Summary: We have upheld a complaint about poor nutritional care. The Care Provider has already offered an appropriate payment to reflect the injustice to Mrs Y. It will carry out a spot check to ensure improvements to practice are being implemented.

The complaint

1. Mrs X complained for her mother Mrs Y. She complained about Mrs Y’s nutritional care in The Lindsay Care Home (the Care Home) owned by BUPA Care Homes Ltd (the Care Provider)
2. Mrs X said this caused avoidable distress.

Back to top

The Ombudsman’s role and powers

3. 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)
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.

Back to top

How I considered this complaint

6. I considered Mrs X’s complaint to us, the Care Provider’s responses and photos of Mrs Y. I discussed the complaint with Mrs X
7. Mrs X and the Care Provider had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

Relevant law and guidance

8. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. The Care Quality Commission (CQC) issued guidance in March 2015 on meeting the regulations (the Guidance.) The Ombudsman considers the 2014 Regulations and the Guidance when determining complaints about poor standards of care.
9. Regulation 10 of the 2014 Regulations says people using care services should be treated with dignity and respect including ensuring privacy and autonomy.
10. Regulation 9 of the 2014 Regulations requires care and treatment to be appropriate, to meet a person’s needs and to reflect their preferences. Care providers should carry out an assessment of needs and preferences and design a care plan to meet needs and preferences.
11. Regulation 14 of the 2014 Regulations says the nutrition and hydration needs of residents must be met. They must receive suitable nutritious food and fluid to sustain life and good health, with support to eat and drink if needed.

What happened

12. Mrs Y had dementia and lived in the Care Home for seven weeks before her family moved her to a different home because of the matters she has complained to us about.
13. Mrs X has provided a photo of her mother taken on the day she left the Care Home. Mrs Y is slumped, does not have the correct type of cup and her food is not cut up. She has food round her mouth.
14. The Care Provider’s first response upheld all the complaints and apologised for the poor care. I have summarised the main points below:
• Mrs Y’s food preferences were in her assessment, but they were not extensive. Staff should have discussed this in more detail with the family
• Mrs Y should have been sitting up correctly for meals
• Her care plan said food should be cut up and this did not always happen. She should have been given the correct cutlery and utensils
• Uneaten meals should have been noted in the records
• Another resident’s swallowing care plan was placed in Mrs Y’s records in error
• There were no concerns about weight, a small increase was recorded.
15. The Care Provider’s second response repeated the apologies in the first response and said:
• The home had changed to digital records and this would prevent records getting mixed up.
• Staff were now checking residents were positioned correctly and given the correct utensils. They had been reminded to cut up food
• Mrs Y should not have been given alcohol because she did not like it
• Staff did not follow up a physiotherapy referral. The new care records had a record to follow up with the GP which would prevent recurrence
• It had reduced the outstanding balance by £2700.

Findings

16. Mrs Y’s care was not in line with Regulations 9, 10 and 14 of the 2014 Regulations. Staff did not follow her nutritional care plan and this resulted in her receiving food and drink not in line with her preferences and in mealtimes not being the pleasurable and dignified experience they should have been. The failure to ensure food was cut up at all times and to ensure Mrs Y had appropriate utensils means care was not in line with Regulation 14 – she did not have appropriate support to eat or drink.
17. The above failings are likely to have caused Mrs Y distress at the time. I note she did not lose weight so there is no evidence her health was significantly compromised.

Back to top

Agreed action

18. The Care Provider has already apologised and reduced the outstanding bill by £2700. This is a significant figure which reflects the distress Mrs Y would have experienced and is higher than the suggested range in our published Guidance on Remedies. Mrs X thinks Mrs Y should not have had to pay anything for her care because, she says the Care Provider should be punished for what she regards as negligent care. While I accept there were faults, these have already been recognised. There are no grounds for me to recommend repayment of the full fee. Our role is not to determine negligence, this is for the courts. And our recommendations are not intended to be punitive.
19. The Care Provider has made some changes to practice including electronic records. This will minimise the chance of recurrence. Within one month of my final decision, a senior manager responsible for quality at the Care Provider will carry out an unannounced visit to the Care Home to inspect admission assessments, nutritional care plans and do a spot check at mealtimes to ensure care staff are providing nutritional care which is tailored to the needs identified in residents’ care plans.
20. The Care Provider should provide us with a written report of the unannounced visit.

Back to top

Final decision

21. We have upheld a complaint about poor nutritional care. The Care Provider has already offered an appropriate payment to reflect the injustice to Mrs Y. It will carry out to carry out a spot check to ensure improvements to practice are being implemented.
22. I have completed the investigation.

Back to top

Investigator's decision on behalf of the Ombudsman