Summary: Mr X complained about the care provided to his mother Mrs Y at the care provider’s care home. There was fault as there were delays in answering her call bell, in sorting her email access and in discussing her meal preferences. The care provider has agreed to apologise and pay Mrs Y £200 to acknowledge the distress and frustration this caused. There was no fault in its involvement in arranging a wheelchair. I have not investigated the care provider’s refusal to accept Mrs Y back after a hospital admission as it is unlikely I would find fault as Mrs Y’s needs had changed.

The complaint

1. Mr X complained about the care provided to his mother Mrs Y at The Granby Care Home (the care home), run by Brighterkind (Granby Care) Limited (the care provider). He said there were delays in answering her call bell, delays in arranging a wheelchair and it failed to properly consider her nutritional requirements as a diabetic. Mr X said this caused Mrs Y distress. He also complained the care provider refused to allow Mrs Y to return to the care home after a hospital admission which meant she had to stay in hospital longer than necessary.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:
• the action has not caused injustice to the person who complained, or
• the injustice is not significant enough to justify our involvement, or
• it is unlikely we could add to any previous investigation by the care provider, or
• it is unlikely further investigation will lead to a different outcome, or

• there is another body better placed to consider this complaint.

(Local Government Act 1974, sections 34B(8) and (9))

5. If we are satisfied with a care provider’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
6. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share the final decision with CQC.

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How I considered this complaint

7. I have considered the information provided by Mr X and discussed the complaint with him on the telephone. I have considered the care provider’s response to the complaint and the latest CQC inspection of the care home. I have considered our published guidance on remedies.
8. I gave Mr X and the care provider the opportunity to comment on a draft of this decision. I considered any comments I received before I reached a final decision.

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What I found

Relevant law and guidance

9. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
10. CQC is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of the fundamental standards and prosecute offences.
11. Regulation 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires providers to have sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the people using the service at all times.

What happened

12. Mrs Y has physical health conditions including diabetes. She mobilises using a wheelchair after an amputation. Mrs Y moved into the care home in April 2020 after a hospital admission. Mr X says the care started to deteriorate around Autumn 2020.

Stage one complaint

13. In April 2021 Mr X wrote to the care home to raise some concerns. In particular, he complained:
• there was a delay in sourcing an electric wheelchair through the NHS. Mr X says the NHS delivered an electric wheelchair to the care home in August 2020 but it was returned as it was too wide for its doors. He says the care home failed to follow this up until April 2021.
• Mrs Y was unable to access her email at the care home despite receiving a new tablet so she could communicate with friends and family. The issue appeared to be with the care home’s network but had not been resolved.
• there were extended waiting times for her call bell to be answered after 7pm, sometimes she was waiting over an hour. Mrs Y would contact Mr X at the time and on occasions this led to her incontinence products leaking which caused her distress. Mr X said he understood Mrs Y had the correct continence products but that she may need more frequent attention due to her diabetes and being on water tablets.
14. The care provider responded to Mr X in May 2021. The response also addressed other issues raised by Mr X.
• Sourcing an electric wheelchair: It said it completed a wheelchair referral to a local charity, the Wheelchair Centre Team in late February 2021. The Wheelchair Centre Team confirmed the referral in early March. The Wheelchair Centre Team requested the GP complete a medical questionnaire which was done and the Wheelchair Centre Team was due to visit on 25 May to ensure the wheelchair was a correct fit for Mrs Y.
• Access to emails: It said its IT Department found no issues with the security firewall which would prevent Mrs Y receiving emails. It had requested one of the IT engineers visit the home to attempt to resolve the issue.
• Call bell times: It had reviewed the nurse call system logs and confirmed there were some instances when Mrs Y’s calls for assistance took longer to respond to than it would expect. It apologised for the distress this may have caused Mr X and Mrs Y. It stated it used an algorithm to calculate staffing ratios based on residents’ needs. It had reviewed this and had agreed to increase the team to better support residents.
• Continence issues: It said it completed a new continence assessment in April 2021. It said the records showed there were occasions when the care team met Mrs Y’s hygiene needs up to 10 times a day. It said Mrs Y would then be prescribed four continence products for 24 hours. It said these were designed to last for several hours but if a resident required more than prescribed it would be for the family to provide.
• Diabetic diet: It said there was a diabetic choice available daily on the menu and the kitchen had a list of each resident’s preferences. It was open to Mrs Y to choose from the menu.

Stage 2 complaint response

15. Mr X remained unhappy. The care provider considered his complaint at the next stage of its complaints’ procedure. As part of this it met with Mr X and Mrs Y in June 2021. It wrote to Mr X following this. It said:
• access to emails: Mrs Y had gained access to her emails in early June. It found the blockage was due to the security settings on its Wi-Fi.
• sourcing a Wheelchair: It said it had considered information Mr X had received from the Wheelchair Centre Team. It said it had not declined an assessment of Mrs Y after it refused the electric wheelchair but at the time the care home was closed to visitors due to the COVID-19 pandemic and outbreaks in the team. The care home was closed to visitors from 28 July 2020 to 27 December 2020 then in February and April 2021.
• Extended call bell times: it said since their meeting staff were documenting when they answered the call bell and why it was rung. It found the log was being maintained and on occasion Mrs Y had to wait 5 minutes. It said Mrs Y required two people to assist with her continence needs so there would be occasions when her call bell was answered and a staff member needed to get further assistance.
• Diabetic menu and choice: the care provider noted Mrs Y said the chef had not discussed her preferences with her. It said it would expect the Chef to visit all new residents to determine their dietary requirements and thereafter discuss the menu with residents. It apologised this had not happened. It said the chef and a senior staff member had since met with Mrs Y and the chef was able to provide her choices.
16. It explained if Mr X remained dissatisfied he could complain to us.

CQC inspection

17. In April 2021 the CQC inspected the care home. It found the care home ‘required improvement’.
18. As part of the inspection it found there were insufficient staff to meet the needs of people in a timely manner both because of the level of support required and the layout of the environment. It referred to people waiting long periods of time for their call bells to be answered as staff were busy assisting other people. It said this was in breach of regulation 18 (staffing).
19. The CQC requested an action plan to understand what the care provider would do to improve the standards of quality and safety.

Hospital admission

20. Mrs Y was admitted to hospital in August 2021 with breathing difficulties. Mr X says Mrs Y was diagnosed with sleep apnoea and given a specialist machine to use for this.
21. He says the Council’s social worker met with him, Mrs Y and the care provider on 19 September to discuss Mrs Y’s discharge. The care provider agreed at the time to accept Mrs Y back at the care home. However, on 25 September, two days before her planned discharge, it changed its mind. Mr X said the care provider said this was because it relied on agency staff at night time who were not sufficiently trained in the use of Mrs Y’s equipment. The care provider says it was not advised by the hospital until the day after the meeting of Mrs Y’s additional health needs. The home then needed to consider whether it could still meet her needs before updating Mr X and Mrs Y that it could not.
22. Mrs Y remained in hospital while the Council and Mr X sought to identify an alternative care home. Mrs Y moved into a different care home in late November 2021.

Findings

Access to emails

23. Mrs Y used emails to communicate with friends and family. Mr X had repeatedly raised his concerns about Mrs Y’s inability to do this with the care home and it took until June 2021 to resolve it. This delay was fault and caused Mrs Y avoidable frustration.

Sourcing an electric wheelchair

24. Mr X says the care home initially refused the electric wheelchair delivered to the care home in August 2020 as it was too wide for the care home doors. As the wheelchair was needed to assist Mrs Y with moving around the care home I could not say this was fault. There was a delay in carrying out a further assessment as the care home did not make another referral until February 2021. However, the care provider has explained how this was compounded by the care home being closed to visitors for periods due to the COVID-19 pandemic. Given the circumstances I am not minded to say this is fault and there nothing more I could achieve by investigating this issue further. Mr X says Mrs Y now has a manual not electric wheelchair. It is for the NHS, not the care home, to decide what type of wheelchair to provide Mrs Y.

Extended call bell times

25. The care provider, in its complaint response to Mr X, accepted there were times when Mrs Y had to wait significantly longer than she should have to have her call bell answered. This was fault which caused Mrs Y distress.
26. The CQC inspected the care home in April 2021. It found there were insufficient staff to meet the needs of people in a timely manner and that people had to wait too long for their call bells to be answered. It identified breaches in the regulations which the care provider was required to address. The CQC is better placed as the regulator of care providers to address the service improvement issues it identified and to ensure these are followed up.

Diabetic menu and choice

27. The care provider explained it provided choices suitable for diabetics on its menu. It therefore was able to meet Mrs Y’s nutritional needs. However, it accepted, following its meeting with Mr X and Mrs Y, that the chef had not met with Mrs Y to discuss her preferences, as per its usual procedure. It had since done this. Mr X said Mrs Y still did not always get the choices requested. I do not intend to investigate this further. This is because the care home is expected to consider every individual’s preferences but is not required to meet them at all mealtimes. There is no evidence Mrs Y’s nutritional needs were not met and Mrs Y no longer lives at the care home.

Refusing to readmit Mrs Y after her hospital admission

28. Mr X says the care home agreed to take Mrs Y back after her hospital admission but then refused two days before her discharge. Whilst I appreciate this was frustrating for Mr X and Mrs Y I do not intend to investigate this further. This is because it is unlikely I would find evidence of fault. Mrs Y’s needs had changed following her hospital admission. The care provider considered it could meet those needs but later realised it could not safely support Mrs Y at night time.
29. It would have been better had it advised Mr X and Mrs Y of this at the meeting on 19 September. However, the care provider says it was not made aware of the change in Mrs Y needs until 20 September. In any case there were only six days between it agreeing to accept her then refusing to. So I cannot say this had a significant impact on the ability to find an alternative care home.

Injustice

30. Mrs Y no longer lives at the care home but the delays in allowing her access to her emails, in discussing her meal preferences and more significantly, the delays in answering her call bell, caused her distress and frustration. The Ombudsman can recommend a symbolic payment to acknowledge the distress caused to a complainant and I have done so in this case.
31. Following its inspection, CQC will follow up the service improvements it identified with the care home, to ensure these are carried out.

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Agreed action

32. Within one month of the final decision the care provider has agreed to apologise and pay Mrs Y £200 to acknowledge the distress and frustration caused by the care provider’s faults.

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Final decision

33. I have completed my investigation. There was evidence of fault causing injustice which the care provider has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman