Summary: Miss X complained about the care HC-One Limited provided to her friend Mr Y during his stay at a care home. HC-One Limited was at fault for failing to produce adequate care plans or offer care to meet Mr Y’s needs. This caused Mr Y distress and uncertainty. It was also at fault for failing to consider whether to contact Miss X about Mr Y’s refusal to accept some care. This caused her distress. HC-One will pay Mr Y £200 and Miss X £100 in recognition of that injustice. It has already taken some action to prevent the fault occurring again, but it will also remind staff they must offer the care set out in someone’s care plan and record doing so.

The complaint

1. Miss X is Mr Y’s friend. Miss X complained about how HC-One Limited (the Care Provider) provided personal and catheter care to Mr Y during his stay at a care home. She says this was distressing for Mr Y and meant his health deteriorated.

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The Ombudsman’s role and powers

2. 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)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. 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)
5. 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

6. I have considered:
• all the information Miss X provided and discussed the complaint with her;
• the Care Provider’s comments about the complaint and the supporting documents it provided; and
• the relevant law and guidance and the Ombudsman's guidance on remedies.
7. Miss X and the HC-One Limited 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

Relevant law

8. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
9. Regulation 9 of the Regulations says care and treatment of residents must be appropriate, meet their needs and reflects their preferences. Associated guidance says to do this, care providers should produce a clear care plan.

What happened

10. Mr Y moved into a care home managed by the Care Provider in 2022 for one week’s respite. On the day of his admission, Miss X had a meeting with a senior care worker. She says she explained in depth about Mr Y’s anxiety and how it impacted on how he accepted personal care. The Care Provider produced care plans based on that meeting. They noted Mr Y:
• “requires 1 x carer to help with personal care needs”
• would need help emptying his catheter bag;
• could communicate verbally but would need reassurance due to his anxiety; and
• may experience anxiety attacks.
11. The plans also recorded Miss X as Mr Y’s next of kin.
12. Daily records of Mr Y’s stay show care workers offered him support with his personal care to get ready for bed on two nights. On one of those nights, a care worker returned to offer their support again. Mr Y did not accept any help. Records of the amount of urine Mr Y produced show he was supported to empty his catheter bag several times each day and night throughout his stay. On one afternoon, Mr Y refused help and spilled the bag “everywhere”. There are no records the Care Provider offered Mr Y support to change his clothes until the evening. He refused.
13. Miss X became concerned about Mr Y’s welfare and removed him from the care home after four nights. She said when she collected Mr Y she found the Care Provider had not changed his clothes since he moved in and they were stained with urine from emptying his catheter. Miss X also said the Care Provider had not used any of Mr Y’s night catheter bags. Night bags have a larger capacity for urine than day bags, to account for the amount produced over night. This reduces the likelihood of infection from the bag getting overfull and urine returning to the kidneys.
14. Miss X complained to the Care Provider, which responded to say:
• Mr Y had been very anxious during his stay and was reluctant to accept help with his personal care and catheter;
• staff had repeatedly offered Mr Y support but he had refused;
• it accepted it should have engaged with Mr Y to reduce his anxiety around accepting care and should have tried different approaches;
• in future, it would review its processes for when it admits new residents to make sure staff have comprehensive discussion with residents’ loved ones, including around anxiety;
• it would also share the outcome of the complaint with staff so they could identify if any further actions were needed; and
• it was sorry for the distress Miss X experienced.
15. Miss X remained unhappy and said the Care Provider had not taken the issues she raised seriously. She was also unhappy it had not contacted her when Mr Y refused care. Miss X then complained to the Ombudsman. She told us that Mr Y’s stay in the care home meant his skin was irritated from not being washed and the site of his catheter was bleeding from not being cleaned or changed.
16. In response to my enquiries, the Care Provider said:
• it accepted the information it took from the meeting with Miss X was insufficiently detailed, which meant it missed recording information on how to support Mr Y with his anxiety. Staff should have completed a dedicated care plan for residents who were stressed or distressed;
• when a resident refuses care, staff should record it. They must then speak to a manager and, when appropriate, contact the person’s next of kin;
• following Miss X’s complaint, it discussed the case at several staff meetings;
• it also gave training to the team in the care home Mr Y stayed in as well as several others it manages. The training covered how to carry out needs assessments and complete records when someone is first admitted to a care home; and
• it was organising external training on how to care for residents who are stressed or distressed.

Findings

17. The Care Provider has accepted the care plans it produced on Mr Y’s admission did not include enough detail on his anxiety to allow it to support him to accept care. In addition, it is not sufficient to say that Mr Y needed help with “personal care needs”. That is not enough information to allow the care workers or Mr Y to know what support he could expect to receive to meet his needs. The care plans did not meet the standard required by Regulation 9, which was fault.
18. The Care Provider’s records show staff offered Mr Y some support with his personal care and catheter. But there are no records staff offered Mr Y support with his personal care on two of the nights he was in the home or any of the mornings. There is also no evidence the care workers offered to help Mr Y wash or change his clothing after he spilled urine from his catheter bag onto himself. The Care Provider also did not change Mr Y’s catheter bag from the day to night versions. While care workers supported Mr Y to empty the bag throughout the night to avoid it getting full, Mr Y should have had a night bag when sleeping to reduce the risk of infection. The Care Provider was at fault for failing to offer Mr Y appropriate care to meet his needs, contra to Regulation 9.
19. On several occasions when care workers did offer Mr Y support, he refused it. The Care Provider has accepted staff did not take sufficient steps to encourage Mr Y to accept support or alert managers of the situation. This was fault. Mr X was entitled to refuse help, but when he did, the Care Provider should have considered what steps it should take next.
20. However, I cannot say that but for the faults set out in paragraphs 17 to 19, Mr Y would have accepted the care. The faults therefore caused Mr Y distress and uncertainty over whether his stay in the care home could have been different. They also caused Miss X distress.
21. The Care Provider should also have considered contacting Miss Y, as Mr X’s next of kin, to alert her to his condition and explore whether she would be able to help encourage Mr Y to accept support to meet his needs. Its failure to do so was fault and caused Miss X distress.
22. The Care Provider has carried out suitable steps to prevent some of the fault occurring again, particularly in completing care plans and needs assessments and in caring for residents with anxiety. I have therefore not made recommendations on those points. I have recommended the Care Provider take action to ensure its staff offer all the care set out in someone’s care plan in paragraph 24.

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Agreed action

23. Within one month of the date of my final decision, the Care Provider will:
• apologise to Mr Y for the distress and uncertainty caused by its failure to offer appropriate care to meet his needs;
• pay Mr Y £200 as a symbolic gesture in recognition of the distress he experienced;
• apologise to Miss X for the distress caused by its failure to appropriately support Mr Y and its failure to consider whether to contact her about Mr Y’s refusal to accept care; and
• pay Miss X £100 in recognition of the distress she experienced.
24. Within three months of the date of my final decision the Care Provider will remind its staff they must offer the care in a person’s care plan and record doing so.

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Final decision

25. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice and prevent reoccurrence of this fault.

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Investigator's decision on behalf of the Ombudsman