Summary: A care home, acting on behalf of the Council, failed to properly communicate with Mrs X during an investigation into an alleged assault on her husband during his respite stay. The care home also delayed informing Mrs X of the outcome of the investigation. There is no evidence to support the allegation Mr X was abused, or that he received poor care.

The complaint

1. Mrs X complains a residential care home, acting on behalf of the Council, failed to investigate her complaints about the first night of her husband’s stay.

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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. We investigate complaints about councils and certain other bodies. Where a care provider is providing services on behalf of a council, we can investigate complaints about the actions of the provider. (Local Government Act 1974, section 25(7), as amended)
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)

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How I considered this complaint

5. I have:

• considered the complaint submitted by Mrs X;
• considered the correspondence between the Council and Mrs X, including the Council’s final response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• Mrs X, the Council and the care home had an opportunity to comment on a draft of this document. All comments made have been considered

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What I found

Relevant legislation

6. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (‘the CQC 2014 Regulations’) set out the requirements for safety and quality in care provision. The Care Quality Commission (CQC)’s Fundamental Standards give guidance to care providers on how to meet the requirements of the Regulations. has issued guidance on meeting the regulations (the Fundamental Standards). The following standards are relevant to how the Home managed Mr X’s care.

• Regulation 12 - providers must prevent people from receiving unsafe care and treatment, and prevent avoidable harm or risk of harm;
• Regulation 17 - providers must keep accurate, complete and detailed records of care and treatment;
• Regulation 18 - providers must tell the CQC of all incidents that affect the health, safety and welfare of people who use services;
• Regulation 20 - providers must be open and transparent with people using their services and their families and must notify them and apologise if something has gone wrong with the person’s care or treatment. Providers must tell the person or their representative if there has been a ‘notifiable safety incident’.

Background

7. Mr X has dementia, he lives at home with his wife, Mrs X, who is his main carer. In late July 2023, Mr X went into a residential respite care for two weeks.
8. The morning after Mr X’s first night, Mrs X telephoned the care home to enquire about Mr X’s first night. Care staff informed her, Mr X had had a settled night. When Mrs X visited Mr X that evening, she says he was distressed and told her that care staff had pulled him by his top and struck him in the face.
9. Mrs X reported the events to the care home manager and was told the allegations would be investigated and that the staff concerned would not be involved with Mr X’s care. Mrs X says she heard no more during Mr X’s stay and only received a response after Mr X returned home.
10. Mrs X says her husband did not settle during his stay and she had to visit him daily, which impacted on her respite from her caring role. She says care staff did not follow his care plan and his care needs were not met.
11. Mrs X says she was disappointed with the lack of communication with care staff.
12. I have had sight of the care home’s daily care records for the whole of Mr X’s stay.
13. The care records show that on the day Mr X arrived he became distressed and displayed challenging behaviour throughout the day. He was shouting for Mrs X and needed significant support and reassurance from care staff. Mr X was monitored by carers every two hours throughout the first night. He was settled until 4am, when he woke and was reported to be agitated and distressed.
14. The following morning Mr X told care staff a male had thrown things at him and assaulted him. The carer immediately reported the allegations and recorded Mr X had been reassured of his safety and that the matter would be investigated.
15. The manager examined Mr X and found no visible injuries. She (care home manager) completed a ‘notification of abuse’ form and commenced an investigation. I have had sight of this document. It details the allegations and the initials of the carers involved.
16. The care home manager sent the notification to the Care Quality Commission and the Council’s safeguarding team the following day. The manager discussed the allegations with Mr & Mrs X and took statements from all the carers involved. The carers involved were moved to a different area of the home so as not to be involved with Mr X’s care. The care manager reported Mr X had at times been distressed during the night, shouting for his wife and displayed some challenging behaviour. He had accepted personal care in the morning, from the care staff he had alleged harmed him.
17. The manager examined the daily care records for Mr X. I have had sight of these records which show that throughout his stay Mr X had periods of agitation, distress, and some challenging behaviour. On some occasions Mr X punched he his head with his hand. Mr X was accepting of care but required significant reassurance and support.
18. The investigation found no evidence to support Mr X’s allegations of abuse. There was no evidence of injury and no evidence to support poor care. The record show Mr X was distressed at being away from his wife, The manager reported no previous concerns or complaints about the carers involved. To lessen Mr X’s distress the care staff involved worked in another area of the care home for the duration of Mr X’s stay.
19. The care home manager sent Mrs X and email on 23 August 2023, two weeks after Mr X returned home, setting out the findings of her investigation.
20. Mrs X was dissatisfied with the response because it does not answer all her questions and she feels she does not really understand what happened on the first night of Mr X’s stay.

Analysis

21. The care home acted on behalf of the Council, so we consider the Council responsible for any fault.
22. Allegations of abuse should be taken seriously and investigated robustly. The relevant authorities should also be notified. There should be open and transparent communication with those affected.
23. In this case, I am satisfied the care home manager responded swifty and appropriately to the allegations made by Mr X. An investigation commenced immediately, Mr X was examined, all parties were interviewed, and the relevant authorities were promptly notified.
24. The daily care records for Mr X were completed properly. There is no evidence to support the allegation that Mr X was abused or that he received poor quality care.
25. There is no fault by the care home in the way the allegations were investigated.
26. However, communication with Mrs X could have been better. Mrs X should have provided with accurate information when she initially enquired about Mr X’s first night. The failure to do so caused Mrs X some mistrust and doubt.
27. Communication with Mrs X throughout the investigation could have been timelier and more transparent. Mrs X should have been updated throughout the investigation and she should not have waited two weeks before being informed about the outcome. This added to Mrs X anxiety and mistrust.

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Agreed action

28. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although we found fault with the actions/service of the care home, we have made recommendations to the Council.
29. The Council should, within four weeks of the final decision, provide Mrs X with a written apology for poor communication during Mr X’s respite stay and for the delay in informing her about the outcome of an investigation into an alleged assault on Mr X.
30. The Council should provide us with evidence it has complied with the above actions.

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Final decision

31. I am satisfied the care home properly investigated a complaint Mr X made about alleged assault during his respite stay.
32. There is evidence of poor communication by the care home with Mrs X throughout an investigation into an alleged assault on her husband during his respite stay. The care home delayed informing Mrs X of the outcome of the investigation.
33. There is no evidence to support the allegation Mr X was abused, or that he received poor care.
34. The above remedy is a suitable way to settle the complaint.
35. It is on this basis; the complaint will be closed.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman