Summary: Mr B complains South West Care Homes was wrong to tell him it could no longer meet his mother’s needs, resulting in him having to move her to another care home. South West Care Homes provided misleading information about his mother’s need for nursing care, but it did not give her notice to leave. It needs to apologise to Mr B and identify the action to take to ensure its staff better understand the difference between residential and nursing care, so they do not provide misleading advice in the future.

The complaint

1. The complainant, whom I shall refer to as Mr B, complains South West Care Homes was wrong to tell him it could no longer meet his mother’s needs, resulting in him having to move her to another care home despite the fact she was happy living at Manor House.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(4), as amended)

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How I considered this complaint

3. I have:
• considered the complaint and the documents provided by Mr B;
• discussed the complaint with Mr B;
• considered the comments and documents Mr B has provided in response to my enquiries;
• invited comments on a draft of this statement from Mr B and South West Care Homes, for me to take account before making my final decision.

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What I found

Key facts

4. Mr B’s mother, Mrs C, has dementia. In August 2018 she went to live in Manor House, a residential home run by South West Care Homes which specialises in caring for people with dementia and people over 65.
5. I asked South West Care Homes to provide the records which support the claim that Manor House was having difficulties meeting Mrs Thomas’s needs. I refer the records it has provided below and to the information provided by Mr B.
6. On 8 January 2019 Manor House contacted a GP over concerns Mrs C was in pain when staff hoisted her. The GP recommended giving her paracetamol an hour before hoisting her.
7. On 11 January Manor House recorded an “episode of challenging behavior, during this episode they hurt others, in their room”. Mrs C refused to let staff wash and change her after soiling herself and slapped them when they tried to help. A member of staff reassured to Mrs C, after which she agreed to accept personal care. Mrs C apologised.
8. Manor House recorded speaking to Mr B on 12 January and agreeing to call the GP on 15 January. Mr B says Manager X:
• asked him to find a nursing home for his mother;
• said his mother had been lashing out when hoisted; and
• often needed three people to do this.
9. After visiting Mrs C, the GP prescribed pain relief for her.
10. On 19 January Manor House recorded problems getting the prescribed medication.
11. On 7 February Manor House recorded Mrs C grimacing and appearing uncomfortable a lot of the time, calling out for help and trying to reposition herself but unable to make herself comfortable.
12. At Mr B’s request, the GP visited on 12 February and, after seeing Mrs C receive personal care, prescribed morphine to be taken 30 minutes before hoisting. Manor House called Mr B and told him an NHS Continuing Healthcare checklist had been completed the day before, which resulted in a referral for a full assessment.
13. At 11.16 on 21 February Manor House recorded Mrs C not wanting to be hoisted into her chair, despite receiving morphine. At 13.55 it records Mrs C being in a lot of pain and asking to stay in bed.
14. On 25 February Manor House asked an Occupational Therapist to assess Mrs C when being transferred, to see if there was a more comfortable way to do this.
15. Mr B arranged for his mother to move to another care home on 28 February. The home provides both nursing and residential care. Mrs C is in the residential part of the home.
16. Mr B complained to South West Care Homes in April. He said:
• Manager X had lied on his mother’s NHS Continuing Healthcare Checklist, saying she needed three people to hoist her, and forced her to leave Manor House;
• Manager X told him the GP said his mother needed nursing care, but the GP denied saying this;
• Manor House had not referred his mother for a continence assessment before she left;
• his mother blamed him for the move as she had not wanted to leave;
• the full NHS Continuing Healthcare assessment had wasted everybody’s time.
17. Mr B referred to the NHS Continuing Healthcare checklist and the comments which he said were untrue:
• “Not safe to transfer as can lash out. Needs regular repositioning which at times requires three members of staff”;
• “Carers feel she is having auditory hallucinations, does not interact with care or daily activities”:
• “Challenging behaviour this is linked to repositioning and hoisting”;
• “Home is currently unable to meet this lady’s needs. Home feels she would be more appropriately placed in a general nursing home with a registered nurse to oversee her needs. This lady has numerous needs which overall make her quite complex with her care and would be too much for a residential placement. Son requested a nursing assessment as he feels she is suitably placed within the care home”.
18. South West Care Homes replied to Mr B’s complaint in June. It apologised for the delay, putting this down to ill health, and said:
• it apologised for the delay in referring Mrs C for a continence assessment, noting it had paid for her continence supplies while at Manor House;
• it could not invite Mr B to the NHS Continuing Healthcare screening visit on 11 February as the NHS assessor had arrived unannounced;
• staff were advised to have three in attendance to transfer Mrs C to try and minimise discomfort, but this was not always needed, but some staff may not have been aware of the requirement;
• it had a report of Mrs C lashing out at two night-staff;
• Manor House asked the GP to increase pain relief several times and it was for the GP to decide what to prescribe;
• the NHS Continuing Healthcare assessor referred to auditory hallucinations, Manor House staff had reported Mrs C shouting “help me” without being aware she had done this;
• Manor House could not meet Mrs C’s needs properly. Residential care covers a wide spectrum of needs, and different homes and staff teams can have different ranges of experience in meeting high levels of needs;
• Manager X accepted her communication and explanations were not always good enough, contributing to misunderstandings which led to the complaint, and apologised.

Did the care provider’s actions cause injustice?

19. South West Care Homes quickly reached the view that it would not be able to meet Mrs C needs when she started to complain of pain when hoisted and after one episode of “challenging behavior”. It has provided no evidence to suggest this behavior was repeated. It contacted the GP about pain relief; this was steadily increased but without significant benefit. It took over a month and half to contact an Occupational Therapist for advice. By that time Mr B was already arranging for his mother to move to another care home, so there is no way of knowing what advice the Occupational Therapist would have been provided.
20. South West Care Homes suggested Mrs C needed nursing care, but there is nothing in any of the records it has provided to suggest that was the case. There is little evidence of Mrs C needing three people to reposition her and this was not reflected in a care plan. It appears staff at Manor House overstated Mrs C’s needs when the assessor came to complete an NHS Continuing Healthcare checklist, resulting in an unnecessary full assessment.
21. However, I cannot hold South West Care Homes responsible for the fact that Mrs C moved to another care home. That was Mr B’s decision, as South West Care Homes did not give her notice to leave. Nevertheless, the misleading information provided by South West Care Homes caused some distress (injustice) to Mr B which warrants a further apology. South West Care Homes also needs to take action to ensure its staff better understand the difference between nursing and residential care.

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Recommended action

22. I recommend South West Care Homes within four weeks;
• writes to Mr B apologising for the distress caused by misleading him about his mother’s need for nursing care;
• identifies the action it needs to take to make sure its staff better understand the difference between nursing and residential care, so they do not provide misleading advice to people in the future.

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Final decision

23. I have completed my investigation on the basis that South West Care Homes will take the action I have recommended.

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Investigator's decision on behalf of the Ombudsman