Summary: We will not investigate this complaint about adult social care provided in a care home. We could not add to investigations already completed by the care provider and the safeguarding authority or achieve a different outcome.

The complaint

1. Ms C says a care provider neglected her relative, Mr D. Ms C says it was very upsetting to watch her relative decline and upsetting that the care provider made her out to be a liar as did not accept its failings. Ms C wants the Council to not commission with this provider. Ms C wants the Care Quality Commission to drop the provider’s rating. Ms C wants the provider to employ caring staff, and to improve its service to other residents.

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The Ombudsman’s role and powers

2. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service but must use public money carefully. We do not start or continue an investigation if we decide:

• we could not add to any previous investigation by the organisation, or
• further investigation would not lead to a different outcome, or
• we cannot achieve the outcome someone wants, or
• there is no worthwhile outcome achievable by our investigation.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

4. I considered information provided by the complainant and the Council.
5. I considered the Ombudsman’s Assessment Code.

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My assessment

6. Mr D went from hospital to a care home for assessment by the Council of his long-term care needs, and for assessment by a physiotherapist and occupational therapist. Mr D was at the care home a couple of weeks before being readmitted to hospital.
7. The Council’s safeguarding team investigated. Safeguarding is protecting adults with care needs from abuse, neglect, or exploitation. The Council found the care provider had neglected Mr D. The care provider completed an action plan, including improving service in areas Ms C mentions such as checking, recording, and caring for skin integrity. However, Mr D died and so the plan to improve his care support was never actioned. The care provider should carry out the learning from this complaint more widely, to improve service to all residents present and future.
8. The Ombudsman cannot achieve the outcomes Ms C wants about the care provider’s quality rating and the commissioning of this care provider by councils and other bodies.
9. It is unlikely an Ombudsman investigation would add to the Council’s safeguarding investigation or achieve any different outcome. The Care Quality Commission regulates care providers in England and has fundamental standards below which care should never fall. The Care Quality Commission regularly inspects the services it regulates, and amends ratings when it sees fit.
10. The Council has a quality monitoring department to oversee care providers it commissions to provide services on its behalf. It will consider if providers have breached contracts, it will work with providers to improve their services where they fall short of expected quality standards and will decide whether to continue to contract and commission with providers.

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Final decision

11. We will not investigate Ms C’s complaint because though it was upsetting and distressing for Ms C I do not consider the Ombudsman could add to investigations already completed or achieve a different outcome. We cannot achieve the outcomes Ms C wants and can provide no personal remedy to Mr D who would have suffered the most significant injustice.

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Investigator's decision on behalf of the Ombudsman