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Fridhem Rest Home Limited (21 005 332)

Category : Adult care services > Residential care

Decision : Upheld

Decision date : 14 Mar 2022

The Ombudsman's final decision:

Summary: Mrs B complained about the care Mrs C received during the last few months of her life. She also complained about restrictions on visiting arrangements for the family. We found fault with some of the personal care Fridhem failed to provide. Fridhem apologised to Mrs B and her family and this was a sufficient remedy for the injustice.

The complaint

  1. Mrs B complained on behalf of her mother Mrs C. She complained about the care Mrs C received in Fridhem Rest Home before she passed away in May 2021.
  2. Mrs B complained Fridhem:
  • restricted visiting times during lockdown
  • failed to involve medical professionals sufficiently in Mrs C’s care
  • failed to provide pain relief medication during end of life care
  • failed to have a clear end of life plan; and
  • provided insufficient personal care in relation to Mrs C’s foot care.
  1. Mrs B said this caused Mrs C pain and distress in the final weeks of her life. She also said the lack of visits contributed to Mrs C’s decline in health.

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The Ombudsman’s role and powers

  1. 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)
  2. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:
  • their personal representative (if they have one), or
  • someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

  1. We normally expect someone to complain to the Care Quality Commission about possible breaches of standards. However, we may decide to investigate if we think there are good reasons to do so. (Local Government Act 1974, section 34B(8), as amended)
  2. This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. We can consider whether the care provider followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.
  3. 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)
  4. 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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How I considered this complaint

  1. I considered the information Mrs B provided with her complaint. I made enquiries with Fridhem and considered its response along with relevant law and guidance.
  2. Mrs B and the Fridhem had an opportunity to comment on my draft decision. I carefully considered any comments received before making a final decision.

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What I found

Law and guidance

  1. The Health and Social Care Act 2008 established the Care Quality Commission (CQC) as the regulatory body for adult social care providers. The CQC produces guidance explaining how care providers should comply with the section 20 regulations (regulated activities) of the Health and Social Care Act 2008.
  2. The CQC has published guidance on meeting the fundamental standards expected of care providers. Care and treatment must reflect the needs and preferences of residents, who must be treated with dignity and respect. Care providers must meet resident’s nutritional and hygiene needs and protect them from abuse. We consider this guidance when deciding complaints about poor standards of care.

What happened

  1. What follows is a brief chronology of key events. It does not contain all the information I reviewed during my investigation.
  2. Mrs C was a resident at Fridhem from 2018. She had dementia and required help with all her personal care needs.
  3. Until April 2021 Mrs C was able to eat, drink, take oral medication and take part in social activities.
  4. Fridhem became concerned about a deterioration in Mrs C’s dementia and health in late April/ early May 2021. Mrs C started to have difficulty swallowing. This affected her ability to eat, drink and take medication.
  5. In early May 2021 Fridhem made some of Mrs C’s family essential care givers. This allowed them to have unrestricted visiting provided they complied with COVID-19 testing and personal protective equipment (PPE) guidelines.
  6. The GP referred Mrs C to the mental health service about her worsening dementia. They also referred her to the speech and language therapy (SaLT) service about her difficulty swallowing.
  7. At the end of May 2021 Mrs C’s condition deteriorated and she sadly passed away.
  8. Mrs C’s family were unhappy with the visiting arrangements and some of the care Mrs C received in the last months of her life. They complained to us and made Fridhem aware of the complaint.
  9. Fridhem responded to the complaint but the family remained unhappy so we investigated.

My findings

  1. I have set out my findings under each of Mrs B’s complaint headings below.

Fridhem restricted visiting times during lockdown

  1. I did not find fault with Fridhem for the way it restricted visiting with Mrs C.
  2. Guidance on visits from relatives to care homes was published in July 2020 and updated several times during the pandemic. It said care providers should ensure policies on visiting and decisions about this were based on an assessment of risk. It said care providers should minimise risk wherever possible considering the circumstances of the care home, individual residents and other local circumstances.
  3. My investigation focussed on events in 2021. At the beginning of 2021 Fridhem experienced a COVID-19 outbreak that affected residents and staff. It was necessary to stop in person visits. Contact between residents and families was by phone call or zoom.
  4. Between February and March 2021 there was regular correspondence between the family and Fridhem about visiting arrangements. Fridhem responded to all the families questions and tried to explain its policy and decision making about visiting.
  5. Between April and May 2021 the family were able to visit Mrs C in person at Fridhem. They did so regularly. Fridhem tried to accommodate the family’s visiting requests whilst balancing the COVID-19 risks and the needs of other residents and families.
  6. At the end of April 2021 the family met with Fridhem staff and discussed Mrs C’s health and visiting arrangements in more detail. Following this meeting Fridhem agreed to get advice from the Council about allowing essential care giver status for some family members.
  7. The Council responded in early May 2021. Fridhem wrote to the family and told them some family members could become essential care givers. This meant these visitors did not have time restrictions.
  8. I understand the family found it incredibly hard not being able to see Mrs C for long periods of time and then having restrictions on the time they could spend with her. I do not underestimate how distressing this must have been.
  9. I have no doubt Mrs C’s dementia was negatively affected by the lockdowns, isolation and restricted visiting. But, that does not mean there was fault by Fridhem.
  10. I found Fridhem acted in the best interests of the residents during what must have been an extremely challenging time. They were faced with everchanging guidelines and risk in a situation they had never previously experienced.

Fridhem failed to involve medical professionals sufficiently in Mrs C’s care

  1. I did not find fault with Fridhem. There was no evidence Fridhem failed to involve medical professionals in Mrs C’s care when it needed to.
  2. There was evidence Fridhem regularly contacted medical professionals if it had concerns about Mrs C’s health.
  3. In February and March 2021 Fridhem contacted the GP surgery about various health concerns and Mrs C was prescribed medication.
  4. In April 2021 Fridhem contacted the GP surgery. It requested a pain review and reported a decline in Mrs C’s dementia.
  5. At the end of April/ beginning of May 2021 Fridhem were concerned Mrs C was having trouble swallowing so it contacted the GP surgery again. It requested a pain and medication review.
  6. Fridhem was then in regular contact with medical professionals until Mrs C passed away at the end of May 2021.

Fridhem failed to provide pain relief medication during end of life care and failed to have a clear end of life plan.

  1. I did not find fault with Fridhem for the end of life care it provided to Mrs C.
  2. Mrs C was prescribed pain relief by the GP, and this was administered by Fridhem staff. Fridhem requested both pain and medication reviews from the GP surgery.
  3. A few days before Mrs C passed away Fridhem said it asked the family if they would give permission for it to contact Mrs C’s GP for anticipatory medication before the weekend. It said at that point Mrs C appeared comfortable so the family said it could wait until after the weekend. Mrs B disagreed. She said this conversation did not take place. I am not able to make a finding on this point. It is about a conversation that is alleged to have happened and which Mrs B disputes.
  4. In response to my enquires Fridhem said:

“… if we have concerns for them (resident), we act on it, we should not be requesting permission to act”

Mrs B also said:

“Ultimately, it’s Fridhem’s responsibility as (Mrs C’s) Care Provider to make sure she was comfortable, to get medical support teams in to administer pain relief”

  1. When Mrs C’s condition worsened on the Sunday evening Fridhem contacted the out of hours service. I did not find Fridhem delayed or prevented Mrs C receiving pain relief when she appeared to need it.
  2. Mrs C had a care plan. In it Fridhem had recorded Mrs C’s wishes for her end of life care.
  3. Mrs B says Fridhem failed to discuss Mrs C’s end of life care with the family. Fridhem says it tried on several occasions, but the family did not respond. I am unable to resolve this issue or make a finding on this point.

Fridhem failed to provide sufficient personal care in relation to Mrs C’s foot care

  1. I found fault with Fridhem for failing to carry out sufficient foot care and failing to keep complete accurate records in respect of this issue.
  2. Regulation 9 of the Health and Social Care Act 2008 says care providers must make sure each person receives appropriate person-centred care and treatment that is based on an assessment of their needs and preferences.
  3. Regulation 17 of the Health and Social Care Act 2008 sets out guidelines for governance. As part of this regulation, care providers must securely maintain accurate, complete and detailed records in respect of each person using the service.
  4. When Mrs C passed away in May 2021 her toenails were so long they had curled over and were digging into her skin.
  5. The family included this in their complaint to Fridhem. In its response Fridhem told the family they could have requested Mrs C’s nails were cut at anytime. Mrs B said they only noticed the toenails during the last few days of Mrs C’s life when they were caring for her. Prior to this they had not reason to check and assumed it was being done as part of her personal care needs.
  6. Fridhem have no records of toenail care for Mrs C in 2021. The chiropody records are from January to August 2020.
  7. In March 2021 two Fridhem staff raised concerns about Mrs C’s toenails and asked for them to be cut. There was no record this was done and the length of the nails in May 2021 suggest it was not. In one of the case recordings it said Mrs C complained her feet were sore.
  8. In response to my enquiries Fridhem said Mrs C did not like having her toenails cut and it could be very challenging. However, there were no records of any unsuccessful attempts. There were also no records of contact with a chiropodist/ podiatrist. Fridhem did not discuss this issue with the family to ask for their support either.
  9. Fridhem failed to meet Mrs C’s needs in relation to her footcare. The evidence suggests this could have caused her pain and discomfort. It also caused the family distress when they saw Mrs C’s toenails during the last days of her life.
  10. Fridhem has apologised for failing to cut Mrs C’s toenails. It also made changes to the way it records footcare. It created a footcare plan on its new case recording system. This is a sufficient remedy. I am unable to remedy the injustice to Mrs C.

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Final decision

  1. I found fault causing injustice. I completed my investigation.

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Investigator's decision on behalf of the Ombudsman

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