Summary: Mrs Z complained a care home failed to provide appropriate personal care to her father-in-law, Mr X, as well as losing some property and failing to safeguard and follow proper financial procedures. There is no fault in respect of the personal care provided by the Care Home. Any fault in respect of failing to follow correct procedures did not result in a significant injustice to Mr X.

The complaint

1. Mrs Z, on behalf of her father in law Mr X, complains a care home, commissioned to provide care to Mr X, has not provided appropriate personal care, has lost some of his property, failed to safeguard Mr X and failed to follow proper financial procedures.
2. This has caused distress to Mr X and his wider family, affecting the time they spend together due to the ongoing issues.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. If we are satisfied with an organisation’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)

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How I considered this complaint

5. As part of the investigation, I have:
• considered the complaint and the documents provided by the complainant’s representative;
• made enquiries of the Council and considered the comments and documents the Council provided;
• discussed the issues with the complainant’s representative;
• sent my draft decision to both the Council and the complainant and taken account of their comments in reaching my final decision.

What I found

Mental Capacity Act

6. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The Act (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so.

Best interest decision making

7. A key principle of the Mental Capacity Act 2005 is that any act done for, or any decision made on behalf of a person who lacks capacity must be in that person’s best interests. The decision-maker also has to consider if there is a less restrictive choice available that can achieve the same outcome. Section 4 of the Act provides a checklist of steps decision-makers must follow to determine what is in a person’s best interests.

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Court of Protection

8. The Court of Protection deals with decision-making for adults who may lack capacity to make specific decisions for themselves.
9. The Court of Protection may need to become involved in difficult cases or cases where there is disagreement which cannot be resolved in any other way. The Court of Protection:

• decides whether a person has capacity to make a particular decision for themselves;
• makes declarations, decisions or orders on financial or welfare matters affecting people who lack capacity to make such decisions;
• appoints deputies to make decisions for people lacking capacity to make those decisions;
• decides whether a Lasting Power of Attorney or Enduring Power of Attorney is valid; and
• removes deputies or attorneys who fail to carry out their duties.

Key facts

10. Mr X was transferred to a care home in February 2021 after experiencing a brain injury as the result of a stroke. A best interest meeting decided a residential placement was appropriate as well as being the least restrictive option for Mr X.
11. The needs assessment found Mr X was at risk of self-neglect and so needed prompting with personal hygiene, to change his clothes and dress appropriately for the weather and to maintain nutrition and hydration.
12. In September 2022, Mr Z complained to the Council about services provided to his father. This included:
• the attitude of staff at the home;
• the home not keeping Mr Z informed about his father’s care;
• the care home taking over his father's finances even though an application had been made to the Court of Protection;
• failure of the care home to give access to finances and so unable to pay father’s bills; and
• accusing him of misusing his father’s finances and about his father’s unkempt appearance.
13. The Council upheld Mr Z’s complaint because the Care Home took over management of Mr X’s finances without involving the Council and carrying out a best interests decision meeting. It also said there was evidence of conflict and miscommunication between the Care Home and Mr Z. The Council said that it would be carrying out a mental capacity assessment and then, if appropriate, a best interests meeting to decide who should manage Mr X’s property and financial matters while waiting for the Court of Protection decision.
14. The mental capacity assessment carried out in October 2022 found that Mr X did not have capacity to make decisions about his finances. The best interests decision found the Council’s Financial Affairs Team (CFA) should take over the management of Mr X’s finances. A file note dated 21 October 2022 shows a referral would be made to the CFA. However, the CFA subsequently decided it had no role to take because applications from both Mr Z and his sister were pending with the Court of Protection.
15. At around the same time Mr Z made a complaint, his sister contacted the Council about financial abuse by Mr Z. As a result the Council made a safeguarding referral. The Ombudsman has considered a separate complaint from Mr Z about this. The police took the lead on the safeguarding investigation and concluded there was no evidence of financial abuse by Mr Z.
16. The Care Home responded to Mr Z’s complaint on 10 October 2022. The response provided comments on all issues raised by Mr Z which included Mr X’s appearance, communication between Mr Z and the Care Home, financial issues; attendance at review meetings and concerns about lack of support to improve Mr X’s brain function.
17. Some of the responses provided are:
• Mr X is responsible for his own laundry and ironing. The Care Home said it would not knowingly allow a person to go out with dirty and un-ironed clothes. In respect of Mr X going out in July with only half a cheek shaved, the Care Home said that Mr X makes his own decisions about whether to shave and sometimes has a wet shave and sometimes uses a beard trimmer. It says it has no recollection of Mr X leaving the home half shaven. It also said that it does keep the family updated regarding medical appointments and that Mr Z was updated on the outcome of an MRI scan;
• Regarding reviews of Mr X’s care and support, the Care Home said that it was aware of the strained relationship between Mr Z and his sister and believed that as a result both parties would not attend at the same time. It said both Mr X and his sister were invited to attend a review meeting but Mr Z was unable to attend due to being on holiday;
• the Care Home kept records and have receipts for all expenditure. It said that Mr Z had placed money in Mr X’s wallet without signing it into the service. It said it can account for all money given to it; and
• that it was a residential service not a brain injury rehabilitation service. It offered to meet with Mr Z to discuss the points noted in the last review he was unable to attend and to discuss any further questions Mr Z had.
18. Mr Z was unhappy with the Care Home’s response to his complaint and so escalated matters. Most of the concerns raised related to financial matters and that Mr Z felt the Care Home had not treated him fairly in how it responded to these issues.
19. In July 2023 a Director for the Care Provider wrote to Mr Z saying it considered it had responded appropriately to the concerns raised and while it could not take his concerns any further it had given them full consideration.

Analysis

20. This complaint is made on behalf of Mr X and is concerned with the care provided to him by the Care Home. This complaint is separate to matters relating to Mr Z’s role in his father’s finances which has been considered separately by the Ombudsman.
21. Complaints were raised about Mr X’s appearance. Mr X’s care and support plan states that he is capable of dressing and washing himself but is at risk of self neglect and so needs prompting. I have looked at the daily case records kept by the Care Home and these show that staff regularly prompted Mr X to wash and shave, sometimes repeatedly on the same day. Examples of what the notes say include:
• 13 July 2021 – Staff verbally prompted Mr X to shower and shave
• 22 July 2021 – Staff prompted Mr X to get up, shower and shave, Mr X declined to shave and then chose to go back to bed
• 2 January 2022 – at 8 18 am Mr X chose to remain in bed ignoring a prompt to getup and have a shower; at 10 30 am Staff checked on Mr X and prompted him to get up for his shower, he chose to remain in bed; 2 pm – staff again prompted Mr X to get up, shower and have his meal and drink
• 2 February 2023 – one verbal prompt to Mr X to get up for a shower, which he chose to do
• 11 February 2023 – Mr X went to his room to get his jacket and trainers, also brought his laundry down
• 17 February 2023 – staff helped Mr X to put clean bedding on his bed
22. The above examples show that the Care Home was prompting Mr X in line with the requirements of the care and support plan. At times Mr X will decline to undertake actions but there is evidence the staff would continue to prompt throughout the day to ensure Mr X was not neglecting himself. There are some notes to show Mr X was carrying out laundry tasks. While I did not see any references to ironing, I cannot assume this means Mr X was not ironing his clothes.
23. In respect of the complaint made about Mr X’s appearance, I have not seen evidence to show this was a matter raised repeatedly by Mr and Mrs Z. If Mr X had left the home on occasions in creased clothes, I am not persuaded this would cause him a significant enough injustice to warrant further investigation. The daily records show that Mr X sometimes chose to shave and sometimes chose not to. I am satisfied the Care Home was meeting the requirements of the care and support plan by prompting Mr X in respect of personal care needs and so I find no fault.
24. A complaint was made about lost items, specifically two leads for charging electrical items and the complaint response indicates they were located in Mr X’s room. Therefore, I have not investigated this further.
25. The separate complaint I investigated focusses on the safeguarding investigation but also covers the issue of financial processes within the Care Home. In that case, I found the Care Home had taken the correct action in respect of the safeguarding complaint. However, there was fault as the Care Home failed to notify the Council before it took over management of Mr X’s finances.
26. Once it was aware of the situation, the Council took action to put things right and followed the correct procedure by completing a mental capacity assessment and a best interests decision. There is nothing to suggest that this caused any particular difficulties to Mr X.
27. I note Mr Z believed the Care Home acted with his sister to take actions against him including opening a new bank account and meeting with a solicitor. It is clear there was a complete breakdown in the relationship between Mr Z and his sister and that there was a lack of trust and communication between Mr Z and the Care Home resulting from this. However, I have not seen evidence to suggest the actions of the Care Home were done other than to protect Mr X.
28. I note that Mr Z acted to freeze Mr X’s bank accounts n November 2022 after becoming the subject of a safeguarding investigation. As a result Mr X had no access to his money until the Court of Protection appointed a deputy. There are emails between the Care Home and the Council which show the Care Home was in fact providing funds for Mr X in this period.
29. As this complaint is made on behalf of Mr X, I have to consider whether the fault identified caused him a significant injustice. The issues were between Mr Z, his sister and the Care Home. Mr X’s needs were met throughout this time and the Care Home stepped in to provide financial support to him when his accounts were frozen. I therefore do not consider Mr X suffered a significant injustice as a result of any fault in this case.

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Final decision

30. I will now complete my investigation as Mr X did not suffer a significant enough injustice to warrant any further action as a result of the fault identified in this case.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman