Summary: We do not uphold Ms X’s complaints about care to her late mother in a care home. Care was in line with Ms Y’s preferences and the home liaised with the GP to ensure Ms Y received healthcare.

The complaint

1. Ms X complained about her relative Ms Y’s care in Chacombe Park Care Home (the Care Home) owned by Barchester Healthcare (the Care Provider). Ms X complained:
1. Ms Y did not have regular showers or baths
2. Her room was dirty (the bin was not emptied, clinical waste was left on the floor);
3. Clothing went missing;
4. The oxygen tube was squashed;
5. Electrical items were not tested;
6. Her chin was not shaved and on one occasion her eyes were not cleaned;
7. There was a failure to arrange for her to see a GP when her legs became swollen
8. She visited Ms Y and found her naked from the waist down, in terrible pain and there were no clothes to give the paramedics.
9. Flu and COVID-19 jabs were not arranged
10. Ms Y was not encouraged to leave her room
11. Ms Y’s hearing aid went missing
2. Ms X also complained about staff rudeness and about incorrect information in a continuing healthcare assessment.
3. Ms X said the lack of care caused avoidable distress.

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The Ombudsman’s role and powers

4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. Ms X complained to us in November 2021, but we declined to investigate as she had not used the Care Provider’s complaints procedure. Her complaint to us is therefore not late as she contacted us within 12 months of the matters arising. The timeframe of my investigation is for the period Ms X was self-funding her care in October and November 2021
6. We provide a free service, but we use public money carefully. We do not start or continue an investigation if we decide:

• any injustice is not significant enough to justify our involvement, or
• there is another body better placed to consider this complaint

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

7. 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. If they have caused a significant injustice or that could cause injustice to others in the future, we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(3 and 4) as amended)
8. 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)
9. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I have and have not investigated

10. I have investigated the complaints in paragraph one. I did not investigate the complaints in paragraph two because:
• The complaint about staff rudeness did not cause significant injustice.
• The complaint about incorrect information is best resolved by the continuing healthcare appeal process if the provision of incorrect information affected the outcome of an application for continuing healthcare. It is reasonable for Ms X to raise this with the relevant NHS body as part of an appeal.

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How I considered this complaint

11. I considered the complaint to us and supporting evidence from Ms X including photos of her mother in the Care Home, the Care Provider’s response and documents set out in this statement.
12. Ms X and the Care Provider 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 and guidance

13. 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.
14. 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.
15. Regulation 12(i) of the 2014 Regulations says a care provider must provide care and treatment in a safe way including by working with health professionals to ensure the health and welfare of residents.
16. The Care Provider’s policy for electrical testing says residents’ electrical items are inspected visually. Defective equipment must not be used. Electrical testing is done annually by an external provider.

What happened

17. Ms Y’s care plans said:
• She was not happy for staff to support her with her facial hair and preferred to do this herself.
• She was supported with personal care so far as she would permit staff to assist her. She was offered a shower, bath or full body wash each day and sometimes refused help. If so, she was supported by wiping her face and hands with wipes.
• She managed her colostomy bag herself. The Care Provider told me she would leave the used bag in a separate bag ready for staff to remove.
• She could tell staff when she was in pain (especially in her legs) and she had pain relief.
• She enjoyed the live talks provided by the home, the afternoon concert and the pat dog. She often preferred not to join in with activities and preferred watching history shows in her room.
18. The Care Provider kept records of Ms Y’s medicines. These show she had pain relieving gel three times a day and paracetamol four times a day.
19. The Care Provider kept a daily record of personal care. This indicates Ms Y received a full body wash or spa bath every day.
20. Statements from care staff said:
• Ms Y sometimes refused support to wash and preferred to wash herself with wet wipes.
• In the afternoons she said she was very hot and she needed to use the commode frequently and so preferred not to dress her lower body. (This was also noted on Ms Y’s care plan.)
• Ms Y refused help with shaving her face. She usually asked for wet wipes to clean her face.
• She managed her colostomy bag herself.
• She communicated well and could tell staff if she needed any help. She had hearing aids which she managed by herself.
21. The Care Provider kept a record of room cleaning. The record said all bedrooms and ensuites were cleaned every day, including emptying the bins.
22. The risk assessment for Ms Y’s oxygen concentrator said:
• It needed to be kept at least 2 meters from heat.
• The room should be well ventilated and the smoke detector working.
• Do not use an extension lead.
• Ensure emollients (such as Vaseline) are not near.
• Ensure the cylinder isn’t covered.
23. Ms Y had end stage cardiorenal syndrome (a condition where the kidneys and heart are not working) She saw the GP on the following occasions:
• On 19 October. The advice was to elevate her legs (due to swelling). The GP prescribed an emollient cream for her legs.
• On 26 October. She was stable.
• On 2 November. She was stable. She had swelling to her feet. The GP noted she could come to the surgery for booster jabs.
• On 9, 11, 25 November when her legs were swollen again and she was advised to elevate them.
24. On 26 November, care staff noted Ms Y was unhappy about elevating her legs and complained they hurt when she did this. By lunch time, Ms Y was asking for a hospital admission saying the heart failure nurse had told her she needed admission for hospital treatment. Staff called an ambulance which took Ms Y to hospital.
25. Ms X used both stages of the Care Provider’s complaint procedure. I have summarised the responses below:
• She had 8 baths and full body washes every day.
• Her room was cleaned every day; the bin was emptied each morning.
• She changed the colostomy bag herself and left it in a small bag on the floor for staff to collect
• It was sorry clothing went missing. Items were returned to her when found.
• Ms Y removed her skirt in the evening as it interfered with her toileting.
• The TV was visually checked by the maintenance team. It was Ms Y’s and would have had an electrical test on the next annual check. The oxygen concentrator was delivered from hospital and would have been checked by the supplier before it was brought into the home.
• The GP spoke to her on 2 November and she said she would take Ms Y to the surgery for her booster jabs. There had been vaccinations arranged in the home, but this was before Ms Y’s stay.
• Ms Y was not keen on staff shaving her chin. It was sorry about the occasion when residue was not wiped from her eyes.
• She managed her hearing aids independently and did not like staff to touch them. When it went missing, staff searched for it, but could not find it.

She saw the GP every week and was examined twice because of swollen legs.

26. The Care Provider told me its risk assessment for oxygen did not say the tubing should not be obstructed and it was sorry that on one occasion the tube was under the machine.

Findings

Ms Y did not have regular showers or baths

27. I do not uphold this complaint. The records show Ms Y had a care plan that addressed her personal care needs. She was offered a bath or a full body wash each day and often elected for the latter. Care was in line with Regulation 9.

The room was dirty (the bin was not emptied, clinical waste was left on the floor)

28. The records show Ms Y’s room was cleaned every day, including the bin being emptied. She left the bag on the floor. We do not apply a standard of perfection when it comes to cleaning and there will be times when a room becomes messy again even though it has already been cleaned. There is no fault.

Clothing went missing

29. The Care Provider has apologised for this and has returned the missing items. I do not uphold this complaint.

The oxygen tube was squashed

30. The risk assessment should have set out for staff to avoid obstructing the tube and to check this when the machine was moved. This did not happen on one occasion which was fault. It did not cause any injustice.

Electrical items were not tested

31. The Care Provider’s policy is to do a visual check of electrical items and an annual test. It acted in line with its policy. So I do not uphold this complaint

Her chin was not shaved and on one occasion her eyes were not cleaned

32. Ms Y’s care plan noted she did not want her staff to shave her chin and on occasion would prefer to use a wet wipe on her face. Care was in line with her stated preferences and with Regulation 9. I do not uphold this complaint.

There was a failure to arrange for her to see a GP when her legs became swollen

33. The records show Ms Y saw the GP regularly during her stay. Swelling was noted and she was advised to elevate her legs. She did not like doing this and was entitled as a capacitated adult to refuse to do so. Care was in line with Regulations 9 and 12 so I do not uphold this complaint.

She visited Ms Y and found her naked from the waist down, in terrible pain and there were no clothes to give the paramedics.

34. The care records indicate it was Ms Y’s preference not to be clothed on her lower body. She could not be forced to wear clothes. She had pain relief for her legs in the form of tablets and gel. I do not uphold this complaint.
35. It is unfortunate there were no clean clothes to give the paramedics. I assume they were in the laundry. I do not uphold this complaint. The priority was to get Ms Y to hospital.

Flu and COVID-19 jabs were not arranged

36. The GP records noted Ms Y needed to go into the surgery for her booster as she had missed the home visit. Care was in line with Regulation 12. I do not uphold this complaint.

Ms Y was not encouraged to leave her room

37. The care plan for activities listed activities Ms Y had enjoyed, but noted she often preferred watching TV in her room. I am satisfied care was in line with her preferences and with Regulation 9. I do not uphold this complaint.

Ms Y’s hearing aid went missing

38. The care plan stated Ms Y did not like staff to touch her hearing aid and she managed this herself. I am satisfied care was in line with her preferences. It is unfortunate the hearing aid went missing, but this is not fault. Care was in line with Regulation 9.

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Final decision

39. I do not uphold Ms X’s complaints about care to her late mother in a care home. Care was in line with Ms Y’s preferences and the home liaised with the GP to ensure Ms Y received healthcare.
40. I completed the investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman