Summary: Mrs Z, on behalf of her mother Mrs x, complained the care provider failed to properly administer medication and failed to provide appropriate personal care. Mrs Z says this has caused distress and undermined her trust. The care provider accepts fault in respect of the administration of medication and some personal care issues, has apologised and taken action. The provides a proportionate and appropriate remedy for the injustice in this case.

The complaint

1. Mrs Z, on behalf of her mother Mrs X, complains the care provider failed to properly administer medication and failed to provide personal care particularly in relation to showering and clothing.
2. Mrs Z says this has caused her distress and undermined her trust in the care provider.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
4. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• the action has not caused injustice to the person who complained, or
• the injustice is not significant enough to justify our involvement, or
• it is unlikely we could add to any previous investigation by the care provider.

(Local Government Act 1974, sections 34B(8) and (9))

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;
• made enquiries of the care provider and considered the comments and documents it provided;
• discussed the issues with the complainant;
• sent my draft decision to both the Council and the complainant and taken account of their comments in reaching my final decision.

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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.

Key facts

9. This section sets out the key events in this case and is not intended to be a detailed chronology.
10. Mrs X is currently resident at Larkhill Hall Care Home in Liverpool. She has assets above the upper capital limit and so is responsible for the full cost of her care. Mrs X has dementia and does not have mental capacity to make decisions about her care. Mrs Z, her daughter, has a lasting power of attorney and so can legally make decisions on behalf of Mrs X.
11. Mrs Z made a complaint to the care provider in May 2023. She raised the following issues:
• Clothing in Mrs X’s drawer which appeared to have not been worn
• Dressing gown missing
• Untruths fed back to Mrs X with regards to personal care supposedly carried out
• Clothing in wardrobe that did not belong to Mrs X including male clothing
• Dirty underwear in Mrs X’s drawer
• Laundry system ineffective
• Ripped clothing that Mrs X was wearing
• Medication in Mrs X’s bag wrapped in tissue
12. The care provider investigated the complaints and responded to Mrs Z on 30 May 2023. It responded on each point as follows:
• Partially upheld as no evidence to suggest whether clothing had or had not been worm. However, recognised there was poor documentation.
• Partially upheld as no evidence a dressing gown was listed but a bed jacket has been located.
• Partially upheld as records show personal care provided but the records lack detail.
• Upheld as male clothing found in Mrs X’s wardrobe.
• Upheld as dirty underwear found in Mrs X’s drawer.
• Upheld as evidence shows Mrs X’s clothing was not always going to the laundry and not returned in a timely manner.
• Upheld as found Mrs X wore ripped clothing on one occasion but this was not communicated to family.
• Upheld as found medication wrapped in a tissue in Mrs X’s handbag. This was not documented when found or action taken to realise the risk this posed if Mrs X not getting the correct medication.
13. In the response the care provider apologised for the fault and provided details of the actions it was taking to prevent errors happening again. This included training for staff and spot checks. The care provider gave details of how Mrs Z could escalate the complaint if she was unhappy with the response.
14. Mrs Z met with care home staff on 8 February 2024. The care home manager explained that Mrs X was refusing help from care home staff and could become distressed when they attempted to prompt and supervise her washing and dressing. It was also noted that Mrs X was very independent and often washed and dressed herself in the morning. The manager explained that care home staff were mindful to balance Mrs X’s best interests without taking away her independence or causing distress.
15. A further meeting took place on 26 March where staff shared evidence of occasions when Mrs X had refused support. The care home manager said she would spend some time trying to support Mrs X with a shower and getting dressed in order to get to know her better.
16. Mrs Z then made a formal complaint to a senior manager in March 2024. Mrs Z said her mother’s care plan had been updated in June 2023 and she had raised issues with managers, but some issues had not been resolved. Mrs Z said she wanted her mother to have the dignity of wearing clean undergarments, to have a regular shower and for her to take her medications as prescribed. She said this had not happened consistently since May 2023. Mrs Z said that as recently as 23 March 2024 she found a tablet hidden in her mother’s handbag and had been told her mother last had a shower on 14 March. Mrs Z asked for a refund of fees backdated to May 2023 and that her mother be exempt from the proposed fee increase from April 2024.
17. The care provider responded to Mrs Z on 11 April. The response acknowledged there had been a number of changes to the management team since May 2023 and Mrs Z’s frustration that the issues had not been resolved. It noted Mrs Z raised issues about the state of her clothes in May 2023 and that no further concerns were raised until December 2023. It noted Mrs X’s care plan changed in June 2023 as she then required assistance to shower and change her clothing.
18. The care provider said the home manager spoke with Mrs X about her morning routine. Mrs X said that she doesn’t need to shower every day and that although people think she needs help, she doesn’t. The manager felt they may risk damaging the relationship with Mrs X and she may refuse help if a careful approach is not taken. The care provider said every effort would be made to prompt Mrs X to shower and to ask again later in the day if she refuses. However, it found no evidence of infections or impact on Mrs X’s well-being relating to poor personal hygiene.
19. The care provider said medication had been found in Mrs X’s handbag on five occasions since May 2023 and said this was not acceptable. It said that one of the tablets had been changed to a dissolvable form which should prevent further issues with that particular tablet. The care provider said its records do not evidence that Mrs X refused medication and so it could not establish which member of staff had been giving the medication when a tablet was recently found in Mrs X’s handbag. It said that it appeared that the majority of the time, Mrs X is taking her medication as prescribed due to the amount actually found. However, it accepted Mrs Z’s concerns.
20. The care provider said that action had been taken so that all staff who administer medication ensure they check the medication has been swallowed. It is hoped that by spending extra time with Mrs X this will reduce the risk of her storing it in her mouth and not swallowing it. It said it would check Mrs X’s handbag daily so that if medication is found they will know which member of staff administered the medication that day and they can work with them. The care provider said it would also contact Mrs X’s GP to see if her medications are available in liquid or dissolvable form.
21. The care provider also responded to Mrs Z’s request for a fee reduction and said this was not possible.
22. Dissatisfied with the response from the care provider, Mrs Z complained to the Ombudsman.

Analysis

23. The information provided shows that Mrs Z raised her initial complaint in May 2023 and that all points were upheld or partially upheld. In response to her complaint, the care provider took action to try to prevent issues recurring. Mrs Z raised some of the issues again but not until the following year which would suggest some improvements were made.
24. After Mrs Z raised further concerns, she met twice with managers at the care home in March and April 2024 to discuss Mrs X’s care. Mrs Z escalated her formal complaint shorty after these meetings and the care provider made a detailed written response.
25. Mrs Z believes the standard of care being offered is not appropriate. She acknowledges her mother seems content in the care home and that she does not want to move her. However, she finds the situation distressing and says she has lost trust in the care provider.
26. When I spoke to Mrs Z recently she told me Mrs X was no longer being given tablets and medication was being provided in liquid form. As a result, there have been no recurrences of the problems with finding medication in Mrs X’s handbag. It would appear this serious issue has now been resolved. However, it took the escalation of the formal complaint for this to happen.
27. The failure to properly administer medication is fault and would be a breach of a fundamental standard of care as set down by the Care Quality Commission. Its fundamental standards say that care and treatment must be provided in a safe way. Not taking prescribed medication regularly could have implications for the person’s well-being. However, no evidence has been presented to suggest any impact on Mrs X as a result of the occasions when medication was found in her handbag. I am therefore not persuaded this fault caused Mrs X a significant enough injustice to warrant any further remedy above the apology that has already been provided.
28. Mrs Z also complained about her mother not getting regular showers. The care provider has explained that Mrs X will often decline the offer of a shower and that she came become agitated if pushed. The care provider has said it doesn’t want to damage the relationship with Mrs X and so will suggest a shower again later in the day.
29. I have checked the daily care records for the period 1 April to 30 September 2024. These show that Mrs X was offered assistance with her personal care needs on a daily basis. Often she chose not to have a shower and would wash independently. There is evidence that sometimes Mrs X became agitated when offered help. However, Mrs X did have both baths and showers regularly throughout the period.
30. I am satisfied the care provider has taken action to meet Mrs X’s care needs. However, it cannot force Mrs X to take a shower if she chooses not to and it has explained the approach it is taking to maintain the relationship with her. While I understand that Mrs Z may prefer it if her mother bathed and showered more frequently, I am not persuaded there is fault by the care provider on this point.
31. In respect of the clothing worn by Mrs X, there have been instances where Mrs Z noted her mother was wearing dirty clothes. Mrs Z finds this upsetting but told me she does not always raise it with staff. The daily care notes indicate Mrs Z often dresses herself in the morning and that she does change her clothes regularly. While it may be upsetting for Mrs Z to notice this, I am not persuaded it is causing Mrs X a significant enough injustice to warrant further action by the Ombudsman.

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Final decision

32. I will now complete my investigation as I am not persuaded Mrs X has suffered a significant enough injustice as a result of the fault identified to make any further recommendations. In coming to this view, I note the care provider has accepted fault, taken improvement actions and offered an apology.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman