Summary: The Ombudsmen will not investigate Ms R’s complaint about the care provided to her late partner, Mr B, in two nursing homes and a hospital Trust, and about the Council’s actions in relation to safeguarding and her partner’s best interests. We are unlikely to find fault in the actions of the Council, the nursing homes and the Trust. We are also unlikely to be able to resolve the conflicting accounts between Ms R and the organisations she complains about.

The complaint

1. The complainant, who I shall refer to as Ms R, complained about the care provided to her late partner, Mr B, in Tadworth Grove Nursing and Residential Home (operated by BUPA Care Homes Limited), Birdscroft Nursing Home (operated by Aster Healthcare Limited), and University College London Hospital NHS Foundation Trust, during 2017. She also complained about the Council’s actions in relation to safeguarding and her partner’s best interests. The Council arranged and partly paid for Mr B’s nursing home placements, Ms R was to pay a top-up fee, and Mr B received NHS Funded Nursing Care in the nursing homes.

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The Ombudsmen’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’. We provide a free service, but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• we are unlikely to find fault
• it is unlikely we could add to any previous investigation by the organisations, or
• it is unlikely further investigation will lead to a different outcome

(Health Service Commissioners Act 1993, section 3(2) and Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

3. I considered information Ms R provided in writing and by phone, and documents and information provided by the Council, nursing homes and the NHS Trust. I also invited Ms R to comment on a draft of this decision, and she provided her comments.

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What I found

4. Mr B had Parkinson’s Disease and lived at home with Ms R until he went into hospital in November 2016. In January 2017 he was discharged to a ‘step-down’ placement at Tadworth Grove Nursing Home. Mr B had to be re-admitted to hospital in April and again in May 2017. During the May 2017 hospital admission a Best Interests meeting took place to discuss whether Mr B should return home with Ms R after discharge, or whether he should be discharged to a nursing home. A a second Best Interests Meeting took place in hospital in June 2017. It was decided that Mr B should be discharged to a nursing home, and he went to Birdscroft Nursing Home on 22 June 2017. Mr B died on 6 October 2017.
5. During 2017 some safeguarding concerns were raised about Ms R putting Mr B at risk by interfering with his care in the nursing homes and in hospital. This included trying to give him food and fluids that were not appropriate for his needs, trying to give him medication which was not appropriate, and going against medical advice. As a result of these concerns the Council and the nursing homes put a number of restrictions in place to safeguard Mr B. Ms R was not happy about these restrictions and her relationship with the nursing homes was strained.
6. Ms R complained about Mr B’s care including how the nursing homes gave him medication, whether he needed pureed food and thickened liquids, why restrictions were placed on her contact with Mr B, and that the second nursing home did not allow her to travel with him to hospital. She also complained that Mr B’s personal items went missing, and staff had a poor attitude towards her. Ms R complained to the Council about the Best Interests decision to place her partner in the second nursing home. She complained to the Trust about the actions of a doctor during a neurology outpatient appointment on 18 September 2017.
7. Tadworth Grove Nursing and Residential Home, the Council and the Trust answered Ms R’s complaint directly. Birdscroft Nursing Home provided a response directly to the Ombudsmen.
8. Ms R told me she remains unhappy with the responses to her complaint because she considers they are full of lies and she does not accept the explanations given.

Analysis

9. When considering complaints, if there is a conflict of evidence the Ombudsmen may make decisions based on the balance of probabilities. This means we will weigh up the available evidence and decide what we think was more likely to have happened.
10. My view is that an investigation by the Ombudsmen is unlikely to find fault in the actions of the Council, the nursing homes and the Trust. We are also unlikely to be able to resolve the conflicting accounts between Ms R and the organisations she complains about through an investigation. The sections below explain how I have reached this view.

The Council

11. Ms R complained to the Council about the Best Interests decision to place her partner in a nursing home rather than allowing him to return home with her. The Council explained that after two Best Interests meetings it was decided that Mr B should go to Birdscroft Nursing Home in June 2017. This was due to concerns that Ms R was not complying with recommendations from the speech and language therapist about Mr B’s requirement for pureed foods and thickened liquids to minimise the risk of him choking.
12. The records from the Council and nursing homes show there were many concerns about Ms R trying to give Mr B foods and fluids that were not appropriate to his needs, over a long period of time. One of the Best Interests meetings noted there was a past and continuing pattern of Ms R taking risks with guidance about Mr B’s eating and drinking. This meant it was not felt safe for Mr B to return home.
13. The Ombudsmen are unlikely to find fault by the Council, as the records I have seen show significant concerns about the risks posed to Mr B by Ms R’s actions. I appreciate that Ms R holds a different view and disputes the responses provided by the Council. An investigation by the Ombudsmen is unlikely to be able to resolve this conflict of accounts.

Tadworth Grove Nursing and Residential Home

14. Ms R disputed that Mr B needed mashed or pureed foods and was unhappy with restrictions put on what she could give him to eat. The Council and Tadworth Grove explained that a speech and language therapist assessed Mr B in March 2017 and recommended mashed foods to minimise Mr B’s risk of choking. Mr B was re-assessed by a speech and language therapist in June 2017 who recommended a pureed diet with thickened fluids, to minimise the risk of Mr B choking. The results of these assessments were shared with Ms R.
15. We are unlikely to find fault by the Council or Tadworth Grove on this issue. The care records confirm the speech and language therapist’s recommendations for mashed and later pureed foods, because of Mr B’s risk of choking due to his swallowing difficulties. I appreciate that Ms R disputes this, but an investigation by the Ombudsmen is unlikely to be able to resolve this conflict.
16. Ms R complained that Mr B’s personal items went missing at Tadworth Grove. The Council and Tadworth Grove said it was not possible to find the clothing she said was missing. Also, Ms R had decided not to have items labelled or marked which made identifying them difficult. We are unlikely to find fault by the Council or Tadworth Grove on this matter, and their complaint responses seem reasonable.
17. Ms R said Mr B went to hospital three times due to not receiving his medication at Tadworth Grove correctly. The Council said there was no evidence to support that this had happened. Tadworth Grove said Mr B went to hospital twice, in April and May 2017, and there was no evidence to suggest this was because of medication not being given correctly. I have reviewed Mr B’s care records and we are unlikely to find fault by Tadworth Grove. There is no indication that medication was not given correctly and that this led to him going to hospital. I appreciate that Ms R disputes this, but we are unlikely to be able to resolve this further through an investigation.
18. Ms R said staff wrongly said Mr B had epilepsy, and that he had a pacemaker, when neither of these statements were correct. The Council and Tadworth Grove said none of the staff could recall saying Mr B had epilepsy, although he did have seizures which was a different matter. Tadworth Grove said there was no mention of a pacemaker in Mr B’s records although they were aware he had a device for Parkinson’s management, which again was different. I have reviewed Mr B’s care records which support the complaint responses provided. We are unlikely to find fault.
19. Ms R complained about restrictions being placed on her contact with Mr B, which she felt was not reasonable. The Council and Tadworth Grove explained there was no restriction on when Ms R could visit. However, restrictions were put in place so she was not alone with Mr B due to concerns about her giving him inappropriate food, drink and medication which would put him at risk. I have reviewed Mr B’s care records. There are various entries about Ms R trying to give Mr B foods, fluids and medication that were not appropriate to his needs and put him at potential risk. We are unlikely to find fault by the Council and Tadworth Grove in putting in place restrictions to safeguard Mr B’s wellbeing. Again, I appreciate that Ms R strongly disputes the complaint responses provided, but we are unlikely to be able to resolve these conflicting accounts through an investigation.
20. Ms R complained that staff at Tadworth Grove had a poor attitude towards her. She said they were rude, called her a ‘nasty piece of work’, and would act inappropriately in front of Mr B. Tadworth Grove said staff were trying to manage the potential risks posed to Mr B by Ms R’s action. Staff raised several concerns about Ms R being rude and abusive towards them. Tadworth Grove apologised for any distress caused to Ms R but said staff were acting in Mr B’s best interests. I have reviewed the relevant records and there are number of entries about difficult interactions between Ms R and staff due to concerns about risks to Mr B. I appreciate that these matters caused Ms R considerable distress but we are unlikely to find fault by Tadworth Grove. The evidence I have seen indicates staff were acting in Mr B’s best interests in a difficult situation for all concerned.
21. Ms R complained Tadworth Grove did not meet Mr B’s hygiene needs and that he never had a bath, shower or shave. Tadworth Grove said Mr B’s records and care plans showed he had baths, with records of the dates, times and temperatures. There was also documented evidence of him being shaved. Having reviewed the records there are entries about personal care being given to Mr B. We are unlikely to find fault on this issue, and are unlikely to be able to resolve these conflicting accounts.
22. Ms R said there were rats in the garden at Tadworth Grove, but a man tried to convince her they were rabbits when she raised this. Tadworth Grove said it was unable to comment on this in detail due to the passage of time. However, all BUPA homes have a Pest Control contract and regular preventative measures and checks are in place. Tadworth Grove also said there was no record of an infestation during the period complained about. We are unlikely to be able to resolve this issue any further through an investigation.

Birdscroft Nursing Home

23. Ms R complained about the restrictions put in place on her contact with Mr B at Birdscroft Nursing Home. Birdscroft said they acted on guidance from social services about safeguarding Mr B’s welfare. Restrictions were in place to ensure Mr B was safe and that Ms R’s visits were monitored by staff. As outlined earlier, I have reviewed Mr B’s care records. There are various entries about Ms R trying to give Mr B foods, fluids and medication that were not appropriate to his needs and put him at potential risk. We are unlikely to find fault by the Council and Birdscroft in putting in place restrictions in order to safeguard Mr B’s welfare. I appreciate that Ms R strongly disputes the complaint responses provided, but we are unlikely to be able to resolve these conflicting accounts through an investigation.
24. Ms R complained she was not allowed to accompany Mr B in an ambulance from Birdscroft to a routine hospital outpatient appointment. The Council and Birdscroft said Mr B had to travel to hospital with a registered nurse as the nurse needed to give him medication. The ambulance could only take one additional person, and therefore it was the nurse who had to accompany him. The Home Manager met with Ms R after the appointment to discuss the outcome. They also suggested Ms R could contact the GP for more information if needed, as the GP would get a letter from the hospital summarising the appointment. We are unlikely to find fault on the part of the Council or Birdscroft, as I cannot see there was any alternative option.

University College London Hospital NHS Foundation Trust

25. Ms R complained about changes made to Mr B’s medication at a neurology outpatient appointment on 18 September 2017. She also complained that despite her asking to see the doctor to discuss the outcome of the appointment this was not permitted. The Trust said the doctor decided to stop one of Mr B’s medications as it was having unwanted side effects, and it was no longer needed due to a deterioration in his condition. The Trust said that due to the passage of time the doctor could not remember whether she was asked to see Ms R after the appointment. Although she usually tried to see relatives this was not always possible if the clinic was particularly busy or running late.
26. I have reviewed the notes of the consultation and the doctor’s letter to the GP summarising the appointment. We are unlikely to find fault by the Trust. The explanation given about the change to Mr B’s medication appears reasonable, and we would not question a clinical decision just because a complainant disagrees with it. I cannot see any indication of fault in how that decision about medication was reached, or in the explanation about why it may not have been possible for the doctor to see Ms R.

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Decision

27. The Ombudsmen will not investigate Ms R’s complaint about the care provided to her late partner in two nursing homes and a hospital Trust, and about the Council’s actions. We are unlikely to find fault in the actions of the organisations, and we are also unlikely to be able to resolve the conflicting accounts about events.

Investigator’s decision on behalf of the Ombudsmen

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Investigator's decision on behalf of the Ombudsman