The Ombudsman's final decision:
Summary: Ms J complains about the way Winslow House Ltd dealt with her concerns and her complaint about its care for her late stepfather. The Ombudsman has found fault by the care provider which caused injustice. The provider has agreed to apologise to Mrs D and Ms J and make a payment to Ms J.
- Ms J complains about the way Winslow House Ltd (the care provider) dealt with concerns she raised about the care for her late stepfather, Mr D, and about the way the care provider dealt with her complaint.
- She also complains the care provider failed to provide a breakdown of its charges when it invoiced the family for Mr D’s care.
- Ms J says the tone of the care provider’s response prevented her from visiting Mr D before he died.
The Ombudsman’s role and powers
- 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 34H(3) and (4), as amended)
- 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.
How I considered this complaint
- I spoke to Ms J about her complaint and considered the information she sent and the care provider’s response to my enquiries.
- I sent Ms J and the care provider my draft decision and considered the comments I received.
What I found
- The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve and below which care must never fall. The Care Quality Commission (CQC) has issued guidance on how to meet these standards. The standards include:
- Person-centred care (Regulation 9): The service user must have care or treatment that is tailored and meets their needs and preferences. Providers must involve a person acting on the service user’s behalf in the planning of their care and treatment.
- Dignity and respect (Regulation 10): Service users must be treated with dignity and respect and in a caring and compassionate way.
- Complaints (Regulation 16): The provider must have a system in place to handle and respond to complaints.
NHS Continuing healthcare
- NHS continuing healthcare (CHC) is a package of care arranged and funded solely by the health service in England for a person aged 18 or over to meet physical or mental health needs that have arisen because of disability, accident, or illness. (NHS Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012
- It is the responsibility of the relevant NHS body to assess the person’s needs and decide whether they are eligible for CHC. A family member or care provider may refer a person to the NHS for a CHC assessment.
- Individuals with a rapidly deteriorating condition that may be entering end of life, may require “fast tracking” for immediate provision of CHC. In these circumstances, there is no requirement to complete the full CHC assessment.
- Complaints about CHC are dealt with by the NHS and the Parliamentary and Health Service Ombudsman.
- Mr D was elderly with health problems. He used hearing aids and had mobility and communication difficulties. Mr D had been admitted to hospital and found to be at end of life.
- The care provider assessed him and said it could meet his needs. Mr D’s wife, Mrs D, agreed to pay for his care privately at £850 per week, but it was anticipated that he would be eligible for CHC.
- Mr D was discharged from hospital to the care home on 31 May 2019. The next day Mrs D was distressed to find carers had shaved off his beard and moustache, which he had had all his adult life. She complained to the home manager who apologised. She said the carers had shaved Mr D as they considered his beard had appeared uncomfortable for him. Ms J’s brother sent a photograph of Mr D so the carers knew what his beard should look like. When Mrs D visited on 3 June 2019, she found Mr D’s beard had been shaved a second time. The home manager wrote a memo for all care staff for the staff room and handovers, and spoke to the carers involved.
- One of Mr D’s hearing aids was found to be broken. Ms J and the family met the care provider on Friday 7 June 2019 to discuss their concerns about how often he was checked, what happened with his beard and the broken hearing aid.
- Ms J says the care provider denied the aid had been broken in the care home and initially refused to fund a replacement. Ms J asked the manager to find out who had broken the aid as she was concerned carers had been reluctant to report it. The care provider asked Ms J to send the details of the hearing aid to enable a replacement to be ordered. The home manager wrote down her email address for Ms J.
- Ms J emailed the hearing aid details the next day, but the email bounced back as the address was wrong. She forwarded the email to the general account but received no reply. The home manager contacted Mrs D on the Monday and the aid was ordered on 11 June 2019. The company said it would take two weeks to provide the replacement.
- Ms J emailed the care provider on 13 June 2019. She said a delay had been caused in ordering the new hearing aid and she asked how often Mr D was being checked. The care provider issued an invoice for the full cost of Mr D’s care for June 2019. It gave the full amount due and did not mention CHC.
- Ms J spoke to the home manager about her concerns about the way Mr D’s care was being managed; she also asked why the care provider had not advised the family to apply for CHC. The care provider says the call was “verbally abusive”. Ms J disputes this; she says she was concerned and frustrated but not rude, unpleasant or disrespectful.
- The director replied to Ms J’s email on 14 June 2019 that “under the circumstances and your tone used to my Care Manager I feel the best outcome for all concerned is that you find alternative accommodation for your father. Please arrange to make an appointment with me at your earliest convenience so as this can be arranged.” Ms J’s brother replied this would be cruel given Mr D was at end of life.
- A new hearing aid was fitted on 17 June 2019. Mr D sadly passed away on 19 June 2019.
- The NHS wrote to the care provider on 20 June 2019, confirming it had agreed to CHC funding of £701.46 per week from 7 June 2019 to 22 June 2019. I can see no reason why the funding was not backdated to the date of Mr D’s admission to the care home.
- The care provider issued a revised invoice for a reduced amount, but the invoice contained no explanation for the charges. Ms J’s brother queried it and the care provider replied: “The recent bill is the difference between the cost of the room and the funding from social services. Also there will be a refund for the hearing aid.” The email was addressed to the late Mr D.
- Ms J made an official complaint on 30 June 2019 about the care provider’s 14 June 2019 email. She said she had felt unable to visit Mr D after that due to the tone of the email. Ms J also complained about the unclear invoicing
- The care provider replied to Ms J suggesting she: “go right ahead and take your opinion of judgement of our care at Winslow House to CQC. This way all concerned will have a fair hearing of the facts.”
- Ms J complained to the Ombudsman. The care provider wrote to Mrs D on 24 July 2019 with an explanation of the charges but did not set out fully the CHC funding. In response to my draft decision, Ms J said our investigation was the first time the family were aware CHC had not been paid for the first week. The NHS had now agreed to refund this.
- In response to my enquiries, the care provider said Mr D was checked regularly in line with its end of life guidance. Usually family were given privacy during their visits, so no checks were made then, but following discussions the carers had been told to carry on with checks whilst the family was there.
- Ms J raised legitimate concerns on 13 June 2019 and 30 June 2019 about Mr D’s care by the care provider. These should have been treated as complaints.
- The care provider’s complaint process says if initial discussions with the home manager do not resolve the matter, complaints can be put in writing to the director “whereupon after completing investigations we will contact you with the outcome.”
- I find the care provider failed to follow this process and investigate Ms J’s complaint when it replied to her on 1 July 2019. This is fault and is potentially a breach of Regulation 16. It has caused Ms J the time and trouble of bringing her complaint to the Ombudsman, which is her injustice.
- I also find the care provider’s email to Ms J of 14 June 2019 was unacceptable. It is not appropriate to ask for a resident who is at end of life to be moved to a new care home, rather than deal with a complaint. I consider if this move had occurred it could have been a breach of Regulation 10. The email caused distress to Ms J to the extent she felt unable to visit.
- There was no fault by the care provider in issuing its invoices. However, as Ms J had already queried the charges and CHC funding, I find that it was unhelpful for the care provider to issue them without explanation, and to do this shortly after Mr D’s death caused additional, unnecessary distress to Mrs D and the family.
- Within a month of my final decision, the care provider has agreed to:
- Apologise to Mrs D and Ms J for the distress caused by its actions.
- Pay Ms J £100 to acknowledge that distress and the time and trouble she has been put to in pursuing the complaint
- There was fault by the care provider which caused injustice to Mrs D and Ms J.. The actions the care provider has agreed to take remedy the injustice caused. I have completed my investigation.
Investigator's decision on behalf of the Ombudsman