Summary: There is no evidence the actions of the care provider caused injustice to Mrs X. It was not part of its role to apply for fast-track funding.

The complaint

1. Mr A (as I shall call the complainant) complains the care provider failed to apply for fast-track health care funding for his late mother Mrs X; delayed in providing shower aids; failed to obtain a speech and language therapy (SALT) assessment as promised and in general terms did not provide the service which was paid for.

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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. If they have caused an injustice we may suggest a remedy (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)

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How I considered this complaint

3. I considered all the information provided by the care provider and Mr A. I spoke to Mr A. Both Mr A and the care provider had an opportunity to comment on this draft statement and I considered their comments before I reached a final decision.

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What I found

Relevant law and guidance

4. 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.
5. The regulations say care and treatment provided to service users must be appropriate, meet their needs and reflect their preferences.
6. The regulations also say complaints must be registered, and necessary and proportionate action taken in response to any identified failures.
7. The NHS funds the whole cost of care where someone is assessed as having a primary health care need (NHS continuing healthcare). If someone’s health is deteriorating quickly and they are nearing the end of their life, they should be considered for the NHS continuing healthcare fast-track pathway, so that an appropriate care and support package can be put in place as soon as possible.

What happened

8. The care provider has provided a copy of a letter from Mrs X’s oncologist to her new GP on 17 January 2020. The oncologist mentioned Mrs X’s poor prognosis and said she would benefit from a fast-track CHC assessment. Mr A says the GP refused to make an application for fast-track funding.
9. Mrs X was admitted to the care home on 5 February. The care provider completed a pre-admission assessment on 3 February in which it was identified that Mrs X had cancer and needed the services of a stoma care nurse. She was described as eating and drinking normally, was at high risk of falls and used a walking stick and sometimes a wheelchair to move around (Mr A says this was only when she was taken to look round the care home).
10. Mr A says he mentioned Mrs X’s poor mobility to the manager who carried out the pre-admission assessment. He says she assured him there would be a shower chair made available for Mrs X and a full mobility assessment carried out. She also said she would apply for CHC as a matter of urgency.
11. The care provider submitted an application for a standard (not fast track) CHC assessment shortly after Mrs X’s admission. The local CHC manager arranged an assessment for 2 March.
12. The care home completed a full range of assessments for Mrs X shortly after admission. The oral assessment notes she had no difficulty swallowing at that time but her dietary intake was poor. The care home notes describe Mrs A as independent with her personal care although reluctant to seek assistance. She was regularly offered showers or a bath but often refused (notes for 09 February say “she doesn’t like the shower”). Mr A points out his mother was understandably nervous about standing on a wet surface with nothing to hold on to, but had a shower the day after the shower chair was made available. She chose to spend most of her time in her own room.
13. The care home records contain an order dated 18 February for stoma equipment to prevent the home running out of supplies.
14. The GP attended Mrs X on 14 February as she was complaining of nausea. The GP prescribed anti-emetic medication.
15. Mr A emailed the care home on 26 February after a visit to his mother and a meeting with the deputy manager. He wrote, “we advised you that mum was…struggling to chew and swallow. You said you would have an assessment done and also recommend softer foods such as cottage pie”. There is no record of request for an assessment.
16. The GP attended again on 28 February and prescribed anticipatory drugs as Mrs X was nearing the end of life.
17. The CHC eligibility checklist (the first stage of the CHC assessment) was conducted on 2 March and the assessor requested more information. Mrs X was admitted to hospital on 3 March, however, and sadly died on 10 March in hospital from aspiration pneumonia.

The complaint

18. Mr A complained to the care provider following his mother’s death. He said the room his mother had been promised was not available when she moved in. He said no shower chair was available for her, and so she did not have a shower for a week after admission. He said the manager did not apply for fast track CHC funding or request a SALT assessment when Mrs X had trouble swallowing.
19. Mr A received an initial response from the care home manager. Mr A wrote again to the care provider as he said the response was not only delayed but appeared as though the manager was clearing his desk before he left.
20. The care provider CEO wrote to Mr A and apologised. She said parts of the previous response had been confusing but it was unlikely, given the timescales involved, that Mrs X would have been able to complete the CHC assessment process. She said it was not the role of the care provider to complete a fast-track application, and the discharging hospital should have started the process which had to be completed by a clinician.
21. The CEO also said the care home notes showed Mrs X had no difficulty eating or drinking while she was in the home and was able to consume a normal diet without thickened fluids. There was therefore no reason to arrange a SALT assessment. Mr A says the care home notes do not reflect what was actually happening – he says she was sick not after eating, but because she was struggling to swallow the food she was given, although he acknowledges she did not have swallowing difficulties when she was first assessed.
22. The CEO apologised that Mrs X’s first choice of room had been unavailable, and that there had been a delay in the provision of a shower chair.
23. Mr A complained to the Ombudsman.
24. The care provider’s managing director says many of the staff who were in post at the time of Mrs X’s stay in the home have now left. He reiterates the apologies made for some poor communication and for the lack of availability of the shower chair when Mrs X moved in. He says as a result of the complaint they endeavour now to ensure specialist equipment will be available for new admissions as necessary.
25. The care provider offers to meet with Mr A and his family to review the concerns which were originally raised.

Analysis

26. The care home properly requested a CHC assessment. It was not able to request a fast-track assessment which had to be requested by a clinician. The documents show the GP was advised to do so by the hospital. It was annoying and frustrating for the family if the care home manager led them to believe she could initiate a fast-track application but that was not possible. It was the responsibility of the GP to do so and they refused. There is no evidence the actions of the care provider caused any injustice to Mrs X in this respect.
27. The care provider apologised for the delay in provision of a shower chair. There is some doubt over the injustice caused to Mrs X who was recorded as disliking and refusing the offer of a shower. However, the apology remedies the injustice which was caused at the time by the delay.
28. The oral care assessment did not record any difficulty swallowing and so no reason to refer for a SALT assessment. The care home notes record Mrs X ate and drank normally except when she suffered from nausea. Mr A disputes the records and says he witnessed Mrs X struggling and reported it to the manager. That was on 26 February: Mrs X was admitted to hospital five days later (which included a weekend). The likelihood of a SALT assessment being undertaken within that timescale is very small indeed so on the balance of probabilities, I do not find the actions of the care provider caused injustice.

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Final decision

29. I have completed the investigation as I have not seen any evidence that injustice was caused to Mrs X by fault on the part of the care provider.

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Investigator's decision on behalf of the Ombudsman