Summary: Mr X complains The Hawthornes care home did not care for his parents properly and failed to treat them as individuals during a respite stay in 2018. The Ombudsman finds the Care Provider’s failure to properly explore and assess Mr X’s parents’ needs before their admission directly contributed to the later difficulties it had providing personal care to Mr X’s mother. This was fault. The Care Provider has agreed to apologise, refund some of the fees paid and consider how it can improve its pre-admission assessment process.

The complaint

1. Mr X complains The Hawthornes care home did not care for his parents properly and failed to treat them as individuals during their respite stay in 2018. He brings this complaint on their behalf.
2. Mr X particularly complains staff did not give satisfactory personal care to his mother and says the Care Provider has blamed his father for that. Mr X believes the Care Provider should apologise and refund some or all the fees paid for his parents’ stay.

Back to top

The Ombudsman’s role and powers

3. 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)
4. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

Back to top

How I considered this complaint

6. I spoke with Mr X and looked at his complaint to the Ombudsman. I also reviewed the documents he sent me about his parents’ care. Mr X is a suitable personal representative for his parents as he has power of attorney for their health and welfare matters.
7. I wrote to the Care Provider to ask questions and reviewed the material it sent in response.
8. 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.
9. I shared my draft decision with Mr X and the Council and I invited them to comment on it.

Back to top

What I found

10. Mr X’s elderly parents have dementia and other care needs. They live at home, visited by carers who attend to them. In 2018, Mr X and his sister decided to arrange a respite period where their parents would be looked after in a residential care home for just under four weeks.
11. Mr X and his sister chose The Hawthornes as they thought it was the best fit for their parents needs. Contracts were signed and a ‘Respite Admission Assessment’ was completed for each parent by a member of staff. This identified relevant medical conditions, care needs and common behaviours. Mr X’s mother’s care plan noted she needed incontinence pads.
12. When Mr X’s sister and others visited his parents, there were at least two occasions where they found Mr X’s mother had been incontinent in urine, without having been given a pad to wear by the care home staff. The care home manager investigated a complaint about this. She accepted there were occasions where staff members could not complete Mr X’s mother’s personal care. She said this was because of the behaviour of Mr X’s father, who was protective towards his wife and often insisted he could look after her.
13. The manager said he often presented a physical obstruction and sometimes even aggression, causing carers to back off and withdraw rather than risk further confrontation. Her investigation concluded The Hawthornes was “not the correct environment” for Mr X’s parents, although it kept them “as safe as possible.”
14. Mr X told the Ombudsman although he accepts his father presents some challenges because of his dementia. This was not hidden when he was admitted. He could not understand why staff did not do more to distract his father or encourage him to move away. Mr X felt the Care Provider was simply looking to blame his father for its failure to properly look after his mother.
15. The Care Provider says it realised soon after Mr X’s parents came to live at the care home there were going to be difficulties. It says it told Mr X’s sister of its concerns, but they agreed the respite period would continue. It said Mr X’s father interpreted his role as being his wife’s carer, even though its staff accepted that was not the case and did not encourage it.
16. The daily care notes for Mr X’s mother show staff members gave her incontinence pads on several occasions. Although the records show lots of personal care related to toileting being provided, they do not always record whether she was given pads to wear. Mr X says, at the end of his parents’ stay at The Hawthornes, there were still many incontinence pads left in the stock they had provided on admission.

Back to top

Analysis

17. First, I recognise the difficulties faced by the Care Provider in this case. The evidence I have seen in the daily care notes, challenging behaviour charts and statements from staff members clearly show some of the challenges posed by Mr X’s father.
18. However, there is no evidence Mr X’s parents’ needs were hidden before their admission. As the Care Provider accepts, the pre-admission assessment did not correctly identify all their needs and behaviours before it agreed to take them in.
19. I have concluded this directly contributed to a situation where the standard of care sometimes fell below what we would expect. I am satisfied this was fault, as it caused an injustice to both of Mr X’s parents. In particular, it meant Mr X’s mother did not always receive the comprehensive personal care she needs. I would not however go as far to say there was a failure to treat Mr X’s parents as individuals.
20. The Care Provider has reflected on the Ombudsman’s involvement in this complaint and now accepts it should refund some of the fees paid by Mr X’s parents. It has proposed refunding one weeks’ worth of fees to Mr X. I recommend it should increase this to offer one weeks’ worth of fees for each parent. I do not believe a further financial remedy is justifiable. The daily care records show Mr X’s parents often received acceptable care, even if there were occasions when it fell below that.
21. The Care Provider should also apologise to Mr X for the fault identified in this case.
22. My investigation of this complaint identified a further issue with the care home’s record keeping. The Care Provider could not produce most of the records I sought about Mr X’s parents’ care. It said it only recently took over responsibility for The Hawthornes and had identified issues with archiving of records. Fortunately, it had sent copies to Mr X at an earlier stage of the complaint process and he could produce them to me. Without these, it would have been difficult to reach the conclusions I have.
23. Also, although there are references to the Ombudsman in the Care Provider’s complaints policy, it is important it also mentions us in its final complaint response letters. It did not do so in this case. The Care Provider says it normally does signpost complainants to us. Although in this case it was not fault, as Mr X found us in good time, there may be cases where it delays someone approaching us.

Back to top

Agreed action

24. By 2 October 2019, the Care Provider has agreed to:
• write to Mr X to apologise for the shortcomings identified in assessing the risks to his parents before it accepted them as temporary residents.
• arrange to refund, via Mr X, £1460 to Mr X’s parents. That represents the £730 weekly fee per person.
25. By 2 December 2019, the Care Provider has agreed to review what it could have added to the Respite Admission Assessment in this case to have enabled a more realistic assessment of the needs of Mr X’s parents. The Care Provider should then make the necessary amendments and ensure all staff members who carry out such assessments are aware of them.
26. The Care Provider should write to the Ombudsman to confirm when it has completed these actions.

Back to top

Final decision

27. There was fault in this case caused by a failure to properly assess Mr X’s parents’ needs before they were admitted to the care home.

Investigator’s final decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman