Summary: Mrs B complained of inadequate care given to Mr B during a respite stay in November 2019. The care provider failed to keep adequate records, raised Mrs B’s expectations about the provision Mr B would receive, failed to provide adequate care on occasion, failed to properly consider Mr B’s diabetes and lost a pair of trousers. That caused Mr B to miss out on some provision, caused Mrs B distress and led to her going to time and trouble to pursue the complaint. A financial payment, training for care home staff and managers, agreement to refund the cost of the missing trousers or replace them and changes to procedures is satisfactory remedy.

The complaint

1. The complainant, whom I shall refer to as Mr B, complained about inadequate care provided to him during a respite stay in November 2019. Mr B is represented by his wife, whom I will refer to as Mrs B. Mrs B says the care provided was inadequate and caused both her and Mr B distress.

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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))

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How I considered this complaint

4. As part of the investigation, I have:
• considered the complaint and Mrs B's comments;
• made enquiries of the care provider and considered the comments and documents the care provider provided.
5. Mrs B and the care provider had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
6. 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

7. Mrs B is the main carer for her husband, Mr B. Mr B went into respite care at one of the care provider’s care homes and stayed between 11 November 2019 and 18 November 2019. Mr B has dementia. Mrs B says the care provider left Mr B’s clothing unchanged for several days, failed to provide him with a daily shower, failed to provide him with paracetamol as agreed, failed to keep proper daily records and lost a pair of his trousers. Mrs B says Mr B arrived home distressed with painful constipation followed by diarrhoea. Mrs B says the care provider charged £1,200 for the weeks stay but provided little more than bed and board.
8. The care provider accepts the care home failed to keep adequate daily records in this case, including failing to keep a food and fluid chart for Mr B. The care provider has provided evidence to show the care home has now introduced a three-day assessment pack for any new residents to help provide a more detailed picture of care needs. I welcome that.

Analysis

9. Mrs B says the care provider agreed to provide her husband with a room on the ground floor and failed to do that. Mrs B says this was important because staffing on the ground floor was greater as it was intended for dementia patients. I have considered the documentary records. That does not record any agreement about what room Mr B would be placed in for respite or on what floor that room would be based. The care provider has clarified though the ground floor is intended for those with a higher level of dementia. The care provider accepts although it did not consider Mr B needed a room on the ground floor it showed him and Mrs B around the ground floor before the respite placement was agreed. In those circumstances it is not surprising Mrs B expected the care provider to provide Mr B with a room on the ground floor. Failure to properly explain the nature of the respite placement, where Mr B would be placed and the type of support he could expect to receive is fault. Failing to do that raised Mrs B’s expectations unnecessarily.
10. Mrs B says the care home failed to change Mr B’s clothes for several days or facilitate him taking a shower. The care provider accepts the daily care records are inadequate and do not record whether carers changed Mr B’s clothes. Given Mrs B’s description of finding Mr B’s clothes in the drawer untouched after three days I consider it likely, on the balance of probability, Mrs B is right and the care provider failed to ensure Mr B changed his clothing on a daily basis. That is fault.
11. In terms of the failure to ensure Mr B took a shower every day, the pre-admission assessment form and care plan refer to a daily shower. It is clear this did not take place every day as there is a record of only two showers during the week. As the daily records are not adequate it is not possible to establish whether carers offered Mr B a daily shower which he refused. As the care provider cannot demonstrate there were attempts to ensure Mr B showered every day though I find it at fault.
12. Mrs B says the care home failed to ensure Mr B did not have access to sugary drinks and treats. Mrs B points out Mr B is diabetic and yet sugary treats were available throughout the home and he was offered sugar in his hot drinks. The documentary records show the home knew Mr B was diabetic. The care provider has also confirmed it has snack boxes available to residents outside of mealtimes. The care plan though records Mr B drank tea and coffee without sugar. As far as I can see there is nothing in the current arrangements in the home to prevent a diabetic person accessing the same sugary treats as available to other residents. It therefore seems likely Mr B had access to sugary treats during his stay. Given he was diabetic and the information provided to the home clearly recorded that, this is fault. I recommended the home revisit how it makes snack boxes available to residents outside of mealtimes to ensure those who are diabetic are not provided with unsuitable snacks. The care provider has agreed to my recommendation.
13. Mrs B says the care home failed to change Mr B after he went to the toilet or carry out adequate care to ensure he was not left with soreness. Having considered the documentary records I note those say Mr B could independently use the toilet. However, the care plan also notes carers were to check Mr B’s skin during his daily shower and report any concerns. As I said earlier, daily showers did not take place. It therefore seems likely, on the balance of probability, carers did not check Mr B’s skin. That is fault.
14. Mrs B says the care home failed to provide Mr B with painkillers despite the fact the preassessment information showed he took painkillers twice a day. Having considered the preassessment form I note it records Mr B takes paracetamol to deal with pain from his left big toe. However, the form does not record how often Mr B receives paracetamol. Nor does the form record how carers would identify the need to administer paracetamol. Failing to include that detail in the preassessment reform is fault. I consider this particularly important for cases such as this one where Mr B has dementia and may therefore not be able to properly articulate when he needs pain relief. Failure to ensure the form is completed properly with full detail provided about medication requirements is fault.
15. Mr B says the care home kept inadequate daily care records which provided contradictory information about Mr B’s bowel movements. I have found no evidence of contradictory records. The records I have seen show Mr B had a bowel movement on three occasions and the bowel chart was properly completed on those occasions. I therefore have no grounds to criticise the care provider.
16. Mrs B says the care home failed to explain the circumstances that led to Mr B losing a pair of trousers while staying for respite. The care provider has since accepted responsibility for the loss of the trousers and has offered to either replace the trousers or reimburse Mr B for the cost of the trousers. I consider that a reasonable outcome for this part of the complaint.
17. Mrs B says the care home unreasonably refused to provide her with a copy of the preassessment form she helped complete before Mr B went into the care home for respite. The care provider says it declined to provide that documentation because Mrs B only has power of attorney for property and financial affairs and not for health and welfare. The care provider says it was therefore following the Information Commissioner’s guidance in refusing to provide Mrs B with a copy of that preassessment form. While I understand Mrs B’s concern given she is Mr B’s next-of-kin it is the Information Commissioner, rather than the Ombudsman, that decides whether a care provider has acted in accordance with the data protection regulations. That is not the Ombudsman’s role. I therefore cannot comment on this part of the complaint.

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Agreed action

18. Within one month of my decision the care provider should:
• apologise to Mr and Mrs B for the faults identified in this statement;
• pay Mr and Mrs B £600 to reflect the failures in care, the distress that caused them and the time and trouble Mrs B had to go to pursuing the complaint;
• arrange with Mrs B to either refund the cost of the lost trousers or arrange for provision of a new pair.
19. Within two months of my decision the care provider should:
• carry out training for staff completing preassessment forms to ensure all sections are completed and relevant details provided about the daily requirements. That should ensure that where medication is required clear information is provided about how the need for that medication will be identified;
• remind staff taking potential residents and their families around the care home to be clear about the room and care that will be provided;
• send a memo to care staff to ensure they are aware of the need to complete detailed daily records showing the care provided, along with food and fluid charts; and
• arrange a meeting for managers at the care home to consider how to make snacks available to residents throughout the day while also ensuring those with diabetes do not have access to inappropriate foods.

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Final decision

20. I have completed my investigation and uphold the complaint.

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Investigator's decision on behalf of the Ombudsman