The Ombudsman's final decision:
Summary: Barchester Healthcare Homes Limited acknowledged that it had not handled a complaint about its resident’s care well and should have addressed issues earlier. It has now made improvements and continues to monitor how it meets the complainant’s needs. The Provider did not consider the time and trouble it had put the complainant’s representative to. It has agreed to apologise to the representative and pay her £150 in recognition of the impact on her.
- Ms B complains about various aspects of her care. Since complaining to Barchester Healthcare Homes Limited (the Provider) some issues have improved but Ms B continues to find some aspects of care fall below her expectations. Her niece, Ms X has complained on Ms B’s behalf. Ms X says:
- She is not certain that temperature problems in Ms B’s room have been resolved. She appreciates that Ms B asks for the radiator to be turned down at night, but staff fail to check whether it needs to be adjusted in the morning;
- The activities have improved but most do not take account of Ms B’s visual impairment;
- Ms B continues to be dressed in dirty clothes;
- Communication with the home about meetings is not good enough and does not take into account that Ms B cannot see posters;
- Mealtimes continue to be very difficult with all residents seated together and long delays. Ms B does not always get the help she needs to eat;
- It is not clear whether the frequency of baths has improved; and
- No account has been taken of the time and trouble Ms X was put to in pursuing Ms B’s complaint.
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))
How I considered this complaint
- I have considered the information provided by Ms X and discussed this with her. I have also considered the Provider’s response to my enquiries including the correspondence between the parties and the Provider’s file records. Both parties have commented on a draft of this statement and I considered the comments made.
What I found
- 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.
- The CQC is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences. CQC has inspected the care home and found that it is inadequate.
- Ms B is blind and lives in a care home. She funds her own care. Her niece, Ms X has power of attorney for Ms B and made a number of complaints on her behalf. She said the Provider had not taken enough action to prevent damp from arising in her room or to deal with this. Ms X first raised this with the home in October 2017. The home did not respond to her, but did redecorate the room. Ms X also complained that Ms B’s clothing had not been washed, and her room was too cold. Ms B needs help charging electronic devices that aid with her visual impairment. Her weekly baths did not always happen and sometimes other residents came into her room at night.
- Ms X initially raised her concerns with the care home managers, but on 28 January 2018 formally escalated her complaint to the regional manager as the home did not respond. The Provider acknowledged receipt of the complaint but Ms X chased the Provider on 11 March as it had not responded to her.
- Ms X said:
- She had no response to her complaint.
- The home had been put into ‘special measures’ by CQC and she asked for the Provider’s action plan.
- The Provider and home still write to her late brother despite being told that the power of attorney had passed to her.
- She visited her aunt and found the radiator was off and the room was extremely cold.
- The member of staff providing activities had been off sick for months and there is very little for her aunt to do.
- The home is fully damp proofed and damage to Ms B’s room was due to a water leak. The home’s maintenance team had followed the correct procedure for the home to authorise works to put this right.
- It now had a full-time activities coordinator in post.
- It would put a temperature sheet in Ms B’s room to be checked twice daily, but staff say that Ms B turns the radiator down or off herself.
- There had been staff shortages in the laundry but this had been rectified. The home will now help Ms B to identify clothes for washing and offer her support at meal times.
- Baths are recorded elsewhere., The Provider agrees that records of baths should form part of the resident’s notes and will train staff on this.
- The Provider apologised for writing to her late brother and amended its records.
- It is clear that Ms B does not turn down the radiator but she has asked the staff to do so and sometimes staff do not turn it back up again. The temperature record sheet had not been put in Ms B’s room. The new manager has agreed to do this and to check that records of the temperature are being kept.
- There is no sign of damp but there was damage possibly caused by a water leak. The room has been redecorated.
- Ms B has said that the activities have improved since the new staff member arrived but she needs the talking book player replaced as it is broken.
- If Ms B agrees, the home will help her identify when her clothes need to be laundered.
- A resident had wandered into Ms B’s room at night but no longer lived at the home. Ms B was happy for night staff to enter her room to check on her as long as they identified themselves.
- The home held meetings about general escalating concerns but did not tell Ms X or Ms B about this. The Provider said that it was unacceptable that it had not responded to her requests for more information about the CQC inspection and the Provider’s action plan. It apologised for this.
- It will review what help Ms B needs at meal times.
- Ms B had brushed her teeth with deep heat gel rather than toothpaste. When she alerted staff, they telephoned 111 for advice and took her to hospital as this was quicker than waiting for the ambulance.
- It appears that Ms B was not being bathed regularly and the Provider said that while she washes herself daily, the infrequent provision of a bath was wholly unacceptable. It apologised.
- It accepted that it had not handled her complaint well and the issues should have been addressed properly sooner, and without Ms X having to escalate her complaint to the regional level.
- It accepted there had been numerous failings and offered a reduction in fees of £3880, equivalent to one month’s fees.
- Activities are better but there is still little account of Ms B’s blindness. The Provider’s response included family visits, but the Provider should be doing more.
- The communication with the Provider is still very poor and Ms X finds it hard to organise medical appointments.
- Mealtimes are still chaotic and Ms X has still found Ms B dressed in dirty clothes.
- When Ms B brushed her teeth with deep heat, the home took her to hospital in a taxi but charged this to Ms B’s account when it was poor care that led to the hospital admission.
The current situation
- I have reviewed the Provider’s response to my enquiries, Ms B’s case notes, the activity coordinator’s records, and correspondence between the Provider and Ms X.
- Ms B’s clothing is labelled but she is very reluctant to change these as she is worried about it getting lost. She will only allow one staff member to assist her with changing and bathing but this carer does not work every week. The Provider has made Ms X aware of the problems. The Provider is trying to improve this by giving Ms B a key worker who will build a relationship with her and encourage her to change more frequently.
- The Provider had to rely on agency staff and acknowledges that its care recording was not as detailed as its standards require. The Provider has now recruited a new care staff team and have worked with the local authority and the CQC to demonstrate marked improvement in the quality of recording. The CQC no longer records the home as having escalating concerns.
- The minutes of a residents meeting show Ms B told staff that she likes some of the new activities coordinator’s work and that he is thoughtful regarding people with sight problems. I have seen the Provider’s activity logs. These show that Ms B has participated in regular activities and it records her level of engagement as good. Ms B has taken part in skittles, quizzes, group discussions, some crafts and group games, as well as one to one sessions. The log also records what the Provider can do to make the session more effective. These record where the coordinator has specifically considered how to make the activities accessible to Ms B.
- The coordinator has also provided a statement. He says he works with Ms B most days addressing her concerns and activity interests. He spends time each day reading and discussing news items. He also checks and arranges her regular medical appointments and updates her calendar and address books with her, as well as checking and returning her recorded books. The coordinator has helped her use a radio for sight impaired people and arranged a visit from a blind charity to talk about activities, services and equipment. However, the charity did not attend and the visit has been rearranged. The coordinator arranged a visit from the British Legion and accompanied Ms B to the remembrance service at a local primary school.
- At the same meeting, the Provider told residents it had recruited two new chefs. Ms B reported that she hoped for improvements as there were still delays in getting meals while people waited for the help needed to eat. The activities coordinator has arranged for the kitchen staff to use a plate map so that Ms B can identify the food on her plate more easily. The Provider says Ms B comes to the dining room early, sometimes as much as an hour earlier than the meal is due to be served and so will experience delays.
- I have seen the logs the Provider keeps of the temperature in Ms B’s room from July to November 2018. The temperature is recorded most days and is shown to be sufficient. The log also shows when staff have turned the radiator up or opened a window.
- I have reviewed the care notes which record Ms B’s day to day activity. These now clearly record when Ms B has a bath. These appear to be every week or sometime fortnightly. However, it is clear that Ms B washes and dresses independently. The new key worker system may allow more frequent bathing. The case notes do not record that Ms B is not able to take care of her personal hygiene.
Is there fault by the Council causing an injustice to Ms B?
- The Provider acknowledged that there had been shortcomings and it should have dealt with these sooner. Its evidence shows that although there were some issues, it has taken action to improve these and importantly, continues to monitor how effective its action is and how it can best meet Ms B’s needs.
- The Provider waived fees for one month. This was a reasonable means to settle the impact on Ms B. However, Ms X had to complain over a period of 12 months with no real improvement until relatively recently. The Provider failed to take into account the time and trouble it had put Ms X to. There is also no evidence that Ms X was informed of the residents’ meetings or what happened at these, this had left her uncertain about whether Ms B’s care had improved. However more recently, there has been better email communication between Ms X and the Provider. The Provider is now doing enough to communicate with Ms X about the care.
- Ms X has reviewed the accounts and says the Provider still has not refunded the taxi fare charged when it took Ms B to hospital.
- The Provider has agreed that within one month of this decision it will show the Ombudsman it has:
- Apologised to Ms X; and
- Paid her £150 in recognition of the time and trouble it put her to in raising issues with it.
- I have completed my investigation. The Provider has acknowledged fault and I have recommended an improvement to its remedy. Under the information sharing agreement between the Ombudsman and the Care Quality Commission (CQC), we will share the final decision on this complaint with the CQC.
Investigator's decision on behalf of the Ombudsman