Summary: Mrs X complained for her husband, Mr X, about respite care at the Sidcup Care Home. There was fault in the way the Council commissioned the care and communicated with the care provider. There was no fault in the care provider’s decision to no longer offer respite care to Mr X in the future.

The complaint

1. Mrs X complained on behalf of her husband, Mr X, who suffers from dementia, about respite care at the Sidcup Care Home. Mr X was made to apologise for inappropriate behaviour and comments made to staff before being told he was not welcome at the care home again. Mrs X feels this shows a lack of understanding of Mr X’s condition.
2. Mr X felt upset and depressed by the incident and wanted to clear his name.

Back to top

The Ombudsman’s role and powers

3. 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)
4. 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)
5. 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)

Back to top

How I considered this complaint

6. As part of the investigation I have considered the following:
• The complaint and the documents provided by the complainant’s representative, as well as the information we discussed in a telephone conversation.
• Documents provided by the Council and their comments in response to my enquiries.
• The Care Act 2014
• The Care and Support Statutory Guidance (Updated 26 October 2018)
7. Mrs X and the Council both had an opportunity to comment on a draft of this decision.

Back to top

What I found

8. Sections 9 and 10 of the Care Act 2014 says councils must assess the needs of an adult who appears to need care and support.
9. Where the council decides someone has eligible needs, it must produce a care and support plan explaining how to meet them. The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support is available locally
10. Where a person’s care is provided by a relative, the Council may offer respite care as a means of giving a break to the carer while the person is looked after by someone else.
11. There are several respite care options, including help at home, visits to day care centres and short stays in a care home.
12. The Council will only fund respite care for people they have assessed as needing it. If a person qualifies for council funded respite care, they can ask the Council to arrange this, or arrange it themselves through direct payments from the Council.
13. The Care Quality Commission (CQC) is the independent regular of health and social care in England. It inspects services to make sure they meet the relevant standards. It publishes its findings, along with performance ratings for care providers.
14. The CQC inspected the Sidcup Care Home in November 2018 and gave it an overall rating of ‘requires improvement’ on 18 January 2019. It found gaps on dementia awareness and said people’s needs and protected characteristics were not always identified or supported.

Back to top

What happened

15. Mr X suffers from vascular Parkinson’s disease and dementia. He has experienced a decline in his short-term memory and becomes confused. He is cared for at home by wife, Mrs X.
16. The Council assessed Mr X in 2017 as having care needs which were met by Mrs X, who was happy to act as his carer. It decided Mrs X required respite and proposed 28 nights of respite care for Mr X a year as well as visits to a dementia day centre two days a week. The Council offered direct payments to meet this need, but Mrs X asked the Council to arrange the care.
17. The Council sent an email booking request to the Sidcup Care Home on 14 January 2019 and arranged for Mr X to have respite care from 23 January 2019 to 30 January 2019. It sent the care home a copy of Mr X’s support plan review dated 7 November 2018. The plan mentioned Mr X’s support needs and his physical health, but not his dementia.
18. Mr X had stayed at the Sidcup Care Home previously in January and April 2018. The Council said it sent a copy of Mr X’s care assessment dated 23 March 2017 to the care provider before these stays. This assessment confirms Mr X has dementia.
19. According to the care notes from the Sidcup Care Home, Mr X’s initial days at the home were uneventful. However, on 29 January 2019 Mr X made other residents feel uncomfortable by standing over them and invading their personal space. He grabbed the hands and arms of carers to get their attention and made inappropriate personal remarks to a nurse. He also prevented the nurse from walking past him when she tried to leave. Mr X was told to apologise by a senior nurse. The next day it was recorded Mr X made unspecified comments to staff of a sexual nature and asked them to sit on his bed.
20. On 1 February 2019 the care provider sent an email to the Council. It said it could not meet Mr X’s needs for future respite care and recommended he be placed in a male oriented environment.
21. The Council initiated a review of Mr X’s care status and determined it was in his best interests to continue to have respite at a conventional care home. It considered a dementia home may have a negative impact on Mr X.
22. The Council has since arranged for Mr X to have respite care at a different provider. It is a specialist dementia care provider with a QCQ rating of ‘good’. Mrs X reported Mr X enjoyed his stay there and got on well with staff.

Response to my enquiries

23. The care provider told me the booking request from the Council failed to say Mr X had dementia. It therefore did not assess him as being a dementia resident. It said Mr X’s social worker should have expressed this in the referral and Mr X should have been referred to a dementia care home.
24. The care provider said it is not a dementia registered home and its staff do not have mandatory dementia training. It has recently started to have training for its staff to improve their knowledge of the condition.
25. The care provider said residents and staff had been made to feel uncomfortable by Mr X's behaviour and as a result it cannot facilitate any further respite care for him. It said that such decisions are, in general, made by the manager based on being unable to meet the resident’s needs. It said at no point did it say Mr X was not welcome at the home and this terminology was not used.

Back to top

Analysis

26. Mrs X was understandably concerned at the way care provider staff spoke to Mr X and handled the incidents, in view of his dementia.
27. The care provider is not a dementia registered home and the Council did not provide up to date information about Mr X’s condition when it sent his booking request. The care provider considered Mr X’s actions and the impact on staff and other residents. It then made a professional judgement to tell the Council it could not meet Mr X’s needs. Mr and Mrs X are upset but the care provider was entitled to make this decision. There was no fault on the care provider’s part.
28. The CQC has highlighted the care provider’s shortcomings on dementia awareness. By its own admission, the care provider is not a dementia registered home and did not provide staff with training at the time of Mr X’s visit. The Council should have given the care provider full and up to date information about Mr X’s dementia when it sent the booking request on 14 January 2019. It did not do so. That was fault on the Council’s part.
29. The care provider did not cut short Mr X’s respite care. It told the Council it could not meet his needs at the end of his visit. Mr X has therefore not missed out on any care.
30. Mr X was embarrassed and distressed at learning the impact of his behaviour and that he could not return to the care provider. He felt upset his condition was not understood. That is his injustice.

Agreed action

31. Within four weeks of my decision the Council will apologise to Mr X for the distress he experienced after it failed provide up to date information about his dementia.
32. In future the Council will ensure it makes care providers fully aware of prospective resident’s conditions when making referrals.
33. As a result of Mrs X complaint, the Council told me it will also:
• Ensure care providers share details of complaints with the Council as early as possible.
• Review existing referral procedures to ensure key information is provided at the time of referral and at all future points when care takes place sporadically, as in Mr X’s case.
• Hold a learning event to reflect on Mrs X’s complaint and to reinforce the processes of sharing appropriate information.
• Implement random audits of practice to ensure compliance.
34. Within eight weeks of my decision, the Council will provide evidence it has taken the above steps.

Back to top

Final decision

35. I have completed my investigation. There was fault in the way the Council commissioned the care and communicated with the care provider. There was no fault in the care provider’s decision to no longer offer respite care to Mr X in the future.

Back to top

Investigator's decision on behalf of the Ombudsman