Summary: Mrs C complained about the actions taken by the Council in moving her mother Mrs B to a nursing home, in a rushed unplanned manner without her consent. She also complained about the care provided by the home. We find fault in the Council’s communication with Mrs C and the original home, which lead to a very pressurised situation. We also find fault with the records kept by the new home and the failure to monitor Mrs B’s weight loss. The Council has agreed to pay Mrs C £750 and her daughter, Ms D, £250 for the distress caused.

The complaint

1. Mrs C complains that Northamptonshire County Council (the Council):
• moved her mother (Mrs B) to a nursing home without properly consulting the family or notifying Mrs C and ignored the home preferred by Mrs C’s daughter; and,
• failed to properly acknowledge or rectify the poor care Mrs C received at the nursing home.

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The Ombudsman’s role and powers

2. 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)
3. If we are satisfied with a council’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)

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How I considered this complaint

4. I have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. I have written to Mrs C and the Council with my draft decision and considered their comments.

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What I found

5. Mrs B had dementia and was placed by the Council in a residential care home (Wendelberrie House [WH]). Her daughter, Mrs C and her granddaughter, Ms D, held power of attorney for her. On 12 October 2017 WH contacted the Council to say it was giving Mrs B notice to leave as it said it could no longer manage her needs due to a deterioration in her condition (unwillingness to take medication, confusion, some aggressive behaviour). The Council agreed to carry out an unscheduled review and asked WH to arrange for a Community Psychiatric Nurse (CPN) to carry out a nursing assessment.
6. On 18 October 2017 WH’s manager told the Council he had given Mrs B 28 days’ notice to leave.
7. On 30 October 2017 the Council rang the manager. He said the CPN had introduced some new medication at night to improve her sleep. This had worked for a week but was no longer having any effect. The Council also spoke to Mrs C who was happy for the Council to complete an assessment and look for a new placement as long as it was near enough for Ms D to visit.
8. The Council assessed Mrs B on 31 October 2017. The assessment concluded she needed nursing care. It also said that Mrs B needed regular monitoring in respect of dietary and nutritional intake because she was prone to decline meals. It said she had not fallen at WH but was at risk of falling due to her shuffling gait and needed space to use her walking frame.
9. The Council also contacted the CPN to discuss the case. He agreed to visit Mrs B on 2 November 2017 to carry out a nursing assessment. The Council received the assessment on 6 November 2017: the CPN agreed that a move to nursing care was necessary. The Council referred the case to the brokerage team on 7 November 2017 to find a nursing home place.
10. On 13 November 2017 the manager of WH contacted the Council to say the situation was now urgent as Mrs B was becoming more verbally aggressive to staff and residents.
11. On 16 November 2017 another home offered a place. Ms D viewed the home on 20 November 2017, but said it was unsuitable (she said there was an odour of urine and faeces and a lack of attention to residents).
12. On 23 November 2017 the manager of WH complained about the time it was taking to find a place for Mrs B. He said the notice period had expired and Mrs B’s bed had been given to a person who was funding their own care. The Council referred the home to its quality team regarding these actions.
13. On 27 November 2017 the Council identified two homes, Wheatsheaf Court and Midland. The Council preferred Wheatsheaf Court as it was cheaper. Ms D said it was a long way for her to visit but she would view Wheatsheaf Court the following day. She also asked for Midland to assess Mrs B so she had a choice. The Council informed Ms D that WH wanted Mrs B to move out by 29 November 2017. Ms D said she felt unfairly pressured to reach a quick decision.
14. On 27 November 2017 the Council sent further details of the case to the Quality Team to see what could be done to ease the urgency of the situation. It also chased Midland regarding the assessment.
15. On 28 November 2017 Ms D said she had done some research and preferred Midland. The Council said the Midland had assessed Mrs B and would offer a place but it would cost around £400 more per week. The quality team said there was not much it could do about the insistence by WH that Mrs B had to move. The brokerage team said that as Wheatsheaf Court had a place which was affordable, Mrs B would have to go there the following day. It said Midland could not offer a place until 1 December 2017 and the Council was unlikely to agree such a high level of funding.
16. The Council spoke to Ms D and she said she felt very pressured. She did not consider it was right or acceptable for the Council to force Mrs B to go to Wheatsheaf Court. The brokerage team insisted Mrs B would have to go to Wheatsheaf Court on 29 November 2017, but it would ask the Assistant Director to consider approving the higher funding for Midland.
17. Ms D visited both homes on 28 November 2017. She contacted the Council the next morning to say the family preferred Midland and the manager had said there may be a bed available on 30 November 2017. She said Wheatsheaf Court was so far away for her to visit and she visited her grandmother once a week. The Council insisted that Mrs B had to move that day to Wheatsheaf Court, even though Ms D said she did not want that to happen.
18. The brokerage team discussed the case with the Assistant Director during the afternoon of 29 November 2017. Ms D called several times to try and find out what was happening. Ms D says she was told by a member of the brokerage team that Mrs B was going to Wheatsheaf Court that day and then hung up on Ms D.
19. The Council says that the Assistant Director rang Ms D that afternoon to explain the Council’s decision: that Mrs C would move to Wheatsheaf Court that day as an interim arrangement and the Council would continue to look for an alternative placement closer to Ms D to facilitate more frequent visiting. There is no record of this call. There are several emails showing that members of the brokerage team spoke to Ms D that afternoon and confirmed Mrs B was going to Wheatsheaf Court.
20. The Council accepted that cost had been a factor in the decision and the significant difference in cost represented a placement for another person. It said neither Mrs C nor Ms D could provide a third-party top-up.
21. Mrs B was moved to Wheatsheaf Court that afternoon around 5 pm.

Wheatsheaf Court

22. The information on record about Mrs B differed from the recent assessment in respect of nutrition. It recorded her weight as 46.7 kg, said she was slim but ate well and was on a normal diet, but preferred finger foods.
23. The family say Mrs B was unhappy at Wheatsheaf Court. On 18 December 2017 Mrs C raised concerns by telephone about the standard of care including medication, inadequate supervision and risk of falling along with concerns about weight loss and medication. She said the home was cold, the arrangements for lunch had been chaotic and inadequate causing Mrs C to not eat any lunch and the management had not been concerned about this.
24. The Council sought a place at an alternative home from 12 December 2017. On 4 January 2018 the Council found an alternative home who could take Mrs B from 8 January 2018. On 5 January 2018 the Council visited Wheatsheaf Court in response to the concerns Mrs C had raised.
25. Mrs B was admitted to hospital on 6 January 2018. Mrs C said the hospital found that Mrs B was very dehydrated with low sodium levels and was very thin. Mrs B did not regain consciousness and died on 8 January 2018.
26. The Council carried out a full contract monitoring visit on 23 February 2018. As a result of this visit, it identified actions that needed to be taken in six areas including nutrition (the lunchtime experience, intake, weights and monitoring), Management Oversight, Recording, Documentation and Staff Support. The Council has monitored Wheatsheaf Court since then and will continue to do so for a further six months.

Complaint

27. Mrs C contacted our office in August 2018 to complain about the Council and Wheatsheaf Court. We referred the case back to the Council to carry out an investigation through its own complaint procedures. The Council responded on 29 August 2018, providing an account of the events leading to Mrs B’s move to Wheatsheaf Court. It said the difference in cost between the two homes was £400 and represented the cost of a placement for another person so the Council could not justify spending this money. The Council acknowledged the situation had caused Mrs C stressed and offered its sincere apologies.
28. Mrs C remained dissatisfied and met with the Assistant Director of the service on 17 December 2018. She asked for further information and records from Wheatsheaf Court about Mrs B’s care. She also asked for information about the notice period given by WH, actions taken by the brokerage team, the availability of other places at that time and knowledge of Care Quality Commission reports. The Council agreed to send additional information to Mrs C. I do not know what information was forwarded.
29. Mrs C had a further conversation with the Assistant Director on 15 February 2019 and the Council followed up the conversation with a letter dated 15 February 20198. This confirmed they spoke about the expected rates of pay and that the Council usually accepted placements at these rates first. They also discussed the third-party top-up and the fact that neither Mrs C or Ms D had been able to afford it. Mrs C said that she may have been able to pay extra for a short period. The Assistant Director explained this would not have been acceptable as third party top-ups tend to be longer term arrangements.
30. The Council upheld the complaint about the frustration caused by the refusal to consider the Midland Home due to cost and the pressure they were placed under due to the actions of WH. It made a goodwill offer of £250. Mrs C had requested £5000.
31. Mrs C complained again to the Ombudsman.
32. In response to my enquiries the Council has provided some records from Wheatsheaf Court. These include its own investigation report noting that between 4 December 2017 and 2 January 2018 Mrs B lost almost a stone in weight. It noted that while there was no requirement to keep intake records due to her weight on arrival at the home, Mrs B had poor dietary intake and records should have been kept to monitor the situation. The report said that the family had been kept informed about Mrs B’s distress and the GP had visited on 4 January 2018 but not recommended any intervention.
33. The Council clarified that it had paid £695 per week for Mrs B at Wheatsheaf Court. Midland wanted £985 per week. The home found in January 2018 wanted £570.
34. Mrs C says the Council told her the maximum weekly amount it would pay was £490 per week. She said she could have easily found a home for £695 per week if she had been told this figure.

Care Quality Commission

35. The Care Quality Commission (CQC) had visited the home in September 2017 and produced a report on 28 November 2017 finding the home required improvement in all five areas of inspection.
36. Mrs C complained to CQC in 2018 about her mother’s experience. CQC visited again in November 2018 and produced another report in February 2019. This downgraded the overall rating to inadequate and put the home in special measures.

Analysis

Moving homes

37. The Council assessed Mrs B 20 days after WH said it could no longer cope with her needs. This also involved the CPN carrying out an assessment and trialling some different medication. I cannot say this timescale was excessive.
38. But the Council did not inform WH of the likely timescale or explore what WH would do if the Council did not find an alternative place. This was fault. It created a very stressful situation for the Council, leaving little time to properly source alternatives. Ms D was put under significant pressure to agree to an option she was not happy with and there was no time to discuss if any compromise could be reached. Mrs C says that if she had known that the Council was willing to pay £695 per week she could easily have found a more suitable home nearer to Ms D. It was fault not to provide important information to Mrs C at this point.
39. I appreciate the Council was in a difficult situation, but I consider it was fault to move Mrs B without the consent of either Mrs C or Ms D, particularly as they had power of attorney for Mrs B. This was another consequence of the rushed last-minute situation which the Council allowed to develop.

Wheatsheaf Court

40. Wheatsheaf Court had incorrect information in its records about Mrs B’s eating and nutrition. It said she had no problem with eating, whereas the assessment done at the end of October 2017 said Mrs B needed regular monitoring in respect of dietary and nutritional intake because she was prone to decline meals. This was fault. It was key information which Wheatsheaf Court should have known about and acted upon.
41. Even without this information it should have noticed Mrs B’s weight loss and taken steps to monitor and improve the situation. The failure to do so was fault.
42. I cannot say this would have made a difference to the outcome for Mrs B, but it caused Mrs C understandable uncertainty about the care Mrs B received in her last weeks, which was very upsetting for her.
43. Her uncertainty has been exacerbated by her observations of the eating arrangements at the home, the findings of the Home’s own investigation into Mrs B’s care, the Council’s monitoring visits and Mrs B’s condition on admission to hospital.
44. I cannot identify any fault with the way the Council responded to Mrs C’s complaints about the home, visiting promptly, identifying faults and carrying out further monitoring.
45. The first CQC report was issued at the same time as Mrs B was moved to Wheatsheaf Court. I cannot expect the Council to have known about its content at this point or for it to have affected the decisions that were made. CQC reports are also available for the public to read.

Agreed action

46. I welcomed the Council’s offer of £250 in recognition of the distress caused to Mrs C, but I considered a higher payment was appropriate and the distress caused to Ms D should be recognised:
47. I asked the Council, within one month of the date of the decision, to pay Mrs C £750 and Ms D £250 for the distress caused to them by the faults identified above.
48. The Council has agreed to my recommendations.

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Final decision

49. I consider this is a reasonable and fair way of resolving the complaint and I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman