Summary: Ms X complained about the care Revitalise Respite Holidays (the Care Provider) provided to her daughter, Ms Y. Ms X is unhappy about how care workers treated Ms Y’s tightly coiled hair when it was in braids. The Care Provider was at fault for poor record keeping, a flawed investigation into Ms X’s concerns and for not telling her when Ms Y no longer had her braids. This caused Ms X uncertainty, frustration and distress and meant Ms Y’s hair was damaged. To remedy the injustice to Ms X and Ms Y, the Care Provider will apologise to Ms X and pay her £250.

The complaint

1. Ms X complained about the care Revitalise Respite Holidays (the Care Provider) provided to her adult daughter, Ms Y, during her three week stay in autumn 2024. Ms X is unhappy about how care workers treated Ms Y’s hair and that male workers provided personal care for Ms Y on one occasion. Ms X said the Care Provider’s actions damaged Ms Y’s hair and caused them both significant distress.

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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. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide further investigation would not lead to a different outcome. (Local Government Act 1974, section 24A(6), as amended, section 34(B))
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. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
7. 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

8. I have considered:
• All the information Ms X provided and discussed the complaint with her;
• The Care Provider’s comments about the complaint and the supporting documents it provided;
• Evidence from Essex County Council;
• The relevant law and guidance and the Ombudsman's guidance on remedies.
9. Ms X and the Care Provider had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

CQC and fundamental standards

10. 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.
11. Regulation 9 of the Regulations says care and treatment of people must be appropriate, meet their needs and reflects their preferences. Associated guidance says that where a person needs intimate or personal care, care providers should make every reasonable effort to respect the preference of the person receiving care. This can include that they receive care from someone of a specified gender or sex.
12. CQC Regulation 17 states care providers must keep an accurate and complete record for each resident.

Safeguarding

13. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

What happened

14. Ms Y is a Black woman with tightly coiled hair. She moved into a home managed by the Care Provider in late August 2024, for just over three weeks, so Ms X could have some respite from her caring duties. Ms Y has paralysis on her left side.
15. Before Ms Y moved into the home, Ms X put Ms Y’s hair in a protective style made up of many small braids. She also completed a pre-arrival assessment form where she detailed what support Ms Y needed. Ms X said this included that care workers should leave Ms Y’s hair alone.
16. The Care Provider reviewed Ms Y’s care plan. It noted Ms Y:
• Needed help with personal care;
• Wanted female staff only; and
• Could engage in care, choose and express her needs and wishes.
17. On the day of Ms Y’s admission to the home, Ms X completed an admission form with a member of staff. Ms X says she recalls the member of staff recording that staff should leave Ms Y’s hair alone. Because of that, she did not leave shampoo with Ms Y.
18. During Ms Y’s stay, she washed her hair herself within her first week. It is possible Ms Y did this with her braids still in. Care workers helped Ms Y wash her hair on four other occasions.
19. On five other days, the Care Provider’s records do not indicate what hair or other personal care Ms Y received, or if she declined it.
20. Ms Y’s care records note that one day she complained that she had received personal care from male agency care workers the day before. One of the agency workers stated she and another female care worker had supported Ms Y that day. They noted male care workers had been working but had supported other residents. The records of which care workers helped Ms Y the preceding day note she received personal care from agency workers, without a specific name.
21. In mid-September, Ms X arrived to take Ms Y home. She found Ms Y’s hair was no longer in braids. Ms X complained to the Care Provider. She said:
• Care workers had removed Ms Y’s braids, washed her hair with unsuitable shampoo and dry brushed it. She said this would have been painful for Ms X and caused damage; and
• Ms Y had a burn mark on either side of her face, which Ms X thought was from a straightener.
22. The Care Provider sent a safeguarding referral to Essex County Council and completed an investigation in late October 2024. It said:
• It had relied on records of Ms Y’s care, her care plan, interviews with three members of staff who had helped Ms Y with her hair, the pre-arrival assessment form, staff rota, and photographs Ms X had taken of Ms Y’s hair.
• Ms X had not mentioned hair care in the pre-arrival assessment form or the admission form;
• Ms Y had capacity to make decisions about her personal care; and
• Ms Y had asked to have her hair washed twice during her stay. It had interviewed the three members of staff who had helped Ms Y wash her hair those occasions. They all said they had washed Ms Y’s hair at her request, using shampoo, and that they had not used heat tools.
• One of them said Ms Y had her hair in braids for a few days after her arrival. One morning, they had found Ms Y with her braids undone. Ms Y had reported they had been uncomfortable during the night so she had removed them. A short time later, Ms Y said her braids had come loose while she was moving in bed.
• On Ms Y’s last day in the home, a care worker supported Ms Y to wash her hair. They then brushed it and put it in a bun for her;
• The home did not have a straightener on premises;
• It did not agree Ms Y had burns on her face, it said the marks were from skin discolouration; and
• It did not uphold Ms X’s allegations.
23. The Care Provider issued its response to Ms X’s complaint the same day. It said it was not at fault in how it acted.
24. The Council considered the safeguarding referral. It noted it had asked the Care Provider for a copy of its admission form but had not received it. It also had not seen the pre-arrival assessment form. The Council decided the evidence that Ms Y experienced abuse or neglect was inconclusive, so it closed the case.
25. I asked the Care Provider to send me a copy of its pre-arrival assessment form and admission form but it did not send them.
26. In late November 2024, the Care Provider stopped running homes like the one Ms Y attended.

Findings

Hair

27. Ms X says she told staff not to touch Ms Y’s hair and that, because they did, Ms Y’s hair had been damaged. However, the Care Provider says there was no information relating to Ms Y’s hair in the pre-arrival assessment form or the admission form. The Care Provider has not sent the Ombudsman a copy of either form. I note the Care Provider was also unable to send copies to the Council, which asked for them as part of its consideration of the safeguarding referral.
28. In addition, the Care Provider’s investigation stated the pre-arrival form and admission form did not include any information about Ms Y’s hair, but the admission form was not listed in the documents the Care Provider said it had relied on during the investigation. Given this, I conclude the Care Provider did not keep a record of the admission form or the pre-arrival assessment form. This was not in line with regulation 17, as set out in paragraph 12 and was fault. Because of this, I cannot say, even on balance, what information the care workers had about how to treat Ms Y’s hair. This caused Ms X avoidable uncertainty and frustration.
29. Ms X said Ms Y could not have removed her braids because she is paralysed on her left side. She said this meant care workers must have removed Ms Y’s braids. As part of its investigation, the Care Provider interviewed a care worker who said they found Ms Y had taken her braids out a few days after moving into the home.
30. It is not clear, from the records, what the care worker meant by this. The Care Provider has since stopped running care homes so I cannot interview the care worker for clarification. As a result, I have ended my investigation into who removed Ms Y’s braids. Any further investigation would not result in a different outcome.
31. Tightly coiled hair of Ms Y’s type needs special treatment as it is more porous than other hair types. It can easily become dry and is prone to breakage at that point. For that reason, it is common to use products designed for that hair type. Ms X uses such products for Ms Y’s hair. In addition, many people with Ms Y’s type of hair will put it in a protective style, such as braids, which reduces the damage to the hair.
32. Once the care worker identified Ms Y no longer had her braids, they should have recorded that in her care records. The failure to do was fault. The Care Provider should have also alerted Ms X so she could advise on what to do, or to bring in products which would allow care workers to help Ms Y manage her hair, while minimising damage. This could have included shampoo. The Care Provider was also at fault for not doing this. The faults in this paragraph caused Ms X distress when she found Ms Y without her braids and with damaged hair.
33. Ms Y washed her hair five times during her stay in the home, once without any help. Ms Y had capacity to decide whether she wanted her hair washing so the Care Provider was not at fault for complying with her wishes. However, the Care Provider did not contact Ms X when Ms Y no longer had braids, so she did not bring in her preferred shampoo and other products. This meant Ms Y and the care workers used standard shampoo to wash her hair, which likely caused some of the damage Ms Y experienced.
34. Ms X thinks care workers used heat tools on Ms Y’s hair. The Care Provider’s investigation noted Ms Y had asked for help washing her hair twice. It had interviewed the three care workers who had supported Ms Y on those occasions, and they all confirmed they had not used heat tools. However, the Care Provider failed to identify that Ms Y had asked for help with her hair a total of four times. As a result, it did not interview the care workers who helped Ms Y on the other two occasions. The poor investigation by the Care Provider was fault and caused Ms X frustration and uncertainty.
35. The type of hair Ms Y has should normally be brushed wet and with products on the hair. Not doing so can cause unnecessary damage. The care records do not indicate whether the care worker who brushed Ms Y’s hair on her last day at the home brushed it dry or wet. This is a further example of poor record keeping, and was fault. It caused Ms X frustration.
36. The Care Provider was also at fault because on five days, it did not record what personal care it provided to Ms Y, including hair care. This was also not in accordance with regulation 17 and caused Ms X uncertainty.

Burn

37. Ms X feels the marks observed on Ms Y’s head were burns caused by a hair straightener. The Care Provider has confirmed it did not have straighteners in the care home and the photos of the marks on Ms Y’s head do not clearly show they were burns. Given that, I am satisfied the Care Provider did not cause the marks and so was not at fault.

Male care workers

38. Ms Y told the Care Provider she was unhappy she had been supported by male care workers the preceding day. However, records of Ms Y’s care on that day only state she had personal care from unnamed agency workers. Once Ms Y complained, care workers considered the issue and noted she had been supported by two female care workers. I have not investigated this part of Ms X’s complaint. There are conflicting accounts so it is likely further investigation would not result in a different outcome.

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Action

39. Within one month of the date of my final decision, the Care Provider will take the following actions:
1. Apologise to Ms X for the distress, uncertainty and frustration she felt because of its poor record keeping, investigation into her concerns and failure to tell her Ms Y no longer had her braids. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Care Provider will consider this guidance in making the apology.
2. Pay Ms X £150 in recognition of that injustice.
3. Pay Ms X £100 on behalf of Ms Y in recognition of the damage caused to her hair by the Care Provider’s use of unsuitable shampoo.
40. The Care Provider will provide us with evidence it has complied with the above actions.

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Decision

41. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman