Summary: Mr X complained about the poor care his mother received during her respite stay at the care home. The Ombudsman does not find fault.

The complaint

1. The complainant, Mr X, complains about the poor care his mother received during her respite stay at the care home.

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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. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers that meet the fundamental standards of care, inspects care services, and reports its findings. It can also enforce against breaches of fundamental care standards and prosecute offences.
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)

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How I considered this complaint

6. I spoke with Mr X about his complaint. I considered all the information provided by Mr X and the care provider.
7. Mr X and the care provider 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

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.
9. Regulation 9 says the care and treatment of service users must be appropriate, meet their needs and reflect their preferences.
10. Regulation 12 says care and treatment must be provided in a safe way for service users.

Summary of the key events

11. Mr X’s mother, Mrs Y, received respite care at the care home between the 11 and 16 of April 2024. A pre-assessment was completed which stated;
• Mrs Y said she would struggle with male care workers. It was noted the care provider explained it could not always guarantee a female carer;
• Mrs Y suffered with occasional bruising to the skin; and
• a bath or shower would be offered to Mrs Y at least once during her stay.
12. Mrs Y’s care plan stated:
• she required assistance with full personal care;
• she could transfer to and from bed with the help of two care workers;
• the care provider had explained to Mrs Y that she may sometimes have a male care worker help her. But it was noted this would be reduced as much as possible; and
• she would like to have a bath or shower and would like her hair washed.
13. The notes state Mrs Y was supported with personal care and a wash every day by a female care worker. Care workers also applied her creams daily. She was assisted to have a bath on the 13 April 2024 and had her hair washed.
14. On the 15 April 2024 it was noted Mrs Y had been struggling with mobilising, especially in the morning when standing to use the toilet. The care provider carried out a stand aid assessment with Mrs Y to see if this would be suitable. But it was noted Mrs Y found this difficult as the sling caused her discomfort, and it was decided this was unsuitable.
15. It was noted that Mrs Y required assistance of two members of staff to assist with transferring and mobilising around the home. But the notes stated if care workers were unable to transfer using this method, Mrs Y may need to be assessed to use a full hoist.
16. Mrs Y went home on the 17 April 2024 and the care provider sent Mr X the invoice. But Mr X raised concerns about the care Mrs Y had received. He said:
• Mrs Y’s hair was greasy, and she could not recall having her hair washed;
• Mrs Y was not using her own wheelchair when he arrived to collect her;
• a male care worker had been assisting Mrs Y with personal care; and
• Mrs Y had unexplained bruising to her arms and discolouration of the skin on her legs.
17. In response the care provider raised a safeguarding alert to the Council. It also investigated Mr X’s concerns and said:
• Mrs Y had her hair washed and dried by a female care worker. Consent was gained from Mrs Y for this to take place;
• it apologised for Mrs Y not being in her own wheelchair. It had reminded staff to be aware that some of the wheelchairs used are the residents own and must always be used only for them; and
• it had not found any evidence to suggest personal care was ever delivered by a male care worker. There was one occasion when a female and male care worker supported Mrs Y to transfer her to her commode.
18. In response to the reports of bruising to Mrs Y’s arms, the care provider reviewed the records and interviewed eight members of staff. It said:
• it was unclear from the photographic evidence if there was definite bruising to Mrs Y’s shins. It said the darkened areas on Mrs Y’s legs were not unlike other skin damaged areas along the entirety of both legs and which is normal for Mrs Y;
• if there was bruising, it said this could have been caused during assisted transfers when Mrs Y’s lower legs may have come into contact with the wheelchair, chair or equipment;
• the bruising to Mrs Y’s arms were consistent with and likely to have been caused by the stand assist sling used on the 15 April 2024. It explained why it completed a stand aid assessment and how Mrs Y complained of some discomfort. It said staff did not see any bruising following the use of the equipment. But it noted that Mrs Y could be guarded against raised her arms during personal care, therefore the bruising would not have been visible whilst her arms were by her side; and
• it had found no evidence to suggest there had been a direct intention to cause harm to Mrs Y.
19. As a result of Mr X’s complaint, the care provider said it had examined its protocols in relation to ensuring non-intrusive observation of an individual's skin where it is not immediately visible during personal care giving. It said it would work hard to ensure that any skin damage is detected in a timely manner in harder to view areas. All skin damage found would be mapped in accordance with best practice and the policies and procedures.
20. Mr X disagreed with the response and said Mrs Y also had skin tears on her bottom, which he said was possibly due to poor skin management.
21. The care provider investigated and said:
• Mrs Y was prescribed two creams for skin care. The evidence indicated regular and correct use of these treatments;
• Mrs Y’s sacral skin was vulnerable and generally red through being seated for prolonged periods. But Mrs Y did not complain of any pain during personal care or cleansing. There was no blood evident during personal care and no open wounds; and
• there was no evidence the care provider had been negligent. It said if skin lesions had been present, this would have been reported to the district nursing team.
22. In May 2023, the Council’s safeguarding team said it would not undertake enquiries. This was because it considered the information already gathered to be proportionate and relevant to the concerns raised. It said:
• the bruising to Mrs Y’s arms looked consistent with a stand aid and sling being used; and
• the pictures of Mrs Y’s legs looked more like discolouration of the skin, rather than bruising.

