Summary: Mr X complains the Lakes Care Centre (where the Council placed his late wife for respite care in May/June 2017) failed to look after her properly, resulting in a significant decline in her mental health and her being sectioned under the Mental Health Act. The evidence does not support this claim.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains the Lakes Care Centre (where the Council placed his wife) failed to look after her properly, when she stayed there for respite care from 24 May to 28 June 2017, resulting in a significant decline in her mental health and her being sectioned under the Mental Health Act.

Back to top

The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, sections 30(1B) and 34H(i), as amended)
4. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)

Back to top

How I considered this complaint

5. I have:
• considered the complaint and the documents provided by Mr X;
• discussed the complaint with Mr X;
• considered the comments and documents the Council has provided in response to my enquiries, which includes the Lakes Care Centre’s records; and
• shared a draft of this statement with Mr X and the Council, and invited comments for me to consider before making my final decision.

Back to top

What I found

What happened

6. Mrs X had vascular dementia. She lived at home with her husband and a package of care arranged by the Council to meet her need for help with personal care (two thirty-minute calls each day). The Council also arranged for Mrs X to attend day services five days a week. According to her March 2017 care and support plan, Mrs X was eligible for respite care so Mr X could have a break from his caring role meeting her other care and support needs. The plan says Mrs X had problems communicating and could be physically aggressive towards her husband, scratching and hitting him. This was mostly around medication administration and personal care. The Council arranged for carers to meet Mrs X’s need for help with medication, to reduce the scope for problems.
7. At his request, the Council arranged for Mrs X to have two weeks of respite care in a care home from 16 May. But Mr X took his wife home on 19 May.
8. On 22 May Mr X told the Council he had problems with his wife while they were staying in a caravan. Her agitation had increased, and he could not calm her down for some time. He said she may need to be in a secure unit for assessment and a change in her medication, as it was not working. The Council offered respite care, but Mr X said this was not the solution.
9. The Council visited on 23 May and suggested Mrs X needed respite care because of the problems they were experiencing. Mr X agreed she should stay in respite care until he returned in about five weeks from a trip to visit family overseas. Mr X said he wanted his wife to stay at the Lakes Care Centre (the Lakes).
10. The Lakes visited on 23 May to assess Mrs X and filled in a pre-admission assessment form. The form lists Mrs X’s medication, which included medication for depression, epilepsy, high blood pressure and to reduce the risk of heart disease/strokes. Mr X says he told the Lakes his wife’s medication needed to be crushed. He says it told him it would need to get her GP’s permission to do this, so he gave permission to contact the GP. This is not mentioned on the form. The Lakes told the Council it could look after Mrs X.
11. The Council arranged for Mrs X to be taken to the Lakes from her day services on 24 May. When she arrived, she had medication (Diazepam) with her which was not on her list of current medication. Mr X says he also sent her with a medication crusher. The Lakes contacted her GP Surgery which said the medication had been stopped in December 2016 and should therefore be destroyed.
12. While she was there the Lakes recorded 19 incidents of violent or aggressive behaviour involving Mrs X towards staff and other residents.
13. On 29 May the Lakes asked Mrs X’s GP to visit as she was lashing out, shouting and very agitated. A GP visited later that day and gave Mrs X “something” for agitation, and prescribed antipsychotic medication and antibiotics.
14. When Mr X rang on 31 May, the Lakes said his wife was unsettled overnight and quite agitated. It tried to reassure him that the changes in her living environment could have caused this and could be transitional.
15. On 1 June Mr X told the Council his wife had been lashing out at the Lakes, which he said was unusual behaviour. The Council noted this was in line with the behaviour he had reported when it assessed her in March. It also told him the Lakes was referring his wife to the Community Mental Health Team (CMHT) for advice. They discussed the possibility of Mrs X staying at the Lakes until October.
16. On 5 June Mr X told the Council he had twice visited his wife at the Lakes and she had been pleased to see him. He said the CMHT had assessed her and was looking to change her medication.
17. From 6 June Mrs X started taking the antipsychotic medication prescribed by the GP in liquid form.
18. On 9 June, based on a recommendation from the CMHT to her GP, Mrs X stopped taking the antipsychotic medication and started taking Diazepam.
19. On 14 June the Lakes told the Council Mrs X was “uncontrollable” and aggressive towards staff and other residents.
20. On 15 June the CMHT increased two of the daily doses of Diazepam.
21. On 21 June Mrs X’s GP visited and asked for a visit from the CMHT because she was agitated. Mrs X was prescribed medication for epilepsy as crushable tablets.
22. Mr X called the Lakes on 23 June as he had received a video of his wife in a distressed state from a family member. The Lakes told him:
• the CMHT was visiting Mrs X daily;
• she refused to wear shoes;
• she was dishevelled because she was refusing help with personal care; and
• it could not force her to do things she did not want to do.

Mr X said he would be returning to the UK. He had to pay more money to change the date of his return flight and wants the Council to pay for this. Mr X also has a photograph of his wife sitting with a plate of food on her lap. He says this was wrong and would have put her at risk.

23. On 27 June the Lakes asked for an emergency visit by the GP as Mrs X was very agitated all day. The GP said to contact the CMHT. The CMHT identified the need for a mental health Doctor to review Mrs X, with the possibility of admitting her to hospital. However, the CMHT told the Council it wanted to explore alternative medication for Mrs X before considering a stay on a Mental Health Ward. It said she was receiving 1:1 support and was more settled and calmer.
24. On 27 June Mr X told the Council he was not happy with the care his wife was receiving at the Lakes.
25. On 28 June Mr X took his wife home. He told the Council she had been happy and settled before he went abroad. But while away he heard she was unsettled so paid to change his airline ticket to return home. The Council arranged for Mrs X’s package of care to recommence.
26. On 3 July, because of the decline in her condition, Mrs X was taken into hospital under Section 2 of the Mental Health Act 1983. Mr X says his wife was dehydrated. She was later detained under Section 3 of the Act. She remained in hospital until August, when she returned home.
27. Mrs X died in December 2018.

Medication Administration Records

28. The Lakes’ records show Mrs X took all her medication on all but three days while she was there. On 6-8 June she refused to take most of her medication, although she did take her medication for depression. There were frequent visits by the GP and the CMHT, which resulted in various changes to Mrs X’s medication in an attempt to address her agitation. It was not until 21 June that any medication was prescribed in crushable form.

Weight, food and fluids

29. Because of her agitation, it was not possible to weigh Mrs X most weeks she was at the Lakes. Nevertheless, the weight chart shows she lost 2.7 kg while she was there. The weight chart also notes that the CMHT was involved. The dietary and fluid intake charts show Mrs X sometimes refused meals and drinks. This was particularly the case on 27 June, when she refused almost everything she was offered.

Is there evidence of fault by the Council which caused injustice?

30. The Council is accountable for the actions of the Lakes as it placed Mrs X there (see paragraph 4 above).
31. There is no evidence to support the claim that the Lakes was responsible for the decline in Mrs X’s condition. The evidence shows her condition was in decline before she went to the Lakes. One of the reasons she went to stay there was to give Mr X a break from his caring role, as he was struggling to cope with the decline in her condition. Mrs X took almost all her medication while she was at the Lakes. Mr X believes the Lakes fabricated the medication records, but there is no evidence which would lead me to support that claim.
32. As Mrs X’s condition declined, the Lakes consulted the GP and involved the CMHT. Although there were times when Mrs X was calm, unfortunately their interventions did not result in a significant improvement in her condition. Consideration was already being given to taking Mrs X into hospital under the Mental Health Act before she left the Lakes. Indeed, Mr X had speculated whether this might be necessary before she went to stay there. It is clear that Mrs X’s condition resulted in her refusing support with personal care. It also resulted in her refusing food and drink. I cannot put this down to fault by the Council or the Lakes.

Back to top

Final decision

33. I have completed my investigation as there is no evidence of fault by the Council.

Back to top

Investigator's decision on behalf of the Ombudsman