Summary: There is evidence of fault in some aspects of the care provided to Mr & Mrs X during their short stay in a residential care home. The care provider’s response to the complaint was factually inaccurate on some points and gave conflicting explanations

The complaint

1. Mr and Mrs X complain about three weeks’ respite care they had at a care home in early 2020. They raised several issues, including:
• inadequate facilities, with room temperature being too cold and lack of Wi-Fi;
• failure to provide proper care, including failure to re-dress Mr X’s bandage or provide the right cream, failure to seek medical attention when Mr X developed a bad cold and chesty cough, and failure to properly administer Mrs X’s medication;
• failure to properly look after Mrs X’s clothes, not changing her clothes daily; and;
• failure to return an £80 deposit for purchases Mr X says he did not make.

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The Ombudsman’s role and powers

2. 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)
3. 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)
4. 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.

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How I considered this complaint

5. I have:

• considered the complaint and discussed it with Mr X
• considered the correspondence between Mr X and the Care Provider, including the Care Provider’s response to the complaint
• made enquiries of the Care Provider and considered the responses
• taken account of relevant legislation;
• offered Mr X and the Care Provider an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

6. 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.
7. 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.
8. When investigating complaints about the standards of care in a care or nursing home, the Ombudsman considers if the 2014 regulations and the fundamental standards have been met. If they have not, we consider whether any identified faults have resulted in injustice.

