Summary: Mrs Y complained about the care provided by Bondcare (London) Limited to her father, Mr Y. She also complained the Care Provider gave her misleading advice about the cost of his placement and how to apply for funding. We found fault by the Care Provider in some aspects of Mr Y’s care. The Care Provider agreed to apologise and make a payment in recognition of the distress caused.

The complaint

1. Mrs X complained about the care provided by Bondcare (London) Limited to her father, Mr Y. Mrs X states the Care Provider left her father in dirty clothes for days at a time and failed to prevent him disappearing from his care home.
2. Mrs X also complained the Care Provider gave her misleading information about the cost of his care home placement and how to apply for Funded Nursing Care. The Care Provider also failed to provide a copy of the contract for her father’s placement or an inventory of his belongings, some of which it lost.
3. Mrs X states Mr Y’s family removed him from the care home because of these matters. She states the Care Provider’s actions caused worry and stress for the whole family including Mr Y’s wife, who subsequently had a heart attack.

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The Ombudsman’s role and powers

4. We investigate complaints about adult social care providers and decide whether their actions have caused injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)
5. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
6. We normally name care homes and other care providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), 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. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

9. I discussed the complaint with Mrs X and considered her complaint and information she provided.
10. I made enquiries of the Care Provider and considered its response and information it provided.
11. I considered our Guidance on Remedies.
12. I set out my thoughts on the complaint in a draft decision statement and I considered Mrs X’s comments in response.

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What I found

13. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
14. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers that meet the fundamental standards of care, inspects care services, and reports its findings. It can also enforce against breaches of fundamental care standards and prosecute offences.

Fundamental Standards of Care

15. 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.

NHS Funded Nursing Care

16. NHS-Funded Nursing Care (FNC) is the funding provided by the NHS to care homes providing nursing, to support the cost of nursing care delivered by registered nurses. If a person does not qualify for NHS Continuing Healthcare, the need for care from a registered nurse must be determined. If the person has such a need and it is determined their overall needs would be most appropriately met in a care home providing nursing care, then this would lead to eligibility for NHS-Funded Nursing Care.

What happened

17. Mr Y had a diagnosis of Vascular Dementia and Type 2 Diabetes. He lived at home with his wife, who cared for him.
18. In September 2023 the Care Provider received an emergency referral for Mr Y, because his wife could no longer care for him.
19. The Care Provider completed an assessment which found it could meet Mr Y’s needs, and it agreed to offer him a placement.
20. Mr Y’s care plan says he needed twenty-four-hour support and supervision to reduce the risk of harm and self-neglect. He needed prompting and guidance on nutrition and personal hygiene tasks. The plan says Mr Y’s wishes about the care he receives should be respected.
21. Mrs X says the Care Provider was informed Mr Y would be applying for funding for his placement as he could not afford to fund his care. She states the Care Provider told her it would arrange FNC and funding from the Local Authority for Mr Y’s care.
22. In September Mr Y’s placement began. The contract for his care said the following:
• a written inventory will be provided detailing Mr Y’s possessions on admission and will be updated as appropriate.
• personal and/or nursing care will be provided in accordance with Mr Y’s assessed needs and Personal Care Plan. This will be reviewed as required and at least every six months.
• the fee for Mr Y’s care and accommodation is £1300.00 per week.
• FNC payments will always be in addition to fees paid by the resident.

The Care Provider states it gave a copy of the contract to Mr Y’s son to return and sign. Mrs X says a contract was not provided to her brother. She also states Mr Y’s family did not received a copy of his care plan nor were they involved in making the plan.

23. Mr Y’s wife signed a consent form. The form says that consent was given to share personal data with organisations associated with the health and social care of Mr Y.
24. Mr Y’s care records state he was found wandering around outside in the car park on two occasions on his first night at the care home. The Care Provider told staff to ensure ground floor doors are locked when they are busy with other residents.
25. On 9 September Mr Y went missing from the care home. A safeguarding report says Mr Y left the home through the front door (left open by a member of staff) at 7:33am. Staff noticed Mr Y was missing at around 09:30am, having checked on him previously that morning and provided him with personal and nutritional care. Mr Y was found by the Police and returned to the home at 11:30am.
26. Following Mr Y going missing the Care Provider reminded all staff to keep doors locked and to make sure residents are not following them out of the home. It also moved Mr Y to a room on an upper floor, where there were additional locked doors providing extra security to prevent him going missing again. Mr Y did not go missing again.
27. The Care Provider submitted safeguarding notifications to the Local Authority and CQC. Both were satisfied with the action taken by the Care Provider.
28. Throughout late September and October Mrs X was in email communication with the Care Provider. In the emails she says:
• she thought the Care Provider was applying for FNC for Mr Y and a consent form was signed for this purpose.
• she is in contact with Social Services regarding additional funding for her father’s care.
• she is confident Mr Y is well cared for and she does not want him to be moved if Social Services request this following its funding assessment.
29. In early October FNC funding for Mr Y was agreed.
30. On 18 October Mr Y left the care home. Mrs X states this was because of concerns about the care provided to him.
31. The Care Provider gave Mrs X a final bill after Mr Y left the care home. The bill was for £7242.86. It asked for payment to be made.
32. On 21 October Mrs X wrote to the Care Provider. She said its invoice was incorrect because it had not deducted Mr Y’s FNC payment from the cost of his care. She also said that £370.00 worth of Mr Y’s belongings had gone missing. She asked for the FNC and cost of Mr Y’s lost belongings to be deducted from the final bill. Mrs X did not seek clarity on the cost of Mr Y’s care.
33. The Care Provider said the cost of Mr Y’s care was £1300.00 per week and his contract said FNC would be in addition to these charges. Therefore it would not deduct Mr Y’s FNC payment from the final bill. It also said it was sorry Mr Y’s belongings were lost but it would not pay for replacements.
34. In response Mrs X asked for a copy of Mr Y’s contract and the inventory of his belongings. It provided a copy of the contract in late November. It did not provide a copy of the inventory.
35. Unhappy with the Care Provider’s response Mrs X complained to it in February 2024. She said the Care Provider:
• did not provide a copy of Mr Y’s contract when initially asked. The contract provided appears to have been written after Mr Y’s placement began as it says he is staying in the room he moved to after going missing from the care home.
• did not make clear the weekly cost of Mr Y’s care, although there had been verbal mention the cost was £1300 per week.
• did not make clear FNC payments would not be deduced from the weekly cost. It should deduct Mr Y’s FNC payment from his weekly care costs.
• did not discuss Mr Y’s care plan with his family or review it every six months.
• Mr Y went missing from the home on his first day. He went missing again on 9 September. Mrs Y states he left the home at 10:30pm on 8 September and staff did not notice he was missing until 7:30am.
• said it would apply for FNC for Mr Y. Mrs X did not realise it had not done so until October.
• lost Mr Y’s possessions and did not provide an inventory of his belongings.
• did not provide a suitable level of care to Mr Y. When he left the home, he was wearing the same clothes he had on five days earlier.

Mrs X said she felt the Care Provider should further reduce Mr Y’s final bill in recognition of the matters she complained about.

36. The Care Provider replied. It said:
• Mr Y’s son did not sign and return the contract for his care. This happened because Mr Y was an emergency admission, and the focus was on moving him to the home.
• Mrs X was aware of the weekly cost of Mr Y’s care as she referred to the charge in emails.
• Mr Y’s contract states the weekly fee is £1300. FNC is paid in addition to this. However it will deduct the amount of Mr Y’s FNC payment from his final bill in recognition of the confusion around this matter.
• there was no agreement it would arrange funding for Mr Y’s care. This is responsibility of a resident’s family.
• apologised for the incidents where Mr X left the care home. It said it acted quickly to move Mr Y to a room on the first floor which had additional security.
• it will deduct the value of Mr Y’s lost possessions from the final invoice.
• Mrs X had previously provided positive feedback about the care Mr Y received at the care home.

The Care Provider did not offer to further reduce Mr Y’s outstanding invoice.

37. Mrs X remained unhappy and complained to the Ombudsman. In response to our enquires the Care Provider said:
• it disagreed Mr X was in dirty clothes when his placement at the care home ended. Mr Y’s care records show he had a bath or shower most days. On the occasions he did not it was because he refused help with his personal care, staff respected this in accordance with his best interests.
• it acted following Mr Y going missing from the care home. It submitted safeguarding notices to the Local Authority and CQC, and both were satisfied with the actions taken.
• it always tries to receive a signed contract before a resident’s placement begins, however Mr Y’s case was difficult as he was an emergency admission. Whilst there has been disputes about the fees, it is clear Mrs X was aware of the fees as she refers to them in emails she sent.
• it does not believe Mr Y was caused an injustice during his stay at the care home. It believes it has acted fairly to resolve Mrs X’s complaint.
38. As part of its response the Care Provider included copies of Mr Y’s care records. The records show Mr Y had regular showers and changes of clothes during his stay at the care home and in the week prior to his placement ending. The records do show Mr Y refused to bathe on some days.

