Summary: There is no fault by the Council in how it investigated Mrs X’s complaint about the care provided to her late mother in a residential home. It carried a full and fair safeguarding investigation which reached evidence-based conclusions.

The complaint

1. Mrs X complains about how the Council responded to her safeguarding referral about alleged neglect of her mother in her care home.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
3. If we are satisfied with a council’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 have:

• considered the complaint and discussed it with Mrs X;
• considered the correspondence between Mrs X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mrs X and the Council an opportunity to comment on a draft of this statement.

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What I found

Relevant legislation

5. The Care Act 2014 sets out a framework for local authorities to protect adults at risk of abuse or neglect.
6. A council must make necessary enquiries if it has reason to think a person may be at risk of abuse or neglect and has needs for care and support which mean he or she cannot protect himself or herself. It must also decide whether it or another person or agency should take any action to protect the person from abuse or risk. (section 42, Care Act 2014)
7. After the enquiry is complete, the authority should consider what, if any, action is appropriate.

What happened

8. Mrs Y was in her sixties. She had dementia and depression and required assistance in all areas of daily living. She moved to the care home in April 2018.
9. On 28 November 2018 Mrs X contacted the Council to report her concerns about the care provided to Mrs Y. She complained about

• soiled bedding and clothing
• unexplained marks and bruises
• medication not being provided
• no concern for client’s dignity
• mental health needs not being met

10. The Council referred the matter to its safeguarding team. It completed an ‘Adult protection notification’ and sent copies to its contracts team and the Care Quality Commission (CQC). It then completed an ‘initial risk assessment’ on 29 November 2018, which recorded Mrs Y to be vulnerable and at risk. The assessor recorded “Mrs Y frequently declines the support and assistance of the staff at Park View. [Mrs Y’s] unwillingness to engage puts her at risk, however this is not resulting from lack of support from staff at Park View”. The assessor telephoned Mrs X, and obtained emails exchanged between her and the care home. Mrs X also provided photographs. The assessor also contacted the CQC.
11. Following the initial assessment, the Council decided to proceed with a full safeguarding investigation on 3 December 2018. On 4 December 2018 a Council officer made an unannounced visit to the care home. The officer discussed the concerns with the care home manager. She also spoke to Mrs Y alone in her bedroom. She reported Mrs Y to be clean and appropriately dressed. The bedroom was clean and tidy with no odours, the bedding was clean, and the bed made. The officer was unable to ascertain Mrs Y’s wishes and feelings in relation to the concerns and concluded she lacked capacity in relation to her care and wellbeing.
12. The following day the officer sent an email to the care home manager to request copies of Mrs Y’s:

• Care & Support Plan
• Diet, nutrition, food and fluid chart
• Weight chart (from admission)
• MAR charts
• Risk assessments

13. She also requested information of all professional interventions, including

• GP
• DN
• ICT OT & Physio
• Dietician
• SALT
• [Mrs X’s] complaint.

14. The officer contacted the care home again on 13 December 2018 to chase the information. The care home responded the same day and it provided all the requested information.
15. On 21 December 2018, Mrs X contacted the Council to say when she arrived at the care home to visit Mrs Y she was unwell, so she contacted the NHS 111 service who subsequently sent an ambulance. Mrs Y was taken to hospital “due to complications from lack of food & water”. Mrs X said the hospital had advised her not to send Mrs Y back to the care home because she was not eating and drinking, and the care home had not addressed this. Mrs X said she wanted Mrs Y to live with her when she was discharged from hospital.
16. The investigating officer from the Council made a second visit to the care home to obtain all Mrs Y’s daily care records. The officer also obtained a MUST chart (Malnutrition Screening TOOL) and a weekly weight chart. The records show the care home was aware Mrs Y was losing weight and that it had made a referral to a dietician, speech and language therapy and the mental health team. I have seen copies of all the above documents. The care home said it had attempted to contact Mrs X several times to discuss Mrs Y’s health issues to discuss moving her from residential level care to nursing care.
17. The council officer made contact with Mrs Y’s GP and the hospital about the reasons for her admission to hospital. The officer also asked for confirmation of the advice Mrs X says a clinician gave her not to send Mrs Y back to the care home. The hospital responded by email saying, “I am unable to comment why [Mrs Y’s] daughter was advised to not send her mother back to the care home but there is no documentation to this affect”. The hospital recorded Mrs Y to be “in late stage dementia”.
18. The officer also contacted the ambulance service. All records were cross checked.
19. The care home’s records showed Mrs Y was often resistant to care offered by care staff and could at times become verbally and physically aggressive if carers persisted. In such situations care staff allowed Mrs Y some time before approaching her again.
20. On 21 December 2018 Mrs X sent an email to the care home to give notice on the contract.
21. The investigating officer exchanged emails with Mrs X in January and early February 2019 about the progress of the investigation.
22. Mrs Y sadly passed away on 13 February 2019. The officer contacted Mrs X on 28 February 2019 to say the safeguarding report was complete but given the circumstances she did not wish to cause further distress. She asked Mrs X to contact her when she was ready to receive the report.
23. On 1 March 2019 Mrs X contacted the Council to say she had a letter from Age UK about the care Mrs Y and other residents received at the care home. She said the Coroner had raised concerns about Mrs Y’s death and would be undertaking a post-mortem.
24. The Coroner did not deem it necessary to hold an inquest into Mrs Y’s death.
25. The investigating officer contacted Age UK on 4 March 2019 to request a formal submission of their concerns and to request supporting evidence. The officer also asked why the organisation had not raised concerns through formal channels. Age UK did not respond. The officer informed Mrs X about this.
26. Mrs X sent the Council a letter from Age UK raising concerns about the care Mrs Y received. I have seen a copy of this document. The Council considered it but decided it offered no further evidence to that which had already been considered.
27. The Council concluded there was no evidence that abuse/neglect occurred. The care home had been able to fully evidence the action taken to improve/maintain Mrs Y’s quality of life, and the decline in Mrs Y’s health could not be attributed to actions of the care home.
28. The Council wrote to Mrs X on 28 February 2019 to explain the action taken during the investigation and the outcome. Mrs X did not respond. Because Mrs X was bereaved the investigating officer waited ‘some weeks’ before notifying her about the closure of the investigation.
29. The safeguarding investigation was closed on 15 May 2019. It concluded ‘abuse discounted’. The Council informed Mrs X on 24 May 2019.
30. Mrs X submitted a complaint to the Council on 30 May 2019. The Council responded in writing on 26 July 2019. The author of the letter set out in detail the actions the Council had taken to investigate the matters Mrs X raised. The complaint was not upheld.

Analysis

31. The Ombudsman is unable to question a professional judgment unless there is procedural fault. In this complaint I have considered the process the Council followed and found no fault in its action.
32. The Council began the safeguarding investigation promptly and the evidence confirms it undertook a full and detailed investigation.
33. Mrs X believes the Council disregarded evidence from Age UK. The records show the Council wrote to Age UK formally, it did not initially respond. When it later received written communication via Mrs X the Council considered the information but decided it did not add to that which had already been investigated during the safeguarding investigation.
34. Mrs Y was reported to be in the late stage of dementia. Her deterioration and death was not subject to examination by the Coroner.
35. There is no fault by the Council in this complaint. It carried a full and fair safeguarding investigation which reached evidence-based conclusions.

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Final decision

36. There is no fault in how the Council investigated Mrs X’s concerns about her late mother’s care.
37. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman