Summary: Mr X complains the Care Provider, Westbourne Care Home, failed to properly care for his wife, Mrs X, while she was receiving respite care. He said this led to her being hospitalised and caused him stress and emotional upset. The Care Provider was at fault when it did not seek advice from a GP or alert Mr X after Mrs X sustained high blood sugar levels over a three-day period. The Care Provider was also at fault when it significantly delayed responding to Mr X’s complaint. Mr and Mrs X suffered injustice as a result. The Care Provider has agreed to pay Mr X £200 to recognise the distress caused by the faults.

The complaint

1. Mr X complained the Care Provider failed to notify him or a GP when Mrs X’s blood sugar levels became dangerously high.
2. Mr X also complained the Care Provider did not respond to his complaint within 28 days, as it said it would.
3. He said this situation has caused him distress and led to emotional upset for Mrs X. Further, Mr X said the Care Provider’s actions led to Mrs X being admitted to hospital for several days.

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The Ombudsman’s role and powers

4. 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)
5. 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)
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.
7. We normally name care homes in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home. (Local Government Act 1974, section 34H(8), as amended)
8. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
9. 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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How I considered this complaint

10. I contacted Mr X and discussed his view of the complaint.
11. I made enquiries and considered the Care Provider’s submission which included Mrs X’s care records, Mrs X’s care plan, the Council’s Section 42 enquiry and the Care Provider’s final response to Mr X.
12. I wrote to Mr X and the Care Provider and considered their comments before I made a final decision.

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What I found

Law

13. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 sets out the standards registered care providers must achieve when providing care services. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
14. Regulation 9 states care providers must provide care and treatment which is appropriate and meets people’s needs.
15. Regulation 12 aims to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Care providers must assess the risks to people's health and safety during any care or treatment and act to mitigate risks.
16. Regulation 19 states care providers must make written information available about any fees, contracts and terms and conditions, where people are paying either in full or in part for the cost of their care, treatment and support.
17. Regulation 20 states care providers must act in an open and transparent way with relevant persons in relation to care and treatment provided to service users in carrying on a regulated activity.

Safeguarding

18. Section 42 of the Care Act 2014 states a council must make necessary enquiries if it has reason to think a person may be at risk of abuse or neglect and has needs for care and support which mean he or she cannot protect himself or herself.
19. Councils must also decide whether it or another person or agency should take any action to protect the person from abuse or risk.

What happened

20. Mrs X is elderly and suffers with dementia and diabetes. She is dependent on insulin to manage her condition. Mr X is her primary carer as Mrs X is unable to make decisions regarding her care.
21. Mrs X moved into the Care Provider’s residential home on 25 October 2019 for two weeks of respite care. Mrs X’s care plan required her carers to give Mrs X insulin three times a day and check and record her blood sugar levels four times a day.
22. On 28 October 2019, the Care Provider contacted Mrs X’s GP because her blood sugar levels were unstable. The GP advised the Care Provider to alter Mrs X’s insulin regime. The Care Provider told Mr X it contacted the GP for advice but did not tell him what the doctor advised.
23. On 29 October 2019, Mr X expressed concerns about Mrs X’s blood sugar levels to the Care Provider manager. The manager assured Mr X that Mrs X was fine. However, between 30 October and 1 November 2019, the Care Provider recorded that Mrs X’s blood sugar was high.
24. Mr X removed Mrs X from the home on 1 November 2019 because he was very concerned about her blood sugar levels. A statement supplied by the Care Provider confirms that when Mr X arrived to collect Mrs X, a carer at the home told Mr X about the changes in Mrs X’s insulin regime and Mr X expressed surprise that he had not been told about this. Later that evening, Mrs X was admitted to hospital due to the high levels of sugar in her blood.
25. Mr X formally complained to the Care Provider. He said Mrs X’s diabetic diary showed her blood sugar was high between 30 October 2019 and 1 November 2019. He said the Care Provider should have contacted him and Mrs X’s GP.
    He said the Care Provider’s failure to do so led to her hospitalisation. Mr X asked the Care Provider to cancel the invoice it had sent for the time Mrs X stayed at the residential home.
26. The Care Provider acknowledged Mr X’s complaint three days later and confirmed it would respond within 28 days, in line with its complaint’s procedure.
27. Following this, the Care Provider referred the matter to the Council. The Council decided to carry out a section 42 safeguarding enquiry. The investigation officer (IO) who carried out the enquiry spoke to Mr X and the residential home manager. The IO also reviewed Mrs X’s care records and diabetic diary.
28. The IO wrote in the enquiry: “The risk associated with high blood sugar levels and mismanagement of diabetes is significantly high which is evident in Mrs X’s hospital admission…the [Care Provider’s] management of Mrs X’s blood sugar levels did not prove effective, which could be due to Mrs X’s access to sugary food and drink… It is evident the Care Provider sought advice early in the respite period then maintained a set insulin regime as per GP advice however the outcome of this was not discussed with Mr X. Mrs X’s blood sugar levels then increased over a three-day period… without constant supervision and control of oral intake, it is unlikely the risk could be managed effectively however, it is likely that at this point GP advice should have been sought and Mr X informed.”
29. The IO concluded the section 42 enquiry with the following recommendations:
• the Care Provider should consult family on all changes to care and review by professionals;
• all diabetes management to be fully formulated in the care plan and risk assessment; and
• improved recording of contact with family and other professionals
30. The Council wrote to Mr X in early December 2019 with its findings and advised it would share the outcome of the enquiry with the Care Quality Commission.
31. Mr X wrote to the Care Provider shortly after this to chase for a response to his complaint. The Care Provider did not respond and so Mr X referred his complaint to the Ombudsman in January 2020.
32. The Care Provider sent Mr X its complaint response in July 2020 after the Ombudsman contacted it. The Care Provider apologised and explained the delay was due to staff members taking annual leave.
33. The Care Provider said one of its nurses stated she told Mr X that Mrs X’s blood sugar was high and updated him on the change to her insulin regime. The Care Provider said it consulted with the GP who prescribed the change and he noted that Mr X agreed with the new regime. The Care Provider conceded it was not consistent in recording Mrs X’s blood sugar levels and advised it would communicate to staff the importance of completing care records in a timely manner.
34. Mr X maintains the Care Provider did not update him on the insulin regime change.

Findings

35. Mr X complained the Care Provider did not take sufficient action to address Mrs X’s high blood sugar levels over a three-day period. The Council launched a section 42 enquiry and concluded that whilst it was difficult for the Care Provider to successfully manage Mrs X’s condition without constant supervision, the Care Provider should have contacted a GP and Mr X during this period. The Care Provider did not seek medical advice despite noting her blood sugar levels were too high. This is fault. Mrs X was later hospitalised with high blood sugar and this caused Mr X significant stress and upset. The Council has made recommendations to ensure this does not happen again in future however, the Care Provider should make a further financial award in recognition of the injustice suffered by Mr and Mrs X.
36. Mr X complained the Care Provider did not contact him regarding the change in Mrs X’s insulin regime. The Care Provider disputed this in its final complaint response. The Care Provider did not make Mr X aware of the GP prescribed changes to Mrs X’s insulin regime until after it had been implemented for several days. The law requires the Care Provider to be open and transparent with service users in relation to their care and treatment. The Care Provider is therefore at fault for this part of the complaint. The Council has made recommendations that the Care Provider should update and consult family members on all changes made to their care. The Care Provider should ensure it takes this action which sufficiently addresses this aspect of the complaint.
37. The Care Provider’s complaints procedure requires it to issue a response to a complaint within 28 days. The Care Provider did not issue a response until it was prompted to do so by the Ombudsman, by which point the complaint had been left unanswered for approximately seven months. This is fault. The Care Provider’s failure to manage the complaint within its own timescales likely caused Mr X stress and further contributed to the breakdown in trust between Mr X and the Care Provider.
38. Mr X does not believe he should pay for the period Mrs X was under the Care Provider’s care. The law entitles the Care Provider to charge for the services it provides to service users. Whilst Mr X is very unhappy and concerned with the care Mrs X received, the Care Provider is entitled to request payment for the period Mrs X stayed at the residential home. The Care Provider is not at fault for maintaining the invoice it sent to Mr X is payable.

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Agreed actions

39. Within one month of the date of my decision the Care Provider has agreed to apologise to Mr X and pay him £200 to acknowledge the distress he and Mrs X suffered because of the Care Provider’s actions and failure to respond to Mr X’s complaint in a timely manner.
40. Within one month of the date of my decision the Care Provider has confirmed it will remind its staff of the importance of responding to complaints in line with its complaint’s procedure.
41. Within one month of the date of my decision the Care Provider has agreed to provide evidence of staff training or instruction showing it has implemented the Council’s recommendations

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Final decision

42. The Care Provider was at fault when it failed to alert Mrs X’s GP to her rising blood sugar levels and delayed responding to Mr X’s complaint. The Care Provider has agreed to carry out the recommendations made to remedy the injustice caused by the fault. I have therefore completed my investigation.

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Investigator's decision on behalf of the Ombudsman