Analysis- was there fault by the care provider causing injustice?

23. Mr X raised concerns around bruising to Mrs Y’s skin. The care provider investigated, and its findings are detailed in paragraphs 18. The Council’s safeguarding team also considered this and decided not to undertake enquiries.
24. Mrs Y’s care plan states she suffers with occasional bruising to the skin. We could not criticise the care provider for carrying out a stand aid assessment. Mrs Y was having trouble mobilising, so it needed to assess other ways of assisting Mrs Y for this to be safe for her. This is in line with regulation 12. Once it was aware Mrs Y was uncomfortable, it stopped the assessment, and it was not carried out again. We could not say the bruising was caused by fault by the care provider.
25. I have reviewed the evidence and have not seen anything to suggest personal care was provided to Mrs Y by male care workers. The care provider stated there was one occasion where a male care worker supported Mrs Y to use the commode. But the care plan did state that Mrs Y had been informed that she may sometimes have a male care worker help her. It was noted this would be reduced as much as possible. In my view, this was reduced as much as possible as there was only one occasion. Therefore, this is in line with the care plan and therefore in line with regulation 9.
26. Mr X reported skin tears to Mrs Y’s bottom. As stated in paragraph 21, the care workers did not notice any open wounds or blood during personal care. The daily personal care record stated care workers were to apply two separate creams to Mrs Y twice a day. I have reviewed the evidence and note this was applied in line with the record. Personal care was also provided daily. This is in line with regulation 9 and I cannot say the skin tears were due to fault by the care provider.
27. As stated above personal care was provided daily. Mr X has raised concerns with Mrs Y having only one bath and hair wash during the week. On the remaining days, it is noted care workers did assist Mrs Y with a wash daily. The pre-assessment completed before Mrs Y’s stay stated staff would offer her a bath or shower at least once during her stay. The care provider told us service users can have a bath or shower daily if they wish.
28. Mr X told us during the pre-assessment, he asked for Mrs Y to have a bath or shower daily as this is what she had at home. There is no evidence to suggest Mr X’s request was agreed. The care provider provided what was in the pre-assessment. We could not say it is fault that the care provider did not provide Mrs Y with a bath or shower daily. I also note there is nothing to suggest the lack of daily bath or shower had a significant detrimental impact on Mrs Y.
29. As part of Mr X’s complaint to the care provider he said Mrs Y was not using her own wheelchair when he collected her. The care provider has acknowledged this and apologised. It said it has reminded staff to be aware that some of the wheelchairs used are the residents own and must always be used only for them. Whilst it was fault for Mrs Y to have not been in her own wheelchair, I do not consider the injustice to be significant.

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Final decision

30. I have ended my investigation and do not uphold Mr X’s complaint.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman