Summary: Mrs X complains about the Care Provider, Greensleeves Homes Trust and its care Home, The Orchards. Mrs X complains about the decision to end Mr Z’s care and how notice to end the care was given by the Care Provider. She says it based the decision on false information and caused Mr Z distress. The Ombudsman finds fault with the Care Provider for its complaint handling and management of communication with Mr Z’s family. The Ombudsman does not find fault with the Care Provider for its decision to end Mr Z’s care or how it gave notice. The Care Provider has agreed to apologise, pay a financial remedy and carry out service improvements.

The complaint

1. Mrs X complains the Care Provider wrongly ended, her husband, Mr Z’s care without good reason and without following the correct procedure.
2. Mrs X says the Care Provider based its reasons for ending on false information and changed his care plan without consent.
3. Mrs X complains this caused Mr Z significant distress and that he died shortly after being forced to leave the care home.

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The Ombudsman’s role and powers

4. We investigate complaints about adult social Care Providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. If they have caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
5. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
6. 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(i), as amended)

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How I considered this complaint

7. I considered Mrs X’s complaint and information she provided. I also considered information from the Care Provider. This included;

• A copy of the contract
• A copy of the communication about the termination of care
• Records about the care delivered to Mr Z, and his care plans.
• Competition and Markets Authority (CMA), “UK care home providers for older people – advice on consumer law. Helping care homes comply with their consumer law obligations” 2021;
• the Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of Care Providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences. I have used the fundamental standards as a benchmark for considering this complaint.

8. I considered comments from Mrs X and the Care Provider on a draft of my decision.

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What I found

Legislation and guidance

9. 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 Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
10. Competition and Markets Authority (CMA), “UK care home providers for older people – advice on consumer law. Helping care homes comply with their consumer law obligations” 2021, “the Guidance” says,

• “1.32 The circumstances in which you can terminate your contract with a resident must be clearly explained in the contract. They must be limited to valid reasons, for example, where you can no longer meet the resident’s care needs even after making reasonable adjustments.
• 1.33 You should not ask a resident to leave the care home without first consulting with them and their representatives, and any other relevant independent professionals, and after efforts have been made to meet the resident’s needs.
• 1.34 You should give the resident at least 28 days’ written notice to leave, unless they are staying with you on a trial period, in which case you must still give them adequate notice to make alternative arrangements.”

11. The Care Provider’s “Contract of Residence and Terms and Conditions” sets out how it would terminate a care arrangement. It says “During the first six weeks of your residents we can end this contract for any reason by giving you at least 7 days’ notice in writing, or, if we believe that you or your visitors have behaved and will continue to behave inappropriately by giving 24 hours’ notice in writing.
12. After the end of the first six weeks of your residents, we can end this contract by giving you at least four weeks’ notice in writing, if, for example

• In our reasonable opinion or on medication or regulatory advice, we cannot give you the level of care you need, or
• You exhibit behaviour that is reasonably considered by us to be violent or disruptive.”

What happened

13. Mr Z moved into the Orchards Care Home in May 2020. On beginning his stay at the home, he appointed his wife, Mrs X as his representative to manage his affairs and finances about his stay. Mr Z had a diagnosis of vascular and frontal lobe dementia.
14. On July 5th 2022 an incident took place where the Care Provider said Mr Z hit another resident, who was hospitalised with their injuries. The Care Provider met with Mrs X on 12th July 2022 to explain that it was giving notice to end Mr Z’s care. It wrote to her on 14th July giving 28 days’ notice.
15. Mrs X was unhappy with the notice to end the care and asked for the appeals process. She said the alleged incident was unwitnessed and that nobody could verify whether Mr Z had hit another resident. Mrs X felt that as Mr Z was nonverbal, there was no way to know what had happened.
16. The Care Provider explained the resident who alleged the attack had injuries which supported the allegations, and that Mr Z was seen walking away. It told Mrs X there had been multiple incidents where Mr Z had been aggressive towards residents and staff, and that it could no longer meet his needs.
17. The Care Provider’s notice to end the care told Mrs X that it needed to prioritise the wellbeing of its residents. It said because of the incidents, it had decided that it could no longer meet Mr Z’’s care needs. It said Mr Z would need to leave the home from 11th August 2022.
18. The Care Provider revised Mr Z’s care plan in August 2022, in preparation for his transfer to a new placement. In the revised care plan, it noted that Mr Z could become agitated and angry on multiple occasions, and this had resulted in him hitting other residents and staff.
19. Mrs X disagreed with the new care plan. She felt it was not accurate and the issues raised in the care plan were untrue. She felt the care plan spoke negatively about Mr Z and exaggerated his behaviour.
20. Mrs X accepted there had been occasions where Mr Z had hit other residents but disputed that he had hit staff or that Mr Z was agitated when staff were delivering care.
21. Mrs X complained to the Care Provider. In her complaint she said rejected the Care Provider’s version of events and wished to be advised of the policies applied and the appeals process for ending care.
22. The Provider told the Local Authority it was ending the placement. The Local Authority began an assessment to decide Mr Z’s eligible care needs and where to place him. The Local Authority then arranged that Mr Z would leave the Care Providers care on 11th August 2022 and moved to a new placement.
23. There was a further incident on 8th August 2022 while Mr Z was waiting to be moved to a new placement, where he hit another resident. This was witnessed by staff.
24. The Local Authority transferred Mr Z to a new placement and he died in October 2022.
25. The Care Provider did not respond to Mrs X’s complaint, and so she bought her complaint to the Ombudsman.

Analysis

26. In the letter to give notice to end Mr Z’s care, the Care Provider says it needed to prioritise the wellbeing of residents, and that it could no longer meet Mr Z’s needs. The care plan said this was because the Care Provider felt Mr Z’s dementia had worsened, which causing more violent incidents.

Care Plan

27. The care plan dated August 2022 was reflective of what the care home had witnessed and experienced. The Care Provider, as the organisation giving care to Mr Z, was entitled to form professional opinions about the care Mr Z needed, based on his behaviours and needs. As the Care Provider had identified that Mr Z’s needs had changed, it took the correct action of reviewing and updating his care plan.
28. I appreciate Mrs X does not agree with the language used in the care plan, however, the Care Provider was entitled to rely on its professional opinions when writing the care plan. The Care Provider referred to the current issues it was experiencing with Mr Z when explaining how his needs were presenting. I find no fault with the Care Provider’s actions about the care plan of August 2022.
29. Mrs X says the care plan should have been developed with her. I understand why Mrs X feels this way, as she says the changes shocked her and she would have liked the opportunity to have her views recorded. However, Mrs X does accept there were times when Mr Z was violent but disputes the language and severity. This was a matter of professional opinion, and not one the Ombudsman is likely to find fault with as the Care Provider has explained how it reached its view.
30. It would have been good practice for the Care Provider to have responded to Mrs X’s concerns in a complaint response, however I will address the issue of complaint handling separately.

Notice to end care

31. Mrs X is also unhappy with how the Care Provider gave notice to end Mr Z’s care. The Care Provider’s contract with Mr Z clearly explained that it could give 28 days’ notice if Mr Z’s behaviour was unreasonable, or if it could no longer meet his needs. In this case, the Care Provider felt both applied.
32. The Care Provider met with Mrs X on 12th July 2022 to tell her it could no longer meet Mr Z’s needs and would be giving notice. The formal notice was given to end Mr Z’s care on 14th July 2022.
33. I appreciate Mrs X does not feel this was a “consultation” with her. However, in this case, when the Care Provider met with Mrs X, she had the opportunity to say she was unhappy, which she did. The Care Provider was entitled to decide if Mrs X’s views would change the decision, and in this case, and in this case it did not. This was a decision the Care Provider was entitled to make.
34. The Care Provider followed the terms and conditions of the contract with Mr Z when giving notice. I do not find fault with the Care Provider in this regard.

Complaint handling

35. When Mrs X complained to the Care Provider, she specifically said she did not know all the incidents that were being referred to in the care plan and disputed the Care Provider’s version of events. She asked for a copy of the policy and any information on the appeals process.
36. I have not seen evidence the Care Provider gave a formal complaint response to Mrs X where it addressed her complaint. This was fault by the Care Provider causing distress to Mrs X.
37. If the Care Provider could not uphold Mrs X’s complaint, it should have explained the reasons why and signposted her to the Ombudsman. Failing to do so was fault by the Care Provider, causing time and trouble to Mrs X and gave her no choice but complain to the Ombudsman.
38. I also note that as part of the complaint, Mrs X asked for a copy of the previous care plan and details of the other incidents. I cannot see the Care Provider gave this information to Mrs X or explained why it would not give this information. This was a failure to manage communication with Mrs X and was fault by the Care Provider, causing further distress.

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Agreed action

39. Within 4 weeks the Care Provider has agreed to

• Write to Mrs X and apologise for the fault identified.
• Pay Mrs X £100 in recognition of the distress and time and trouble taken.
• Review how it ensures that formal complaints are responded to in a timely manner, and that complaints are signposted to the Ombudsman.

40. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

41. I have completed my investigation. I find fault with the care provider for its complaint handling and communication management. I do not intend to find fault with the Care Provider for how it gave notice to end Mr Z’s care or how it reviewed Mr Z’s care plan.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman