Summary: Mrs Z complains about the standard of care provided to her mother at Wolfrun Rose Care Home and the delay in responding to a complaint about this. We will not pursue the complaint about the standard of care because Mrs Z’s mother has died and so a personal remedy cannot be provided. There was fault in the complaint handling and the action already taken by the care provider is considered appropriate.

The complaint

1. Mrs Z, on behalf of her mother Mrs X (deceased), complains about the standard of care received at Wolfrun Rose Care Home and about the failure to respond to her formal complaint about this.
2. Mrs Z says the care issues caused distress and she was frustrated about the failure to respond to her complaint.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any fault has not caused injustice to the person who complained, or
• any injustice is not significant enough to justify our involvement, or
• further investigation would not lead to a different outcome, or
• there is no worthwhile outcome achievable by our investigation.

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

4. We normally name care homes and other care providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
5. 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)
6. 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

7. As part of the investigation, I have:
• considered the complaint and the documents provided by the complainant;
• discussed the issues with the complainant;
• sent my draft decision to both the care provider and the complainant and invited their comments.

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What I found

Fundamental Standards of Care

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. The CQC is the statutory regulator of care services. It keeps a register of care providers that meet the fundamental standards of care, inspects care services, and reports its findings. It can also enforce against breaches of fundamental care standards and prosecute offences.
10. The CQC provides guidance for providers on meeting the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 16 is concerned with receiving and acting on complaints. The purpose of this regulation is to ensure people can make a complaint about their care and treatment and to ensure all complaints are thoroughly investigated, without delay, and necessary action taken where failures are identified.

Key facts

11. Mrs X was a resident at Wulfrun Rose Care Home from September 2022 to January 2023. Mrs X died in hospital at the end of January 2023. Mrs Z made a formal complaint to MACC Care Limited on 21 June 2023. Frustrated by the lack of response, Mrs Z complained to the Ombudsman. On 16 February 2024, the care provider forwarded a copy of the complaint response dated 12 February. Mrs Z told me she had not received the complaint response and so I forwarded a copy to her on 29 February 2024.
12. Mrs Z explained that she does not live locally to the care home but would visit her mother regularly for extended stays and would often spend all day in her room. She says this enabled her to get a full picture of the practices in the home.
13. Mrs Z’s formal complaint covered the following issues:
• Lack of a care plan
• Pain relief and medication
• Management of contractures
• Professional misconduct
14. In its response, the care provider apologised for the delay in responding explaining this was due to the long term sickness absence of a member of staff.
15. Below is a brief summary of its response on each of the above points:
• There was a care plan in place from day one that was reviewed and evaluated at least monthly. Mrs Z did not hold a lasting power of attorney and Mrs X did not want her to have a copy. In January, Mrs X agreed the care provider could show her children the care plan during a meeting.
• The care provider provided details showing Mrs X’s GP carried out a monthly medication review. This showed that pain relief would be as required, rather than a regular basis until the review on 10 January 2023. It acknowledged pain relief was a significant concern for Mrs Z but explained what staff did to ensure it was provided as required.
• The care provider says that a pre-admission assessment was discussed regarding Mrs X’s contractures including contact from an occupational therapist. It confirmed the cushions the family purchased were used when possible due to Mrs X needing to be repositioned regularly due to her having pressure ulcers. It acknowledged there could have been more effective communication with Mrs Z about where a poster was showing how to position the cushions.
• The care provider partially upheld the complaint about professional misconduct saying one of the issues raised about the mattress should have been reported as a safeguarding issue. It also says the manager reported feeling “attacked” by Mrs Z and she recognised her approach towards Mrs Z may have seemed unprofessional at times. The care provider says that attempts should have been made to manage this relationship differently.
16. The Ombudsman’s role is to remedy fault causing significant injustice to the person making the complaint. Where the injustice claimed, as in this case, is distress, we would normally recommend a symbolic payment. However, our Guidance on Remedies manual says that we will not normally recommend a symbolic payment when the complainant has died. This is because a symbolic payment cannot have the same effect once the person affected is dead.
17. As explained at paragraph above, we have to use public money carefully. I am therefore not persuaded it would be appropriate or proportionate to investigate matters where, even if I found fault, I would be not be able to provide any remedy to the person affected. I will share this decision with the Care Quality Commission (CQC) so it is aware of the concerns raised. It is also open to Mrs Z to contact the CQC directly herself to raise the concerns she has about the standard of care at Wulfrun Rose Care Home.
18. However, there is fault in the complaint handling in this case. Mrs Z made the formal complaint in June 2023 and it took over seven months for the care provider to respond. In November 2023, the care provider told us it would investigate all the matters that it could while the staff member was on long term sick leave. No further contact or update was provided by the care provider until February 2024.
19. While there may have been matters that could not be investigated until the staff member returned to work, I consider that a response could have been provided based on the records held by the care home and by seeking the views of other staff members.
20. The failure to provide a timely response or to keep Mrs Z informed about the reason for the continuing delay, is fault. I am satisfied the care provider has now provided a detailed response to Mrs Z’s complaint and apologised for the delay. I consider this to be an appropriate remedy and so am not making any further recommendations.

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Final decision

21. I will now complete my investigation as the Care Provider has already taken appropriate action to resolve the complaint.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman