Woodcot Lodge (23 015 999a)
Category : Health > Community hospital services
Decision : Closed after initial enquiries
Decision date : 09 Jul 2024
The Ombudsman's final decision:
Summary: We will not investigate this complaint about the Council’s decision to place Mrs X in a care home or about the care she received there. There is not enough evidence of fault with the care for us to investigate and we are unlikely to achieve more by investigating the complaints about the placement in the care home.
The complaint
- Mrs X complains the Council placed her mother, Mrs Y, in the same Care Home (the Home) she had been at before a hospital stay in January 2023. She is also unhappy with the time the Council took to facilitate her mother’s move to Mrs X’s home.
- Mrs X also complains about the care provided to Mrs Y at the home, specifically about how the Home managed her mother’s fall, nutrition, medication and social inclusion.
- Mrs X said the failings in care meant Mrs Y’s health suffered, which caused Mrs X anxiety and stress.
- Mrs X said she would like action taken against the social worker, acceptance that her mother’s fall was due to neglect, and an apology. She would also like extra training for home staff for caring for residents with dementia.
The Ombudsman’s role and powers
- We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:
- there is not enough evidence of fault to justify investigating, or
- any injustice is not significant enough to justify our involvement, or
- we could not add to any previous investigation by the organisation, or
- further investigation would not lead to a different outcome.
(Local Government Act 1974, section 24A(6), as amended, section 34(B))
How I considered this complaint
- I have considered information provided by Mrs X and the Council.
- I considered the Ombudsman’s Assessment Code.
My assessment
- Mrs X said she repeatedly told staff she did not want her mother to return to the Home following her hospital stay. The records show the Home also specifically asked the Council to check with the family if they wanted Mrs Y to return, as it was aware of the family’s concerns.
- The Council confirmed it checked with Mrs X’s sister and she said they were happy for Mrs Y to return to the Home. Hospital records listed Mrs X’s sister as Mrs Y’s next of kin. I recognise Mrs X disputes the Council’s record, but she has accepted she and her sister reluctantly accepted their mother would return to the Home.
- While the Council consulted with Mrs Y’s family, it was also aware of Mrs X’s specific concerns. The Council’s complaint response accepted it would have been good practice to have spoken to her given these concerns and apologised for not discussing the proposed move. I consider we are unlikely to achieve more in this regard.
- The Council accepted it took longer than it would have hoped took to arrange Mrs Y’s discharge from the Home in its complaint responses. It said it aims to complete assessment and discharge in 28 days. The Council explained this was delayed partly by a need for an occupational therapy visit to Mrs X’s home and her illness also impacted the assessment.
- I also understand from Mrs X’s complaint correspondence, the occupational therapist had some leave which may have also delayed the visit. Mrs Y’s discharge took place around two months after she had returned to the Home.
- The Council has accepted discharge took longer than expected. There were reasons for at least some of this delay. The Council has also apologised for the delay and explained it is working to improve discharge times within the Home. I consider this is a reasonable and proportionate outcome and we are unlikely to achieve more.
- Mrs X raised several issues with the care provided to Mrs Y by the Home. This included a fall Mrs Y suffered in December 2022. Mrs X believes the Home’s staff left Mrs Y alone in the lounge and forgot about her. The Council explained the Home’s staff recorded Mrs Y was watching TV and wanted to continue watching a film. The records note a member of staff was with her until around 7:45pm. Staff heard Mrs Y fall soon after 8pm and called for an ambulance.
- Mrs X disputes the Home’s accounts. She feels it was out of character for Mrs Y to watch TV for a long time and does not consider she would have been able to manage this because of her dementia.
- Mrs Y was not receiving 1:1 care needing constant supervision. The records show the Home’s staff checked Mrs Y regularly while she was in the lounge. They also show she asked to stay in the lounge. The Care Act sets out the need for care staff to consider a person’s wishes. This also applies to people who have limited or fluctuating ability to understand because of conditions such as dementia. I therefore consider we would be unlikely to find fault with the Home agreeing to Mrs Y’s wishes, even if this was out of character.
- Mrs X also had concerns about Mrs X’s medication. This included that the Home gave Mrs Y more laxatives than prescribed and that they did not give antibiotics to Mrs Y in liquid form.
- The Council’s complaint responses explained the laxatives were given as prescribed and that Mrs X had misinterpreted the medication chart. It considered Mrs Y received laxatives in amounts consistent with her bowel activity. This is supported by the records and the outcome from a safeguarding enquiry. I note Mrs Y suffered from a norovirus around this time, which may have accounted for her not appearing well.
- A GP prescribed Mrs Y antibiotics for a chest infection. The Home explained Mrs Y took these well in tablet form to start with, but when she started struggling, it sought advice from the GP. They advised the Home to break the tablets, which it did successfully.
- The Home took medical advice when Mrs Y had difficulty with swallowing pills. It followed this advice and was able to give Mrs Y her medication as prescribed. Having considered the records, I do not consider there is enough evidence of fault with how the Home managed Mrs Y’s medication.
- Mrs X complained about a lack of stimulation for Mrs Y in the Care Home. She also said Mrs Y was left in her room alone at times with no access to a drink.
- Mrs X has not given specific details of when Mrs Y could not engage with any activities at the Home. However, records show she was mobile and moved around the Home before her fall. Following this, records suggest Mrs Y’s mobility was limited and she also had other illnesses.
- The Council’s complaint response explained Mrs Y was often sleepy, but staff encouraged her to sit for food and drink. The care plan and records indicate her nutritional needs were monitored and that staff interacted with Mrs Y regularly each day. Her mobility would have likely restricted her choices for other activities in the Home. I understand family visited regularly too.
- Mrs Y’s care plan set out her nutrition and hydration needs, which included assistance and encouragement when eating and drinking. I note that care records do not record any issues with dehydration and note Mrs Y moved to having thickened fluids when she had difficulty swallowing. From the evidence I have seen, I do not consider there is enough evidence of fault with helping Mrs Y with her fluid intake or with encouraging social inclusion.
Final decision
- We will not investigate Mrs X’s complaint about Mrs Y’s placement at the Home or the care she received. There is not enough evidence of fault with the care provided to warrant an investigation. I do not consider we would achieve more by investigating her complaints about Mrs Y’s placement at the Home.
Investigator’s final decision on behalf of the Ombudsman
Investigator's decision on behalf of the Ombudsman