The Ombudsman's final decision:
Summary: Mrs X complained the Care Provider gave her grandmother, Mrs G, insufficient notice to leave Hanley House Residential Care Home and then refused to let her collect her personal possessions. Mrs X said this caused distress and inconvenience to Mrs G and other family members. The Care Provider was at fault when it failed to provide written confirmation it had given Mrs G notice and failed to give her sufficient notice. It has agreed to apologise and make a payment to Mrs D to acknowledge the distress and anxiety this caused.
- Mrs X complained the Care Provider gave her grandmother, Mrs G, 28 days’ notice to leave Hanley House Care Home but then, two days later and without any further warning, refused to allow her back into the home after she left it to go to hospital.
- Mrs X says this caused her aunt, Mrs D, who was with Mrs G, anxiety and distress as Mrs G had nowhere to go. Mrs G was also caused distress because she could not return to the care home or collect her possessions until the following day.
The Ombudsman’s role and powers
- 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)
- If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
- 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 Mrs X and considered her view of her complaint.
- I made enquiries of the Care Provider and considered the information it provided. This included Mrs G’s care records, her contract with the Care Provider and complaints correspondence.
- I also made enquiries of the local authority with safeguarding responsibilities for the Care Provider and considered the documents it provided.
- I wrote to Mrs X and the Care Provider with my draft decision and considered their responses before I made my final decision.
What I found
- Mrs G is an elderly lady who, on 5 June 2019, moved into a residential care home owned by the Care Provider.
- Mrs G’s contract stated either side must usually give 4 weeks’ notice to terminate the placement. However, in certain circumstances, the care home could give one week’s notice. These included situations where “if, having consulted you and taken advice from the appropriate member of the primary health team… concerning your present and future care needs, the Company is no longer able to meet your needs”.
- Mrs G’s care records show that initially she was happy at the care home, ate and drank well and took her medications.
- However, from the beginning of July 2019, the care records noted Mrs G’s mental and physical health began to deteriorate. She became confused and disorientated and began to hallucinate. She also started to decline food and fluids and her medications. This was because she became convinced people were trying to poison her. She was also reluctant to let her carers check her for pressure sores.
- As Mrs G continued to deteriorate, the care home involved the help of the Council’s Crisis Team, Care Home and Disability Team, Dementia Team and the Mental Health Team. The care home also made calls to 111 and an ambulance attended.
- A doctor visited on a number of occasions. The doctor prescribed an anti-hallucinatory drug to be administered in Mrs G’s food. The district nurse periodically visited Mrs G as well.
- On 17 July, the care home phoned for an ambulance because of health concerns which it thought were related to Mrs G not drinking or taking her fluids. Mrs G refused to let the paramedics carry out any tests and so the care home contacted the out of hours GP for advice. The GP said they would refer the matter to the mental health team and that if her condition continued to deteriorate over the weekend, to contact the out of hours GP.
- Mrs G continued to refuse most of her food and fluids and to not take her medications or allow the carers to check her skin for pressure sores.
- On 24 July, a doctor came to see Mrs G to determine if she was at end of life. The doctor said Mrs G was not at end of life but if she continued to refuse food and fluids, her health would deteriorate. The doctor said there was nothing further the care home could do other than keep Mrs G comfortable. Shortly afterwards a member of the mental health team came to visit Mrs G. Whilst there they helped to apply cream to her feet.
- The same day, the care home noticed some sores on Mrs G’s feet. The manager phoned the mental health team member who had visited earlier that day. The team member said they had not noticed any sores on Mrs G’s feet.
- The district nurse visited later that afternoon. The daily notes recorded the care home said the blisters had come up over the past day because Mrs G was refusing care and staying in bed. The notes said there was a discussion with the district nurse, Mrs G’s community practice nurse and Mrs D about the fact that Mrs G now needed nursing care rather than residential care. The care home manager said the care home could no longer meet Mrs G’s physical health needs. Mrs D said she would look for a nursing home.
- The nurse also asked the Council to help find Mrs G a nursing home as a matter of urgency but the Council said there were no vacant places. Mrs D however managed to find a nursing home to take Mrs G but there were no vacancies until Monday 29 July.
- On Friday 26 July, Mrs G required further medical support which she initially refused. The care home called an ambulance and Mrs G went to A&E at the hospital. The Care Provider which owned the care home states it spoke to Mrs D and said Mrs G could not return to the care home because it could not meet her needs. The Care Provider says that during the call Mrs D said she understood the situation.
- On the evening of 26 July 2019, a nurse from the hospital telephoned the care home manager to ask if the care home would take Mrs G back for the weekend until she could go to the nursing home on Monday as she was not being admitted to hospital.
- Records from the Council note that on the same day, the care home manager phoned the Council’s safeguarding team distressed because the hospital would not admit Mrs G and was going to return her to the care home. The manager said the care home could not meet Mrs G’s needs.
- The care home manager escalated the matter to a senior staff member at the Care Provider who decided it would be unsafe to accept Mrs G back for the weekend as the care home could not meet her needs.
- Mrs G still owned the property she had lived in before going into the care home and so went to stay there. Mrs D asked if they could collect some of Mrs G’s personal possessions for the weekend. The care home declined but said it would deliver these to Mrs G that evening.
- The care home says a staff member went round that evening with Mrs G’s items but no one answered the door.
- Mrs G spent the weekend at her property with Mrs D looking after her. On the Monday, she was admitted to a nursing home.
- During my investigation the care provider said it had been advised by the Council not to accept Mrs G back after she left hospital on the Friday. An email between Council officers dated 28 July 2019 states “I didn’t advise [the care home manager] that [Mrs G] shouldn’t return to the care home, the Manager was already of the opinion she wasn’t going to return there. She thought a safeguarding [investigation] would be the result of her refusing to take [Mrs G]”.
- Under the terms of Mrs G’s contract, either side can give 28 days’ notice, or, in circumstances when the care home cannot meet the resident’s needs, it can give 7 days’ notice.
- A discussion took place on 24 July where the care home gave Mrs D notice that Mrs G must leave because it could no longer meet her needs because Mrs G now required nursing care. The care home took advice from the district nurse before it made that decision. The care home was entitled to give 7 days’ notice in these circumstances. However, it failed to follow this up with written confirmation. This is fault.
- However, Mrs D knew that the care home had given notice and quickly organised a nursing home which could take Mrs G so a lack of written confirmation did not cause her a significant injustice.
- The care home refused to allow Mrs G to return on the Friday when the hospital would not admit her. It said it would not be safe to do so because it could not care for Mrs G properly.
- Mrs G’s contract stated that in situations where the care home could not meet a resident’s needs, it would give 7 days’ notice. By this stage, Mrs G had been on 2 days’ notice to leave. Therefore, the care home did not give her sufficient notice and this is fault.
- The care home said it made this decision not to allow Mrs G to return after considering her deteriorating health, including pressure sores, dehydration, and paranoia which was preventing her from eating and drinking. It said it was unsafe for her to return to the care home, even just for three nights over the weekend.
- I acknowledge the care home was concerned about meeting Mrs G’s needs. However, it failed to properly consider her best interests when it refused to let her return. By this stage, she had no other placement to go to. The hospital would not admit her, the Council had no emergency nursing home placement available and the nursing home identified by Mrs D could not accept Mrs G until Monday. As a result, Mrs D’s only option was to return with Mrs G to her former flat for the weekend. The email between Council officers dated 28 July further evidences the fact the care home had concerns that its refusal to not accept Mrs G back might constitute a safeguarding concern. The Care Provider’s failure to properly consider the options and what was in Mrs G’s best interests is fault.
- This caused Mrs D an injustice. She had no choice but to look after Mrs G with no time to prepare and in a property not set up to meet her needs. This caused her unnecessary stress and anxiety.
- In relation to collecting Mrs G’s possessions, the care home says it tried to give these to Mrs G the same day but was unable to because Mrs D and Mrs G were out when it tried. I cannot say what happened, but Mrs G received her possessions without unnecessary delay. I will not investigate this further.
- Within one month of the date of the final decision, the Care Provider has agreed to apologise and pay Mrs D £250 to acknowledge the distress and anxiety caused to her by the faults identified in this decision statement.
- There was fault, leading to injustice. The Care Provider has agreed to my recommendation. Therefore, I have completed my investigation.
Investigator's decision on behalf of the Ombudsman