and

contributions of your colleagues.

26 You must consult and take advice from colleagues when appropriate.

28 You must make a referral to another practitioner when it is in the best interests of

someone in your care.

35 You must deliver care based on the best available evidence or best practice.

42 You must keep clear and accurate records of the discussions you have, the

assessments you make, the treatment and medicines you give, and how effective

these have been.

43 You must complete records as soon as possible after an event has occurred.

61 You must uphold the reputation of your profession at all times.

Therefore, for all of the above reasons, the panel determined that the facts found

proved in Charge 1(a), 1(b), 1(c), 1(d), 2, 3(a), 3(b), 3(c), 3(d) and 4(c) each amounted

to serious professional misconduct.

Impairment:

Having found misconduct, the panel went on to decide whether Mrs Griffiths’ fitness to

practise is currently impaired. The NMC defines fitness to practise as a registrant’s

suitability to remain on the register unrestricted.

The panel had in mind the remarks of Cox J in the case of Council for Healthcare

Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927

(Admin) in relation to the appropriate guidance identified by Dame Janet Smith in the

Fifth Shipman report:

“Do our findings of fact in respect of the doctor's misconduct, deficient

professional performance, adverse health, conviction, caution or

determination show that his/her fitness to practise is impaired in the sense

that s/he:

a. has in the past acted and/or is liable in the future to act so as to put

a patient or patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the

medical profession into disrepute; and/or

c. has in the past breached and/or is liable in the future to breach one

of the fundamental tenets of the medical profession; and/or

d. has in the past acted dishonestly and/or is liable to act dishonestly

in the future”

The panel was satisfied that limbs a, b, and c were engaged in this case.

The panel considered that Mrs Griffiths had brought the profession into disrepute and

breached fundamental tenets of the profession. The panel considered that Mrs Griffiths’

actions and omissions placed residents at an unwarranted risk of harm.

The panel next considered whether Mrs Griffiths’ conduct was remediable. Whilst the

panel considered it had been disadvantaged by not having any evidence from Mrs

Griffiths of her actions since the date of the charges or her current circumstances, it did

consider that Mrs Griffiths’ misconduct was potentially remediable.

The panel then went on to consider whether Mrs Griffiths had remedied her misconduct.

The panel noted that there was no evidence before it that Mrs Griffiths had undergone

any training. The panel also noted that it had no evidence before it to suggest that Mrs

Griffiths had shown any insight or remorse for her misconduct. It did note, in relation to

Charge 2, that Mrs Griffiths had alleged that Resident B had said words to the effect of

she had “pissed her pad” and that she, Mrs Griffiths, would not have used such

language. The panel considered that was an attempt by Mrs Griffiths to deny

responsibility for using such a phrase and to wrongly attribute the phrase to an elderly,

vulnerable resident and showed poor insight on Mrs Griffiths’ part.

The panel had regard to the signed letter from Mrs Griffiths to the NMC dated 2 August

2015, in which she stated “I Jo Griffiths hereby confirm that following legal advice from

the Royal College of Nursing, I have decided to disengage from my NMC Fitness to

Practise proceedings. … I do not wish to work in nursing any longer…”. The panel

considered that this statement demonstrates that it is unlikely that Mrs Griffiths has

made any attempt to remediate her practice.

The panel next considered whether Mrs Griffiths was likely to repeat her misconduct.

The panel determined, in the absence of any evidence that Mrs Griffiths had remediated

her misconduct, that she is liable in the future to put residents/patients at unwarranted

risk of harm, bring the nursing profession into disrepute and breach fundamental tenets

of the nursing profession. The panel cannot be satisfied that it is highly unlikely that Mrs

Griffiths will not repeat her actions, and it considered that there is a risk of future

repetition.

The panel therefore determined that Mrs Griffiths’ fitness to practise is currently

impaired by reason of her misconduct. To find otherwise would undermine public

confidence in the profession and in the NMC as a regulatory body.

Determination on sanction:

Having determined that Mrs Griffiths’ fitness to practise is impaired, the panel

considered what sanction, if any, it should impose. The panel can conclude this case by

taking no action, imposing a caution order for one to five years, a conditions of practice

order for no more than three years, a suspension order for a maximum of one year or a

striking-off order. In reaching its decision, the panel considered all the evidence that has

been placed before it, as well as the submissions of Mr Mulchrone on behalf of the

NMC. It heard and accepted the advice of the legal assessor.

The panel had regard to the Indicative Sanctions Guidance (ISG) and employed the

principles of proportionality, weighing the interests of residents/patients and the public

with Mrs Griffiths’ own interests.

The panel considered the least restrictive sanctions first, before moving on to consider

more restrictive sanctions. It has borne in mind that the purpose of a sanction is not to

be punitive, though it may have a punitive effect. The panel has had regard to both the

public interest and Mrs Griffiths’ own interests and considered the mitigating and

aggravating factors in this case. The panel has borne in mind that the public interest

includes the protection of residents/patients, the maintenance of public confidence in

the profession and declaring and upholding proper standards of conduct and behaviour.

The panel determined the mitigating factors are that:

• Mrs Griffiths has had a long nursing career, with no evidence of previous

misconduct.

The panel determined the aggravating factors are that

• Mrs Griffiths’ misconduct involved elderly, vulnerable residents;

• Mrs Griffiths sought to attribute words to the effect of “pee in your pad” to an

elderly resident;

• Mrs Griffiths put residents at an unwarranted risk of harm;

• There is no evidence of remorse, insight, or remediation by Mrs Griffiths;

• The misconduct spanned several different areas of practice, including basic care,

record keeping, medication administration and identifying and escalating

concerns about a resident’s condition.

The panel first considered whether to take no action, but concluded that this would be

inappropriate in view of the seriousness of Mrs Griffiths’ misconduct as reflected in the

panel’s findings of fact and impairment. The panel decided that to take no action would

not take into account the need to protect the public, nor would it take into account the

need to uphold confidence in the profession and to maintain the standards expected of

a registered nurse.

Next, in considering whether a caution order would be appropriate, the panel took into

account the ISG, which states that, ‘a caution may be appropriate where the case is at

the lower end of the spectrum of impaired fitness to practise and the panel wishes to

mark that the behaviour was unacceptable and must not happen again’. The panel was

satisfied that Mrs Griffiths’ misconduct was not at the lower end of the spectrum of

impaired fitness to practise. The panel determined that such a sanction would put no

onus on Mrs Griffiths to remedy the failings that have been identified in her practice and,

for the same reasons as given above, this sanction is neither appropriate nor

proportionate.

The panel next considered a conditions of practice order. The panel had regard to the

ISG, specifically the key considerations for imposing a conditions of practice order. At

paragraph 67.4, it states a conditions of practice order may be appropriate if a registrant

demonstrates a “potential and willingness to respond positively to retraining.” Mrs

Griffiths has stated, in her letter to the NMC dated 2 August 2015, that she does not

“wish to work in nursing any longer.” The panel considered that this demonstrated a lack

of willingness to retrain.

Further, the panel noted that paragraph 67.8 of the ISG states that a conditions of

practice order may be appropriate if “it is possible to formulate conditions and to make

provision as to how conditions will be monitored”. The panel considered that whilst it

may be possible to formulate conditions to address misconduct such as identified in this

case, it did not have any information as to Mrs Griffiths’ current circumstances, and was

therefore unable to make provisions for conditions to be monitored. In these

circumstances, the panel determined that it could not formulate appropriate, practicable

and workable conditions of practice that would adequately address Mrs Griffiths’

misconduct.

The panel next considered a suspension order. The panel had regard to the ISG and

the key considerations to take into account when considering a suspension order. It

noted the following:

71 “This sanction may be appropriate when some or all of the following factors are

apparent (this list is not exhaustive):

71.1 A single instance of misconduct but where a lesser sanction is not sufficient.

71.2 The misconduct is not fundamentally incompatible with continuing to be a

registered nurse or midwife in that the public interest can be satisfied by a

less severe outcome than permanent removal from the register.

71.3 ...

71.4 ...

71.5 The panel is satisfied that the nurse or midwife has insight and does not

pose a significant risk of repeating behaviour.

71.6 …”

The panel considered that Mrs Griffiths’ misconduct was not a single instance, it

occurred on more than one day, it concerned several areas of nursing practice and

involved a number of vulnerable residents. Further, the panel found that Mrs Griffiths

has not shown any insight into her misconduct, has demonstrated no remorse, and

there is a risk of her repeating this misconduct. The panel concluded that the

seriousness of the misconduct found proved meant that the public interest could not be

satisfied by temporary removal from the Register. Therefore, a period of suspension

would not be the appropriate sanction in this case.

The panel considered the most severe sanction, that of a striking off order. The panel

considered that Mrs Griffiths’ misconduct was a serious departure from the relevant

professional standards set out in the Code.

The panel noted in the ISG that a striking off order may be appropriate when a

registrant has done “harm to others or [has behaved] in such a way that could

foreseeably result in harm to others, particularly patients or other people the nurse …

comes into contact with in a professional capacity, either deliberately, recklessly,

negligently or through incompetence, particularly where there is a continuing risk to

patients. Harm may include physical, emotional and financial harm.” The panel

considered that Mrs Griffiths had put residents at unwarranted risk of harm, and was

liable to do so in the future.

Further, the panel noted that a striking off order may be appropriate where a registrant

has shown a “Persistent lack of insight into seriousness of actions or consequences”.

The panel had no evidence before it demonstrating any remorse, insight or remediation

of Mrs Griffiths’ misconduct.

The panel concluded that the seriousness of this case is incompatible with ongoing

registration. It considered that Mrs Griffiths’ misconduct is fundamentally incompatible

with her being a registered nurse. In particular it took into account Mrs Griffiths’ serious

departure from the Code and her misconduct which had the potential to cause harm to

residents.

In all the circumstances, the panel concluded that a striking-off order is the only

sanction which is sufficient to protect the public interest and that public confidence in the

profession and the NMC would only be sustained if Mrs Griffiths’ name is removed from

the Register.

The striking-off order results in the removal of Mrs Griffiths’ name from the Register,

thus preventing her from working as a registered nurse. Mrs Griffiths may not apply for

restoration until a period of five years has elapsed since the striking-off order was made.

An application for restoration will not be granted unless a panel of the Conduct and

Competence Committee is satisfied that Mrs Griffiths meets the requirements for

admission to the Register and, in addition, is a fit and proper person to practise as a

nurse. The panel, therefore, directs the Registrar to strike Mrs Griffiths’ name from the

Register. Mrs Griffiths will be informed of this decision in writing.

Decision on Interim Order and reasons:

The striking-off order will not take effect until the end of the appeal period (28 days after

the date on which the decision letter is served) or, if an appeal has been lodged, before

the appeal has concluded.

The panel therefore considered the submissions made by Mr Mulchrone that an interim

suspension order should be made to cover the appeal period for a period of 18 months.

The panel accepted the advice of the legal assessor and took account of the guidance

issued to panels by the NMC when considering interim orders and the appropriate test

as set out at Article 31 of The Nursing and Midwifery Order 2001. It may only make an

interim order if it is satisfied that it is necessary for the protection of the public, is

otherwise in the public interest or in Mrs Griffiths’ own interest.

The panel was satisfied that an interim order is necessary for the protection of the public

and in the public interest to uphold the reputation of the profession. The panel

considered that, for the same reasons as given above, an interim conditions of practice

order is not appropriate in these circumstances. The panel concluded that an interim

suspension order for a period of 18 months was necessary in this case.

The period of this order is for 18 months to allow for the possibility of an appeal to be

made and determined.

If no appeal is made then the interim suspension order will be replaced by the striking-

off order 28 days after Mrs Griffiths is sent the decision of this hearing in writing.

That concludes this hearing.

conduct and competence committee - the nursing & … · mrs griffiths was not present or...

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