Summary: Mrs X complains the care provider agreed to care for her and then terminated her care without clear rationale, leaving her and her family in distress. The Ombudsman finds no fault with the care provider for how it assessed Mrs X’s care needs and made the decision to end her care. The Ombudsman finds fault with the care provider for its complaint handling. The care provider has agreed a service remedy.

The complaint

1. Mrs X complains the care provider assessed her needs and agreed to care for her, and then renegued on this agreement after one day.
2. Mrs X complains the care provider provided no clear rationale for changing its mind about being able to care for her or asking her to leave.
3. Mrs X also complains about the care providers handling of the complaint.

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The Ombudsman’s role and powers

4. 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 34B and 34C)
5. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
6. 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)

7. If we are satisfied with an organisation’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

8. I considered the complaint from Mrs X and additional information provided by her representative Mr Y. I also considered information from the care provider. I considered comments from Mr Y and the care provider on a draft of my decision.

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What I found

What happened

9. Mrs X has Alzheimer’s and previously lived at home with her husband, Mr Y.
10. Mr Y contacted the care provider as it was felt that he could no longer help care for Mrs X at home as her needs had become too great.
11. The care provider arranged for a telephone pre-assessment with Mr Y to discuss Mrs X’s care needs and establish whether the care provider could provide residential care to Mrs X.
12. In the preassessment, the care provider asked Mr Y whether Mrs X required support to wash. The provider recorded that Mr Y said that previously Mrs X had refused assistance to wash and had pushed carers away, but this had changed now that actions were being explained to her before being carried out.
13. The pre-assessment also recorded that Mrs X needed some support to stand and be mobile.
14. Also in the pre-assessment, the care provider recorded that on the section about social skills, Mr Y had said that Mrs X was a “sociable person with no behaviour issues, including physical or verbal behaviours and that she is a quiet lady”.
15. The care provider also went through a tour of the home with Mr Y. On the sheet for the tour of the home, there was a section which stated that “we do not have a separate unit for our residents with Dementia, making ours an unsuitable environment for those with physical and/or verbal aggression”.
16. The care provider agreed to arrange residential care in its care home for Mrs X. It arranged that she would arrive on 12 July 2021 with Mr Y to begin her care. Mr Y was informed that Mrs X would be on a four-week trial of the care provider.
17. The day after Mrs X arrived, the care provider contacted Mr Y with concerns that Mrs X had become violent and required significantly more mobility support than was previously discussed.
18. The care provider rang Mr Y again on the 14th July 2021 to say that Mrs X had continued to be violent and that the provider could not care for her needs. It recommended that Mr Y find a care provider who would assess Mrs X and provide specialist dementia and Alzheimer’s care. The care provider gave Mr Y details of potential suitable alternative care providers.
19. Mrs X had an assessment with the new care provider on 15th July 2021, where it was agreed she would transfer to their care. She moved to the new provider on 19th July 2021.
20. Mr Y complained to the Independent health complaints advocacy about the care provider. He complained that it had terminated his wife’s care after one day and without clear rationale.
21. Mr Y also bought his complaint to the Ombudsman.

Analysis

Mrs X’s care

22. As part of my investigation, I have reviewed the assessment completed with Mr Y prior to Mrs X entering the care facility. Although Mr Y told the care provider his wife had previously pushed carers away, he also said that his wife was not physically or verbally violent.
23. In the seven days she was in the care providers care, the care provider recorded that Mrs X had been violent 22 times. The care provider also said it spoke to Mr Y about this and he admitted that his wife had previously been violent, but he had not said this during the assessment as he was concerned people would care for her differently.
24. The care provider’s care notes and records of incidents are consistent and detailed. On balance, I am of the view that Mrs X did not start to become violent on moving into the care providers setting. It was likely that she was struggling with violence prior to her move.
25. By not telling the care provider of her full care needs, the care provider was not able to make a balanced decision about whether it could care for Mrs X. Additionally, the care provider had made it clear to Mr Y that it was not a suitable setting for violent residents prior to Mrs X moving in.
26. The care provider provided details of alternative care providers that would be more suitable for Mrs X. It gave these details to Mr Y soon as the concerns arose and continued to care for Mrs X to the best of its abilities.
27. This was a reasonable approach for the care agency to take, and would have helped identify a suitable placement for Mrs X as soon as possible.
28. I do not consider there to have been fault by the care provider in its care towards Mrs X. It was not fully aware of her needs when it agreed to provide care and had told Mr Y it would not be able to meet her needs if she was violent.
29. When the care provider established it could not meet her needs it gave Mr Y the details for a more suitable setting and helped facilitate the assessment.

Complaint handling

30. When Mr Y bought his complaint to the Ombudsman, he had not complained directly to the care provider about his concerns. Therefore, the care provider had not investigated his complaint.
31. The Ombudsman contacted the care provider and asked if it would be willing to investigate the complaint. The Ombudsman will only consider complaints where the provider has had the opportunity to investigate.
32. The care provider said it would not be investigating. The Ombudsman was satisfied the provider had then been given the opportunity to investigate and had refused.
33. It is not reasonable for care providers to refuse to investigate complaints once it is aware of the complaint. The Ombudsman expects providers to investigate complaints once it has been bought to attention.
34. The refusal to investigate the complaint was fault by the care provider, however this has not caused injustice to Mrs X or Mr Y as they did not complain to the care provider in the first instance, and the Ombudsman has since investigated the complaint.

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Agreed Action

35. Within 12 weeks of the final decision the care provider has agreed to review how it responds to complaints and how it decides when to investigate. This should include how it responds to the Ombudsman.

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Final decision

36. I have now completed my investigation. I find no fault with the care provider for how it decided to end care for Mrs X. I find fault with the care provider for its complaint handling.

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Investigator's decision on behalf of the Ombudsman