Summary: We will not investigate Mrs X’s complaint about respite care provided to her late husband, Mr X. That is because we are unlikely to add anything further to the Council’s investigation.

The complaint

1. Mrs X complained about the care her husband, Mr X received, after he received two weeks respite in a residential home (the Home). She said the Home:
• Used a wheelchair for transfers despite Mr X being mobile.
• Used incontinence pads during the day, despite Mr X being continent.
• Failed to ensure Mr X ate and drank enough.
• Did not recognise Mr X had a urinary tract infection (UTI).
• Allowed Mr X to develop a pressure sore to his heel.
2. Mrs X was also unhappy about how the Council completed the safeguarding meeting after she raised her concerns. She said she could not challenge the information the Home provided.
3. Mrs X wants the Council to uphold more of her complaints. She also does not feel she should have to pay for respite care that was neglectful.

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The Ombudsman’s role and powers

4. The Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or may decide not to continue with an investigation if we decide:

• we could not add to any previous investigation by the organisation, and
• further investigation would not lead to a different outcome.

(Local Government Act 1974, section 24A(6))

5. Where someone has died, we will not normally seek a remedy for injustice caused to that person in the same way as we might for someone who is still living. We would not expect a public or private body to make a payment to someone’s estate. Therefore, if the impact of a fault was on someone who has died, we will not recommend an organisation make a payment in recognition of, for example, the impact of poor care that person might have received while they were alive. This is because the person who received the poor care cannot benefit from such a payment.

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How I considered this complaint

6. I considered information provided by the complainant and the Council.
7. I considered the Ombudsman’s Assessment Code.
8. The complainant had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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My assessment

9. Mr X had a two-week period of respite at the Home at the start of 2021. On the day he returned home, Mrs X said he was struggling to mobilise and his urine smelt strongly. Later that evening, Mr X was admitted to hospital after he fell out of bed.
10. Mrs X contacted the Council with concerns about the care he received at the Home. The Council arranged a virtual strategy meeting to discuss the concerns. It decided to complete safeguarding enquires. Mrs X subsequently complained to the Council.
11. The Council responded to Mrs X in April 2022. It said its safeguarding enquiry had:
• substantiated her concern about the use of incontinence pads;
• partially substantiated her concern about Mr X’s fluid and food intake; and
• partially substantiated her concern the Home did not detect Mr X had a UTI.
12. The Council provided explanations for its findings and set out recommendations it had made to the Home.
13. It did not uphold the complaint about Mr X’s mobility deteriorating whilst at the Home. It said a wheelchair had been used on one occasion and it might have been used if Mr X were tired when walking back to his room.
14. In respect of the pressure sore, it said the Home had recorded Mr X’s skin as healthy. The Council said it had spoken to a Tissue Viability Nurse who had said such a sore could develop within an hour. The Council could not conclude whether the sore had developed at the Home or following his admission to hospital.
15. The Council acknowledged Mrs X felt she did not have the opportunity to speak at the initial strategy meeting. It apologised for the Social Worder not contacting her after the meeting and said it had recommended this happen in future.
16. Although Mrs X is dissatisfied the Council had not upheld all her concerns about the Home, further investigation by the Ombudsman is unlikely to lead to a different outcome. The Council has considered information provided by Mrs X and the Home. It has also sought specialist advice as necessary. The Council has made recommendations for improvement where it identified fault. We could not add anything to the previous investigation.

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Final decision

17. We will not investigate this complaint. This is because further investigation by the Ombudsman is unlikely to lead to a different outcome.

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Investigator's decision on behalf of the Ombudsman