Summary: There was no fault in the care the Council-commissioned care home provided to Ms X’s father, Mr Y. The Council also appropriately investigated and responded to Ms X’s complaint.

The complaint

1. Ms X complains the Council-commissioned care home failed to provide her late father, Mr Y, with suitable care. She also complains the Council’s investigations into her concerns was inadequate. She says the poor care ultimately led to his death and caused her uncertainty and distress. She wants the care provider to acknowledge there was poor care and review its procedures on how it cares for vulnerable residents. She also wants the Council to review how it investigates complaints of poor care and ensure its investigations are appropriately robust.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
4. 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

5. I read Ms X’s complaint and spoke with her about it on the phone.
6. I made enquiries of the Council and considered information it sent me.
7. Ms X and the Council had the opportunity to comment on the draft decision. I considered their comments before making my final decision.

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What I found

Legal and administrative background

The fundamental standards

8. The Health and Social Care Act 2008 (regulated activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The fundamental standards include minimum standards for:
• Person-centred care
• Food and drink
• Maintaining accurate and complete records
• Safeguarding from abuse.
9. When investigating complaints about the standards of care in a care home, the Ombudsman considers if the 2014 regulations and the fundamental standards have been met. If they have not, we consider whether any identified faults have resulted in injustice.

The Council’s complaints policy

10. London Borough of Ealing has a complaints policy to facilitate the effective handling of complaints. It screens each complaint and allocates it a complaint category, which determines the scale of the investigation a timescale for the complaint response. The complaint will then be investigated which can include interviewing relevant persons and gathering relevant documents and records. The shortest timescale to provide a response is 20 working days.

What happened

11. In 2019, Ms X’s father, Mr Y, lived in a Council-commissioned care home. He had health and care needs due to a previous stroke and other conditions. Mr Y’s needs and level of required assistance was set out in a series of care plans. His needs included assistance with personal care and feeding. He also had an indwelling urinary catheter, which was drained regularly by care staff and changed every three months at the hospital.
12. In February 2020, a GP review recorded his health was generally stable. His catheter was changed at the hospital at the end of the month.
13. In March 2020, the records show staff provided care for Mr Y in line with his care plans. Care staff gave Mr Y his medication as prescribed. When Mr Y became unwell, staff called the GP. Mr Y was prescribed antibiotics and advised to self-isolate for 7 days in case he had COVID-19. Care staff monitored his condition, and Mr Y’s health improved.
14. In April 2020, the records show care staff provided care for Mr Y in line with his care plans. Care staff gave Mr Y his medication as prescribed. A GP reviewed Mr Y at the end of the month and prescribed eye drops for an eye infection.
15. In May 2020, the records show care staff provided care for Mr Y in line with his care plans. Care staff gave Mr Y his medication as prescribed. The care home also reviewed Mr Y’s care plans this month and considered them to still be an accurate record of Mr Y’s care needs.
16. In mid-May, care staff had concerns Mr Y may have a urine infection. They rang the GP, who assessed Mr Y, diagnosed a urine infection and prescribed antibiotics. Mr Y had his catheter changed at the hospital at the end of May.
17. On 8 June 2020, the GP reviewed Mr Y again. Care staff told the GP he had a history of high blood sugars over the past four days. All other clinical observations were normal. The GP advised care staff to monitor Mr Y and said they would review in two days.
18. On 10 June 2020, the GP reviewed Mr Y. Mr Y’s blood sugars were still high. The GP decided Mr Y may have a urine infection and prescribed antibiotics. The GP record said no other source of infection had been identified. The GP advised care staff to encourage Mr Y’s fluid intake and continue to monitor his blood sugars. They advised care staff to request a further GP review if Mr Y’s blood sugars remained raised.
19. The daily care log on 12 June 2020 recorded that Mr Y ate and drank well. Care staff assisted with care in line with his care plans. Mr Y was checked hourly during the night, with no concerns recorded by overnight staff.
20. On the morning of 13 June 2020, care staff noticed that Mr Y appeared weak and the right side of his face was drooping more than normal. The nurse took clinical observations and checked his blood sugar which remained high. The care notes record Mr Y ate breakfast, was drinking well and took all his medication that morning.
21. The nurse was concerned about Mr Y’s presentation and ongoing high blood sugars and so rang the GP surgery at 10am. The surgery said it would arrange for a GP to call them back. As the GP did not immediately call back, care staff rang 111 for medical advice, but the 111 advisor told them to call back the GP. The GP called the care home at about 1pm and told care staff to call an ambulance for Mr Y as the reported symptoms suggested he may have had a stroke.
22. Care staff rang for the ambulance and, after assessment by paramedics, Mr Y was taken to hospital.
23. Mr Y remained in hospital and died nine days later.
24. In July 2020, Ms X complained to the Council. She said the care home had delayed calling for the ambulance, even though it was suspected Mr Y had suffered a stroke. She said on admission to hospital, hospital staff had said Mr Y was severely dehydrated. She said Mr Y had received poor care at the home which had led to multiple infections. Mr Y had been unable to fight these off at the same time, and this had ultimately led to his death.
25. The Council investigated Ms X’s complaint. It gathered information from the care home and the GP. It considered the information and decided there was no evidence to warrant further investigations and no evidence of poor care or neglect. It said neither the hospital nor the coroner had raised any concerns about the standard of Mr Y’s care.
26. Ms X remained unhappy and brought her complaint to us.

Findings

27. I have reviewed care records from 2019-20 and am satisfied the care home provided suitable care for Mr Y during this time. The evidence shows that:
• Appropriate care plans were in place to meet Mr Y’s care needs.
• Care staff kept suitable daily records of the care provided.
• All prescribed medications including pain relief and courses of antibiotics were administered to Mr Y.
• Care staff liaised with health services to ensure Mr Y’s catheter was changed every three months at the hospital.
• Care staff liaised appropriately with Mr Y’s GP when they had concerns about his health.
28. When staff had concerns about high blood sugars on 8 June 2020, they acted appropriately by contacting Mr Y’s GP for further review. They continued to monitor his blood sugars between 8 and 13 June, following GP advice.
29. Care staff provided care for Mr Y in line with his care plans on 12 June 2020 and checked on him regularly overnight. On the 13 June 2020, when the nurse had concerns about Mr Y’s presentation, they considered what action to take. They took his clinical observations and tested his blood sugars. The records say Mr Y appeared weak and had a more prominent facial droop on the right side but also that he ate and drank well with assistance that morning and took all his medications. The nurse decided to contact Mr Y’s GP rather than ring an ambulance. This was a clinical judgement based on available information at the time and was not fault.
30. There was a delay in the GP surgery ringing the care home back, but this delay was not the care home’s fault.
31. The Council investigated Ms X’s concerns appropriately under its complaints policy. It gathered appropriate information from the care home and Mr Y’s GP. It considered the information received and found no evidence to suggest neglect or poor care. It responded to Ms X within the response timescales set out in its policy, addressing each point of her complaint. The Council was not at fault.

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Final decision

32. I have completed my investigation. The Council was not at fault.

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Investigator's decision on behalf of the Ombudsman