Summary: Miss X complained about the Care Provider that runs a care home her father stayed in for four months. She raised concerns about standards at the Care Home which she says caused issues with her father’s behaviour, and believes the home wrongly gave him notice to leave based on incorrect information. The Care Provider was not at fault.

The complaint

1. Miss X complained about the Care Provider that runs a care home her father,
   Mr Y, lived in for four months (the Care Home). It gave Mr Y notice, saying it could not meet his needs, but based this decision on incorrect information, which it did not evidence, and did not seek the appropriate advice beforehand.
2. Miss X says the Care Provider did not accept responsibility and deflected responsibility by making allegations about her. For example, it told the Council’s adult social care department that she had “manhandled” her father when helping him transfer to his new care home.
3. Miss X has several concerns about standards at the Care Home and she believes some of Mr Y’s behaviour was a result of poor care. Her concerns include that the Care Home:
• did not have enough staff, and staff were not properly trained in dementia care.
• did not properly clean Mr Y’s room and excluded him from activities.
• lost some of his possessions and did not keep an inventory.
4. Miss X says Mr Y was very unhappy in the Care Home, he lost weight and was unkempt. Miss X experienced distress as a result of her father’s distress.

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The Ombudsman’s role and powers

5. 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)
6. If we are satisfied with a care provider’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

7. I considered the information Miss X provided.
8. I made enquiries of the Care Provider and considered the comments and documents it provided.
9. I looked at the relevant law and guidance, including the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
10. I wrote to Miss X and the Care Provider with my draft decision and considered comments I received before issuing my final decision.

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What I found

11. 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.
12. The fundamental standards include:
• Safe care and treatment (regulation 12) and staffing (regulation 18), which include that sufficient numbers of suitably qualified, competent, skilled and experienced staff must be provided to meet the needs of the people using the service and to keep them safe.
• Safeguarding service users from abuse and improper treatment (regulation 13), which includes that providers must have robust procedures and processes to prevent people using the service from being abused, and that they must take appropriate action without delay where concerns are reported.

What happened

13. The Care Provider assessed Mr Y at the end of August 2018, as his family was considering him moving to the Care Home. The Care Provider says it was not given proper, detailed information about Mr Y when it carried out the pre-admission assessment. I have seen that assessment and his care plan from a previous placement. These did not mention challenging behaviours that later became evident.
14. The service user contract, which Miss X signed at the end of August, listed terms and conditions. These said if the Care Provider could not meet a resident’s needs, it would discuss the need for finding alternative accommodation with relevant parties, giving 28 days’ notice.
15. The contract stated residents could bring some possessions to personalise their room following consultation with the manager. It said the home would take no liability for any clothing lost during residents’ stay. Miss X signed an inventory of items. This said the Care Provider would not take responsibility for items brought in after the day of admission unless the home was notified of them in writing.
16. Mr Y moved into the Care Home at the end of August 2018. In September, Miss X brought further items to the Care Home. The Care Home wrote down what she brought in, listing more clothes and some decorations. The Care Provider says Miss X later brought further items without notifying staff.
17. The care records showed some occasions where care staff noted Mr Y was unsettled, and they had difficulties giving him personal care. They recorded he had urinated on the floor of his bedroom on some occasions. Carers recorded he ate and drank well. The Care Provider says it noted Mr Y showed challenging behaviour related to incontinence soon after his admission, but at first it decided this was probably due to his anxiety about moving. The first record of this was in mid-September, two and a half weeks after Mr Y moved into the Care Home.
18. The Care Provider created a care plan the next day for Mr Y’s challenging needs. This noted Mr Y could refuse to cooperate and listed ways in which staff could reduce this. It noted staff should support him to engage in activities that interested him, to avoid idleness.
19. The Care Provider held a review at the end of October. The Care Home staff talked about how Mr Y enjoyed music activities. They discussed they were struggling to deal with his incontinence issues and the amount of deep cleaning that was necessary due to this. Miss X said Mr Y had incontinence issues when he lived with her. The Care Provider says Miss X steered the conversation to her relationship with her sister, which Miss X disputes. The notes show this was partly in the context of Miss X warning the Care Home her sister may be critical of it when she visited. The manager says due to Miss X’s distress, they ended the meeting early.
20. The care records kept by carers showed Mr Y then became frustrated during personal care and had incontinence issues more regularly. At the beginning of November, Mr Y was found in another resident’s room after having been incontinent. The Care Provider says other residents’ families complained verbally to care staff.
21. The Care Provider says it became clear Mr Y’s behaviours were too complex for its staff to manage. Mr Y required high levels of care and supervision. It says it could not manage the damage to the Care Home environment, and Mr Y’s and others’ possessions.
22. In November, the Care Provider completed another care plan giving instructions to carers about maintaining Mr Y’s dignity when he was incontinent. The Care Provider held a meeting two days later. It discussed the issues with Miss X, who made suggestions about what she felt could help – for example, installing laminate flooring in Mr Y’s room. They discussed Mr Y collapsed frequently, which seemed to be when he became highly agitated.
23. The care records at this time showed a further increase in the frequency of incidents. Mr Y began putting multiple layers of clothing on regularly, and there were more records of him refusing to eat. In mid-November, the Care Provider served notice to Mr Y, to expire in mid-December. This gave more than 28 days’ notice. The Care Provider says this was the correct thing to do and was in Mr Y’s best interests. The notice letter said the care home could not meet Mr Y’s needs.
24. The following week, the mental health community team visited Mr Y, to discuss his needs and the care home’s ability to meet them. This followed a referral from the GP. Miss X felt the mental health team should have been involved earlier. The Care Home recorded the mental health team did not think the Care Home could meet Mr Y’s needs and would like him to move homes. It gave advice, and the Care Provider tried providing a carer at all times, but it says this distressed Mr Y and he did not want to be monitored so closely. The Care Provider says it discussed the issue with CQC, who said it should not keep a resident in its care if it could not fully meet their needs.
25. Mr Y moved to a new care home in mid-December. The Care Provider says
    Miss X transferred Mr Y from the home in an aggressive manner. The incident report records Miss X spoke to Mr Y “sternly”. The Care Provider says Mr Y was distressed and refused to leave the care home. Two Care Home staff say they witnessed Miss X pushing Mr Y and speaking to him aggressively about needing to go. Miss X disputes the Care Provider’s description of that event. The Care Provider reported the incident to the local council’s safeguarding team. The council took no further action. Miss X felt the Care Provider reported this to deflect responsibility from its own actions.
26. Miss X discussed missing items with the Care Provider after Mr Y had moved out of the Care Home. This included various items of clothing and a bath mat. The Care Home found some items. Miss X said some items had not been added to the inventory. She told the Care Home, given the number of items that were missing, she expected some reimbursement. The Care Provider issued a credit note for £35 in February 2019 to recognise that some items had gone missing. The Care Provider told us this was a good will gesture as it did not have a record of some items Miss X brought to the home. Miss X says it only paid £30.
27. The Care Provider disputes Miss X’s assertion there were not enough staff members on shift. CQC found the Care Home had sufficient staffing on its latest inspection. The Care Home also provides dementia care training for its staff, with regular refreshers as a requirement of the job. The Care Provider told me Mr Y was always invited to activities but often declined. It says he liked to join in musical activities. The Care Provider says Mr Y was happy at the Care Home. It says weight loss is typical for someone with his condition.
28. Miss X feels the care staff did not take the time to understand what Mr Y was trying to communicate so he became agitated which led to the behaviours the home observed. She says the Care Provider wanted to “get rid” of Mr Y rather than try to solve the problem. She believes there is a lack of proof, as the records are inaccurate. She says the involved professionals collectively felt the Care Provider did not do enough before giving Mr Y notice.

Analysis

29. Miss X complained about the Care Provider giving Mr Y notice, which she says it based on incorrect information. I have seen evidence in the Care Home’s daily records and cleaning logs that Mr Y showed challenging behaviour relating to incontinence issues. He was also found in another resident’s room having been incontinent. The Care Provider was not aware of Mr Y’s challenging behaviours before he moved into the Care Home. I have not seen evidence of substantive complaints from other residents’ relatives, as the Care Provider clarified they raised concerns verbally with care staff. It would be good practice for the Care Provider to ensure verbal complaints are written down in future, so they can be relied on later as a contemporaneous record.
30. The Care Provider created a care plan and tried to ensure it kept Mr Y occupied. It gave instructions for staff to reduce Mr Y’s distress. It provided a carer full time after the mental health team advised this. The mental health team’s visit was after the Care Provider had served notice, however the Care Provider had needed to ask a GP to make the referral. I cannot say that the Care Provider would not have served notice to Mr Y had the mental health team been able to visit sooner. It ultimately decided it could not meet Mr Y’s needs. It was entitled to make that decision and Mr Y is reported to be more settled in his new care home. The Care Provider was not at fault.
31. There is no substantive evidence to support Miss X’s claims there were not enough members of care staff. I have seen evidence of carers’ training schedules and the records of activities the Care Home tried to engage Mr Y in. This supports the Care Provider’s assertion it offered activities, but Mr Y often declined. I have seen no substantive evidence to lead me to believe the quality of care provided to Mr Y was not acceptable.
32. The Care Provider’s contract, which Miss X signed, says the Care Provider was not liable for clothing lost during residents’ time at the Care Home. Most missing items were clothing. The bath mat, which was not found after Miss X told the Care Home it was missing, was not on the list of possessions the Care Home was notified about. The Care Provider offered to pay Mr Y £35 as a goodwill gesture. I make no recommendation related to this because the Care Provider was not at fault. Miss X says the Care Provider refunded Mr Y £30 instead of £35. I have seen the credit note raised for £35.
33. Miss X believes the Care Provider blamed her on some occasions to deflect responsibility from itself. Miss X says it is not true that she redirected conversations to talking about her relationship with her sister. I cannot say what happened at meetings, as I was not present. However, the Care Provider’s record of the meeting of October suggests Miss X provided the Care Home relevant information about her sister in good faith. I cannot determine whether discussions about her sister meant the attendees could not fully discuss Mr Y as the Care Provider asserts. I also cannot determine what happened on the day Mr Y moved out of the Care Home. However, wherever a Care Provider has concerns, it has a duty to report these to the council. Miss X was disappointed the Care Provider did not tell her at the time its staff had concerns about the manner in which she removed Mr Y from the Care Home. It is good practice for care providers to tell a person whose behaviour concerns them that they intend to report an incident to the council. However, in some circumstances this is not safe or appropriate, and a decision should be made in each case about whether to notify the person they are reporting. I have seen no substantive evidence to support Miss X’s complaint the Care Provider tried to deflect responsibility on to her.

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Final decision

34. I have completed my investigation. There was no fault in the Care Provider’s actions.

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Investigator's decision on behalf of the Ombudsman