Summary: We will not investigate this complaint about the standards of care and level of service the complainant received while in residential care. This is because there is insufficient evidence of any actions by the Care Provider having causing the complainant to suffer a significant and personal injustice.

The complaint

1. The complainant (Mrs X) is complaining about the standards of care and level of service her mother (Mrs Z) received while in residential care at Grove Park Care Home, which is owned and managed by Avery Healthcare Limited (the Care Provider). Mrs X’s complaint relates to:
1. There being no segregation of care home residents who have severe dementia from other residents of the home.

2. The serving of inadequate quality meals at the home and which consistently lack choice and nutritional value.

3. There being an ongoing odour of urine within the corridors of the care home, therefore suggesting a lack of cleaning and/or support to residents.

4. There being a lack of staff within the care home to assist visitors and to provide active supervision of residents to inform support.

5. The care home elevator being out of order which in turns created problems for visitors leaving the building.

2. In summary, Mrs X says Mrs Z was frightened and distressed by other residents and ended up keeping to herself in her room and having meals brought to her rather than walk to the dining room. Mrs X alleges the Care Provider failed to adequately support Mrs Z to eat her meals, or offer good quality and varied choices. As a desired outcome, Mrs X wants the Care Provider to acknowledge its failings, improve the services offered and provide a partial refund of the care fees in order to compensate for the distress and impacted caused.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide the action has not caused injustice to the person complaining, or the injustice is not significant enough to justify our involvement. (Local Government Act 1974, sections 34B(8) and (9)).
4. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set the fundamental standards that registered care providers must achieve. The Care Quality Commission has guidance on how to meet the fundamental standards.

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How I considered this complaint

5. I considered information provided by the complainant and the Care Provider. I also considered the Ombudsman’s Assessment Code.

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My assessment

Lack of Resident Segregation

6. Mrs X says the lack of segregation meant Mrs Z was encountering people who presented challenging needs which caused her to feel frightened. Mrs X says she was was led to believe this would not be the case prior to choosing the care home. The Care Provider has confirmed that the home offers care to a range of residents with differing types of dementia/older age memory loss, and associated needs. It also explains there was no record or feedback from Mrs Z directly with respect to feeling frightened which prevented it from taking steps to support her.
7. The care home being a place which accommodates different levels of dementia and memory loss would suggest a degree of unavoidable and challenging symptoms being exhibited. There is no evidence to suggest this is a consequence of any actions by the Care Provider, but rather this being inherent in caring for the needs of service users presenting complex needs. I have also not seen any evidence of the Care Provider having informed Mrs Z would not encounter any residents displaying more advanced needs, but rather that this was not initially recognised when choosing the home. I do not consider this is something the Care Provider can reasonably prevent by enforcing a blanket policy of segregation. Such action could be perceived as a deprivation of liberties which can only be lawful if authorised by a local authority, and such deprivation being the least restrictive possible having considered a residents individual needs and risks.
8. We must be satisfied the alledged fault has caused the complainant a significant and personal injustice. This means the Mrs X must show a likelihood of fault by the Care Provider causing Mrs Z serious loss, harm or distress. While I appreciate the points raised, there is no evidence to suggest Mrs Z has been caused an injustice due to any actions or fault by the Care Provider. The evidence suggests the concern is indicative of the care setting and type of care provided there.

Poor Quality Food and Lack of Choice

9. In addition, Mrs X says the food offered to Mrs Z by the Care Provider lacked variety and was of poor quality and nutritional value. Regulation 14 of the Fundamental Standards requires care providers to make sure service users have adequate nutrition and hydration to sustain life and good health and reduce the risks of malnutrition and dehydration while they receive care and treatment.
10. The Care Provider initially responded to Mrs X when considering the complaint internally. It referred to daily records which it says shows Mrs Z ate most meals and chose what she would like eat, and that her weight had been stable during her time at the home. The complaint information submitted by Mrs X does not contest any of the Care Provider’s response and records, or which leads me to question whether its actions have fallen short of Regulation 14. This does not lead me to question the accuracy of the Care Provider’s records. The evidence does suggest Mrs Z being dissatisfied with some meals which resulted in her and her husband having an amicable meeting with the chef at the home to discuss feedback so to accommodate any preferences. On balance, there is insufficient evidence that any actions caused Mrs Z a significant enough injustice to warrant an investigation, such as prejudicing her health or care needs.

Continuous Urine Odour in Corridors

11. Mrs X further complains about a continuous smell of urine on the floor Mrs Z’s room was located. The Care Provider says that as a care home which supports residents with a range of needs, including continence care needs, those residents are afforded continence care based on need. However, it says timely continence care still emits an odour. It also says it has daily cleaning schedules and protocols in place to reduce odours and ensure a high standard of cleaning. I am satisfied that is a reasonable response from the Care Provider. Within a care setting which accommodates residents with varying needs, there would clearly be unavoidable instances of the issues complained about which are indicative of resident care needs, as opposed to resident care needs not being met. There is insufficient evidence of any action by the Care Provider in respect of this part of the complaint having causing Mrs Z to suffer serious loss, harm or distress.

Lack of Staff and Support Offered

12. The complaint also raised concerns with respect to public areas at the care home, such as lounges, not being adequately supervised, and that there seemed to be a general lack of staff to be found anywhere in certain parts of the home. This is based on Mrs X’s observations when visiting Mrs Z at the care home. Mrs X says this was a problem for visitors who found themselves trapped several times due to being unable to get out of the building without staff being around. The complaint is made on behalf of Mrs Z and so we can only consider matters experienced by her. We are unable to investigate any concerns or injustice caused to any general visitors of the home.
13. I have however considered Mrs X’s point that this issue also seemed to suggest a lack of supervision of residents which could extend to Mrs Z. In response, the Care Provider states there were no residents at the home at this time who required one to one supervision. Further, it confirmed that care staff go where the care is needed within the home, as opposed to being in a fixed space. That is a reasonable response in my view and I have not been presented any evidence of care needs not being met. In my view, this part of the complaint does not give details of Mrs Z having been caused an injustice due to a lack of supervision.

Elevator Being Out of Order

14. I recognise Mrs X also states her unhappiness with the care home elevator not working which caused hardship for visitors, including Mrs Z’s elderly husband. For the reasons stated, I cannot consider any injustice to individuals not named in the complaint submitted to us. The complaint is brought on behalf of Mrs Z as the person affected. There is no indication in the complaint information that this particular matter impacted Mrs Z directly. There is therefore insufficient evidence of any action by the Care Provider having caused Mrs Z an injustice.

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Final decision

15. We will not investigate this complaint. This is because the restrictions I outline at paragraph three (above) applies.

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Investigator's decision on behalf of the Ombudsman