Summary: Mrs X complained that the Council’s commissioned care provider did not provide good care and treatment for her husband. The Council’s safeguarding investigation showed the care home had implemented all necessary measures to manage Mr X’s health. The Council has now offered to waive the contribution as there was some poor communication by the care provider which caused distress to Mrs X.

The complaint

1. Mrs X (the complainant) complained about the poor care and treatment of her husband in the Old Rectory Care Home from November 2022 when he was resident for a period of respite care. She complains that despite frequent calls to the social care team no action was taken in respect of her complaints that he was neglected and malnourished in the home until he was admitted to hospital. She also complains that the Council, which said it found no safeguarding concerns but said there were ‘quality issues’, did not waive the fees

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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. I spoke to Mrs X.
5. Both parties 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 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.
8. Regulation 10 says service users must be treated with dignity and respect.
9. Regulation 14 says the nutritional and hydration needs of service users must be met.
10. 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

11. Ms X has dementia. Mrs X looked after him at home but he attended day care at the Old Rectory during the week. In November 2022 Mrs X arranged for Mr X to spend a period of respite care at the Old Rectory as his needs had increased significantly.
12. At first it appeared that Mr X had settled in the home and Mrs X asked for the placement to be made permanent. However, by mid- December Mrs X asked for Mr X to be moved to another care home. She said Mr X had a chest infection which she believed had gone unnoticed and his mobility had deteriorated. In January 2023 he developed a pressure sore on his heel.
13. The social work case recording shows that there was a conversation with the care home’s deputy manager about Mr X’s condition. The deputy manager said the pressure sore had developed because Mr X had been less mobile for a while. She said the community mental health team (CMHT) had increased Mr X’s medication because of his increased agitation and aggression towards staff. However, he had become drowsy and hard to rouse so the care home had asked the CMHT to reduce the medication, which they did. The care home had made a referral to the tissue viability nurse and Mr X was wearing the appropriate footwear.
14. Mrs X continued to raise concerns and said she wanted to take Mr X home again. She said his medications had been altered without her involvement. However, Mr X was then admitted to hospital. While he was there Mrs X said she did not want him to return to the Old Rectory. She raised a safeguarding concern. She said he had lost weight while in the care home and she had concerns about his skin integrity.
15. The safeguarding investigation did not find any evidence of neglect or acts of omission by the care home. The safeguarding investigator identified the following actions taken by the care home:

“intake monitoring charts;

SALT [speech and language therapy] referral;

MDT [multi-disciplinary team] with GP and CMHT;

fortified diet with full-fat dairy;

commenced soft diet and enhanced support at mealtimes;

air flow mattress;

pressure relieving cushion and Devon boots obtained and in use.”

(There were other care issues identified which did not relate to Mr X’s care.)

16. Mr X returned home in February 2023 and Mrs X continued to look after him for some time until he went into a different care home.

The complaint

17. In March 2023 Mrs X complained to the Council about Mr X’s treatment in the home. She said she had told the social worker in December 2022 that she wanted her husband moved but there was no action taken as she was told his needs required further assessment before that could happen. She said she no longer trusted another home to look after him. She said it was a failed placement, and she asked for reimbursement of the invoice she had received for his assessed contribution to the fees.
18. The Council investigated the complaint, and a manager spoke to Mrs X. The manager responded formally in November 2023. She said she partially upheld the complaint about the care home as although the safeguarding investigation had not found any concerns, there had been some quality issues reported. She said managers had been reminded of the need to communicate more fully with families. She said it had been decided not to waive the invoice however as there had been no acts of omission.
19. Mrs X complained to us in November 2024.
20. The Council agrees to waive the invoice in view of the distress experienced by Mrs X over her husband’s care.

Analysis

21. There were some failings in communication between Mrs X and the care home staff but there is no evidence that he was treated without respect. It was an unfortunate side-effect of the increased medication, prescribed to ameliorate his agitation, which caused him to appear disassociated.
22. The safeguarding investigation was conducted appropriately although Mrs X disagreed with its outcomes. Care issues which were raised for further monitoring were not relevant to Mr X.
23. In my view that Council’s agreement to waive the invoice is sufficient to remedy the distress caused to Mrs X.

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Action

24. The Council should provide us with evidence it has complied with the above action.

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Decision

25. I have completed this investigation on the basis that I find fault causing injustice, and the Council has agreed actions to remedy injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman