Summary: Ms X complained about poor care provided to her late father, Mr Y, and poor communication by a Council-commissioned care home. The Council was not at fault.

The complaint

1. Ms X complains about poor care provided to her late father, Mr Y, and poor communication by a Council-commissioned care home between June 2020 and January 2021. She says the care home:
• Provided a poor standard of personal care support.
• Refused to allow Mr Y to see his granddaughter on his birthday in June 2020.
• Did not support Mr Y to communicate with his family either face-to face or virtually, despite repeated requests from family.
• Has not provided a satisfactory explanation as to why Mr Y often did not have his hearing aids in or his phone with him, making it difficult for family to contact him.
• Accepted it delayed notifying the GP of his death and mixed up another resident’s belongings with Mr Y’s belongings, but has not provided an apology to her for the distress this caused.

2. She also says the Council’s investigation into her complaint was flawed and biased towards the care home.
3. She says the care home’s actions meant Mr Y had minimal contact with his family in the months prior to his death and have caused her and her family significant distress. She wants the Council to accept the care home was at fault and for the care home to provide her with a formal apology and a financial remedy to acknowledge the faults and distress caused.

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The Ombudsman’s role and powers

4. 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)
5. 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 read Ms X’s complaint and spoke with her about it on the phone.
7. I made enquiries of the Council and considered information it sent me.
8. Ms X and the Council had the opportunity to comment on the draft decision. I considered comments received before making a final decision.

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What I found

Background information

9. 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. The fundamental standards include minimum standards for:
• Person-centred care
• Maintaining accurate and complete records
• Ensuring people are treated with dignity and respect
• Safe care and treatment
10. When investigating complaints about the standards of care in a care home, we consider 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

11. In 2020, Ms X’s father, Mr Y, lived in a care home. Mr Y had several health conditions.

Standard of personal care

12. I have reviewed care homes records from June 2020 to January 2021. The records show:
• Mr Y was deemed to have capacity to make his own decisions and choices until December 2020.
• Staff reviewed Mr Y’s care plans each month.
• Care home staff assisted Mr Y with personal care regularly each morning and evening. Sometimes he would decline to get out of bed or to shave.
• Mr Y was assisted with his continence needs regularly throughout the day and night.
• Mr Y was weighed monthly and in the months prior to his death his weight and body mass index (BMI) remained in or slightly above normal range.

The visit in June 2020

13. In May 2020, the care home sent a newsletter to all families, including Mr Y’s. The newsletter said that due to a change in government guidance related to the COVID-19 pandemic, the home would not be allowing visitors in the building. Instead, it would be booking visits to see residents in their visitor pod. It said these visits would be restricted to two visitors at a time and to 30 minutes. The care home also decided not to allow children to visit residents during this time.
14. In June 2020, Ms X, her mother Mrs Y, and Ms X’s teenage daughter attended the care home to visit Mr Y in the visitor pod. Ms X asked the care home to allow all three of them to visit Mr Y. The care home did not agree to this. It said in line with its current restrictions, it could only allow two visitors to visit and was not allowing children to visit residents. Ms X was dissatisfied with this but agreed her daughter would not visit Mr Y. Ms X and Mrs Y visited Mr Y in the visitor pod and stayed for about 30 minutes.

Care home support to enable communication between Mr Y and his family

15. In May 2020, the care home gave families details of a private messaging system which it had put in place to help families communicate with residents whilst there were visiting restrictions. It gave families details of how to register with this service and said families could upload messages and pictures to the system and staff would assist residents to access any messages or photographs uploaded using the care home’s tablet devices. The care home says Ms X and Mrs Y did not register for this service.
16. The care home said Mr Y had a mobile phone which he used to communicate with his family. However, Mr Y would often choose to turn his phone off. As Mr Y was deemed to have mental capacity, the care home say they had to respect this choice.
17. The family would sometimes ring the home and ask to speak to Mr Y, and the records show staff would try and facilitate this. However, the care home said the family would often ring later in the evening when it was not a convenient time.
18. The care home said that some staff allowed Ms X to use their personal phones to video call Mr Y, as his phone did not have this facility. It says this was not care home policy and these staff did this as a gesture of goodwill during COVID-19 restrictions.

Mr Y’s hearing aids

19. Records show in October 2020, Mrs Y told the care home Mr Y could not hear when she was speaking to him on the phone. The care home reminded staff to encourage Mr Y to use his hearing aids, ensure they were kept clean and the batteries were changed regularly.
20. In November, Mrs Y asked staff about Mr Y’s hearing aids. Staff told her these were in working order but that Mr Y continued to refuse to wear them.
21. Later that month, Mrs Y rang the care home to speak to Mr Y. She said Mr Y could not hear her as he did not have his hearing aids in. Mr Y told staff he did not know where his hearing aids were and did not want to wear them. Staff encouraged Mr Y to talk to Mrs Y but Mr Y refused to do so.
22. The care home said both Ms X and Mrs Y knew Mr Y would often turn his phone off and choose not to wear his hearing aids. Mr Y had capacity to make these decisions and it was his choice to do so.
23. Ms X complained to the Council. She said the home had told her Mr Y’s hearing aids had been misplaced, but they could not replace them as the care home would not allow them to visit. The Council contacted the care home who explained they currently had staff who had tested positive for COVID-19 and so were following public health guidance by not allowing any outside persons into the home unless it was a life threatening or end of life situation. The home acknowledged it was a distressing time for families but said it had to follow public health guidance. The Council relayed this information to Ms X. The Council says Ms X did not contact them again after this phone call, so it presumed she was satisfied with this explanation.

Lack of formal apology

24. The care home said it apologised to Ms X at the time for the delay notifying the GP of Mr Y’s death and for mixing up Mr Y’s belongings with other residents. The Council said it also provided an apology from the care home within its complaint response to Ms X.
25. In December 2021, the care home wrote to Ms X to provide a formal apology for these errors.

My findings

26. Where a care provider is providing a service on behalf of a council, we consider the council to be responsible. Although I have considered the care home’s actions in this investigation, as the Council commissioned Mr Y’s care I have made findings against the Council.
27. I have reviewed the care home daily records from June 2020 to January 2021. The evidence shows the care home attended to his personal care needs in line with his care plans. His care plans were reviewed regularly each month. Mr Y would sometimes choose not to shave or get out of bed, but he had capacity to make these decisions. There is no evidence of poor care. The Council is not at fault.
28. The care home had informed all families including Ms X in June 2020 that, in line with government guidance, it was not allowing visitors in the care home building. It had told Ms X that visits would only be allowed in its visitor pod and would be restricted to two visitors. When Ms X and Mrs Y arrived for the visit, the care home appropriately considered their request to allow Ms X’s daughter to also visit Mr Y. It decided this was not in line with its current restrictions and so did not allow it. The care home appropriately considered the request in the context of its own policy and government guidance at the time, and decided it could not allow Ms X’s daughter as a third visitor. This was not fault.
29. I am satisfied the care home made appropriate efforts to support Ms X and her family to communicate with Mr Y. It set up a private messaging system and told families how to register with this. Ms X and Mrs Y did not register for this service, but this was their choice. Staff also tried to help Ms X communicate with Mr Y using their own private mobile phones. The records show Mr Y at times declined to wear his hearing aids and speak to his family. He would also at times turn his phone off. These were choices made by Mr Y who had capacity to make these decisions. The Council was not at fault.
30. Ms X says the care home has not apologised for the delay in reporting Mr Y’s death and for mixing up other residents clothing with Mr Y’s belongings. The Council apologised on the care home’s behalf in its complaint response. This is an appropriate remedy for the distress caused by these actions. Since Ms X brought her complaint to us, the care home has also written to her to apologise for these actions. The Council is not at fault.
31. There is no evidence of bias in how the Council investigated and responded to her complaint. The Council is not at fault.

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Final decision

32. I have completed my investigation. The Council is not at fault.

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Investigator's decision on behalf of the Ombudsman