Summary: The evidence does not show the actions of the care provider caused injustice to the late Mr X. The cause of Mr X’s death has already been established by the coroner and it is not the role of the Ombudsman to question that.

The complaint

1. Ms A (as I shall call the complainant) complains about the care and treatment of her late father Mr X in the care home. She says the care provider failed to respond promptly to her concerns about his illness and that negligence by the care provider contributed to her father’s death.

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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 34 B, 34C and 34 H(3 and 4) as amended)
3. We provide a free service but must use public money carefully. We do not start or continue an investigation if we decide:

• further investigation would not lead to a different outcome, or
• we cannot achieve the outcome someone wants.

(Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

4. I considered the information provided by Ms A: I also considered the information provided by the care provider, which includes the daily records, food and fluid charts, and care plans for Mr X. Both Ms A and the care provider had the opportunity to comment on an earlier draft of this statement and I considered their comments before I reached a final decision.
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I found

Relevant law and guidance

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. Regulation 12 says care providers must have arrangements in place for appropriate action in case of medical or clinical emergencies.
8. Regulation 14 says care providers must make sure that people have enough to eat and drink to meet their nutrition and hydration needs and receive the support they need to do so. It says “water must be available and accessible to people at all times. Other drinks should be made available periodically throughout the day and night and people should be encouraged and supported to drink.”

What happened

9. Mrs X was already resident in the care home (for respite) when Mr X joined her on 25 March 2020 after a hospital admission for a stroke. Ms A says due to Covid-19 restrictions she was unable to visit her parents but spoke to them daily by telephone.
10. Ms A says her father began to complain of ‘loose bowels’ on 4 April. The care home notes show Mr X was poorly with sickness and loose bowels on 7 April. Ms A emailed the care home manager on 13 April and said her father was complaining of illness and was not eating.
11. The care home manager responded on 14 April. She said Mr X’s weight would be monitored. She said they had contacted the GP for a consultation.
12. Mr X continued to refuse meals or eat only small amounts. The care provider kept a food and fluid intake chart for him. The weight chart shows Mr X did not lose weight between admission on 25 March and the next recorded weighing on 14 April.
13. The care home records for 16 April record a conversation with the GP who prescribed supplement drinks for Mr X.
14. On 17 April Mr X was found to be confused and had low oxygen saturation levels: the care home staff called 111. An ambulance attended the home. The care home notes show paramedics carried out further observations when they arrived. They did not take Mr X to hospital as all observations were ‘fine’ and there was a greater risk of his contracting Covid-19 in hospital. They advised care staff to encourage fluids to prevent dehydration.
15. Notes for the following days show that staff gave Mr X the supplement drinks as prescribed, made homemade milkshakes when he refused them, and encouraged his fluid intake as advised.
16. Sadly Mr X died on 20 April.
17. A coroner’s inquest was held on 17 February. A paramedic who attended said it was possible Mr X had a urinary tract infection. The coroner concluded Mr X had died from natural causes.
18. Ms A raised a safeguarding alert with the local council. The council considered the care home’s documentation but did not carry out an investigation as there was no evidence of poor care.
19. Following the inquest Ms A made a formal complaint to the home. She said her father had died because of the care provider’s neglect.
20. The care provider responded. The director said all food and fluid charts had been fully completed. She explained how the charted quantities (“a few mouthfuls”, for example) had been calculated. She said staff contacted the GP after Ms A raised concerns, but the GP had not requested a stool sample although he had prescribed high calorie drink supplements. She said there was no presentation of a UTI or sepsis when the paramedics saw Mr X and they were happy for the care home to continue to care for Mr X. She said the GP also explained that UT infections did not always show symptoms but developed very quickly.
21. Ms A remained dissatisfied and complained to the Ombudsman. She says his care plan was incorrectly completed by the care provider – it recorded that he “loved tea” but Ms A says he never normally drank tea, only coffee, and more than once she found cold cups of tea in his room. Ms A also says when she was allowed to visit him (Covid 10 restrictions applied at the time of these events) it took him several hours to drink a small glass of water.
22. I have considered the care plans, risk assessments, daily notes and relevant charts (food and fluid intake/ weight monitoring) for Mr X. The food and fluid charts show Mr X refused more fluids, or only took small amounts, as time went on. By 19 April he was recorded as only accepting ‘sips’ of water.

Analysis

23. The care provider’s records show food and fluids were encouraged in accordance with Mr X’s care plan. When the GP prescribed supplements these were tried: when Mr X refused them, the care home made its own milkshakes for him instead. Water and other fluids were always available for him: both Mrs X and the care home staff were on hand to provide it.
24. The evidence shows the care provider called for medical advice appropriately when Ms A raised concerns.
25. Paramedics saw Mr X and were content the care home could continue to meet his needs.
26. The coroner has determined the cause of Mr X’s death and it is not the role of the Ombudsman to question that decision.

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Final decision

27. I have discontinued investigation of this complaint as further investigation would not lead to a different outcome for Ms A.

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Investigator's decision on behalf of the Ombudsman