Summary: Mrs B complained about the way in which the care Provider had terminated its contract with her late mother (Mrs D) after a hospital stay. Mrs B was given very little notice to find an alternative placement. We found some injustice. The Care Provider has agreed to apologise to Mrs B, make a symbolic payment to her and has changed the terms of its contract to include this emergency scenario.

The complaint

1. Mrs B complained that Topsham Care Limited (the Care Provider) unreasonably refused to accept her late mother, Mrs D back to the care home after a hospital stay in February 2025, failed to give Mrs B adequate notice of this decision, was rude to Mrs B during communications, misrepresented their conversations and cancelled an important hospital appointment for Mrs D without telling Mrs B. Mrs B said these events caused her significant distress and inconvenience and affected her mother’s mental health.

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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(1), as amended)

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How I considered this complaint

4. I considered evidence provided by Mrs B and the Care Provider as well as relevant law, policy and guidance.
5. Mrs B and the Care Provider 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

6. Mrs D was living in a home run by the Care Provider. The contract she signed in February 2024 said that the Care Provider may terminate the agreement by giving 7 days written notice if:

‘We decide in our absolute discretion that we are unable to provide the Services (or any appropriate alternative) to you after we have assessed your needs’.

7. She had been admitted to hospital on three occasions between September 2024 and January 2025.
8. On 11 February Mrs D went to hospital for a fourth time due to issues with leg wounds. She returned the same day with medication. The Care Provider’s records note several conversations with the hospital requesting an assessment by its management team before Mrs D could return because it was not meeting her needs effectively, particularly pain management and she was frequently going back to hospital.
9. The hospital confirmed Mrs D was medically fit for discharge but would refer Mrs D to the pain management team. The notes also show that the Care Provider asked the hospital to change an appointment for the vascular clinic on 24 February as Mrs B was unable to take her on that day. It was rearranged for 5 March.
10. On 17 February, the care records say that the district nurse service had seen Mrs D that morning but decided to discharge her because she was repeatedly refusing to have her dressings changed. Care staff would continue to monitor the wounds and call the district nurses back if they had concerns.
11. However following concerns raised by the physiotherapist, a district nurse attended on 19 February. Mrs D was very reluctant for the wounds to be dressed but the nurse said it would be the best option for healing and Mrs D agreed to the dressings. The following day Mrs D had removed her dressings and the district nurse visited again to reapply them.
12. The district nurse attended again on 24 February as Mrs D had removed the dressings again due to the pain. They reapplied the dressings and said they would visit three times a week. Mrs D removed the dressings again that night. A nurse reapplied them, but the following morning Mrs D had removed them again and was bleeding from the wounds.
13. On 26 February Mrs D saw the district nurse and said she did not want a full leg dressing. The nurse applied some smaller dressings and said they would visit daily.
14. Overnight the Care Provider called an ambulance due to significant bleeding on one of Mrs D’s legs due to her removing the dressings. Mrs D was admitted to hospital. She asked the Care Provider not to call Mrs B as she was out of the country.
15. On 28 February the Care Provider had a telephone conversation with the hospital frailty team, expressing concerns about Mrs D returning to the home, due to the high level of nursing needs which it could not provide. The Care Provider considered a nursing placement would be more suitable. The notes said the hospital was in full agreement that Mrs D’s needs would be best met in a nursing home placement.
16. Later that day the Care Provider spoke to Mrs B by telephone informing her of the decision not to accept Mrs D back due the deterioration in her condition and the need for a higher level of nursing care. The Care Provider said that Mrs D had mentioned nursing care after a recent hospital discharge. Mrs B said she could not find anywhere else for at least 28 days as she was currently away, then back for a week and away again until the end of March.
17. On 3 March Mrs B requested clarification of why Mrs D could not go back to the home. The Care Provider explained that it could no longer meet Mrs D’s needs. Mrs B said the hospital staff were not aware of this and that the Care Provider had not communicated properly with the hospital. Mrs B was very unhappy with the situation and said she was not prepared to pay any of the March bill for Mrs D's care.
18. Mrs B made a formal complaint on 4 March and requested a refund of the deposit and fees already paid for March 2025. The Care Provider terminated the contract on 4 March then refunded the deposit and any fees paid after 28 February.
19. The Care Provider responded to the complaint on 31 March. It said:
• Mrs D has expressly asked the Care Provider not to contact Mrs B when Mrs D went into hospital. She had capacity to make that decision and the Care Provider respected it.
• The Care Provider had no alternative but to refuse to accept Mrs D back to the home because it could not meet her needs.
• It acknowledged the difficult position it placed Mrs B in, but it could not accommodate people it could not care for, even for a short period to allow Mrs B to find an alternative home.
• It sincerely apologised for the way Mrs D’s residence ended and felt with hindsight that a full and frank discussion after one of the previous hospital stays may have gone some way to preparing Mrs B and Mrs D for this outcome and more time to find an alternative placement.
• It acknowledged that the vascular appointment had been changed but could not see the reason for that change and apologised if it was due to the Care Provider’s actions.
20. Mrs B complained to us.
21. In response to our enquiries the Care Provider said that Mrs D’s health had been in decline since October 2024 with 6 hospital admissions and 34 reviews by the GP surgery, in addition to monitoring by the district nurse team. It said the frailty team at the hospital agreed she needed nursing care beyond that which the Care Provider could give in a residential setting and that the frailty team had referred Mrs D to a community care manager on 11 February 2025 to look for a more suitable residential placement (noted on the discharge summary).
22. The Care Provider also said to me that it would have been pointless to have given Mrs D seven days’ notice because it could not safely look after her and she would have incurred another week’s fees.
23. Mrs B reported the Care Provider to the Care Quality Commission (CQC) in April 2025. CQC closed the case on 25 April 2025 with no further action required but said there had been some difficulties in communication between the hospital and the family which may have contributed to the misunderstanding.

Findings

24. The decision whether or not to accept Mrs D back to the home was one for the Care Provider to make and I understand the reasons for this decision given the deterioration in Mrs D’s health and the increasing number of medical interventions she required.
25. The complaint is more about the way in which this decision was communicated to Mrs D and Mrs B. The contract required seven days’ written notice and did not contain any exception to this. I understand the Care Provider’s reasoning for not giving the required notice at this point and that it benefitted Mrs D financially as it saved her a further week’s fees. I also note the Care Provider contacted Mrs B the same day to inform her of the decision and again when she returned from abroad on 3 March. However, it did not send any written notification as a follow-up until after the contract had been terminated or provide any evidence of who at the hospital was dealing with Mrs D’s case. This was fault which caused uncertainty to Mrs B and Mrs D at a difficult time.
26. I also agree the Care Provider’s view that a discussion at an earlier point would have been beneficial to prepare Mrs D and Mrs B for a likely move. This would have been helpful after the discharge on 11 February 2025 when the hospital had already made a referral to the Community Care Manager. This may have prevented some of the distress caused by the suddenness of the decision on 28 February and the failure to do so was fault.
27. I welcome the decision not to charge Mrs D any fees beyond 28 February as she received no more care, and it was the Care Provider’s decision to terminate the contract without notice. However, I consider Mrs B was caused avoidable distress by the manner of the termination and the short period of time she had to find an alternative placement.

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Action

28. In recognition of the injustice caused to Mrs B, I recommend the Care Provider within a month of the date of my final decision:
• further apologises to Mrs B and pays her £150; and
• considers amending the terms of its contract to make clear there are circumstances in which Care Provider can terminate the contract without any notice being given.
29. The Care Provider has agreed to the recommendations and has already amended its contract. It should provide us with evidence it has complied with the above actions.

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Decision

30. I find fault causing injustice. The Care Provider has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman