Summary: Miss X complained the Council failed to provide appropriate care and support for Mrs Y during her six week stay and dismissed the family’s concerns about Mrs Y’s presentation and wellbeing. We found there was no evidence of fault in the care and support the care home provided to Mrs Y.

The complaint

1. Miss X complained the Council failed to provide appropriate care and support for Mrs Y during her six week stay. Miss X says Mrs Y lost 12 kilograms in weight whilst at the care home and was admitted to hospital with dehydration.
2. Miss X also complained the care home dismissed the family’s concerns about Mrs Y’s presentation and wellbeing.

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The Ombudsman’s role and powers

3. 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)
4. When considering complaints we make findings based on the balance of probabilities. This means that we look at the relevant available evidence and decide what was more likely to have happened.
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)

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How I considered this complaint

6. I considered evidence provided by Miss X and the Council as well as relevant law, policy and guidance.
7. Miss X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

What happened here

8. Mrs Y was diagnosed with Alzheimer’s dementia many years ago and had a stroke in March 2024. She lived at home with her husband who was her main carer. As Mrs Y’s condition deteriorated Mr Y struggled to support her and the family asked for a care needs assessment.
9. The care assessment determined a package of care at home was not suitable as it would not be responsive enough to Mr and Mrs Y’s needs. It said Mrs Y required specialist dementia care in a safe environment to reduce the risk of harm. Mrs Y was at high risk of wandering and loss of dignity and was no longer able to understand the risks to herself. She was also at high risk of malnutrition, dehydration and self-neglect without specialist care as she had become suspicious of her family and environment.
10. The assessment noted Mrs Y was currently very suspicious of food and fluids and had restricted her intake. As a result she had lost a stone and a half in the last four to six weeks despite her family’s best efforts to encourage her to eat.
11. Mrs Y moved to the care home on 30 September 2024, initially for three weeks’ respite, with the option for the place to become permanent.
12. On 18 October 2024 Mrs Y’s family attended a best interest meeting at the care home to discuss Mrs Y’s care and accommodation. The notes of this meeting show a discussion around Mrs Y’s medication. The care home manager noted Mrs Y was mainly complaint with her care but did not sleep well and was taking time to become familiar with her new environment.
13. Mrs Y’s son raised concerns about Mrs Y not making it to the ensuite and the care home manager suggested changes to make it easier for Mrs Y to find the toilet in the night.
14. The care home manager also noted Mrs Y was not eating or drinking well and had lost weight. Mrs Y’s weight was 60.95 Kg when she moved to the home and she was currently 59.0 Kg. The care home was monitoring her weight and weighing her weekly. It was also providing Mrs Y with a fortified diet and was monitoring her food and drink intake daily.
15. The meeting agreed it was in Mrs Y’s best interest to remain in residential care at the care home.
16. Mrs Y was admitted to hospital on 14 November 2024 and passed away on 20 November 2024.
17. On 26 November 2024 Mr Y contacted the Council to advise he had cancelled Mrs Y’s contribution towards her care home charges from 14 November 2024. He told the Council he was not happy with the care Mrs Y had received and was shocked by her condition when she was admitted to hospital.
18. The care home contacted Mrs Y’s family on 3 December 2024 to arrange to send flowers to Mr Y. The family advised Mr Y would not want any flowers as he was very unhappy with Mrs Y’s care and wanted to make a complaint. The care home manager arranged a meeting with Mr Y for 9 December 2024 to discuss his concerns.
19. The records of this meeting show Mr Y had two specific concerns:
• The family had raised concerns about Mrs Y’s presentation which were dismissed by care home staff. Mr Y acknowledged a paramedic did attend and an ambulance was subsequently called.
• Care home staff had not supported Mrs Y with her toileting needs during the night.
20. The care home investigated Mr Y’s concerns and responded on 24 December 2024. It had reviewed Mrs Y’s care notes and confirmed there was evidence staff assisted Mrs Y to the toilet during the night on several occasions. There were also occasions where Mrs Y declined assistance. The care home also said there was a floor sensor in place which enabled staff to respond promptly if Mrs Y attempted to go to the toilet independently.
21. In relation to Mrs Y’s presentation on 14 November 2024 the care home said it had spoken to the staff member involved and reviewed the records. It noted Mrs Y had been seen by three healthcare professionals that day and after taking Mrs Y’s observations, the staff member contacted 111 for guidance. This led to a specialist paramedic visiting to assess Mrs Y.
22. The care home said the member of staff had tried to reassure Mrs Y’s family by sharing that no concerns had been raised earlier in the day and apologised if her explanation had come across in the wrong way and caused distress.
23. As the family were not satisfied with the care home’s response, they have asked the Ombudsman to investigate their concerns. These include issues that Mr Y had not raised as part of his complaint. Miss X complained about:
• A lack of food and hydration. She says staff would present Mrs Y with a meal and walk away. They did not ensure she attempted to eat or drink and did not offer any assistance or offer any alternative. Miss X says Mrs Y was only supported to eat and drink when her family were visiting.
• Inadequate room/ facilities. Miss X says Mrs Y’s mattress was springy and uncomfortable which led to Mr Y bringing his own mattress into the care home to ensure Mrs Y was comfortable. She also complained the ensuite toilet was faulty for several weeks and that the floor sensor was inadequate. It was small and would not be triggered if Mrs Y got out of the other side of the bed. Miss X also said staff would not invite Mrs Y to take part in activities at the home and she only went on two day trips during her six week stay
• Weight loss. Miss X says Mrs Y’s weight dropped dramatically during her stay and that when family raised this with staff they dismissed their concerns. Miss X says that when Mrs Y was weighed on 14 November her weight had dropped to 48 Kg.
• Having to fight for medical attention. Miss X says they had to insist a doctor was called to Mrs Y on 7 November 2024 when Mrs Y was sleepy and unresponsive. A GP visited and advised to ‘watch and wait’. Miss X says the family’s concerns were repeatedly dismissed over the following week and she had to call for a manager on 14 November 2024. Mrs Y was then taken to hospital that evening with high salt in her blood system which Miss X says was due to severe dehydration.
24. Miss X complains that had the family known Mrs Y was at the end of her life they could have done more to make her more comfortable.
25. In response to my enquires the Council has provided copies of the care home’s daily care records for Mrs Y. These records frequently refer to Mrs Y’s family’s visits and detail the family’s concerns on 7 and 14 November 2024. But there is no reference to Mr Y replacing Mrs Y’s mattress, concerns about a faulty toilet or the family raising concerns about Mrs Y not being supported to eat or her weight loss.
26. The daily care records include details of the food and fluids offered to Mrs Y throughout each day, and the amount she consumed. They also note that staff would attempt to encourage Mrs Y when she declined meals and snacks or drinks.
27. The records also show that, where Mrs Y consented, staff weighed Mrs Y each week. The last record is for 2 November 2024, when Mrs Y weighed 55.5 Kg.
28. In addition the records show staff carried out regular welfare checks throughout the night and where necessary assisted Mrs Y to the toilet.
29. Mrs Y’s records for 7 November 2024 note that at around 5pm Mrs Y’s family told staff Mrs Y was not feeling well. Staff assisted Mrs Y to her room and took her blood pressure. The notes show Mrs Y’s son then arrived at the care home just before 6pm and questioned why the care home had stopped Mrs Y’s medication. The care home confirmed there had been no changes to Mrs Y’s medication. According to the records Mrs Y’s son asked the care home to arrange for a doctor to visit or he would call an ambulance.
30. The care home called the doctor who examined Mrs Y then spoke to her son. The records say the doctor then told care home staff Mrs Y would be expected to eat and drink less and was likely to decline in her presentation and cognition.
31. Mrs Y went out for a planned dray trip with the care home the following morning and the doctor visited again that evening to review Mrs Y’s condition. The records say Mrs Y’s family were present during the doctor’s visit and that Mrs Y’s condition was declining.
32. The daily notes for 14 November 2024 record a district nurse visited Mrs Y in the morning and she had a pedicure in the afternoon, An entry at 7:31pm says a member of staff was with Mrs Y from around 6pm as Miss X was concerned about Mrs Y’s presentation. The member of staff tried to take Mrs Y’s observations and then called 111 for advice. A paramedic completed an assessment over the phone and the arranged for a paramedic to attend. The records say a paramedic arrived a few hours later and advised that Mrs Y be taken to hospital.
33. The care home did not notify the Council of Miss X’s complaint at the time. The Council has since carried out an investigation and identified service improvements. The care provider has also reviewed its internal systems to ensure all managers and senior team members understand their responsibilities regarding complaint handling and safeguarding reporting.
34. In response to the draft decision, Miss X says that although Mrs Y’s condition was deteriorating before she moved to the care home, she was still able to eat and drink with close monitoring from the family. She asserts care home staff did not encourage Mrs Y to eat or drink, and they did not consult the family on alternative options.
35. Miss X is also concerned the care home did not document Mrs Y’s weight on 14 November 2024, showing a 7kg loss in 12 days.

Analysis

36. Based on the documentation available there is no evidence of fault in the care and support the care home provided to Mrs Y.
37. The care home records show staff carried out welfare checks at regular points during the day and throughout the nights. Many of the night time checks also include reference to checking the bed sensor and/ or assisting Mrs Y to the toilet.
38. It is clear there were concerns both prior to and throughout Mrs Y’s stay at the care home about her poor appetite and fluid intake. The care home had carried out risk assessments and were monitoring Mrs Y’s food and fluid and her weight.
39. Mrs Y’s family visited daily and the records show that even with their encouragement and assistance Mrs Y could be reluctant to eat or drink.
40. There is no evidence the care home delayed or was unwilling to seek medical advice or intervention. Mrs Y was reviewed by doctors, a nurse and district nurses during her stay at the care home. There is no evidence they raised any concerns about her care.
41. When Mrs Y’s family raised concerns about Mrs Y’s presentation on 7 November 2024 the care home arranged for a doctor to attend. The records say the doctor spoke with Mrs Y’s family and explained Mrs Y’s condition was declining and about the DNAR (Do Not Attempt Resuscitation) and the plan in place to keep Mrs Y comfortable.
42. The care home also sought medical advice when Mrs Y’s family raised concerns about her presentation on 14 November 2024. Mrs Y was then taken to hospital. The records say Mrs Y had been presenting as her usual self during the day and it was only in the evening there were concerns about her condition. I note a district nurse had visited Mrs Y on the morning of 14 November 2024. There is no evidence they raised any concerns about Mrs Y’s presentation earlier that day.
43. I have examined all the evidence the care provider has about Mrs Y’s short time in its care. I am satisfied it acted promptly in response to issues with Mrs Y’s declining health and appears to have provided appropriate care in line with her needs.

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Decision

44. I find no fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman