Summary: We will not investigate this complaint about adult social care because it is unlikely we will add to the Care Provider’s investigation or reach a different outcome. There is a differing version of events and the person affected has died, so we cannot clarify matters or achieve any remedy for them.

The complaint

1. Ms B has many concerns over her mother, Ms C’s, care. Ms B says the care home neglected Ms C when a care worker dropped Ms C to the floor rather than following the care plan which required two care workers and a hoist. Ms C got a painful injury and needed medical treatment. Ms B says Ms C’s health declined rapidly after this incident. Ms C did not feel safe and spent a lot of time in her room. Ms B says the poor care hastened Ms C’s death. Ms B feels guilty and responsible for trusting the Care Provider to look after Ms C, and her mental health is affected by the upset.

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The Ombudsman’s role and powers

2. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

3. Ms C has died; we have accepted Ms B as suitable to make the complaint.
4. 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
• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome.

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

5. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened. Sometimes we may not be able to make a finding.

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How I considered this complaint

6. I considered information provided by the complainant, the Care Provider, and the Local Authority safeguarding team.
7. I considered the Ombudsman’s Assessment Code.

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My assessment

8. Ms C lived at Elstree Court care home, run by HC-One Limited (the Care Provider). A few days after moving into the home an incident occurred where Ms C got injured. Ms C and the Care Provider have differing versions of events about what happened. An Ombudsman investigation is unlikely to find out what happened, especially given Ms C has died so we cannot speak with her. The Ombudsman also could not decide the Care Provider’s actions contributed to Ms C’s death.
9. The Care Provider responded to Ms B’s complaint, explained the actions it was taking to improve service, and it apologised to Ms B for her distress.
10. Ms B alleges neglect. Local authorities have responsibility for safeguarding vulnerable adults, to keep them safe from abuse or neglect. The Local authority safeguarding team has considered the matter, and decided to close the concern on the basis it was satisfied with the actions the Care Provider has taken.
11. Even if we did investigate and find fault causing injustice to Ms C, we can provide no remedy to her. It is unlikely we could add to the actions the Care Provider has already taken, especially given the safeguarding team was satisfied with the protective measures put in place.
12. Ms B is understandably distressed that her mother was injured. However, this injustice would not justify our involvement. The Care Provider has apologised to Ms B for her distress, and it is unlikely we would achieve anything further.

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Final decision

13. We will not investigate Ms B’s complaint because it is unlikely we will find evidence of fault, it is unlikely we would add to the Care Provider’s investigation or reach a different outcome.

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Investigator's decision on behalf of the Ombudsman