Summary: Mrs B complained on behalf of Mrs C that the Council had placed Mrs C in a nursing home where she did not receive adequate care resulting in admission to hospital. We have not found fault with the actions of the Council.

The complaint

1. Mrs B complained on behalf of Mrs C that Sandwell Metropolitan Borough Council (the Council) placed Mrs C in Ash Lodge Nursing Home where she did not receive adequate care resulting in two admissions to hospital in March and August 2022. This caused Mrs C and her family significant distress.

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The Ombudsman’s role and powers

2. 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)
3. 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

4. I have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. Mrs B and the organisation 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

5. Mrs C has dementia, multiple sclerosis (MS) and lupus, which are all progressive conditions. In March 2021 she moved into Ash Lodge Nursing Home (the Home). When she moved into the Home she was able to sit in the lounge and interact with other residents. She could also walk short distances with support.
6. The Home’s records show that it carried out a number of risk assessments when Mrs C arrived and reviewed them on a monthly basis.
7. In December 2021 the physiotherapist recommended Mrs C use a zimmer frame with assistance from two people to mobilise short distances. They visited twice more in December and recommended a different type of frame.
8. By February 2022 Mrs C needed to be supported at all times by two carers. The physiotherapist visited again and recommended use of a zimmer frame with two people for chair transfers only. She needed a wheelchair for any distance.
9. During this time Mrs C’s MS declined causing incontinence and affecting her ability to sit. Her Lupus also deteriorated and severely affected her skin. The Home was in regularly contact with Mrs C’s GP about treatment for this and a community matron specialising in tissue viability was also involved in her care. The records show there were detailed wound treatment plans and nursing care plans to manage the skin problems. The pressure area risk assessment showed a deterioration in skin integrity from late 2021, moving from moderate risk to high and very high risk.
10. The Home also noted she had lost a lot of weight. Staff referred Mrs C to the MS nurse and the dietician for nutritional supplements. These actions were detailed in the nutritional risk assessment and records.
11. In March 2022 the GP noted the Lupus was deteriorating and attacking Mrs C’s own skin tissue causing severe discomfort. On the advice of the GP, the Home started using a long-term catheter to try and ease the impact of the incontinence on the skin condition. Unfortunately, Mrs C regularly pulled out the catheter which had to be reinserted. In mid-March the Home contacted the GP about a possible urinary infection. They recommended she go to hospital, where she stayed for a week.
12. By April 2022 the physiotherapist recommended caring for Mrs C from bed as transfers were now unsafe. She needed three people for support when standing and could not be left unattended in a wheelchair.
13. Mrs C’s social worker met with Mrs B and another family member. The family blamed poor care by the Home for Mrs C’s admission to hospital. The nurse from the Home explained that it was Lupus attacking the skin tissue and not pressure sores from wet pads. The nurse recommended the family speak to the GP to discuss the condition. The social worker considered Mrs C was well looked after.
14. In May 2022 the physiotherapist reviewed Mrs C with Mrs B and another family member present. The physiotherapist noted the MS and Lupus had got worse and staff needed to use a hoist and sling for transfers. They also said they would continue to do exercises with Mrs C. The records show Mrs C had several exercise sessions in May.
15. Mrs B complained to the Home saying that poor care had led to a deterioration in Mrs C’s health. The Home responded with a detailed account of the action it had taken to care for Mrs C. It apologised for not taking sufficient culturally appropriate care of Mrs C’s hair and offered to meet with the family to discuss their concerns. Mrs B responded in June 2022 she thanked the Home for their hard work but questioned why Mrs C was getting worse and whether the correct action was being taken in respect of her skin. She questioned why Mrs C deteriorated so rapidly in March 2022 necessitating an admission to hospital.
16. In June 2022 the hospital confirmed a diagnosis of severe irritant contact dermatitis. It recommended various creams and a skin regime. Mrs C continued to pull out the catheter. By July 2022 she was unsafe when using the bath and staff bathed her from bed pending a review assessment.
17. In August 2022 Mrs C was again admitted to hospital after appearing unwell one morning. The family and the ambulance staff raised a safeguarding concern as she arrived in hospital lying on wet towels with an open wound and a possible infection.
18. The Council made enquiries of the hospital and the Home. The hospital confirmed it was severe contact dermatitis caused by urine and the Home detailed all the actions it had taken to try and protect Mrs C’s skin over the previous six months. The Council closed the safeguarding enquiry as it was satisfied that the Home had taken all the necessary interventions and acted appropriately by calling the ambulance when Mrs C’s condition deteriorated. It did not consider that neglect had occurred.
19. The family moved Mrs C to a different nursing home when she was discharged from hospital.

Analysis

20. It must have been very distressing for Mrs C’s family to witness her decline when she was in the Home. However, I have not identified fault with the care provided to her by the Home. Mrs C has progressive conditions which have got worse and there is no evidence that poor care contributed to this decline.
21. The Home’s records are complete and detailed. They show that the Home carried out all the necessary risk assessments on Mrs C and reviewed them on a monthly basis noting changes. The pressure area risk assessment supports the fact that it was the deterioration in Mrs C's Lupus condition which was the main cause of her skin problems. The regular physiotherapy assessments show that Mrs C’s MS affected her mobility to a greater extent after December 2021.
22. The Home had detailed care plans, nursing care plans and wound care plans which were all reviewed regularly. The daily care records are detailed and consistent, showing that when concerns were raised about Mrs C’s demeanour, actions was taken. The records also show that the Home was in regular contact with Mrs C’s GP surgery and the community nursing service. When Mrs C’s weight loss was noted the Home promptly contacted the dietician for advice and supplements.
23. The social worker in April 2022 was satisfied that Mrs C was well-cared for and the safeguarding investigation supported the Home, concluding that its interventions were appropriate. The Home accepted it had not offered Mrs C appropriate haircare. It apologised for this and rectified the situation after Mrs B complained. This was an appropriate and satisfactory response.

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Final decision

24. I have completed my investigation into this complaint as I am unable to find fault causing injustice in the actions of the Council towards Mrs C.

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Investigator's decision on behalf of the Ombudsman