Summary: Mr X complained on behalf of his mother-in-law, Mrs Y, that a residential care home unfairly refused to let Mrs Y return to the care home after a visit to hospital. There was no evidence of fault.

The complaint

1. Mr X complained on behalf of his mother-in-law, Mrs Y, that Cornelia Manor Residential Care Home, Newport, Isle of Wight (the Care Provider) unfairly refused to let Mrs Y back into the care home after a visit to hospital. Mr X said in doing so the Care Provider breached its agreement with the Council to allow Mrs Y to remain at the home until a new placement could be found.
2. Prior to Mrs Y’s visit to hospital, the Care Provider had served the Council with 28-days’ notice to end Mrs Y’s placement. This expired and an alternative placement had not been found so the Care Provider agreed to let Mrs Y stay until the Council found a new placement.
3. When the Care Provider would not let Mrs Y return, she had to stay in hospital for an extended period. This negatively affected her wellbeing, and she stopped eating and drinking.

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What I have and have not investigated

4. Having considered the Care Provider’s complaint response letter, I am satisfied with its explanation as to why it would not accept Mrs Y back from hospital.
5. I focused my investigation on the reasons for the delay in securing a new care home placement for Mrs Y.

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The Ombudsman’s role and powers

6. 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)
7. 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)
8. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)

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How I considered this complaint

9. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Statutory guidance

10. Where the care planning process has determined a person’s needs are best met in a care home, the council must provide for the person’s preferred choice of accommodation, subject to certain conditions.
11. Councils must also ensure the accommodation is suitable to meet a person's needs.
12. Where a council has assessed a person’s needs require a particular type of accommodation, the person must have the right to choose between different providers, provided that:
• The accommodation is suitable for the person’s assessed needs.
• The accommodation is available.
• The provider of the accommodation is willing to enter into a contract with the council to provide the care.
13. Councils have a duty to ensure sufficient supply of care and support services locally. A person should not have to wait for their assessed needs to be met. However, in some cases a short wait may be unavoidable, such as when a person has chosen a particular setting that is not immediately available.

Being asked to leave a care home

14. A care home should clearly explain, upfront, the reasons why it may ask a person to leave. This should also be set out in a resident’s contract.
15. The reasons must be valid ones, for example:
• The care home cannot meet a resident’s care needs anymore, even after making reasonable adjustments.
• A resident has repeatedly not paid their fees and has large arrears.
16. The care home should give a resident at least 28 days’ written notice to leave.

What happened

17. I have summarised below some key events leading to Mr X’s complaint. This is not intended to be a detailed account of what took place.
18. Mrs Y suffers from dementia with Alzheimer’s. She moved into Cornelia Manor Residential Care Home, which is run by Hillview Care Limited, in 2020 when her husband became too unwell to care for her.
19. The Care Provider gave 28 days’ notice to end Mrs Y’s residency in March 2022 because it could no longer meet her care and support needs. It listed Mrs Y’s challenging and aggressive behaviour, as well as her refusal to accept care from staff, amongst its reasons.
20. In early April 2022 the Council asked the Care Provider to let Mrs Y stay at the care home while it looked for a new placement for her.
21. The Care Provider agreed to extend Mrs Y’s placement by two weeks beyond the 7 April deadline. However, it said the Council would have pay the higher needs rate.
22. In mid-April 2022, six care homes told the Council they could not offer Mrs Y a placement. The Council had contacted a further four care homes and was waiting to hear back.
23. The Care Provider contacted the Council in early May to ask if it had found a new placement for Mrs Y. The Council said it was struggling to find vacancies.
24. The Care Provider contacted the Council on 5 May to advise Mrs Y had gone to hospital following a fall. The Care Provider said it decided not to let Mrs Y return to the care home when she left hospital because it could no longer meet her needs. The Care Provider said if it agreed to let Mrs Y return it would effectively be accepting it could meet her needs, which it cannot.
25. An internal Council email from May 2022 states another care home declined to provide a placement for Mrs Y. The Council noted it had exhausted most care homes on the island.
26. Mr X complained to Hillview Care Limited on 12 May 2022. He said it was in breach of an agreement it made to let Mrs Y stay until a new placement was found. Amongst other issues, Mr X said the family had not received any reports about Mrs Y’s behaviour since February 2022, indicating an improvement, and the Care Provider advertises itself as being able to accept residents with mild dementia – which is Mrs Y’s diagnosis.
27. Hillview Care Limited responded on 17 May. It apologised Mrs Y could not return, and for the upset caused. It said:
• It served 28 days’ notice to Mrs Y on 10 March 2022, which is common practice when it can no longer meet someone’s needs.
• The Council should have found a new placement for Mrs Y by 7 April but despite its efforts this was not possible.
• The Council asked the Care Provider to extend the notice period while it searched for a new placement. The Care Provider agreed to a short extension only if the Council continued to search for a new placement.
• It was due to plan a meeting with Mr X and the Council when Mrs Y had a fall and was taken to hospital.
• Government guidance states people should isolate for ten days when returning to a care home from hospital, or isolate for six days if they have tested negative for COVID-19 for three days. In the Care Provider’s experience, Mrs Y became aggressive when isolating and would punch staff or shout at others, and it has had to move other residents away for their protection. Mrs Y has also refused to take COVID-19 tests. The Care Provider therefore considered it could not continue to care for Mrs Y and could not accept her back.
• The decision was made for Mrs Y’s safety and that of other residents and staff.
28. Mr X raised concerns with the Council on 23 May about Mrs Y not eating or drinking in hospital. The Council started a safeguarding enquiry and wrote to the hospital.
29. Mrs Y was discharged from hospital on 12 July 2022 to a new care home in another part of the country where she has family. She remains there as a permanent resident.

Our investigation

30. In response to our enquiries, the Council said it put in consistent efforts to find an alternative care home for Mrs Y. It contacted 21 care homes but there were either no vacancies or they could not support her needs.
31. The Council also agreed an increase in funding to the original care home during this period so as not to impact the continuity of Mrs Y’s care.
32. The Council told us the island has a high percentage of older people and COVID-19 has seen a significant increase in acuity and complexity of older peoples’ needs when discharged from hospital. This means a high demand for care home placements. In addition, due to its island location, the Council has a limited number of placements to choose from and families often decline to receive care on the mainland.

Analysis

33. I can appreciate Mr X’s distress when the Care Provider said it would not let Mrs Y return. Mr X considered the Care Provider was going back on its word and letting Mrs Y down.
34. The email from the Care Provider stating it agreed to an extension as long as the Council’s search for a new care home continues was not worded well. It gave Mr X the wrong impression. I found the Care Provider wanted the extension to be a short-term solution. It made its position clear to the Council that it did not want to agree to more extensions, as that would negate the point of it issuing notice on Mrs Y’s placement.
35. However, I found the Care Provider was entitled to decide it could no longer meet Mrs Y’s needs and it therefore could refuse to provide care on that basis.
36. The evidence I have seen supports the Council’s position that it made efforts to source a different care home for Mrs Y. Unfortunately, it was not able to do so. However, that was not from a lack of trying or because of any delays. The Council did what it could by paying a higher rate for Mrs Y to stay with the Care Provider, but it could not stop the Care Provider from refusing to let Mrs Y return after she went to hospital.
37. While the Council has a duty to ensure enough care and support services in its area to meet demand, I do not find the Council at fault for being unable to find a suitable care home for Mrs Y in this case. Availability of dementia specialist care homes was impacted by the COVID-19 pandemic and I am mindful of the fact the Council’s local area is a small island. I am also satisfied the Council made sufficient efforts to find a suitable care home.

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Final decision

38. I have completed my investigation. There was no evidence of fault.

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Investigator's decision on behalf of the Ombudsman