Decision : Closed after initial enquiries
Decision date : 22 Mar 2019
The Ombudsman's final decision:
Summary: The Ombudsman will not investigate Mrs A’s complaint about the actions of her late mother-in-law’s, Mrs B’s, care provider. This is because he could not add to the care provider’s response or make a finding of the kind Mrs A’s wants even if he investigated.
- Mrs A says her mother-in-law’s, Mrs B’s, care provider should have ensured her pendant was placed around her neck so she could call for the emergency services when she needed them. Mrs A says Mrs B was left with uncovered food and not given her medication on the day she fell. Mrs A says Mrs B would have been able to get emergency treatment sooner and would not have been left alone in pain for over an hour when she fell and broke her hip. Mrs A says she complained to the care provider but did not receive a response so has asked the Ombudsman to investigate.
The Ombudsman’s role and powers
- We investigate complaints about adult social care providers. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:
- the action has not caused injustice to the person who complained, or
- the injustice is not significant enough to justify our involvement, or
- it is unlikely we could add to any previous investigation by the care provider, or
- it is unlikely further investigation will lead to a different outcome, or
- we cannot achieve the outcome someone wants.
(Local Government Act 1974, sections 34B(8) and (9))
How I considered this complaint
- I spoke to Mrs A and considered the information and documentation provided by her and the care provider. I sent Mrs A a copy of my draft decision.
What I found
- Mrs A complained to Mrs B’s care provider about its actions on the day Mrs B fell and was unable to access emergency services because she was not wearing her pendant.
- The care provider says it investigated Mrs A’s complaints and responded in November 2018. Mrs A says she did not receive the response despite chasing it. The Ombudsman could not say why Mrs A did not receive the letter or why it was not resent when Mrs A contacted the care provider. However, Mrs A has now received a copy so any injustice to her has been remedied.
- The care provider’s response says:
‘the care worker did attend the morning call and remained within the call for 46 minutes; the care worker has stated that she cannot recall that particular visit; the care worker has apologised for not ensuring the medication had been taken, and that she believes Mrs B may have requested rolls and butter for breakfast, the care worker does recall attending a visit and being told that Mrs B had gone into hospital with a broken leg. Further information shows that it would have been impossible to move the armchair closer to the bed.
The call track log shows that the care worker logged into her call at 07.49am and remained in the call for 46 minutes, logging out at 08.35am, I have looked into the pendant alarm, the initial risk assessment does not mention a pendant alarm, I have spoken to the assessor who completed the risk assessment, who has stated that a pendant alarm at that time was not there and not mentioned. It is believed that a pendant alarm was provided, however, this was not made known to [the care provider]. Care workers have been interviewed and have stated that there was a pendant alarm but Mrs B had this under her pillow or around her neck, the care workers stated that they never handled the pendant alarm. The allocated care worker stated that she left Mrs B comfortable and safe in her armchair at the end of the visit, Mrs B’s Daughter in Law stated that she arrived at the home at 09.00am when she found Mrs B on the floor, Mrs B was on her own for a period of 25 minutes, it cannot be determined how long Mrs B had been on the floor during those 25 minutes.
- Mrs B’s care package did not include ensuring she wore or had close access to her pendant, so the Ombudsman would not be able to make a finding that Mrs B was caused an injustice by her care provider. The care provider has apologised that Mrs B was not given her medication on the morning she fell. The Ombudsman could not add to this.
- The Ombudsman will not investigate this complaint. This is because he could not add to the care provider’s response or make a finding of the kind Mrs A’s wants even if he investigated.
Investigator's decision on behalf of the Ombudsman