Summary: The complaint is about council-funded care in a nursing home. There was no fault in the care of the late Mr E.

The complaint

1. Mr D complains about his late father Mr E’s care at Claremont House and Lodge Nursing Home, Caister-on-Sea (the Nursing Home). Norfolk County Council (the Council) arranged and funded the Nursing Home. Mr D complains about the quality of care and about the cleanliness and temperature of Mr E’s room.

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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. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word ‘fault’ to refer to these. 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)
4. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)

5. The Nursing Home acted on behalf of the Council in delivering care to meet Mr E’s care needs. Any fault by the Nursing Home would be fault by the Council.

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How I considered this complaint

6. I considered Mr D’s complaint to us, the Nursing Home’s response and documents described later in this statement. The parties received a draft of this statement and I took comments received into account.

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What I found

Relevant law and guidance

7. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. When investigating complaints about council-funded care placements, the Ombudsman considers the 2014 Regulations when determining complaints about poor standards of care.
8. Regulation 9 of the 2014 Regulations requires care and treatment to be appropriate, to meet a person’s needs and to reflect their preferences. Care providers should carry out an assessment of needs and preferences and design a care plan to meet needs and preferences.
9. Regulation 12(i) of the 2014 Regulations says a care provider must provide care and treatment in a safe way including by working with health professionals to ensure the health and welfare of residents.

What happened

10. Mr E moved into the Nursing Home from hospital where he had been treated for an infection. He had dementia. Before going into hospital, Mr E had been confused and had reduced mobility, resulting in a fall at home. Mr E’s care needs had increased and the family felt he needed more care than they could provide at home. So the Council arranged a placement in the Nursing Home.
11. The cleaner kept a record of housekeeping in each room. The record for Mr E’s room indicated the room was deep cleaned the day before he moved in.
12. Both the Nursing Home and the Council drew up care plans describing Mr E’s care needs. Those care plans noted he had dementia, sometimes refused personal care and threw his blankets off and refused to let anyone replace them. He needed patience and encouragement from staff to accept care. He needed support to get dressed and undressed and would not be able to complete these tasks independently.
13. The Nursing Home kept daily records of the care staff gave. They include a number of entries where Mr E refused food and where he refused to have his clothes changed.
14. On 20 November, a member of staff noted Mrs E had complained Mr E’s room was cold. In a statement, the staff member said Mrs E had also complained about finding Mr E without a blanket on. The staff member said she turned up the thermostat and asked the maintenance man to bring a heater. The staff member told Mrs E that Mr E could change rooms if they wanted to. The family agreed. Mr E was noted to be distressed at finding Mr E uncovered and dressed in only his underwear. The member of staff explained Mr E refused to keep blankets on and staff would keep checking on him. When asked, the carer on duty said on the previous check, Mr E had the blankets on and was asleep.
15. Mr E saw the GP on 20 November and the GP checked his chest. The GP prescribed antibiotics for a chest infection.
16. On the day of Mr E’s death, 21 November, the records indicated staff checked on him every 2 to 3 hours. He had a settled night and by 7 am he was noted to be awake and chesty. Staff changed his bed clothes and made him comfortable. He had a few mouthfuls of porridge at 9 am but declined any more food. He was washed and changed at 11 am and helped on to the commode at 2 pm. At 3.40 pm he was assisted with personal care and weighed. He had medication at 6 pm but could not manage one of the tablets. The nurse noted Mr E’s wife was present and she explained to Mrs E that Mr E was quite frail and may become more unwell. Mrs E went to make tea at 6 pm and at 6:10 pm, she called the nurse to say Mr E was not responding to her. The nurse checked Mr E and there were no signs of life. She called the GP surgery and they had nothing on record suggesting the death was expected. A nurse practitioner from the GP’s surgery certified Mr E’s death.
17. The Care Provider, Healthcare Homes provided two responses to Mr E’s complaint. It said:
• Mr E’s carpet was due to be replaced and it was sorry this did not happen before he moved in
• The domestic records showed the room and bathroom had been deep cleaned the day before Mr E moved in.
• It was sorry the bedroom was cold. Staff turned up the heating straight away and provided an extra heater in Mr E’s room. The boiler was reset and there was no fault in the heating system
• The manager offered a different room and the family agreed Mr E would move to that room the following week
• The care records and statements from staff showed Mr E was covered with a duvet before they left him to attend to a different resident
• He received care every 2 to 4 hours day and night
• The GP saw Mr E on 20 November as a new patient. Mr E was chesty so the GP prescribed antibiotics which the pharmacy delivered the same day. He had the first dose the same evening
• Mr E’s pre-admission assessment was completed when he was still in hospital in October, but he was not admitted to the Nursing Home until November. In future, the Care Provider would ensure there was a further assessment 3-4 days before admission.
18. The Council told us it had waived the charge for Mr E’s care. The Care Provider told us it had made changes to procedure as a result of Mr D’s complaint:
• Senior managers were doing spot checks to ensure high standards of cleaning
• Thermostats have been boxed in so a comfortable temperature can be maintained
• Up to date information/assessment was sought about new residents if any admission was delayed.

Was there fault?

The room

19. There is conflicting information about the state of Mr E’s bedroom. The records indicated it was deep cleaned; the family said the floor was not clean.
20. I do not consider there is enough evidence of fault. I have taken into account that the Nursing Home offered a change of bedroom when the family complained.

The temperature

21. There is no fault because when Mr E’s family raised concerns, staff took action straight away by turning up the heating and arranging an extra heater

Mr E’s care

22. The care plans noted Mr E was sometimes resistant to care and tended to throw off his bedclothes. I am satisfied this is what is likely to have happened between the last time check on Mr E by carers and his family arriving and seeing him partially dressed and with no bedclothes on. The records also noted Mr E sometimes refused personal care and there are recorded incidents of him declining to be changed. I am satisfied care was in line with Regulation 9 of the 2014 Regulations and there was no fault.
23. Mr E experienced chestiness. I am satisfied staff at the Nursing Home responded appropriately by liaising with the GP who saw Mr E on the same day and prescribed antibiotics, which commenced straight away. Care was in line with Regulation 12 of the 2014 Regulations and so there was no fault.

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Final decision

24. There was no fault in the Nursing Home’s care of the late Mr E. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman