The Ombudsman's final decision:
Summary: The home is at fault for a lack of transparency in its dealings with Mrs B and a failure to provide clarity about its intention not to readmit Mr C. The home must refund a proportion of Mr C’s fees and his deposit. It must also pay a sum to reflect distress caused.
- The complaint is brought by Mrs B, as the representative of her father, Mr C. Mrs B complains that Jeeves Care Homes Ltd (‘the company’), the owner of the Carrington Care Home, Nottingham (‘the home’) was at fault for:
- A failure to readmit Mr C after a stay in hospital;
- A failure to respond properly to her emails and phone calls; and
- A failure to refund money that was owed to her.
The Ombudsman’s role and powers
- We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
- If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
- We normally name care homes in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home. (Local Government Act 1974, section 34H(8), as amended)
How I considered this complaint
- I corresponded with Mrs B and then made enquiries of the company. I considered the facts before me and applied the relevant regulations and guidance.
- I sent a copy of my draft report to Mrs B and to Ms X and considered their responses.
What I found
- The home’s contract contains the following terms:
- residents must pay a deposit and one month’s fees in advance before admission;
- Further payments should be made monthly one week in advance;
- If they are admitted to hospital, residents should pay their full fees for the first three months of absence;
- A resident may be asked to leave if the home is unable to provide suitable care. The home will usually give 28 days’ notice but may ask the resident to leave on shorter notice if the circumstances require it; and
- If a resident wishes to leave, he or she must give the home 28 days’ notice.
- Mr C is an elderly man with significant health problems and vascular dementia. In early 2017, he moved into residential care at the home. He paid a deposit and a month’s fees in advance in accordance with the terms of the contract. At the beginning of the next month, he paid a further month’s fees. Shortly thereafter, he fell and broke his hip. He was admitted to hospital.
- Mrs B says that she spoke to the manager and the nominated individual at the time of the hospital admission about the future. She says they told her that Mr C could return to the home after his discharge from hospital unless he needed nursing care.
- After two weeks in hospital, medical staff decided Mr C was fit to be discharged the next day. In the interests of clarity, I will refer to the proposed day of discharge as ‘Day 1’. All subsequent days will be numbered in relation to Day 1.
- Mrs B says she phoned the home the day before Day 1 to tell the manager that Mr C was to be discharged the next day. The manager said she would need to visit Mr C in hospital before she could agree to readmit him.
- Notes made by a hospital occupational therapist (OT) on Day 1 show that the OT phoned the home manager and told her that Mr C was fit for discharge but would require a pressure cushion, which the hospital could supply.
- The notes record that the home manager said she could not readmit Mr C until she had spoken to her team. The OT wrote that she would not, therefore, order the cushions required until the home accepted Mr C.
- Mrs B says the manager visited Mr C in hospital on Day 3 and assessed him and told her that Mr C could return to the home but would need a mattress.
- An OT note on the hospital notes for Day 4 records ‘Telephone call to patient’s residential home to clarify patient is able to return there once discharged. [Home manager] is reluctant to take patient back without a clear plan/explanation of patient’s needs since admission. OT explained that this information is sent in the discharge [notes].’
- Mrs B states that the hospital phoned her on Day 4 and told her that the home had said it could not readmit Mr C. She says ‘They got the consultant to ring [the home] to confirm dad is medically fit and his needs had not changed. Also, a senior nurse and physio spoke with [the home] to confirm this’.
- Mr C remained in hospital. Mrs B says the hospital phoned her on Day 7 to say that the home had refused to readmit Mr C because it could not meet his needs. Mrs B also says the manager phoned her with the same message.
- Mrs B emailed the home. She said ‘I am totally and utterly shocked to have received a phone call today to say [the home] will not be able to take my dad back…I don’t understand why the situation wasn’t looked into 3 weeks ago so we could have made alternative arrangements’.
- Mrs B says that, later that day, she went to the home to collect her father’s belongings. While there, she says she spoke to a senior staff member, Ms X, and asked if anything could be done. Ms X said that Mrs B should leave Mr C’s possessions in his room and she would ask the district nurse for advice.
- Mrs B says she told Ms X it was urgent because the hospital wanted to discharge Mr C as soon as possible. She says that Ms X said she would phone back the next day (Day 8).
- Mrs B did not receive a call from the home on Day 8. She sent an email to Ms X saying ‘was just wondering if you had heard anything more yet following on from what we discussed last night? .... I spoke to the ward earlier and they said physio had been with dad and had him out of bed and walking today which is brilliant’.
- Mrs B says that she phoned the home again on Days 9 and 10 but no one was available to discuss the matter. Hospital records show that the hospital also made efforts to chase the home for a response.
- Mrs B says that, on Day 11, the hospital phoned her and said it would have to discharge Mr C. Mrs B placed Mr C in a different care home. She returned to the home and removed Mr C’s possessions and returned Mr C’s key.
- On day 14, Mrs B wrote to the home and explained that she had placed Mr C elsewhere. She said she was seeking repayment of fees from Day 1 onwards when the home had not readmitted him and the refund of her deposit. She explained how sad she was that Mr C had not been able to return to the home where he had been happy.
- Ms X said she would look into what had happened but did not reply. Mrs B then sent three further emails over the next few days with no reply.
- On Day 23, Ms X sent an email to Mrs B saying that she had been surprised that Mrs B had removed her father’s things ‘before the nurses had had a chance to advise us on the best way to care for him and for us to look at the possibility of moving rooms around so we could bring him onto the middle floor’.
- Mrs B met the manager on Day 36 to discuss the events. After the meeting, there was an exchange of emails. The manager said
- ‘Hospitals are very quick to discharge people out if they can, without all the necessary paperwork and in particular a discharge summary or all the necessary care arrangements. However, as a care home we are in breach of our care commitments to take anyone into the home without this in place as this puts the individual and those caring for them at risk’.
- Ms X had been trying to arrange a larger room on a lower floor. This became available the week after Mrs B had removed Mr C’s possessions from the home. His room on the third floor would have been too small and people discharged from hospital often require greater care while being rehabilitated
- The home never accepted anyone back from hospital without information from an OT or physio
- Sometimes hospitals just tell families that people can be released whereas the home had a duty to refuse to admit Mr C ‘until everything was in place’
- A suitable room was now available again
- Mrs B wrote to the manager saying
- The manager had phoned Mrs B on Day 7 and told her that the home could not readmit Mr C. She had not mentioned anything about being unable to readmit him without a patient summary at that time.
- Mrs B had gone to the home on the evening of Day 7 to pick up her father’s belongings and had met Ms X. Mrs B had asked Ms X for help. Ms X had said that she would ask the district nurse for guidance and phone Mrs B back the next day. Ms X did not mention anything about a patient summary either. Ms X did not contact Mrs B as arranged nor did she return any of Mrs B’s calls.
- Mrs B had returned to the home to remove Mr C’s possessions on Day 11. Again, no one said to her that they were waiting for a patient summary.
- It was thirteen days before Ms X wrote to Mrs B telling her she had broken her contract with the home.
- A few days later, Mrs B emailed the manager again. She said that she had spoken to Social Services who had explained to her that there was no requirement for a hospital to give a patient summary to a home prior to discharge.
Was there fault causing injustice?
- In this case, there are two conflicting accounts of events. The Ombudsman must reach a decision on the available evidence as to which is more likely. We make our decisions on ‘the balance of probabilities’; that is, we decide which version of events is more likely to be true.
- In order to decide this, I have looked for corroboration at the NHS notes, provided by Mrs B and the email trail between Ms X and Mrs B, also provided by Mrs B. The home has provided a copy of its contract and an email containing Ms X’s account but no other evidence.
- I have found that the evidence suggests strongly that Mrs B’s version of events is more likely to be true. I therefore find that the home was at fault and Mrs B and Mr C suffered injustice as a result.
- The manager told Mrs B, in her email of Day 36, that the home could not readmit Mr C without a patient summary and it had not readmitted him because there wasn’t one.
- The hospital records show that the manager did not ask for a patient summary on Day 1. She said, on this occasion that she could not readmit Mr C until she had spoken to her team. She did ask for a patient summary on Day 4. The hospital notes show that an OT told her that this would be provided on discharge.
- In her email of Day 36, the manager also said that she could not have readmitted Mr C without assurance from an OT that Mr C would be comfortable in the home.
- The hospital notes show that various medical staff members, including two OTs, assured her on Days 1 and 4 that that Mr C was fit to return to the home.
- The hospital notes show that, on Day 4, the manager told medical staff that the home could not care for Mr C. Mrs B says the manager told her the same thing that day. Neither Mrs B nor the hospital record the manager having requested a patient summary.
- Mrs B returned to the home on the evening of Day 4 to pick up her father’s possessions. While there, she met Ms X and explained how sad she was. She asked if Ms X could help and explained the urgency of the situation as the hospital was insisting on discharge.
- Ms X said she would try to help. She did not help. She made no further contact with Mrs B for eleven days. The hospital notes show that the hospital made further efforts to contact the home without success. Mrs B says she phoned the home on at least three occasions and emailed once.
- She heard nothing until Day 11 when the period for which Mr C had paid in advance expired. The hospital was insisting on discharging Mr C. I find that Mrs B had no choice but to place Mr C in another home on Day 11.
- The manager claimed in her email of Day 36 that the home had been looking to house Mr C in a new room on a lower floor but there is no mention of this anywhere in the NHS notes nor in Mrs B’s record of phone calls, nor in the emails sent by Ms X to Mrs B that the home had ever considered this.
- Ms X said, in her email written to Mrs B on Day 23, that she had been trying to arrange for Mr C to stay at the home and was waiting for input from district nurses when Mrs B removed him, thereby breaking the contract. I do not agree with this view.
- Even if this is true, and there is no evidence that it is, Ms X still knew that Mrs B had gone to the home on Day 4 to pick up Mr C’s belongings having been told, by the manager, that the home could not care for Mr C.
- Ms X was therefore aware of the urgency of the situation but she did not contact Mrs B again for eleven days. During this time Mrs B and the hospital made numerous calls to the home asking for a commitment. The hospital notes show that the manager had refused to readmit him.
- Mrs B accepts that she has to pay fees for the period when her father was in hospital up to Day 1 as this is stipulated by the contract. However, she argues that the provider then breached the contract by its refusal to readmit him. She has requested payment of the fees from Day 1 and the return of her deposit.
- The home says Mr C was in hospital until Day 11 so must pay the fees for that period. It says that Mrs B breached the contract by removing Mr C from the home on Day 11 so she has forfeited Mr C’s deposit.
- The home was at fault and that fault caused injustice. It did not provide Mrs B with an accurate account of its actions in the period concerned and, in the end, she had no option but to take her father elsewhere.
- Mrs B was not in breach of the contract. The home breached the contract on Day 1. The home should either have refused to readmit Mr C immediately, and refunded any fees due from that date on or readmitted him. It did neither.
- Mrs B and Mr C were both caused distress by the events set out above. Mr C stayed in hospital for two weeks after being declared fit for discharge. Mrs B was distressed and was put to considerable time and trouble trying to get her father readmitted and subsequently finding her father a new residential home.
- It is the Ombudsman’s role to restore people to the position that they would have been but for the fault they have suffered.
- Having found fault, I make the following recommendations;
- Within six weeks the home should:
- apologise in writing to Mrs B and Mr C;
- refund the deposit and the fees due for days 1 to 11;
- Within two months, the home should publish a protocol which sets out, for the benefit of staff, residents and carers, the process and requirements when a resident has been in hospital and seeks readmission to the home.
- I recommended in my draft report that the care company should;
- pay Mr C £150 for the distress it caused him and
- pay Mrs B £150 for the distress it caused her and £150 for the time and trouble she spent on this matter.
- The company has stated that it does not intend to comply with this recommendation. It remains our position that the home should pay these sums to Mr C and Mrs B.
- I uphold the complaint. I find the home was at fault. I have proposed a remedy to reflect my decision.
Investigator's decision on behalf of the Ombudsman