Summary: Ms A and her sister Ms B complain that the care provider gave notice on their late father’s placement without due reason and they had to find another placement at short notice for their elderly father who has dementia. The care provider failed to meet Mr X’s needs and gave notice inappropriately; the care provider agrees to acknowledge that and pay a suitable sum to Ms A and her sister in recognition of the stress caused.

The complaint

1. Ms A and her sister (the complainants) says the care provider gave notice on their father’s placement when he required a temporary increase in minor care services (increased blood glucose monitoring) which they say they would have provided themselves. Instead, they had to find an alternative placement for Mr X at short notice which caused disruption for him and distress and anxiety for them.

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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. 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)
5. 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

6. I considered evidence provided by Ms A, the care provider and the local NHS diabetic nursing team as well as relevant law, policy and guidance.
7. Ms A 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

Relevant law and guidance

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 that care providers should provide opportunities for relevant persons to manage the service user's care or treatment, and adds, “'Manage' in this context may mean being actively involved, overseeing or making decisions about their care or treatment depending on how much they need or want to be involved. This may include …. using appropriate equipment and technology”. It says “People using the service and/or those lawfully acting on their behalf should be given suitable information, advice, instruction and/or emotional support to help manage any care and treatment safely.”

What happened

10. Mr X, an elderly man with dementia and Type 2 diabetes, became resident in the care home in September 2023. His diabetic condition was known to the care provider and he was visited on a daily basis by the District Nursing team to administer insulin. His care plan states that the District Nursing team also monitor his blood glucose levels daily. The care plan was reviewed on 2 January 2024 and states no changes had taken place in the last month.
11. The diabetic nursing notes for December show the diabetic nurse met the senior carers to discuss Mr X’s care and said she would send a glucose monitoring machine to the home. She noted Mr X had never suffered a ’hypo’ while he had been in the home but discussed action in case he had a hypo. She said the senior carer was “happy that all care staff have an understanding of hypos and how to treat”.
12. Ms A says that problems began after the home came under new management in mid-December. Her sister Ms B was asked to come in to see the new manager at the start of January 2024 regarding Mr X’s care. The manager told her at the meeting that the diabetic nurse had said Mr X now required blood glucose readings to be taken four times a day and the home could therefore no longer meet his medical needs.
13. The daily care notes for 12 January say, “Conversation with daughter as staff at Sedgley Court are unable to meet (Mr X’s) needs due to blood sugars requiring to be taken four times daily, also staff are having difficulty communicating with (Mr X).
14. An email dated 07 February from the diabetic service to Ms A shows this was not what the nurse had said. She explained she wanted readings taken before or after a meal so she could adjust his insulin appropriately. She was happy for family members to do this as they had in the past.
15. The diabetic nursing service says it contacted the home on 28 December, 4 January and 8 January to obtain Mr X’s blood glucose levels but did not receive a response. It says “On 9 January 2024, the team contacted the care home by telephone to request blood glucose levels. An email was then received from the care home with the blood glucose levels taken from the district nursing notes. The care home informed the DOT that as they are a residential home, Sedgley Court do not check blood glucose levels. This was not mentioned at the initial consultation, and they had previously undertaken care for a resident requiring blood glucose monitoring”.
16. On 12 January the former care home manager wrote to Ms B and said “Following on from our recent discussions regarding the diabetic nurse instructions regarding (Mr X)’s blood sugars and insulin. It is with regret that I feel we can no longer meet his needs in a safe and measured way.” She confirmed she was giving 28 days’ notice on his placement.
17. Ms A emailed the manager and pointed out that the diabetic nurse had offered training to obtain more accurate records. The manager replied that “As our home is residential, we are unable to take (Mr X)'s blood glucose levels, the nurses do mention training but unfortunately due to our policies we are unable to cater for this, this is also because are staff are not trained if blood sugar readings are not within normal range and how to deal with what can be a dangerous situation”.
18. Mr X moved to another care home.

The complaint

19. In April Ms B wrote to the care provider to complain about the way her father had been treated. She said the way they had been told of the termination of the contract was abrupt and dishonest, implying the carers were being asked to perform nursing tasks. She said “(the manager) told my sister no carer was able to take blood sugar readings and used it as an excuse to move my dad. The nurse just wanted readings before or after a meal so that she could adjust his insulin intake prescription. She was happy for a family member to take the blood sugar readings as we have done in the past”. She said as a family they were devastated as their father had settled in the home.
20. Ms B also complained that the standards in the care home had deteriorated from December. She said they took their father out of the home for two days over Christmas but when they took him back, “his room was a mess, smelt of urine and no one had bothered to clean his room, do his bed, or take his laundry which was lying on the floor. I then made the bed myself and my sister cleaned the room”. She said her father was moved from his room to another for the last two weeks he was at the home. She said the handover on the day of his transfer was poor and not all his notes could be found. She asked for a refund for the two days over Christmas and the last two weeks of his care.
21. Ms A complained again after the initial response. In respect of the blood glucose monitoring, she said “The district nursing team required these readings on a temporary basis to tailor his insulin levels as there had been some changes. I would have expected that reasonable adjustments could have been made to facilitate this and this certainly was the opinion of the district nursing team. Readings taken by a family member over random days and times would have been accepted by the District Nurse”. She provided photos of the state of her father’s room after Christmas. She said her father’s records had been incomplete.
22. The care provider’s former commissioning director replied. She said, “the reasons for the request to find alternative placement for your father …was due to a change in his care needs that required additional nursing interventions from the district nurse teams that were not sustainable. The care staff at Sedgely Court are not insured, trained, or have the experience to monitor blood sugars.” She said he was displaying behaviour that was challenging for the care team because his diabetes was unstable. She agreed the state of Mr X’s room was unacceptable as seen in the photos. She said all the necessary medication charts had been handed over on the day of Mr X’s transfer. She concluded “I am unable to fully substantiate your complaint due to the lack of evidence and delays with raising the concerns as explained in my responses and therefore I am unable to refund the care fees as requested”.
23. Ms A and Ms B complained to the Ombudsman.
24. The care provider says “Sedgley Court is a residential care home with no nurses. Blood sugar monitoring and the administration of insulin is the responsibility of the District Nursing teams”.
25. The care provider says it cannot find any documented discussions about Mr X’s care with the District Nursing Team or Diabetic Nursing team. It cannot provide any documented discussion about concerns over Mr X’s care.
26. The daily notes provided by the care provider show some episodes of Mr X being unsettled and showing challenging behaviour on a couple of occasions prior to notice being given on 12 January.
27. The care provider says Mr X required increasing nursing interventions due to the instability of his diabetes and associated behaviours. It says measurement or monitoring of glucose is a nursing intervention which the home (a residential care home) could not provide.
28. Mr X has now died.

Analysis

29. The care provider gave notice because it said Mr X required increasing nursing interventions and was displaying challenging behaviours which staff had difficulty managing. There is no evidence that he required increased nursing interventions and his family point out that any disturbed behaviour probably arose from his diabetic needs which were under investigation.
30. The evidence shows that the diabetic nursing team was happy for the temporary increase in blood glucose readings to be taken by Mr X’s family. There was no suggestion that care staff would be involved in any nursing intervention such as administration of insulin. The diabetic nursing team had provided the care home with a blood glucose reader and confirm that no concerns were raised about this at the initial consultation in October, and the home had previously collected blood glucose readings for another resident.
31. The blood glucose readings could have been taken by family for the short period they were required but the care provider made no attempt to put that provision in place. The regulations clearly state this should be facilitated (see para 8 above).
32. The records provided by the home do not show any discussion about Mr X’s disturbed behaviour with his family.
33. The care provider agrees that Mr X’s room was left in an unacceptable state over Christmas but says it was too late to consider that complaint properly.
34. There is no plausible reason why the care provider gave notice to Mr X except that the management of his care was temporarily out of the ordinary.

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Action

35. Within one month of my final decision the care provider will apologise to Mr X’s family for the distress and anxiety caused by its unwarranted actions in terminating his placement.
36. Within one month of my final decision the care provider will review the way it puts its policies into practice to ensure that it is not in danger of appearing to use them as an excuse to terminate the placement of residents.
37. Within one month of my final decision the care provider will make a payment of £500 to Mrs X in recognition of the distress caused to her by the disturbance of her husband from his home, and £300 each to Ms A and Ms B to recognise the distress and anxiety caused to them.
38. Within one month of my final decision the care provider will refund two days care charges for the unacceptable state of Mr X’s room over the Christmas period.
39. The Care Provider should provide us with evidence it has complied with the above actions.

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Decision

40. I have completed this investigation on the basis that the actions of the care provider have caused injustice, which the completion of the recommendation above will remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman