Summary: Mrs X complains on behalf of her husband Mr X about a lack of cold running water during his stay at a care home. She also complains about a lack of care and about actions the home took when she wanted to discharge her husband. The Ombudsman has found no evidence of fault in the way the Care Provider cared for Mr X. The Care Provider accepts there was a problem with the water and has already offered a suitable remedy to Mrs X.

The complaint

1. Mrs X complains about her husband’s stay at a care home in April 2019. She says the ensuite bathroom had no cold running water during his stay which meant the toilet would not flush. She said her husband did not receive sufficient nursing care and she had to remain at the home to support him with eating and using the toilet. She is also unhappy the manager contacted the council when she decided to take her husband home before his stay was due to end. She would like the fees for the stay refunded and recognition of the stress and cost she was put to.

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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. 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. (section 26A or 34C, Local Government Act 1974)

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How I considered this complaint

5. I have considered the complaint made by Mrs X and the documents she provided.
6. I considered the Care Provider’s comments about the complaint and the documents it provided in response to my enquiries.
7. I gave Mrs X and the Care Provider an opportunity to comment on my draft decision and I considered their responses.
8. 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.

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What I found

Background

9. 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.
10. Regulation 9 says people using a service should have care or treatment that is personalised specifically for them. A clear care and/or treatment plan, which includes agreed goals, must be developed and made available to all staff and others providing care.
11. Regulation 13 places a duty on care providers to safeguard service users.
12. Regulation 15 applies to property and equipment. The guidance says adequate support facilities, including enough bathrooms and toilets for the number of people using the service, must be provided. All premises and equipment must be clean and properly maintained.

What happened

Mr X’s stay

13. In April 2019, Mr X had surgery. The hospital recommended he be discharged to a care home for up to two weeks to receive nursing care.
14. The Care Provider assessed Mr X while he was still in hospital. The assessment indicated Mr X was largely independent with eating and drinking and using the toilet. It noted Mr X required assistance with washing, dressing and moving around. The assessment included a care and support plan which said Mr X could use his call bell to request assistance as required.
15. The Care Provider admitted Mr X on a Friday. It said it did not usually admit new residents on a Friday but Mrs X had asked it to on this occasion because being in hospital was having a damaging effect on Mr X. Mr X was admitted in the evening and the Care Provider gave Mr and Mrs X a copy of its terms and conditions.
16. The Care Provider’s daily records show that on admission Mr X could eat and drink independently. He was having difficulty using his walking frame. The records say “his wife is organising private physiotherapy.” The Care Provider’s moving and handling risk assessment showed Mr X needed the support of up to two care staff to change position or move around.
17. Mrs X says on admission the toilet in the ensuite bathroom flushed but did not refill. She said she reported this to a member of staff. In response to my enquiries, the Care Provider provided its maintenance records. Staff noted a lack of cold water in one room on Friday, though not the one Mr X was resident in.
18. The following day, records show Mr X could drink and feed himself independently. However, by the evening he was showing some signs of confusion. The Care Provider asked for a GP to visit. The GP prescribed medication but care notes for the early hours of the following morning suggest Mr X was resistant to taking it. The records say staff nursed Mr X in bed because of his confusion and agitation. The Care Provider said Mr X was using a urine bottle as he was struggling to weight bear.
19. Mrs X says she couldn’t find anybody to update Mr X’s care plan to take account of his decline. She decided to stay at the home to support him with eating and using the toilet. In response to my enquiries, the Care Provider said in their view Mrs X stayed at the home because she felt Mr X would be less confused if she was present during mealtimes. Her presence might have encouraged him to eat and drink more.
20. By the Sunday morning, Mr X was taking his medication but still showing some signs of confusion. Mrs X told staff she wanted to take Mr X home, but the nurse advised her to allow his medical needs to resolve first. The home manager spoke with Mrs X about her desire to take Mr X home. The notes say, “Mrs X said that everything was fine with the home and staff, she just felt he could recover better at home.” The manager suggested speaking to social care about putting care in place for when Mr X returned home. In a later discussion, a staff member told Mrs X the Care Provider had a duty to ensure Mr X had safe care in place at home.
21. Mrs X says she continued to report the issue with the cold water to other care staff over the weekend. She says staff told her there was an airlock and nothing could be done about it. The maintenance records show staff reported “no water intermittently through the day” on the Sunday. The cleaning records note an intermittent fault in two rooms on the Sunday, including the one Mr X was in.
22. Mrs X says maintenance staff visited Mr X’s room on Monday and told her the problem with the water was affecting several rooms and the laundry.
23. Mrs X decided to take Mr X home on the Monday. Staff spoke to Mr X’s GP, who made a referral to the district nursing service to visit Mr X at home the following day. The notes show the deputy manager contacted social care to organise care at home. Social services did not feel Mr X was at immediate risk because he had family support overnight. The Care Provider lent the family a wheelchair to support taking Mr X home.
24. The Care Provider sent me a copy of its terms and conditions, which Mr and Mrs X both signed on 15 April 2019, the day Mr X left the home. The document says a person should sign it before they begin their stay. However, it goes on to say that even if not signed, the terms and conditions will apply. The document says if a stay is for fewer than seven days, the Care Provider will still charge residents for a minimum of seven days.
25. In response to my enquiries, the Care Provider sent evidence it was aware of the airlock problem with the water before Mr X’s stay and was addressing this.
26. The Care Provider also said that a full care plan is usually developed over the first couple of days of a resident’s stay. It said Mr X presented quite differently after he was admitted due to his underlying health needs. The Care Provider said its aim was to treat the underlying health condition to enable Mr X to recover and allow a more accurate assessment of his needs to take place.

Complaint to Care Provider

27. Mrs X complained to the Care Provider in April. She said the lack of cold running water was unhygienic. She said there were other problems including tables not fitting over the bed and there being no glasses for water. She asked the Care Provider to refund some of the cost of Mr X’s stay.
28. In its response to Mrs X’s complaint, the Care Provider said it was aware of an airlock in the water system and was taking steps to correct this. It said the airlock caused an intermittent fault and supply was only interrupted for a short time. The nurse in charge when Mr X was admitted said there was a water supply to his room and night staff confirmed the same. The Care Provider said the problem with Mr X’s room began on the Sunday, and another bathroom was available across the hall from the room if necessary. It apologised if staff had not told Mr and Mrs X about other bathrooms.
29. The Care Provider also said tables could be raised and lowered to fit over beds. It did not provide drinking glasses because some residents needed to have their fluid intake closely monitored by staff. The provider said according to its terms and conditions, Mrs X would need to pay for the whole seven days of Mr X’s planned stay, despite taking him home early.
30. In May, Mrs X wrote to the Care Provider disputing its findings. Mrs X said night staff could not flush the toilet and left it for the daytime staff to get buckets of water to do so. She said no cold water was available during Mr X’s stay. She said all residents should have their own ensuite bathrooms to help with infection control and shared bathrooms would not be allowed. Mrs X expressed her unhappiness that the Care Provider had contacted the council and had implied Mr X would be at risk if he went home.
31. The Care Provider responded to Mrs X in June. It said the problem with the water was intermittent, but evidence suggested staff had not reported the issue for repair quickly enough. It apologised and said it had introduced checks to ensure staff referred repairs and faults to the maintenance team immediately. The Care Provider said there was no requirement for all residents to have their own ensuite bathroom and it had not been possible to move Mr X to an alternative room as the nursing unit was full during his stay. It said it had already offered the room at a reduced rate but would offer Mrs X a further £100 as a goodwill gesture.
32. On its decision to contact the council, the Care Provider said the hospital did not think Mr X was fit to go home and needed care from a registered nurse. It was concerned that Mr X would be returning home with only Mrs X to support him. It apologised for any distress this may have caused.
33. Mrs X says she was not told there was another bathroom across the hall. In my discussions with her, she said she felt it was unlikely Mr X could have accessed this bathroom. He would have needed to use a wheelchair which was not provided.
34. Mrs X also said staff did not help Mr X to bathe or shower during his stay and he was washed in bed. She said staff seemed reluctant to help Mr X to use the toilet. Mrs X said staff did not help Mr X to mobilise during his stay and he was not offered any physiotherapy.

Analysis

35. The Care Provider has provided evidence of its assessment of Mr X’s needs and an initial care and support plan. The change in Mr X’s presentation and the short length of his stay prevented it from updating his care plan. However, there is no evidence it failed to meet Mr X’s needs. Regarding physiotherapy, given it was the weekend and Mr X experienced a deterioration in his health, it appears unlikely he would have received or been able to engage in further therapeutic support during his short stay.
36. The Care Provider has accepted there was a fault with the water. It was correct to say there is no requirement in the fundamental standards to provide individual ensuite bathrooms for residents. It is not possible for me to make a finding on whether the problem with the water was constant or intermittent. On balance, I am satisfied there was an alternative bathroom available nearby. The records suggest Mr X was not regularly using the bathroom because of difficulties weight bearing and then confusion caused by his increased medical needs. The records show staff cleaned his room daily and there is no evidence he came to harm because of the lack of cold water. On this basis, I am satisfied there was no significant injustice caused to Mr X by the fault. The Care Provider has already offered to refund Mr and Mrs X £100 and the Ombudsman does not propose to add to this.
37. The Care Provider has a duty to safeguard its residents. It was not fault for the Care Provider to contact the council to seek a care package for Mr X at home or express concerns about him returning home without a care package. It discussed this with Mrs X before it contacted the council.
38. The Care Provider’s terms and conditions say that payment is required even if the resident stays less than seven days. Mr and Mrs X both signed their acceptance of these terms. There is no fault in the Care Provider deciding not to refund any portion of the stay.

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Agreed action

39. Within one month of the final decision, the Care Provider will issue the £100 refund it offered in its complaint response to Mrs X.

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Final decision

40. I have completed my investigation. There was fault by the Care Provider but I am satisfied with the action it has proposed to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman