Summary: Mr X complained that he was refused admission to Gracewell of Woking care home on the day he was due to move in. He was told this was because of his HIV status which he had disclosed months previously and which he did not need to disclose. This caused him shock and devastation and he had packed up his life ready for moving. We find the Care Provider caused significant injustice; it did not communicate adequately with Mr X and did not deal properly with his complaint about this. We recommend the Care Provider apologise and pay Mr X £500 and take action to avoid similar problems in future.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains that Care UK Community Partnerships Limited (the Care Provider):
• Offered him a place at Gracewell of Woking (Greenview Hall) care home, knowing his HIV status.
• Did not advise him that he could not move there until the day of his planned move there.
• Stated its Charter did not allow people with HIV to live there yet kept him on the waiting list for a future place.
• Did not respond adequately to his complaint about this.
2. Mr X had packed and sorted out his affairs ready for the move and says he was shocked and devastated when he was refused admission. He was further offended by the lack of communication with him about this.
3. While the Care Provider is now responsible for dealing with this complaint, these events took place before the Care Provider took over the home in February 2022. The home was then called Gracewell of Woking. I have referred to the original organisation as Gracewell of Woking throughout this statement for clarity.

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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 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

6. I considered information from the Complainant and from the Council.
7. I sent both parties a copy of my draft decision for comment and will take account of the comments I receive in response.

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What I found

Background

8. The NICE social care guideline SC1 – “Managing medicines in care homes”, published 14 March 2014, says: “Care home staff (registered nurses and social care practitioners working in care homes) should assume that a resident can take and look after their medicines themselves (self-administer) unless a risk assessment has indicated otherwise (see recommendation 1.13.2)” (1.13.1)

What happened

9. Mr X says he was on the waiting list for Gracewell of Woking for some months, having initially enquired in June 2021 and made his HIV status clear. Gracewell of Woking received his medical records in mid July 2021, in which his HIV status was also clear.
10. Gracewell of Woking offered Mr X a place from 22 September 2021. The deputy manager assessed him on 13 September when he was told a place was available immediately. Mr X subsequently agreed to bring forward his admission date to 15 September and on that day, he was refused admission. Mr X says his representative was told that this was because of his HIV status and that Gracewell of Woking’s Charter did not allow people with HIV to be resident.
11. Two days later, Mr X complained to Gracewell of Woking.
12. The following week, Mr X’s consultant physician telephoned and emailed Gracewell of Woking about Mr X’s situation. Gracewell of Woking replied to the email. It said it had declined admission to Mr X because it was waiting for confirmation from its Regional office that it could provide support for Mr X given his HIV. It also needed further information on Mr Y’s condition and long term care pathway and its policy did not allow self medication. The consultant physician replied advising there was no specific guideline or care pathway required for Mr X and that he self medicated without problem. They noted that if Mr X had not disclosed his HIV status, as he was not required to do, his admission would have gone ahead without problem. They also provided a copy of the National AIDS Trust guide for care providers which includes a reference to the NICE guideline SC1.
13. Gracewell of Woking wrote to Mr X, the letter is undated, and cited “unforeseen circumstances” which led to his admission being refused. It did not mention self medication issues. Mr X wrote further in October but received no response.
14. In November, the National AIDS Trust (NAT) wrote to Gracewell of Woking about Mr X’s situation and concerns about its approach to people with HIV. In December, Gracewell of Woking wrote to the NAT advising that admission was refused as Mr X was self medicating. It was also waiting for information to inform a long term care plan. The NAT responded and noted that this explanation differed significantly from both the information he was given at the time and that in the written response to his complaint. It said it was unclear why Mr X had now been offered a place if they could not take self medicating residents. It also referred Gracewell of Woking to NICE guideline SC1 (see paragraph 8).
15. In April 2022, the Care Provider (Care UK Community Partnerships Limited), wrote to Mr X with a formal response to his complaint. It said there were, and still are, no concerns around accepting HIV-positive residents into Gracewell homes. However, Mr X was self medicating and wanted to continue this. Under the Gracewell of Woking policy, it could not accept self medicating residents. The home manager was advised by the care and quality team, to organise a long term care pathway plan for Mr X. The Care Provider says Mr X asked to move in sooner. The decision to decline this was based on the self medication policy and that there was not enough time to put in place training for staff to meet Mr X’s care. If Mr X had agreed for staff to administer his medication, he would have been accepted. It says Mr X did later confirm he was happy for staff to administer his medication and he was immediately placed back on the waiting list.
16. The Care Provider says it does not have access to the old Gracewell policies but confirms the policy was to not allow residents who self medicated. It also confirms there were no residents in Gracewell homes that were self medicating. It says it has since implemented weekly discussion groups to discuss GP summary reports in detail before it plans any move-in. It also says it is implementing a new policy around self medication.
17. The Care Provider offered Mr X a room at the end of January 2022 but he was not sure if he was ready to move in.

Did the Care Provider cause injustice?

18. Mr X had come to terms with a difficult change in his life and was prepared to move into the Gracewell of Woking care home. When he was refused admission and given to believe this was because of his HIV status, he was “shocked” and “devastated”. Mr X was not told he couldn’t move in on the 15 September but would be fine on 22 September if he would allow staff to administer his medication. He was told he could not move in because of his HIV. I am satisfied this caused him significant, undue stress, anxiety, confusion and inconvenience. It is fortunate that he was able to stay in his home.
19. Having made the decision not to admit Mr X, and having received his complaint, Gracewell of Woking did not write to him with an apology and clear explanation for the events. It added more uncertainty by advising that the refusal was due to “unforeseen circumstances” and then did not respond to his next letter. However, when Mr X’s consultant and NAT challenged its actions, it did write and explain in some detail about why it had taken this action. I consider this demonstrates a lack of respect and dignity in the way it treated Mr X.
20. I accept that the self medicating policy was the core reason behind the refusal, but I am concerned this became an issue so late in the admission process. Gracewell of Woking should already have addressed this before offering Mr X a place. I am reassured to note the discussions the Care Provider has since implemented which hopefully will ensure similar problems do not arise again.
21. The self medicating policy did not reflect good practice and the Care Provider should ensure this is quickly addressed. I am pleased to note a trial of a new policy though I do not know what the policy is. In order to reflect good practice, the policy should follow the recommendations of NICE guideline SC1.
22. I recognise the Care Provider already has some of the work I have recommended underway, which is to be commended. However, I have made these recommendations so we can be clear the work has been completed and addresses the cause of injustice in this complaint.

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Agreed action

23. To remedy the injustice caused to Mr X, I recommend the Care Provider:
• Apologise for the lack of adequate communication with Mr X as noted above;
• Pay Mr X £500 to recognise the injustice it caused;
• Review its communication processes to ensure people are given clear offers in writing and clear explanations for any refusals also in writing. All admission arrangements should be confirmed in writing.
• Review its complaints process to ensure a full response is provided to the complainant in accordance with good practice.
• Review its self medicating policy to ensure this also reflects good practice and the NICE guideline SC1 in particular.
• Complete the first two recommendations within one month of my final decision, and the rest within three months. Submit evidence to me of this. Suitable evidence would include:
1. Copy of the apology.
2. Confirmation of the payment.
3. An action plan showing action taken on the remaining recommendations.

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Final decision

24. I have completed my investigation. The actions I have recommended will remedy the injustice as far as possible.

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Investigator's decision on behalf of the Ombudsman