Finding

Contract, inventory, and fees

39. It is agreed that a signed contract was not retuned prior to Mr Y’s placement commencing. The contract provided to Mrs X in November 2023 said Mr Y was staying in the room he occupied after going missing on 9 September 2023. The contract provided to Mr Y’s son on the day the placement began would have stated the room Mr Y initially occupied. For this reason I cannot be certain Mr Y’s family were provided with a contract at the time his placement began.
40. Mrs X says the lack of contract meant she was unaware of the cost of Mr Y’s care. However correspondence shows that Mrs X was aware of the cost of Mr Y’s placement as she refers to the correct fees in emails to the Care Provider and to being verbally advised of the weekly fee. Therefore I do not consider Mr Y’s family were unaware of the cost of his care regardless of whether a contract was or was not provided to them.
41. Mrs X also states she was not aware that Mr Y’s FNC contributions would not be deducted from his weekly fee. The uncertainty around the contract means I cannot be certain Mrs X was aware of this when Mr Y’s placement began. However the Care Provider has deducted the total amount of Mr Y’s FNC contributions from his care bill and so, Mr Y has paid the amount Mrs X anticipated. For this reason I consider the claimed injustice has been appropriately addressed.
42. Mrs X states the Care Provider said it would arrange funding for Mr Y’s care. She says Mr Y’s wife signed a consent form so it could discuss this matter with the Local Authority. The Care Provider disagrees. Email correspondence between Mrs X and the Care Provider shows she believed the Care Provider would be arranging funding for Mr Y before the Care Provider clarified its position in early October. I have not seen any evidence Mrs X was given clear information about who would apply for Mr Y’s funding prior to October. While I note the Care Provider does not apply for funding on behalf of its residents, the evidence available supports that Mrs X was unclear this was the case.
43. The Care provider’s contract says an inventory of belongings will be taken. There is no evidence an inventory was taken. The Care Provider accepts this and has deducted the cost of Mr Y’s lost belongings from his bill. I consider this suitably addresses the injustice caused by his belongings being lost.

Mr Y going missing from the care home

44. I understand Mr Y left the care home building and was found in the car park on the day his placement began. The Care Provider took measures to prevent a recurrence. While no harm was caused to Mr Y the incident would have caused distress to Mr Y’s family.
45. Mr Y went missing from the care home on 9 September. This is fault which caused Mr Y’s family further distress.
46. Following the incident the Care Provider moved Mr Y to a room on the first floor to make it more difficult for him to go missing in future. It also reminded staff to close doors and put-up signs around the home. The Care Provider made a safeguarding referral to both the Local Authority and reported the incident to the CQC. Both were satisfied with the actions taken by the Care Provider. Mr Y did not go missing from the care home again. Therefore I consider the Care Provider took appropriate action in response.

Standard of care

47. Mrs X complains the care given to Mr Y was not of a suitable standard. She states that on the day his placement ended he was wearing the same clothes as five days earlier. The care records provided show that Mr Y’s clothes were changed during this period and that he also showered. The records state that on the days Mr Y did not shower it was because he did not want to and his wishes were respected, as per his care plan.
48. The care records show Mr Y was provided with care in accordance with his care plan for the period he resided at the home. I also note Mrs X did not raise concerns about the quality of the care received by Mr Y before he left the home or in the period immediately after he left. Correspondence between Mrs X and the Care Provider also show she was complimentary about the care he received during his stay.
49. For the above reasons I do not find fault by the Care Provider in how it provided Mr Y’s care.

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Agreed action

50. Within one month of my final decision, the Care Provider will:
• apologise to Mr Y’s family in writing. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• pay Mr Y’s family £500. This is in recognition of the distressed caused to Mr Y’s family by the fault I have identified. The payment should be made by cheque to Mr Y’s wife.
51. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

52. I have found fault in the Care Provider’s actions which caused Mr Y’s family distress. I consider the agreed actions are suitable to remedy the complaint. I have completed my investigation.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman