Summary: Mrs X complained that the Council placed Mr X in a care home a long distance from their home and it was difficult for her to visit. She also complained that when Mr X was moved to a closer home, his needs were not reviewed and problems with his catheter care continued. There is no evidence of fault on the part of the Council. The first placement was the only available option, and Mr X’s catheter care was managed appropriately.

The complaint

1. Mrs X (the complainant) says the Council placed her husband in a care home some distance from her home and it was too far for her to visit often. She says while he was there, he pulled out his catheter on numerous occasions and was admitted to hospital: she also complains about poor and insanitary conditions in his room. From there he was moved to a much closer home, but she says no review of his needs was carried out.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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)

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How I considered this complaint

4. I considered evidence provided by the Council and Mrs X as well as relevant law, policy and guidance.
5. The Council and Mrs X both had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Relevant law and guidance

6. Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions.
7. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has.
8. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.
9. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The Act (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so.

What happened

10. Mrs X was Mr X’s carer. Mr X has dementia and his changing needs became too difficult to manage at home. Mr X has medication needs and uses a catheter which he does not always tolerate.
11. In November 2023 there was a crisis when Mrs X reported to the local police that Mr X had harmed her and she was worried about how to manage his behaviour. Mr X’s Community Psychiatric Nurse said Mr X’s needs “would be best met in an EMI Nursing respite placement to provide support in assessing his current needs”.
12. The Council says it was requested to source an emergency nursing dementia care placement for Mr X. It says it initially looked at its block-booked service but there was no suitable placement available. It says its brokerage service then contacted an additional 13 homes but of these only one, care home A which was 19 miles from his home, was able to offer a placement. Mr X was transported by ambulance due to his aggressive behaviour. He became a temporary resident there in December.
13. The care notes show that Mr X was frequently unsettled – on one occasion setting off the fire alarm in the night – and staff asked the mental health services to alter the timing of his dementia medication. He was also recorded as frequently pulling at his catheter and on occasion pulling it out, when he needed hospital care to replace it. He had episodes of urinary retention which also required hospital care.
14. In January Mrs X made a complaint to the home. She said communication was poor. She said the care home misplaced items of Mr X’s clothing and when she found them in his wardrobe they were still soiled. On another occasion she found he was wearing trousers which were too tight, which belonged to another resident, and was not wearing underwear. She said this was a temporary placement which she found it difficult to visit, and she wanted to know when he would be moved.
15. The care provider replied on 26 January. Mrs X says she never received this response but the care provider says the manager handed it to Mrs X on 30 January when she visited Mr X. Mrs X denies this. The care home notes confirm Mr X visited on 30 January. Mrs X emailed the care home again in March as she said she had not received the reply.
16. The complaint response apologised for any poor communication and the distress caused by problems with Mr X’s catheter. It acknowledged that hygiene issues and soiled clothing were unacceptable. It recognised the emotional toll on both Mr and Mrs X and said staff would receive further training in managing Mr X’s emotional well-being. The care provider acknowledged the delay in transferring Mr X to a closer placement but said the referrals and assessment were the responsibility of the allocated social worker.
17. The social worker had reviewed Mr X’s needs at a visit on 23 December 2023 at which the Council says Mrs X was present along with a carer from the home. (Mrs X says she did not visit then). The review stated “It would be my professional recommendation that (Mr X’s) needs would be best met in a EMI residential placement. (His) needs can no longer be managed in the community. (Mr X) has an enlarged prostate and catheter in situ resulting in him having to attend hospital in the result of any difficulties with his catheter. (Mr X’s) behaviours are manageable and with the support of district nursing team he would be able to be supported in a least restrictive manner.”
18. The Council’s brokerage team was requested to source a permanent placement: one of the criteria was that the new placement should be within 2 miles of Mrs X’s home as she was unable to drive. Care home B was 1.3 miles from her home and Mr X was transferred there on 20 February 2024.
19. Mrs X complained to us about Mr X’s care.
20. The Council says after Mr X’s transfer to care home B, his social worker carried out a non-statutory review over the telephone and requested comments from Mrs X and from care home B. The Council says, “both were informed that as (Mr X) was settled the case would close to (the social worker). On case closure the case would be closed under annual review and at that stage another face-to-face review would be conducted. “

Analysis

21. It was unfortunate and distressing for Mrs X that the only placement which could be found for respite was so far from their home: however, at the time Mrs X asked for help, it was an emergency, and the available placement was the only option for Mr X.
22. The care provider acknowledged there were issues of concern while Mr X was present in care home A, not least the failures of communication which meant Mr X was sometimes not aware that Mr X had been taken to hospital again. The hygiene failings were distressing for Mrs X and did not respect Mr X’s dignity. I am satisfied the care provider apologised for those shortcomings and took steps to improve where possible. It was, however, as the manager explained, a matter for the social work team to assess Mr X’s needs and arrange a transfer when possible.
23. The letter of response to the complaint was dated but not addressed: the care home manager says she hand-delivered it to Mrs X. Mrs X says she did not receive it (and I note she was still asking for a response some weeks later). In any event, I am satisfied the letter did contain an appropriate apology and recognition of some shortcomings in communication and hygiene standards, and an indication of further training in managing residents’ emotional well-being.
24. In respect of the catheter care problems experienced by Mr X, I have not seen any evidence that the care provider failed to take appropriate steps to manage the ongoing problem. Clinical advice was sought where necessary.
25. There is evidence that reviews of Mr X’s needs were undertaken and a transfer to a much closer placement effected as a result.

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Decision

26. I have completed this investigation on the basis the actions of the Council’s commissioned care provider have remedied any injustice caused at care home A. I do not find fault in the arrangements for the placement or the subsequent transfer.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman