Tavyside Health Centre (22 009 919a)

Statement Upheld General practice 29-Mar-2023

Summary: We investigated a complaint about a hospital discharge and care provided to Ms Y in a care home. We found fault with the Trust, who did not initially involve Mrs X with the discharge planning for Ms Y in March 2021. The Trust has apologised to Mrs X and made service improvements to ensure the fault does not happen again. We consider this to be enough to remedy the injustice to Mrs X. We also found fault with the Health Centre, who did not speak to Mrs X before prescribing antidepressants to Ms Y. This caused Mrs X unnecessary worry and distress. The Health Centre agreed to apologise and make service improvements to remedy this injustice. We found no fault with the Council.

Kennedy Way Surgery (22 005 405a)

Statement Upheld General practice 07-Mar-2023

Summary: Mrs C complained about the alleged failure of a Care Provider and a GP Surgery to communicate with her about her late mother’s health and personal welfare when her mother did not have capacity to make specific decisions. We found the Care Provider and the GP Surgery had information to show Mrs C was her mother’s attorney for health and personal welfare. We found they both failed to communicate with her and involve her in best interests decisions when it was likely her mother lacked capacity to make specific decisions. The Care Provider and the GP Surgery have agreed to our recommendations and will apologise to Mrs C and make a symbolic payment to recognise the injustice caused. The organisations previously acted to improve when dealing with Mrs C’s complaint.

Woodsend Medical Centre (22 004 125b)

Statement Not upheld General practice 02-Mar-2023

Summary: We found fault with the care provided to Mrs H by the Trust and West Northants Council when she started to display challenging behaviour due to dementia. We also found fault with the actions of the Approved Mental Health Practitioner service acting on behalf of North Northants Council as it did not properly involve Mr H in the Mental Health Act Assessment process even though he was Mrs H’s nearest relative. These organisations will apologise to Mr and Mrs H and pay them a financial remedy. They will also take action to prevent similar problems occurring in future.

The Wells Medical Practice (22 012 879a)

Statement Closed after initial enquiries General practice 13-Jan-2023

Summary: We will not investigate Mrs X’s complaint about Kent County Council. That is because she has already appealed to the SEND Tribunal.

Coquet Medical Group (22 002 090d)

Statement Not upheld General practice 20-Dec-2022

Summary: We found fault in the way a Council, Mental Health Trust and GP Practice supported a vulnerable man in the community for over two years. Each of the organisations has accepted its failings and the impact of them and has taken steps to prevent recurrences, so we have not recommended any further action. We also found a Hospital Trust failed to properly assess the man’s mental capacity while he was an inpatient. This has left the man’s family with uncertainty which is an injustice to them. The Hospital Trust has agreed to provide an apology and to offer a small financial payment to address this.

Heaton Medical Centre (21 012 428a)

Statement Upheld General practice 31-Oct-2022

Summary: We found fault by the Practice and a care home acting on behalf of the Council with regards to how they managed Mrs H’s medication. We also found the care home failed to maintain appropriate hygiene standards at times. Although this fault did not have a significant impact on Mrs H’s care, it caused her son, Mr G, considerable confusion and distress. The Council and Practice will apologise to Mr G and take action to ensure similar problems do not occur in future.

Heaton Medical Centre (21 012 428b)

Statement Upheld General practice 31-Oct-2022

Summary: We found fault by the Practice and a care home acting on behalf of the Council with regards to how they managed Mrs H’s medication. We also found the care home failed to maintain appropriate hygiene standards at times. Although this fault did not have a significant impact on Mrs H’s care, it caused her son, Mr G, considerable confusion and distress. The Council and Practice will apologise to Mr G and take action to ensure similar problems do not occur in future.

The Crouch Oak Family Practice (21 011 711b)

Statement Not upheld General practice 28-Sep-2022

Summary: We have found fault with St Augustine’s Care Home’s (owned by The Sisters Hospitallers of the Sacred Heart of Jesus) record keeping, communication around Mrs P’s end of life care, its visiting arrangements, and its complaint handling. CSH Surrey also missed the opportunity to assess Mrs P for fast-track NHS continuing healthcare. Those faults caused Mrs P’s daughters, Mrs M and Ms N, a personal injustice. The Home and CSH Surrey should apologise and carry out improvements to remedy their injustice.

The High Street Surgery (21 009 384b)

Statement Not upheld General practice 22-Sep-2022

Summary: Ms A complained about several organisations involved in her father, Mr D’s care, when his physical health and behaviour deteriorated towards the end of his life. Mr D had dementia. Ms A said failings in Mr D’s care meant his family were distressed by his deterioration. We found fault with a Council. and it agreed to take action to improve. We also found fault with an Ambulance Trust, but it has taken appropriate action to address this fault. We did not find fault with the other organisations.

Claughton Medical Centre (21 013 695c)

Statement Closed after initial enquiries General practice 25-Apr-2022

Summary: We will not investigate Ms P’s complaints about her mother’s care and treatment as it would be reasonable for her to use an alternative legal remedy. Further, we will not investigate her concerns about the Council’s handling of her complaint as there is insufficient injustice arising from complaint handling alone to warrant an investigation.