Summary: Mrs C complains the Care Provider was not transparent over care fees and failed to provide suitable care to Mr C which resulted in a decline in his health. The Care Provider is at fault for failing to keep full contemporaneous records about the support it provided Mr C and for failing to properly consider his communication needs. To remedy the uncertainty, anxiety and distress these actions caused Mr C and Mrs C, the Care Provider has agreed to apologise to Mr C and Mrs C, pay £300 to Mr C and £150 to Mrs C. It will review how it documents daily living activities and communication needs. It will also remind staff and provide staff training about recording and how to support people with communication needs.

The complaint

1. The complainant, who I call Mrs C, complains in her own right and on behalf of her husband, who I call Mr C.
2. Mrs C complains Care UK Community Partnerships Limited, the “Care Provider”:-
1. gave conflicting and incomplete information about care costs;
2. did not provide activities for Mr C to engage in;
3. lost clothing;
4. did not provide suitable care.
3. Because of these failures Mrs C does not consider Mr C received value for money. She also says Mr C’s health declined because of the Care Provider’s failure to provide suitable care.

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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 spoke with Mrs C and considered information she provided. I made enquiries of the Care Provider and asked it several questions. I considered the Care Provider’s response and the following:-
• care records;
• contract between the Care Provider and Mrs C;
• communication before Mr C’s placement;
• The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences. I have used the fundamental standards as a benchmark for considering this complaint.
7. Mrs C and the Care Provider had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Background information

8. Mr C lives with his wife Mrs C who provides support to meet his care needs. Mrs C needed respite for Mr C while their bathroom was refitted. Mrs C used a third party home finder who helped her choose Halecroft Grange. At the time it was part of Sunrise Senior Living. The Care Provider took over in November 2021.

What should have happened

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.
10. Regulation 9 “Person Centred Care” says care providers should “enable and support relevant people to make or participate in making, decisions relating to the service user's care or treatment to the maximum extent possible…”.
11. Regulation 10 care providers must make sure that they provide care and treatment in a way that ensures people's dignity and treats them with respect at all times. This includes making sure that people have privacy when they need and want it, treating them as equals and providing any support they might need to be autonomous, independent, and involved in their local community.
12. Regulation 17 says care providers should “maintain securely an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided.”
13. Regulation 19 says care providers must make written information available about any fees, contracts and terms and conditions, where people are paying either in full or in part for the cost of their care, treatment, and support.

What happened

14. Mrs C used a third party agency to find a place for Mr C. At first there was confusion about the cost of the placement. This included whether an offer of three weeks of respite for the price of two was available and the actual price of the room. There was a difference of £200 depending on the room type and a higher weekly cost because the placement was short term. Mrs C chose a private room with a private bathroom which cost £1753 per week.
15. Mrs C signed a contract which detailed the costs of the care. Mrs C says the care costs kept rising and she had no option but to sign the contract as building work was due to start the next day to coincide with the care.
16. The Care Provider completed a care plan which says:-
• Communication, “I am able to verbalise my needs, wishes, requests and emotions using simple language. I am able to understand your request but will only respond with yes/no”.
• Preferred activities, “My activity and interaction preferences include playing cards, quizzes, word searches, exercise and football.”
17. In response to my enquiries the Care Provider says,
• “Mr C (sic) was offered to join in all activities in the evening this being the pub quiz. Mr C (sic) attended the quiz which began at 7pm with our activities team. we (sic) also have in the bistro area of the reminiscence neighbourhood residents not ready to retire to their room support and a drink of their choice and a social chat with others before day staff finished at 8pm which Mr C (sic) did take part in. There is a TV in the main lounge showing sporting events/news and activities team would also use for film nights.
• During Mr C’s (sic) stay he made informed choice around his evening activities and what time he would like to retire to bed.”
18. The care home’s daily records consist of coded entries. They allow for a free text narrative. During Mr C’s stay the care home records that he watched TV, had a trip out and joined in with music, arts, and crafts. In its response the Care Provider says Mr C would watch group activities, if he was called he would join in for a few minutes and then withdraw. It also says, “After trying to encourage Mr C (sic) to do activities, it became clear he would join in for 10/20 minutes before no longer interested or walking away”.
19. Mrs C says Mr C can only communicate by saying “yes” or “no”. Mr C finds communicating stressful and will cough when anxious. Mrs C says it would be difficult and stressful for Mr C to join in group activities without support especially if the activity needed him to communicate.
20. In response to Mrs C’s complaint the Care Provider accepted there were missing items. This included a bath sheet, medicine dispensing syringe, plastic protective pants, boxer shorts, rugby shirt and T-shirt. The Care Provider has agreed to repay the costs of these items if Mrs C provides information about the cost.
21. Mrs C says the loss of these items caused her time and trouble. She had to make emergency arrangements for a new medicine dispensing syringe as soon as Mr C returned home.
22. Mrs C says Mr C’s health and well-being declined to such an extent that when he returned from the care home he could no longer go to his usual day centre.

Is there fault causing injustice?

23. A third-party agency arranged the care home including relaying information about the care costs. It was up to the agency to provide Mrs C with the relevant information for her to make an informed decision. While I understand Mrs C feels she had no choice but to sign the contract because of the timings, she agreed to the costs, terms and conditions of the placement. I therefore find no fault in this part of the complaint.
24. The Care Provider accepts it lost several items. This is fault. The Care Provider has agreed to pay Mrs C for the cost of these items. This offer is welcomed. Mrs C also had time and trouble in getting new items in particular the medicine syringe which she needed urgently.
25. The care records provided include insufficient narrative about the activities Mr C took part in, the support carers provided, and the difficulties Mr C had. This is not in line with Regulation 17 detailed above and is fault.
26. Mr C has communication needs. There is no care plan about how care staff should support Mr C with his communication, and what communication methods to use so he could fully engage in activities. The failure to adequately record is fault and not in line with Regulation 17.
27. The Care Provider has since provided statements from carers about how they encouraged Mr C to take part in activities. The statements do not however reflect a person centred approach about how to encourage or involve Mr C more in activities given his communication needs and that this was his first time in residential care. This is fault and a potential breach of Regulations 9 and 10.
28. Mrs C says that Mr C’s health declined because of the Care Provider’s actions. I cannot say there is a causal link between the actions of the Care Provider and Mr C’s health. Nor can I say but for the faults identified Mr C would have joined in more activities the care home offered. There is however uncertainty about what effect, if any, the care home’s actions had on Mr C which has affected both Mr C and Mrs C. Mrs C has also had the time, trouble, and anxiety of dealing with the complaint.

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Agreed action

29. I consider there was fault in the Care Provider’s actions which caused Mr C and Mrs C injustice. The Care Provider has agreed to take the following actions to remedy the complaint:-
1. apologise to Mr C and Mrs C for the failures I have identified in this statement;
2. pay £300 to Mr C and £150 to Mrs C in recognition of the uncertainty, time and trouble these faults have caused Mr C and Mrs C;
3. pay Mrs C £100 so she can replace the lost items;
4. I am aware the Care Provider has taken over this care home in the last nine months and is taking action to ensure its recording is in line with its usual recording practices. The Care Provider has agreed to evidence that staff know when and how to use the narrative sections if the current system continues; or provide evidence staff have and are trained in any new recording system which allows a narrative as part of the recording;
5. remind staff and if appropriate provide staff training about the importance of compiling communication plans for people who have communication difficulties;
6. remind staff about the importance of maintaining people’s possessions and review whether the systems in place are sufficient as far as possible to prevent reoccurrence.
30. The Care Provider should complete (a) to (c) within one month of the final decision and (d) to (f) within three months of the final decision.

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Final decision

31. I have found fault in the actions of the Care Provider. I consider the agreed actions are suitable to remedy the complaint. I have now completed my investigation and closed the complaint.
32. 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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Investigator's decision on behalf of the Ombudsman