Summary: We did not uphold the complaint. The late Mr Y’s care in a nursing home was appropriate and in line with national standards.

The complaint

1. Mrs X complained about her late relative Mr Y’s care in Kingsthorpe Grange Nursing Home (the Nursing Home). Northamptonshire County Council (the Council) arranged and funded Mr Y’s care. Mrs X complained the Nursing Home’s care of Mr Y was inadequate because it failed to make sure he ate, did not wash or shower Mr Y and did not support him to sit or walk.
2. Mrs X said the Care Home caused Mr Y’s death and caused her avoidable distress.

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The Ombudsman’s role and powers

3. 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)
4. The Nursing Home provided services on behalf of the Council to carry out legal duties to provide or arrange services to meet Mr Y’s care needs. This means we can investigate Mrs X’s complaints about poor care to Mr Y.
5. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word ‘fault’ to refer to these. 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, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

6. I considered Mrs X’s complaint to us, the Council’s response to her complaint and documents from the Nursing Home and Council described later in this statement.
7. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

8. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. The Care Quality Commission (CQC) issued guidance in March 2015 on meeting the regulations (the Guidance.) We consider the 2014 Regulations and the Guidance when determining complaints about poor standards of care. Relevant to the complaint are:
• Regulation 9 which requires care and treatment to be appropriate, to meet a person’s needs and to reflect their preferences. Care providers should carry out an assessment and design a care plan to meet needs and preferences.
• Regulation 12(i) which says a care provider must provide care and treatment in a safe way including by working with health professionals to ensure the health and welfare of residents.
• Regulation 14 of the 2014 which says the nutrition and hydration needs of residents must be met. They must receive suitable nutritious food and fluid to sustain life and good health, with support to eat and drink if needed.
9. 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 they cannot protect themselves. The council must also decide whether it or another person or agency should take any action to protect the person from abuse or risk of abuse. (Care Act 2014, section 42)

What happened

Background

10. Mr Y had Parkinson’s disease, a condition where parts of the brain become damaged over many years. Mr Y moved into the Nursing Home in February 2020. Before this, he was in hospital having treatment following a fall and for aspiration pneumonia (a lung infection caused by breathing in vomit) and pressure sores. Mr Y moved to a second nursing home in July which is not part of this investigation.
11. The hospital sent a report when they discharged Mr Y to the Nursing Home. The report said Mr Y had pressure sores on both heels and his mobility (ability to move around) had got worse in the last six months. He had frequent falls. He needed two people to help him to transfer (change position) and he was virtually bedbound and was not motivated to do physiotherapy. The report said Mr Y had ‘no potential for rehabilitation.’ This meant Mr Y’s mobility would not likely improve with further therapy. He was also noted to vomit after eating and store food in his mouth and spit it out.

The Nursing Home’s records

12. The Nursing Home kept detailed care plans for Mr Y. Staff recorded his care in detailed daily notes, for example: his food and drink, his weight, when they gave personal care and his general wellbeing, mood and how he slept.
13. The care plan for personal care said Mr Y could do most personal care things for himself like hand and face washing and teeth brushing. He needed support to shave. He liked to have one weekly shower and needed two staff to help him with transfers and provide assistance. The daily records indicate these actions took place.
14. The nutrition risk assessment for Mr Y noted he was at risk of malnutrition. The Nursing Home weighed Mr Y each month. He lost 5 kg in March but no more and his weight was stable the next three months. Mr Y’s weight remained within the healthy range during his stay at the Nursing Home. The eating and drinking care plan said Mr Y needed assistance with feeding and sometimes refused food. He needed a normal diet and support from staff with eating as he was at risk of choking and was also to be offered milkshakes. Daily food charts showed Mr Y often refused supper but would have milk instead. The dietician provided advice in April and May.
15. The risk assessment for pressure sores said Mr Y was at risk. There was a detailed care plan describing how nurses should treat Mr Y's heel sores. The care plan was reviewed regularly and nursing staff sought advice from the tissue viability nurse. The records indicate one of the sores healed but the other still needed dressing.
16. The mobility care plan said Mr Y was reluctant to move and was nursed mainly in bed. Staff moved him using a hoist. One time he sat out of bed in a reclining chair and could not keep a safe position. So the Nursing Home referred him to a physiotherapist for a special chair. Reviews of the mobility care plan indicate staff tried to encourage Mr Y to move his legs while sitting on the bed but he would not do this.

Mrs X’s complaint to the Council

17. Mrs X complained to the Council in July 2020 shortly after Mr Y moved to a different nursing home. The Council wrote to her to say it was opening a safeguarding enquiry (see paragraph 9) and so would not respond to her complaint until it had completed the safeguarding enquiry.

The safeguarding enquiry

18. A social worker looked at Mr Y’s care records, spoke to senior staff at the Nursing Home and Mrs X and completed a safeguarding enquiry report. I have summarised the enquiry report below:
• The Nursing Home’s notes indicated contact and advice from the dietician in April and May. Mr Y was prescribed food supplements and he was also seen by the GP in June about refusing to eat. The food charts suggested he did eat but sometimes refused support and he needed prompting to eat and encouragement to have milkshakes and fortified meals.
• The nutrition assessment said staff needed to monitor what Mr X ate. The weight charts showed weight loss but then Mr Y’s weight stabilised.
• The falls risk assessment said he needed a hoist for transfers and he could not sit safely in an ordinary chair so was referred to the physiotherapist and on the waiting list.
• The records around pressure sores indicated advice from the tissue viability nurse and GP. The charts indicated the sore on the left heel was healing but the right one still needed dressing.
• There was no record of Mr X declining personal care. He had a shower once a week as set out in his care plan.
• The Nursing Home provided the new home with a detailed summary.
19. The social worker spoke to Mrs X and summarised what she had read in Mr Y’s care notes. The conclusion of the safeguarding enquiry was that there was no evidence of neglect.
20. The Council responded to Mrs X’s complaint in November. The response said the records showed Mr X was bedbound when he went into the Nursing Home and he had pressure sores on both heels and was reluctant to eat. The records showed the Nursing Home:
• sought advice from a dietician, the tissue viability nurse, who provided advice on the pressure sored and the GP.
• monitored what Mr X ate after he lost weight. He was offered milk shakes or snacks. He could eat solid food.
• encouraged Mr X to move about even though he was reluctant and referred him to a physiotherapist for a suitable chair
• provided a detailed summary to the new nursing home.
21. The Council did not uphold any of Mrs X’s complaints, so Mrs X complained to us.

Was there fault?

22. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. In this case, any fault by the Nursing Home would be fault by the Council.
23. There was no fault by the Nursing Home in its care of Mr X because:
• The Nursing Home kept detailed care plans describing Mr X’s needs and the steps to take to meet those needs. Staff reviewed these plans regularly to make sure they were still appropriate. This was in line with Regulation 9 of the 2014 Regulations.
• Mr X was bed bound and he was also noted to be reluctant to engage with mobility exercises and to have no potential to improve. The Nursing Home tried to encourage Mr X to improve his mobility with leg exercises with little success. And it referred Mr X to a physiotherapist for a special chair.
• The Nursing Home staff made appropriate referrals to the NHS to support Mr X’s needs around pressure care, diet and general health. This was in line with Regulation 12(i) of the 2014 Regulations.
• In relation to eating (nutrition) the Nursing Home acted appropriately by keeping detailed records of everything Mr X ate, weighing him regularly and referring him to a dietician when he lost weight in the first month. There was no further weight loss and Mr X’s weight remained within a healthy range. Care was in line with Regulation 14 of the 2014 Regulations.
• There is no evidence to support Mrs Y’s complaint that Mr X did not receive regular personal care or a shower. The care plans and daily records indicated that he did.
24. Mrs X said the Nursing Home caused Mr Y’s death but there is no evidence to support this and it is not our role to make this finding in any event.

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Final decision

25. I did not uphold the complaint. The late Mr Y’s care in a nursing home was appropriate and in line with national standards for care in care homes.
26. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman