A Winnipeg care home waited six hours to call an ambulance after one of its residents had a stroke earlier this year, a CBC News I-Team investigation has found.

Family members of Evelyn Gabbs say they were outraged with the long delay staff at Fred Douglas Lodge took to send the 95-year-old to hospital.

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Evelyn Gabbs had lived at Fred Douglas Lodge in Winnipeg for much of the last six years. She died in January, four days after having a stroke at the personal care home. (CBC)

"If she had been attended to right away, they might have been able to help her and … brought her back a little bit," her daughter, Donna Gabbs, told CBC News.

"But she was already past the point of coming back to life."

Evelyn Gabbs, who had lived at the care home for much of the last six years, began experiencing symptoms of a stroke on the morning of Jan. 14.

According to the care home's records, obtained by CBC News, a licensed practical nurse at Fred Douglas Lodge had noticed around midday that Gabbs was unresponsive when touched on her right side, her tongue was hanging out of her mouth, she had no gag reflex and she was unable to swallow.

Waited for another nurse

The nurse decided not to call for an ambulance at that time, but instead wait for a registered nurse, according to the home's records.

The records indicate that Gabbs showed the same symptoms when she was checked again at 3:30 p.m.

Staff left a voicemail message for Gabbs's daughters at 4:20 p.m., followed by another message an hour later, asking them to call the care home because there had been an incident.

It was not until 6 p.m. that Donna Gabbs received her message, called Fred Douglas Lodge and learned what happened.

"I said, 'You're just phoning me now? Why didn't you send her to the hospital?'" she recalled saying to a care home staffer.

The employee told her, "We wanted to wait until we could get in touch with you," she said.

Family was billed for ambulance ride

The family insisted that Evelyn Gabbs be sent to hospital. She arrived at Seven Oaks Hospital by 7 p.m.

According to the Fred Douglas Lodge's policies, it must pay for the ambulance if it calls for one. The resident's family must pay if it makes the decision to call the ambulance.

The Gabbs family was later charged $383 for the ambulance ride.

"I'm thinking they waited for us because they didn't want to pay for the ambulance," Donna Gabbs said.

The Winnipeg Regional Health Authority (WRHA) has since said it will cover the ambulance cost.

Seven Oaks Hospital was full when Evelyn Gabbs arrived, so her family decided to bring her back to Fred Douglas Lodge, on the advice of doctors who said she would be more comfortable at the home until she died.

Given less morphine than prescribed

Before Gabbs was discharged from the hospital, doctors prescribed up to 10 milligrams of morphine, to be administered every two hours.

But Gabbs was given only five milligrams of morphine every four hours, according to the care home's records.

"One of the nurses finally told my sister, 'Your mother is suffering, but we haven't done anything about it because we haven't been given instructions to increase her pain medication'," Donna Gabbs said.

The morphine dosage was increased four days later — just hours before Evelyn Gabbs passed away.

No one from Fred Douglas Lodge or the WRHA would agree to be interviewed on Gabbs's case, despite numerous requests by CBC News this week.

But in a statement issued Thursday afternoon, the WRHA said it is investigating the concerns raised "about both the delay in communications between Fred Douglas Lodge and her family and the timeliness of the care she received after her stroke.

"Both Fred Douglas Lodge and the [WRHA] have apologized to family representatives for what happened and committed to keeping them informed," the statement read in part.