Summary: There is some evidence that the care provider did not always meet Mrs X’s hydration needs while she was resident. The care provider should apologise and pay a sum to Mrs X and Mrs A in recognition of the distress caused.

The complaint

1. Mrs A (as I shall call her) complains the care provider did not provide a good standard of care and treatment for her mother Mrs X. She complains that her mother was twice admitted to hospital, the second time following an unwitnessed fall, and on the second occasion the hospital staff advised she should not return to Hawthorne House due to safeguarding concerns. She also complains that the family paid for a month’s respite care, but Mrs X was only at the home for a few days.

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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)
3. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

5. I considered the documents provided by Mrs A and by the care provider. Where the care provider was asked for documents and did not provide them, I reached a provisional decision on the balance of probabilities, which I have now confirmed. Both the care provider and Mrs A had the opportunity to comment on an earlier draft of this statement and I considered their comments before I reached a final decision.

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What I found

Relevant law and guidance

6. 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.
7. Regulation 9 says the care and treatment of service users must be appropriate and meet their needs.
8. Regulation 14 says the nutrition and hydration needs of service users must be met.
9. Regulation 19 says “Providers must give people information about the terms and conditions of their care, treatment or support, including the expected costs and the requirement to pay for their care, treatment and support. This applies to people who pay the provider in full or partially.”
10. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

What happened

11. Mrs X was admitted to Hawthorne House for 4 weeks’ respite in August 2023: her husband was already resident. Mrs A says the plan was for the couple to have a joint assessment to see how they would manage (Mr X had recently been in hospital) after returning home.
12. The signed terms and conditions of service say, “should a resident require hospital treatment or be otherwise temporarily absent from the Home, the home will retain the accommodation for four weeks at the agreed weekly charge”.
13. There were some initial problems when Mrs X was admitted to the home. Her room was not immediately ready; the pillow and quilt were stained and inadequate, and there was no member of staff available to greet her.
14. On 26 August Mrs X began to complain of chest pain. Paramedics were called and took her into hospital where she remained until 28 August.
15. On 8 September Mrs X started to complain of pain in her wrist and said she must have banged it overnight. The care home staff called 111. Paramedics took Mrs X to hospital where she was admitted to a short-stay medical ward. Mrs A says Mrs X was admitted with severe dehydration and confusion. The care home notes state “called acute medical short stay unit to get update on (Mrs X) and they have explained that there is a safeguarding in place and she is to have a CT scan”.
16. Mrs A complained to the care provider. The care home manager responded apologising for the poor state of Mrs X’s room on admission. She said she could not reimburse the family for the amount of days Mrs X had spent in hospital but would refer this to the finance team who would contact her. She agreed that staff would co-operate with the safeguarding investigation which had commenced.
17. Mrs A complained to the Ombudsman. She said she wanted a reimbursement of the fees paid for her mother who had only spent a small amount of time in the home and did not return after hospital staff advised she should not. She said the care provider had never given her the information she requested or contacted her further despite promising to do so.
18. The care provider says there are no contractual discrepancies and care provided was in accordance with the required protocols. It has provided the care notes which show the amounts of fluid offered and taken. These show that Mrs X drank only 650ml in the 24 hours prior to her hospital admission on 9 September although the care notes say “fluids pushed”.
19. Mrs A says her mother’s condition was considerably worse after the few days spent in Hawthorne House than previously and she now required a much higher level of care than anticipated. She says the amount of money paid privately for her respite in Hawthorne House was unjustified as she only spent a few days there and did not receive a good standard of care.
20. In response to my draft statement the care provider has now sent me details of the outcome of the safeguarding alert. This shows the safeguarding alert was raised by a staff member who accompanied Mrs X to hospital on 8 September, who alleged there was a shortage of staff at the home. The safeguarding alert did not proceed to section 42 enquiries and was closed without further action on 3 October.
21. Mrs A disputes the fluid records provided by the care provider. She says her mother often did not drink unless prompted to and actively encouraged. She also says, “If the hospital had not instigated safeguarding procedures, my mother would have been discharged and returned to the care home, but obviously they were of the opinion that it was not safe for her to return”.

Analysis

22. The care provider complied with the terms and conditions of the contract in respect of the retention of the fees paid.
23. The care provider apologised for the poor state of Mrs X’s room when she arrived at the home. That remedies that aspect of the complaint.
24. However, it is notable that the concern for Mrs X’s condition in hospital was such that staff said she should not return to Hawthorne House and raised a safeguarding alert. That, coupled with the small amount of fluids given, points to a potential failure or inability on the part of the care provider to meet Mrs X’s hydration needs.

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Agreed action

25. Mrs X has now died and any injustice suffered by her cannot be remedied.
26. Within one month of my final decision the care provider should apologise to Mrs A for the failure to provide a good standard of care to Mrs X in the few days she was resident.
27. It should also offer the sum of £250 to Mrs A in recognition of the distress and anxiety caused to her.
28. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

29. I find the actions of the care provider caused some injustice to Mrs X and her family which the completion of the recommendations at paragraphs 22 and 23 should remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman