Summary: Ms C complained about the care home commissioned by the Council. She complained about the way it acted in response to her mother’s deteriorating health. We found fault with regards to the care home’s actions, especially with the way it communicated with the family. The Council has agreed to apologise for this and pay a financial remedy for the distress Ms C experienced.

The complaint

1. The complainant, whom I shall call Ms C, complained to us on behalf of her (late) mother, whom I shall call Mrs M. Ms C complained about the care home where her mother lived, that was commissioned by the Council. Ms C said:
• The care home failed to keep the family sufficiently updated, and in a timely manner, about deteriorations in her mother’s condition, during the last months of her stay.
• The care home failed to request a care review in a timely manner.
• There were errors in the copy of the care home’s care plan of her mother.
• The care home told the social worker incorrect and defamatory information.
• A duty social worker concluded her mother needed nursing care before she had carried out a needs assessment.
2. Ms C also complained there was a delay by the social working in contacting the Commissioning Team, once she was informed the home would not take her back.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
5. 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

6. I considered the information I received from Ms C and the Council. I shared a copy of my draft decision statement with Ms C and the Council and considered any comments I received, before I made my final decision.

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What I found

7. Mrs M moved into the care home in December 2019 after a deterioration in her health. Following the move, the Council carried out an annual care review by telephone in April 2020, which concluded her needs were being met.
8. Ms C said her mother had Parkinson’s disease and had started to experience Dementia approximately a year and a half prior to her death. She said the family were initially happy with the home because it was easy to access by public transport and she was happy with the previous manager.
9. Ms C complained that, during the last few months of her mother’s stay, the care home failed to keep the family appropriately updated about medical issues, including deteriorations in her mother’s condition. She said the family only found out by coincidence that:
• Her mother had become doubly incontinent. This only happened because the home suddenly asked for more underwear and nightclothes, as these had become soiled.
• Her mother had moments when she would moan loudly. As a result, the home placed her mother in her bedroom, as “she was disturbing the other residents”.
10. I reviewed the care home’s communication between August 2020 and January 2021. It showed that, despite various important events and interventions (such as a lesion, a cancelled hospital appointment, an unwitnessed fall, thrush in Mrs M’s mouth, a CPN review meeting, a SALT referral and a medication review), there was no evidence the care home contacted family members to update them about these.
11. Ms C said that, due to the concern about the change in her mother’s needs, the family asked for a copy of her care plan on 30 November 2020, to see what else had changed and not been communicated. She complained there was a lot of incorrect information in the care plan:
• It mentioned the incorrect amount of children her mother had.
• It said she was divorced.
• They incorrectly put a family friend as a contact.
• The plan did not show there had been an increase in needs. It did not note any nursing needs.
• It did not mention that staff was removing her mother from public areas when she became “loud”; how long she would have to stay in her room, or what other strategies or professional advice had been sought to manage this.
12. Ms C contacted the Council on 8 December 2020 to express her concerns and ask for an assessment / review in light of her mother’s increased needs. The home asked for a care review five days later. Ms C said it did this only because of the concerns she raised (about changing needs) and the fact she had contacted CQC and the Council. Ms C complained the care home failed to request a care review in a timely manner. She said that even though the care home told the Council in December 2020 that it had been concerned about a deterioration in her mother’s condition and an increase in her needs, and that it felt she now needed nursing care, it failed to contact the Council in a timely manner to ask for a review of her care needs.
13. The Council told me that:
• There were a number of contacts with health professionals from September 2020 onwards due to a change in Mrs M’s health needs. These included the Parkinson’s Nurse, Dietician, Speech and Language Therapist and GP, all in response to her changing health needs.
• The home advised they wanted to wait for the outcome of these interventions before asking the Council for a review. This was to try and see if these could be managed within the home, before asking the Council to determine if the placement at the home continued to be suitable.
14. The Council contacted the care home on 11 December 2021, to discuss the concerns Ms C had raised with them. Ms C complained the home told the Council incorrect information. She said:
• The new manager of the home said the family had not visited her mother since March 2020. This was not true as her father and brother visited during the brief reopening in the summer of 2020 between lockdowns, and there had been telephone calls and a video call with her mother too.
• That the home had shared information with Ms C’s brother by telephone when needed.
15. The record of the call said the duty social worker explained she had received a call from Ms C the day before. In response, the home said:
• It already told Ms C’s brother previously that his mother had become double incontinent. This was one of the reasons why the home requested more clothes, especially underwear. They also informed him that his mother wears pads and that the home had referred her to the incontinence nurse.
• Although the husband recently visited on 30 November, no one had visited since March 2020. Even when the family calls, they don't even ask to speak to Mrs M.
• They are doing more than usual for Mrs M and now feel they can no longer meet her needs as she needs nursing care. As such, the manager asked the duty social worker to treat the conversation as a request for a care review. The manager was unsure if she had to let anyone else know about this. The social worker said she would find out and get back to the care home about this, but never did.
16. After the duty social worker spoke to the care home, he spoke to Ms C to provide feedback from the conversation. Ms C complained the social worker told her that her mother had nursing needs and would need a nursing home, even though she had not visited or assessed her mother yet. I reviewed the records of the conversation between Ms C and the social worker. The record states the home decided they are doing far more than maybe they should be doing; 2:1 support with mobility and dealing with emotional behaviour. Therefore, they have asked to arrange a review / re-assessment of her needs as they feel they can no longer meet them. The social worker explained what would happen next. Ms C thanked her for the information.
17. On 11 January 2021, Mrs M’s allocated social worker contacted the home to arrange a review of care. The home thanked the worker as they were struggling to meet her needs. However, six days later the care home called her brother to say they had to call an ambulance for his mother as she had been “foaming at the mouth”. However, Ms C said that when she called the home, it did not tell her that they would not be able to take her mother back from hospital.
18. Mrs M went into hospital on 17 January 2021 with reduced communication, lethargy and reduced oral intake. The care home told the social worker the next day they would not be able to meet Mrs M’s needs anymore, due to a deterioration of her condition. As such, they felt she would need a nursing care home. The home said they would therefore appreciate if she would not be discharged back to the home.
19. The manager of the home told the social worker that Mrs M’s family had been informed about this. However, this was not true. Ms C said it was the hospital who told her on 19 January 2021 that her mother was ready for discharge, but that the manager of the home had told them that they would not allow Mum to return to the home. Ms C said she was in shock when she found out.
20. The Council said that following Mrs M being admitted to hospital, it received a referral from the hospital three days later asking ‘support from social care to find an alternative placement’ for Mrs M. The Council allocated a hospital social worker on the same day as receipt of the referral.
21. The social worker spoke to Ms C the same day and said she would ask information from the ward to see what her mother’s current needs were. She said it would be best to arrange a temporary assessment bed outside the hospital to enable adult social care to assess her mother in an impartial environment. Ms C agreed to this.
22. The social worker asked the care home to explain over the phone what needs it believed were nursing needs that it would not be able to meet. The records show the home was struggling to explain this, but reluctantly agreed to explain this in a further email. The home also failed to provide a clear explanation of this in the letter it wrote to Ms C on 21 January 2021.
23. The Hospital Integrated Discharge Service said in an email on 21 January 2021 that: Mrs M needs a hoist for transfers, which is a nursing need. Information from the hospital showed and explained why the hospital believed she would require nursing level care now.
24. The Council told me that it, and the care home, have acted appropriately in responding sensitively to support Mrs M’s needs. However, it said that on reflection there were learning points as outlined below:
• The duty social worker should have contacted the home in response to their question on 11 December 2021, as to if they ‘had to let anyone know’ about the request for a review of Mrs M’s needs.
• Although there was regular communication between the home and family members, the specific communication about why Mrs M now required support from a nursing home were not as well recorded as they could have been. There was potential for communication to be improved in this area.
25. Following the Council’s investigation into Ms C’s complaint, it wrote to the care home in January 2021 to remind them of the following contractual responsibilities:
• To tell the Council within three working days of any changes to a Service User's circumstances that may require review and reassessment of the Service needed.”
• To tell the Council and the Service User's family/carers as soon as possible, and no later than within one working day, when there has been a serious injury or illness, or significant deterioration in the health or well-being of any Service User.
• To give one-week written notice if the care home wants to terminate a placement, when the Service User is temporarily absent from the Care Home due to hospitalisation.

Analysis

26. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of the care home, I have made recommendations to the Council.
27. I found that:
• There is no evidence in the records to show the home actively updated the family about important health interventions and events with regards to Ms M. As such, I found it failed to communicate appropriately about these issues.
• The care home included incorrect information in Ms M’s care plan. It furthermore failed to record what staff should do in case Ms M would become loud (other than taking her to her bedroom). The care home should also not have included contact details for a family friend, without checking this with Mrs M or her next of kin first.
• During the time reviewed, the care home failed to discuss with Ms C or her family that it was concerned it may no longer be able to meet her mother’s increasing needs, why it was concerned about this and what needs it felt were nursing needs and therefore better met in a nursing home.
• The care home’s statement that no one had visited since March 2020, and that the family were never asking to speak to Mrs M on the phone, was not accurate.
28. When the care home told the social worker on 18 January 2021 that it would not take Mrs M back, it failed to give official notice to the Council. It should have given seven days written notice to the Council. In addition, the social worker failed to advise the care home of this and what the correct procedure was to follow. The Council has since written to the care home to remind them of their contractual responsibilities to follow the proper procedure for giving notice on placements and also for notifying the Council when a Service User’s needs change.
29. I did not uphold Ms C’s complaint that a duty social worker concluded on 13 December 2020 that her mother had nursing needs before he completed a care review.
30. Furthermore, I found that the Council’s recommendation on 20 January 2021, that Mrs M should be discharged into an assessment bed, was appropriate.

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Agreed action

31. I recommended the Council should, within four weeks of my decision:
• Provide an apology to Ms C and pay her £200 for the distress she experienced.
• Work with the care home to address its shortcomings in the way it communicates with family members.
32. The Council has told me it has accepted my recommendations.

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Final decision

33. For reasons explained above, I found there was fault, as a result of which I should uphold the complaint.

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Investigator's decision on behalf of the Ombudsman