Summary: There is no evidence the care provider’s actions caused any injustice to Mrs A. The care provider was entitled to enforce the terms of the contract and give notice to Mrs A.

The complaint

1. Mrs X (as I shall call her) complains the care provider gave notice to her elderly mother (Mrs A) after Mrs X complained about failure to notify her of falls, restrictions to her visits, and delays in providing personal care to Mrs A.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)

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How I considered this complaint

3. I considered the information provided by Mrs X and by the care provider. I spoke to Mrs X. Both parties had an opportunity to comment on an earlier draft of this statement and I considered their comments before I reach this final decision.

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What I found

Relevant law and guidance

4. 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.
5. Regulation 10 says service users must be treated with dignity and respect, and that they are supported to wash, bath, use the toilet and hold private conversations.
6. Regulation 12 says service users must receive care and treatment in a safe way, and that care providers should all that is reasonably practicable to minimise risks, using risk assessments to make required adjustments.
7. Regulation 16 says care providers must investigate complaints and take necessary and proportionate action in response.
8. The contract which Mrs A had with the home says

The Proprietor may give notice…. requiring the Resident to leave the Home under any of the following circumstances:

a) Non-payment of fees.

b) If, having consulted the Resident and taken advice from the appropriate members the primary health carer team (General Practitioner, health visitor, community nurse or social services) concerning the present and future care needs of the Resident, the Proprietor is no longer able to meet those needs.

c) Circumstances for behaviour which the Proprietor feel may be seriously detrimental to the Home or the welfare of other Residents while, at the same time, bearing in mind the nature of the care we provide

d) Serious breach of contract

9. The Deprivation of Liberty Safeguards provide legal protection for individuals who lack mental capacity to consent to care or treatment and live in a care home, hospital or supported living accommodation. The DoLS protect people from being deprived of their liberty, unless it is in their best interests and there is no less restrictive alternative.

What happened

10. Mrs A went to live at Highlands Borders care home in February 2022. She has dementia and requires assistance with all activities of daily living and personal care. She is at high risk of falls and uses a wheelchair. There is a Deprivation of Liberty Safeguards authorisation in place for her.
11. The care home records note there was a dispute between Mrs X and her brother Mr Y from the start of the placement when they made allegations about each other.
12. The care home records show four recorded falls in April 2023. Mrs X complained that she had only been notified of one fall. At a family meeting in June, Mrs X raised concerns abut poor communication. The manager explained the care notes showed relatives had been informed on each occasion but said that staff may have called Mr Y instead. Mrs X said she had a strained relationship with her brother and they did not speak to each other. She also said another resident’s partner had told her Mrs A had fallen many more times. The manager said this was not the case and that it would be better to speak directly to the manager of deputy manager about Mrs A’s condition. The manager suggested using a floorbed for Mrs A to prevent further falls in her room, and placement of a floor sensor.
13. In July 2023 the care home records show Mrs X was upset that the manager had allowed Mr Y to take Mrs A out on her birthday. The records say “there was an incident of shouting and pointing at me (the manager)”. Mrs X was recorded as saying she would “take it further” if the manager supported her brother. The manager noted she called the doctor who said Mrs A could go out with Mr Y or anyone else if she was well enough. The manager asked Mr Y to come later but he refused: the manager explained to Mrs X there was nothing further she could do. Mrs X says she had previously arranged a cream tea in the care home for her mother’s birthday but had to cancel it because of this decision.
14. Mrs X asked the care home to apply for an urgent DoLS authorization for Mrs A as then Mr Y would not be able to take out Mrs A for long hours. Mrs X says this was to avoid her mother being in her wheelchair for too long. The records show the manager received advice from the council’s DoLS team that this was a family matter and not a matter for them.
15. Mrs X complained to the care provider in August. She complained she had not received any follow-up information about her mother’s falls. She complained about the arrangements for her mother’s birthday. She also complained about the quality of the meals provided.
16. The care provider responded. She apologized if staff had not kept Mrs X informed about the follow-up investigations in to Mrs A’s falls. She said it was not the role of care home staff to mediate between family members. She said in respect of the quality of food, that residents had a different soup or hot option available evening as well as sandwiches (with the main meal given at lunchtime).
17. Mrs X complained again in October, partly about the quality of food given – she said there was insufficient fresh fruit available – and also about her mother being left in her wheelchair for long periods. She said she had also complained to the CQC.
18. The care provider responded. She said there was a record of Mrs A being moved into a comfortable chair before 10 on the morning Mrs X had complained she was in her wheelchair until 1 pm. She also said fruit was always available in the home and added that it was not possible for Mrs X, who was not present all the time, to see everything Mrs A was eating.
19. At the beginning of November the manager wrote to Mrs X. She said in the light of concerns about Mrs X asking inappropriate questions of staff, and possibly taking photographs, Mrs X was now asked to make an appointment when she wanted to visit, and to meet with her mother in a designated private area.
20. Mrs X complained to the CQC about the restrictions. She also arrived for an unannounced visit after being requested to make appointments. Notes of the manager’s telephone call on 14 November with Mrs X say, “(Mrs X) shouted at me telling me that I am wrong and I am making up accusations and stopping her from seeing her Mum because she has complained about me. I reminded her several times that I am not stopping her from seeing her Mum and that she can come whenever she wants to just call us before.”
21. On 16 November the care provider wrote to give notice on Mrs A’s contract and wrote to Mrs A’s social worker at the same time. She said the reason for notice was the behaviour of Mrs X; “constant complaints of the same nature which are not upheld. False accusations of abuse, aggressively shouting at the home manager, harassment through emails, questioning staff, many safeguarding complaints that are not upheld and closed, calls to the CQC, doctors, occupational therapist and so on. Despite our attempts to address and resolve these issues, the situation has not improved”.
22. Mrs A moved to another care home. The local council put in place an acceptable behaviour contract for Mrs X to adhere to in the best interests of Mrs A.
23. Mrs X complained to the Ombudsman. She said the care provider had failed to log incidents when Mrs X fell, left her mother in soiled underwear for unacceptable periods of time, and had ordered items in Mrs A’s name after she left the home. She also said staff had made false allegations about her.
24. The care home manager says Mrs X’s behaviour was affecting the staff and other residents and had an impact on the smooth running of the home because of the time spent dealing with her complaints. She says Mrs A was happily settled and giving notice was the last resort. In respect of the complaint that items were ordered in Mrs A’s name after she left the home, the manager says an order is placed for incontinence pads on a three-month basis for the whole home. She says when the order arrived, she put some aside for Mrs A and Mrs X collected them.

Analysis

25. There is no evidence that the care provider sought to hide evidence of the falls suffered by Mrs A, although on occasion staff may have notified Mr Y, not Mrs X.
26. There is no evidence of undue delays to providing personal care.
27. It was not the role of the care provider to involve itself in a family dispute. The records show the manager was evenhanded in her treatment of Mrs X and Mr Y.
28. The care provider was entitled to ask Mrs X to make appointments to visit her mother and to do so in a private designated area (or Mrs A’s room). There is no fault there.
29. The records show many attempts to respond to Mrs X’s complaints but not to Mrs X’s satisfaction. The care provider acted in accordance with the terms of the contract in giving notice.

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Final decision

30. I have now completed this investigation. There is no evidence the actions of the care provider caused any injustice to Mrs A.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman