Summary: Mrs X complained about the care provided to her mother, Mrs Y, at a Council commissioned care home. The care provider was at fault for not having proper records of the care it gave to Mrs Y. There was also fault in the care it gave to Mrs Y before she went to hospital. This impacted Mrs Y’s dignity and comfort and caused Mrs X distress and uncertainty about the care provided. The care provider has acknowledged these concerns. The Council have agreed to provide Mrs X and Mrs Y with a financial remedy to properly recognise the injustice and take action to improve the care home’s record keeping.

The complaint

1. Mrs X complained about the care provided, by the Council commissioned care provider- Eighton Lodge Residential Care Home, to her mother, whom I shall refer to as Mrs Y. In particular, she complained that:
• Care workers falsified care records.
• Care workers had left her mother sat for a long time in a wheelchair while in distress, and the care records for that day were incomplete.
• Care workers did not call for a GP when they should have.
2. Mrs X says this caused her mother unnecessary suffering and caused them both distress.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended). In this case the care home was commissioned by the Council so was providing services on its behalf.
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)
6. 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

7. I have considered the information Mrs X sent us.
8. I considered the responses submitted by the care provider and the Council.
9. I considered the fundamental standards which are incorporated in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
10. Both Mrs X and the Council had the opportunity to comment on my draft decision and considered any comments before I made my final decision.

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What I found

What should have happened

11. 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.
• Regulation 10 sets out that service users must be treated with dignity and respect. Staff must respect people’s personal preferences, lifestyle and care choices.
• Regulation 12 is about safe care and ensuring people are receiving care that avoids them coming to harm or risk of harm.
• Regulation 14 is about meeting nutritional and hydration needs. Providers must make sure people have enough to eat and drink to meet their nutrition and hydration needs and receive the support they need to do so.
• Regulation 17 is about good governance. This includes keeping accurate, complete and detailed records about people receiving care, including records of care provided and decisions made about care.

Background

12. Mrs X told us Mrs Y has advanced dementia. She told us she was cared for at the home she complains about, between September and December 2021, until she went into hospital.

What happened

13. Mrs X told us she had concerns about care provided to Mrs Y. She told us she would find drinks placed out of her reach, and care workers had not always properly washed Mrs Y or visited her in good time.
14. Mrs X says she and another member of her family were present during one visit in October, and the care worker recorded they had checked Mrs Y’s incontinence pad, which Mrs X said did not happen.
15. Mrs X said she then raised a complaint with the care providers about this and other concerns she had.
16. The care provider wrote back to Mrs X telling her they had investigated her concerns. It told Mrs X it accepted the care provided on occasions was later than it should have been, and washing standards were below their expectations.
17. The care provider apologised for this and told Mrs X it would work with their staff to improve Mrs Y’s care.
18. Mrs X was unhappy with this response because it had not considered the visit that she said the care workers had wrongly recorded.
19. In a further response, the care provider told her it could not rule out that a staff member had wrongly recorded their actions at the visit. It also said they were moving from paper-based records to electronic records.
20. Mrs X gave us information that Mrs Y’s health was worsening from late October onwards. She said the GP and other health care professionals were then regularly visiting Mrs Y.
21. Mrs X visited Mrs Y in mid-December and as she came into the home, saw Mrs Y was sat in a wheelchair in the foyer area. Mrs X says she saw Mrs Y had no blanket and her nightdress was above her knees. Mrs Y says she saw a care worker then move Mrs Y back to her room.
22. Mrs X then went back with Mrs Y to her room, she found her to be unwell and had difficulty speaking. Because Mrs X was concerned, she asked the staff to contact Mrs Y’s GP.
23. Shortly after this, the GP visited and examined Mrs Y. They recorded that Mrs Y looked ‘waxy and unwell’ and had not passed any fluids that day. The GP asked for Mrs Y to be seen by the ambulance service, who later took Mrs Y to hospital.
24. Mrs X was concerned staff had not called for a GP earlier. She was also unhappy to have found Mrs Y had been sat for a long time, in a wheelchair, where she was not able to properly rest. Mrs X made a further complaint.
25. In their first response about this concern, the care provider said because Mrs Y had vomited earlier, a staff member had thought it ‘appropriate’ to keep Mrs Y nearby to allow for increased monitoring. The care provider did agree it would have been better if they had given Mrs Y a proper seat so she would have been more comfortable.
26. The care provider also accepted Mrs X’s concerns about the way Mrs Y was dressed and agreed Mrs Y would be more comfortable and ‘dignified’ had the care workers given her a blanket.
27. In its response to our request, the Council provided records of Mrs Y’s care that day. Mrs X also provided us with the daily record of food and drink that day.
28. The daily care chart has a record of Mrs Y being in a wheelchair, in a downstairs area from midday until 3pm. The care notes have an entry recorded at 6.51am and then nothing else recorded, until 9.52pm, which says Mrs Y went to hospital around 9pm.
29. The food and drink record for that day has a record of three drinks provided during the breakfast period only.
30. In one of its complaint responses to Mrs X, the care provider said the care notes had no updates because Mrs Y was continuously in the foyer area. It accepted it should have made a record of care.
31. The care provider apologised it had not given Mrs Y a blanket while she was downstairs. It also said they would not normally call for a GP after one episode of vomiting.
32. In its response to our enquiry, The Council said they had an expectation the care notes should have been kept up to date on the day. It also said the care records should have included Mrs X’s request for a GP.

My findings

33. In response to an earlier complaint, the care provider acknowledged some checks were completed late and there had been some issues with Mrs Y’s personal care. It apologised for this. This was appropriate.
34. When Mrs X visited the home in December, Mrs Y was in the communal area of the home, in her wheelchair and had been there for several hours. The care provider acknowledged they should have placed Mrs Y in a proper chair so she could rest, and they should have given her a blanket for her personal dignity. That is fault which could have caused Mrs Y discomfort and impacted her dignity.
35. One of the standards of care is to meet nutritional and hydration needs. There is no evidence the care provider gave or tried to give Mrs Y any food or fluids other than at breakfast. That is fault and leaves uncertainty over whether Mrs Y ate or drank anything further that day.
36. The standard of care about good governance emphasises the importance of keeping proper care records and decisions about care.
37. The care provider told Mrs X that staff decided to keep Mrs Y close at hand because she had vomited earlier that day. There is no record of this decision or a note to say when Mrs Y vomited. That is fault and this fault was compounded by Mrs X’s concerns about the accuracy of records previously.
38. Mrs X feels the care provider should have called for a GP earlier. I cannot make a finding on this because I have not been given any information about what the staff knew about Mrs Y’s condition. I have considered the care provider was aware of the general worsening of Mrs Y’s health leading up to this point and was monitoring her condition.
39. The faults highlighted will have caused Mrs X distress because she is now uncertain about the quality of care the home was giving Mrs Y. This has caused Mrs X an injustice. The Council should provide a financial remedy as a symbolic payment to properly recognise the injustice caused to Mrs X and Mrs Y.

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Agreed action

40. When a council commissions another organisation to provide services on its behalf, it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of the care provider, I have made recommendations to the Council.
41. Within six weeks of the date of my final decision the Council should:
• Make a payment of £150 to Mrs X to recognise the avoidable distress and uncertainty she experienced in the standards of care provided.
• Make a payment of £150 to Mrs Y to recognise the discomfort and distress she experienced as a result of poor care.
• Satisfy itself the care provider has reminded staff of the importance of accurate record keeping to prevent any reoccurrence of the fault.

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Final decision

42. There was fault in the care provider’s record keeping and standards. This caused an injustice for which I have recommended a remedy and service improvement.

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Investigator's decision on behalf of the Ombudsman