The Ombudsman's final decision:
Summary: Mrs B complains about the way the care home handled the ending of her mother’s residence in a care home. She says that it affected her mother’s well-being, her abilities declined and she had to move to another care home. The home failed to provide and retain a copy the contract, to inform the family of the emerging concerns about Mrs C’s mental health, to provide proper notice of the termination of the contract and there were errors in the complaint handling. The care provider will, within a month of this decision, apologise to Mrs B for these failings.
- Mrs B complains on behalf of her mother Mrs C. Mrs C was living in St Mary’s Care Centre. Mrs B complains about the way the home handled the ending of her mother’s residence there. She says the home didn’t warn the family it could not manage her mother’s behaviour or provide the care she needed. She complains also about aspects of the standard of care provided. She says that as a result it affected her mother’s well-being, her abilities declined and she had to move to another care home.
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 provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe it is unlikely further investigation will lead to a different outcome. (Local Government Act 1974, sections 34B(8) and (9))
- Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.
How I considered this complaint
- I considered the complaint and spoke to Mrs B. I asked the care provider for its comments on the complaint and additional information. I sent a copy of a draft of this statement to Mrs B and the care provider and invited their comments
What I found
- Mrs B’s mother Mrs C moved into St Mary’s in December 2017 following a stroke and re-ablement. Private Medicare Limited (PML) runs St Mary’s. Mrs B and her siblings were not happy with aspects of the care. Mrs B has referred to some examples but the overarching concern was there was not enough stimulus or interaction for her mother. Mrs B did not raise a complaint with PML about this at the time.
- On 5 March the manager of the home, Mrs X, asked the family to come into a meeting. At the meeting Mrs X referred to Mrs C’s declining mental health and the impact of that on other residents. She gave the family notice of ending the contract.
- The family asked for details of the reported decline in Mrs C’s mental health and behaviour. This was not provided. There was reference to a report being prepared and then lost. PML said it could not share any information with the family as they did not have a lasting power of attorney for Mrs C.
- Mrs B complained to PML. They apologised for the loss of the report. The responses recognised why the family had not been informed about the challenging behaviour.
- The home assessed Mrs C before she moved in. I do not consider there is any evidence of any fault in that assessment. There is nothing to show the home should have identified at that point that it could not meet Mrs C’s care needs.
- There should be a contract between the care provider and the resident. Mrs B said the family did not have a contract. PML have not been able to provide a copy of one. They say that a copy would normally be given to the family when it is signed when the resident moves in.
- It is fault that PML do not have a copy of the contract. Given that and Mrs B’s recollection being there was no contract I conclude, on the balance of probabilities, that there was no contract. That is fault.
- The specimen contract PML has provided says that notice of the termination should be given in writing with four week’s notice. This did not happen. No written notice was given. That is fault.
- There is a wider point here which is fundamental to the complaint. The family had no knowledge that the home had found Mrs C’s mental health to be declining. The home’s care records show that by the middle of January 2018 when the care plan was reviewed staff had sufficient concerns to note that if Mrs C’s behaviour continued to decline then closer monitoring with the use of behaviour charts would be needed. The family were not told of these emerging concerns. The first the family were aware was when the decision had already been made in March that the home could no longer meet Mrs C’s needs. This was wrong. The family should have been told of the concerns as they became an issue.
- In responding to Mrs B’s complaint PML said that a report had been prepared providing details of Mrs C’s behaviour which had led to the decision. The report was for the social worker as the home said it could not share the information with the family as there was no lasting power of attorney in place. In responding further PML said the report must have been lost and was assumed to have been shredded. In responding to my enquiries PML has said that no over-arching report was prepared but they have not been able to locate any behaviour charts. The care records only show behaviour charts being started after the family had been given notice so I can see no reason to think there were any other records.
- PML has provided inconsistent and unclear information about what documentation, if any, was prepared. This all comes back to the same key point that the family had not been given any warning that there was a problem with Mrs C’s behaviour.
- PML has considered whether it should report the possible loss of data to the Information Commissioner’s officer but has decided it does not meet the threshold. I consider it is far from certain there was any report or documents prepared but if Mrs B is concerned that there has been a possible loss of data then she can raise that with the Information Commissioner. But it was fault that PML was not clear with Mrs B about what it had done in response to her questions on this point.
- Mrs B considers there was a lack of stimulation for Mrs C on a day to day basis and this contributed to her decline. She says that since moving she is much better.
- The care records do not provide any conclusive information about this. PML has provided a list of activities that were offered while Mrs C was resident and those which she attended. This shows that she only took part in a few events but it was for Mrs C to decide if she wished to take part. I cannot say there was a failing by the home to do more to encourage Mrs C to take part.
- Mrs B has commented that many of the listed events were cancelled. I do not know how many were cancelled but I do not consider this to be a significant point in my overall consideration of the complaint and I am not, therefore, going to take it further.
- As I explain above I consider there has been fault by PML which has caused injustice to Mrs C and her family. But even if there had been no fault I consider the outcome is likely to have been the same. If the home had told the family of the concerns about Mrs C’s behaviour and whether it could meet her needs I consider it unlikely this would have altered the sequence of events. But the family would have been better prepared.
- PML said it had written off over £500 of care charges. Mrs B has commented that it was £414 but that the issue for the family was not about financial compensation. I am not going to try to establish the exact amount because this is not the focus for the family. Mrs B has asked that PML to make both a written and personal apology. PML has agreed to apologise in writing which I consider to be satisfactory but I hope it may consider making a personal apology which the family would find valuable.
- PML will apologise to Mrs B for the faults found.
- The home failed to provide and retain a copy the contract, to inform the family of the emerging concerns about Mrs C’s mental health, to provide proper notice of the termination of the contract and there were errors in the complaint handling. The care provider will, within a month of this decision, apologise to Mrs B for these failings.
Investigator's decision on behalf of the Ombudsman