What happened

9. Mrs X has dementia and Mr X is her carer. Mr X had an operation at the beginning of January 2020, and so both Mr and Mrs X required a period of respite. Mrs X went into one unit of the care home at the end of 2019 for three weeks’ respite, and Mr X went into another unit in the same care home a week later, for two weeks’ respite. Mr X has raised several issues about their time at the care home.
10. Mr X says he asked the care home to help obtain some emollient cream as recommended by the hospital for his surgery site. He says the care staff were not clear in telling him whether they could do this, so he and Mrs X walked to the pharmacy a mile away from the home, in freezing weather when it was getting dark. The Care Provider says its staff had told Mr X they could get the cream that afternoon, but that Mr X did not want to wait and chose to go to the pharmacy himself. It says he did not tell care staff he was leaving the premises with Mrs X. It says if he had, they could have ordered a taxi for Mr and Mrs X.
11. Mr X says he had to bring an extra chair and table into his room to make it habitable. The Care Provider said it had brought extra furniture to Mr X’s room immediately on his request, to accommodate Mrs X visiting his room.
12. Mr X says he asked the staff for the care home’s Wi-Fi password, but nobody provided it to him. He says the staff had lied about there being signal problems, but when the unit manager returned from leave, they had connected Mr X straight away. The IT manager apologised that staff had not been able to connect Mr X to the Wi-Fi, but the Care Provider says this was based on Mr X wrongly telling the IT manager this was the case. It says when staff members checked Mr X’s phone for him, it was connected and only needed to be refreshed. The Care Provider says staff gave the correct password to Mr X on his arrival. It says there was no connectivity issue during Mr X’s stay. However, I have seen an internal email from the head of IT dated 12 January 2020, which confirms a problem with Wi-Fi connection and explained “A piece of kit has failed, should be replaced this week. Can I meet with the resident on Tuesday and explain”.
13. Mr X says Mrs X’s clothes were not being changed daily and he had to change her himself on several occasions. The Care Provider denies this. The care records show Mr X did approach care staff on one occasion to ask them to change Mrs X’s top because it was dirty. He says care staff put clean clothes in the laundry basket at times, the Care Provider says Mrs X did this and the care staff moved clothes back out where they noticed this. Mr X says on leaving, some of Mrs X’s clothes had gone missing. The care home told them some items had accidentally been sent to the laundry, despite their daughter having agreed to do all laundry. The Care Provider apologised for this. Mr X says the care home told him it did not provide a laundry service, but the Care Provider says this is incorrect and Mr and Mrs X specified their daughter would take their laundry. The records show a carer went to the laundry and managed to locate some of the missing items and returned them to Mrs X’s daughter. The carer apologised that she had not been able to locate all the missing items and said the care home would contact Mr X if the items were found.
14. Mr X says in mid-January, he had asked a nurse to redress a bandage which had come loose. He says the nurse advised him they would do this after the medication round, and then there was an emergency. The Care Provider says medications are more time-sensitive than Mr X’s bandage, and that it was understandable the nurse attended to the emergency first. Mr X says he held the bandage in place for three hours. In response to enquiries made by this office the Care Provider says Mr X only requested his dressing be changed after the nurse’s medication round and he had agreed she should first attend to the emergency. Mr X says the bandage came undone again, so he decided to redress it himself.
15. Mr X says his room had been unbearably hot to begin with, and the maintenance technician could not fix the problem, leading to the room instead being freezing. Mr X says, despite assurances from care staff that they had reported this to management, his room remained freezing for 11 days. Mr X says this led to him developing a severe cold and a bad, chesty cough. Mr X says the care staff brought him a portable heater on the last night of his stay. The Care Provider says it was recorded once that Mr X complained of a cold room, the staff offered extra blankets immediately and the heater was provided the next day. The care records confirm Mr X complained the heating was broken in his room on 18 January 2020, and that a portable heater was provided. The Care Provider says the issue was resolved on 20 January 2020.
16. Mr X says he asked the care home for medication to help with his cold and cough, but the carers did not tell him they could call a doctor to prescribe something more effective than paracetamol. The Care Provider says Mr X asked for a cold and flu hot drink sachet, which it does not keep in stock. It offered paracetamol which Mr X declined. The Care Provider says Mr X did not have cold symptoms that warranted a GP referral, however it referred Mr X to the GP two days later, 15 January 2020 as his nose was runny. A Nurse Practitioner from the surgery visited Mr X and prescribed an antihistamine.
17. Mr X says it took him a month to recover at home from his cold and he believes he should have seen a GP and not a Nurse Practitioner.
18. Mr X says the care home had not adapted its medication rounds appropriately to Mrs X’s medication specifications, for example giving some medication before food and medication which needed to be taken with, or after, meals. The Care Provider says it needed to stick to the timings stated by the prescriber but that it had put in place an arrangement to enable Mr X to give Mrs X her medications at times.
19. At the end of January 2020, after Mr and Mrs X had returned home, Mr X complained to the Care Provider.
20. In mid-February 2020, the Care Provider responded to Mr X’s complaint. It apologised the stay did not meet Mr and Mrs X’s expectations. It said it acknowledged some of Mrs X’s clothes were taken to the laundry in error and that Mr X had to wait longer than anticipated for help with his dressing. It said that aside from these issues, it did not uphold his complaint and did not agree its staff had acted unreasonably. It said it would remind its staff to check the laundry more carefully. It offered £100 as a “goodwill gesture” but it said a bigger amount was not warranted. In this letter, the Care Provider said Mr X had declined the nurse’s offer of applying a new dressing.
21. At the end of February 2020, Mr X sent a further complaint letter to the Care Provider. He said he was concerned the Care Provider had distorted the truth in its response, for example, saying the family had recovered all items of Mrs X’s lost clothes, and saying it was care staff that had suggested the care home obtain emollient cream for Mr X. He said he had raised his concerns with the carers during his stay, but his complaints had not been communicated to the unit managers. Both managers had later accepted Mr X’s account and apologised to Mr X when he explained his experience to them over the telephone.
22. Mr X told the Care Provider it had trivialised his serious complaints, and its offer of £100 was an insult. He says the Care Provider did not refund an £80 deposit for purchases he never made.
23. In mid-March 2020, the Care Provider wrote to Mr X explaining how it had investigated his complaint. It said the managers of both units had spoken to their staff, and it had sought clarity where Mr X’s accounts did not match those of its staff. It said it had no reason to believe the accounts its staff were false. The Care Provider explained Mr X had only paid £40 deposit, and this had now been refunded. It offered to organise a refund for clothes Mr X believed were missing and asked him to provide an itemised list. It explained it did not wish to trivialise how Mr X felt, but it could not justify a larger refund. It added that it is a charity and must be responsible about how it uses its funds and donations. In this letter, the Care Provider acknowledged the nurse had changed Mr X’s dressing, but only the top bandage. Mr X says the Care Provider gave inconsistent information in this respect.
24. Mr X wrote to the Care Provider in response. He said it had denied the true facts about what had happened during his and his wife’s stay. He said “several items of underwear and socks” were still missing. He said he had now been informed the Care Provider had made a mistake by only charging for one deposit of £40, rather than two for both Mr and Mrs X.
25. The Chief Executive of the Care Provider telephoned Mr X to discuss his complaint and then wrote to him on 2 April 2020 with her findings. She said “…there are always lessons to be learnt from complaints that we received, and we can always with hindsight have done things better, on the whole, I am fully satisfied that our staff behaved and acted in a reasonable and honest way” She acknowledged Mr & Mrs X had paid a “considerable sum for your stay with us and do still feel dissatisfied” and offered £750 as a gesture of goodwill.
26. Mr X does not believe the offer is sufficient.

Analysis

27. There are significant differences in Mr X’s and the Care Provider’s explanations. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. 
28. The Care Provider has given some conflicting explanations. For example, the Care Provider says medications are more time sensitive than Mr X’s bandage, but then its next complaint response says Mr X only asked the nurse to change his bandage after the medication round. It also says there were no issues with the Wi-Fi connection when the records show otherwise.
29. In other matters, it is clear Mr X’s expectations were not met. On some points the evidence is clear, and it is possible to come to a finding, on other it is not.
30. It is not possible to find on the issue relating to the emollient cream. Both parties have differing accounts. The records do not reflect the conversations Mr X had with the carers. Mr X left care home to purchase the cream himself, taking Mrs X with him, without informing the care home. Had he informed the care home a taxi could have been ordered so he need not have walked in freezing weather. The care home would also have been able to record that he and Mrs X had left the building, and the time of their return.
31. In relation to the extra furniture Mr X needed in his room. I cannot criticise the Care Provider here. Residents have individual requirements; the room would have been furnished for a single person. Mr X asked for additional furniture to accommodate visits from Mr X and it was promptly provided.
32. Mr X says Mr X’s clothes were not changed daily. Whilst it is not possible for me to know if Mrs X’s clothes were changed daily, the records do show that on one occasion Mr X asked care staff to change Mrs X’s top because it was dirty.
33. The records show some of Mrs X’s underwear was lost in the laundry. In its complaint response the Care Provider says all items were recovered and returned to Mrs X. This is not what the records show, a carer recorded that some items were found, but some were not. The carer told Mr X the care home would contact him if they were found. The Care Provider has offered to reimburse Mrs X if Mr X could provide an itemised list. He should not have had to do so.
34. The records do report a fault with the heating in Mr X’s room. Mr X says this was ongoing for 11 days, the Care Provider says it was repaired in two days, and a portable heater was provided until the repair was complete. It is not possible to come to a finding on the length of time the heating was broken. Mr X says this caused him to have a severe cold and chesty cough. It is not possible to determine the cause of Mr X’s illness.
35. Mr X complains carers only offered him paracetamol for his cold and did not offer to call a GP to prescribe something more effective. The Care Provider says initially Mr X’s symptoms did not warrant a call to a GP. Carers made a judgment at the time and I cannot say they acted with fault. It was reasonable to offer a widely used analgesia for colds and flu, and it did contact a GP two days later. Mr X was seen by a Nurse Practitioner who prescribed an antihistamine. Mr X believes he should have seen a GP not a Nurse Practitioner. It was for the Nurse Practitioner to decide if Mr X needed to see a GP, not the care staff.
36. In relation to medication timings. Mr X says care staff did not adapt medication rounds to Mrs X’s medications needs. The Care Provider response to this is contradictory. It says it administered Mrs X’s medication as stated by the prescriber, but then goes onto say it put in place an arrangement to enable Mr X to give Mrs X her medication. I cannot understand why it would have needed to make such an arrangement with Mr X if it had administered Mrs X’s medication as prescribed. On balance, I find in Mr X’s favour.
37. Mr X was dissatisfied with the Care Providers response to his complaint. I can understand why. Mr X says the Care Provider ‘distorted the truth and denied the true facts.’ I cannot say the Care Provider intended to distort the truth, but it was factually inaccurate on some points and it gave conflicting explanations. I agree with Mr X that the initial offer of £100 was not sufficient. Mr X was put to unnecessary time and trouble challenging the Care Provider’s response. It then offered £750 as a gesture of good will but failed to identify its conflicting explanations. This added to Mr X’s frustration and compounded his sense of injustice.

Agreed action

38. The Care Provider will within one month:

• provide Mr X with a written apology for the failings highlighted above and make a payment of £1000 in acknowledgment of the failings, and the time and trouble Mr X has been put to pursuing the complaint with the Care Provider and the Ombudsman.

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Final decision

39. There is evidence of fault in some aspects of the care provided to Mr & Mrs X during their short stay in the care home. The Care Provider’s response to the complaint was factually inaccurate on some points and gave conflicting explanations.
40. The recommendations above are a suitable way to remedy the injustice caused.
41. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman