Summary: Mrs X complained about the quality of care provided to her late relative during a respite stay. The care provider was at fault. It failed to keep adequate records and did not respond to Mrs X’s complaint. It has agreed to apologise to Mrs X and make a payment to acknowledge the distress caused to her. It has also agreed to review its procedures.

The complaint

1. Mrs X complained about the quality of care provided to her late relative, Mr Y, during a respite stay at Vicarage House Nursing Home. In particular, she complained Mr Y’s bed was not made or changed during his stay, his laundry was not done, he did not always receive mid-morning or supper time drinks and his medication was not properly administered. In addition, the care home failed to respond to the complaint and charged significantly more for the stay than the advertised rate. This caused Mr Y and Mrs X distress and frustration.

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The Ombudsman’s role and powers

2. 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)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. 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)
5. We may investigate complaints from a person affected by the matter in the complaint, or from someone the person has authorised in writing to act for him or her. If the person has died or cannot authorise someone to act, we may investigate a complaint from a personal representative or from someone we consider suitable to represent the person affected. (section 26A or 34C, Local Government Act 1974)
6. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.

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How I considered this complaint

7. I have considered the information provided by Mrs X and have spoken to her on the phone. I have considered the information provided by the care provider in response to my enquiries.
8. I gave the care provider and Mrs X the opportunity to comment on a draft of this decision. I considered their comments in reaching the final decision.
9. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share a copy of the final decision with CQC.

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What I found

10. 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.
11. The fundamental standards say:
• the care and treatment of service users must be appropriate, meet the person’s needs and reflect their preferences. The care provider must assess the person’s needs and preferences and provide appropriate care and treatment to meet these needs.
• care providers must keep accurate, complete and current records for each person in their care, including a record of the care and treatment provided and decisions about care and treatment.
• Care providers must have an effective and accessible system for identifying, receiving, handling and responding to complaints from people using the service, people acting on their behalf and other stakeholders. All complaints must be investigated thoroughly and any necessary action taken where failures have been identified.

What happened

12. Mr Y lived with Mr and Mrs X. In April 2019, Mr Y went to stay in the care home for two weeks respite. This was his first respite stay. The pre-admission assessment noted Mr Y was not social and preferred to spend time alone and eat meals in his room. It noted he self-medicated but needed support with eye drops. It noted Mr Y had capacity and could use the call bell. He needed a soft diet as he had limited teeth, and liked coffee mid-morning and orange juice with lunch. It also noted he liked a warm drink at bedtime. He needed limited assistance with dressing.
13. Mrs X also provided a care plan to the care home which set out Mr Y’s daily routine. It said Mr Y self-medicated but needed support with his eye drops and with applying cream to his legs.
14. Following the stay, in late April 2019, Mr X delivered a hand-written note to the care home manager raising concerns about Mr Y’s stay. The care provider says the note was not given to the manager but left in the office. Mr and Mrs X did not receive a reply, so Mrs X sent a complaint letter in mid May 2019. She raised concerns that:
• the care home did not always top up Mr Y’s dosette box with his regular constipation medication (it was given 25 times not 31), he had not had cream applied to his legs and his eye drops were supposed to be given 10 minutes apart but were administered one after the other;
• his bed was not made or changed,
• his clothes were not washed,
• he had poor tv reception;
• he did not receive an Easter gift left for Easter Sunday until late on the Monday; and
• he lost weight and did not receive a mid-morning coffee or his supper time drink and cake.
15. Mrs X was also unhappy that Mr Y was charged £950 a week when the advertised rate on the website was £585 to £750 a week.
16. Mrs X contacted the Ombudsman as she did not receive a response to her complaint. The care provider told us the care home manager emailed them a response to the concerns raised at the end of May 2019. The care provider says it printed this off at the time and sent it to Mrs X. Mrs X says she has never received a response to her complaint.
17. The care home manager’s response, addressed to the care provider, accepts they failed to acknowledge the list of concerns Mr X had left at the care home. The manager said they had discussed the stay with Mr Y before he left and he was very complementary and did not raise any concerns at the time. The manager said:
• They found no evidence Mr Y’s bed was only made twice or that his sheets were not changed;
• They assisted Mr Y with his eye drops but were not advised to leave a gap between drops, they did top up his supply of constipation medication but they were not told about applying cream to his legs;
• Mr Y ate well during the stay and enjoyed his food. They had not weighed Mr Y as it was a short respite break. Mr Y did not miss meals or his mid-morning and evening drink and staff had discussed his diet with him;
• The care home did have poor tv reception but the tv was working properly and Mr Y spent time in his room watching it;
• Mr Y did not inform staff about his dirty washing but placed it in the wardrobe where it was not seen. They acknowledged staff should have asked him about this;
• Staff did fail to give Mr Y his Easter gift until late on the Monday; and
• Mrs X was aware of and had agreed to the cost of the stay in advance.
18. In response to our enquiries the care provider says Mr Y self-medicated and looked after his own personal care. It has not provided any records of Mr Y’s stay. It said Mrs X provided a care plan which it returned at the end of the stay. It has not provided any daily records or notes of the care and support provided to Mr Y during his stay at the care home. It said the care home manager spoke with Mr Y who raised no complaints during his stay.
19. Mr Y died in August 2019.

Findings

Care and support

20. The care provider completed a pre-admission assessment so was aware of Mr Y’s needs before his respite stay. Mrs X also provided a detailed care plan setting out Mr Y’s daily routine. The pre-admission assessment makes no mention of creaming Mr Y’s legs. However, this is referred to in the care plan Mrs X provided. The failure to administer the cream is fault. However, the cream was not medically prescribed and there is no evidence this caused Mr Y a significant injustice.
21. The care provider was aware Mr Y took medication to prevent constipation. Mr Y did not receive all the medication he should have, receiving 25 sachets not 31. This is fault. However, there is no evidence this had a significant impact on Mr Y.
22. Neither the pre-admission assessment nor care plan refer to Mr Y needing a gap of 10 minutes between his eye drops. As this was not communicated to the care home, I am not critical of it for administering the eye drops without leaving a gap.
23. The care provider accepts it delayed giving him his Easter gift. This delay may seem a minor fault however it left Mr Y distressed as Mrs X says he thought they had forgotten him. It also acknowledged that it failed to ask Mr Y if he had any dirty laundry. This is fault. Mr Y was paying for a service he did not receive. It says Mr Y’s bed was made and changed. I will not investigate this issue further as I could never establish now whether or not this happened.
24. Mrs X says Mr Y lost weight. The care provider says Mr Y ate well during his stay. Mr Y was not weighed when he entered the care home so I cannot know whether or not he lost weight. However, the care provider has no records of the care and support it provided to Mr Y during to stay. I therefore cannot say whether Mr Y ate adequately or what care and support he received. This is fault and is a breach of the fundamental standards which requires care providers to keep records for each person in their care. Mr Y was self-caring. However, Mr Y was staying in a care home not a hotel. As a minimum I would expect the care provider to have noted in the daily records how Mr Y was each day.
25. Mr Y has since died. So, I cannot discuss the concerns with Mr Y or assess what impact the faults had on him. Also, I cannot now achieve any remedy for him. However, the lack of records caused Mrs X distress as she cannot be certain Mr Y was supported appropriately.

Complaint handling

26. The care home manager accepted they failed to acknowledge Mr X’s hand-written complaint. There is no evidence the care provider acknowledged Mrs X’s written complaint of mid May 2019. I would have expected the care provider to write to Mrs X directly setting out the complaint response and signposting them to us if they were dissatisfied with the response.
27. The care provider says it sent Mrs X a copy of the email the care home manager provided to them in response to her complaint. The care provider has provided no evidence to show this was emailed to Mrs X and so on the balance of probabilities I do not consider it was sent. There is also no evidence the care provider posted a copy of the complaint response to Mrs X. This is fault and is a breach of the fundamental standard which requires care providers to have an effective system for handling and responding to complaints.
28. The care provider says it would have been happy to meet with Mrs X to discuss her concerns. Had the care provider offered this at the time, it may have avoided Ombudsman investigation.

Agreed action

29. Within one month of the date of the final decision, the care provider has agreed to apologise to Mrs X and pay her £150 to acknowledge the distress and uncertainty caused by its faults.
30. Within two months of my final decision the care provider has agreed to:
• review its procedures to ensure records are kept for all residents, including those on respite stays. This should include a care plan and daily records, in line with the fundamental standards.
• review its complaints procedure to ensure it responds appropriately to complaints and signposts complainants to the Ombudsman.
• remind its staff of the importance of acknowledging and responding to complaints appropriately and in line with its complaint procedure.
31. It should provide evidence to the Ombudsman that it has done this.

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Final decision

32. I have completed my investigation. There was fault causing injustice which the care provider has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman