Summary: Mrs X complains Abbeycroft Residential Care Home failed to look after her uncle properly and continued to charge for his placement after saying he could not return as it could no longer care for him. It was wrong to charge for the uncle’s room after Abbeycroft made it clear he could not return there. It needs to refund the money paid for the room from 13 February to 1 March 2019.

The complaint

1. The complainant, whom I shall refer to as Mrs X, complains Abbeycroft Residential Care Home failed to look after her uncle, Mr Y, properly and continued to charge for his placement after saying he could not return as it could no longer care for him.

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What I have investigated

2. I have investigated events in 2019.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(4), as amended)
4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)

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How I considered this complaint

5. I have:
• considered the complaint and the documents provided by Mrs X;
• discussed the complaint with Mrs X;
• considered the comments and documents Regency Healthcare has provided in response to my enquiries;
• shared a draft of this statement with Mrs X and Regency Healthcare, and taken account of the comments received.

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What I found

Key facts

6. Mr Y lived at Abbeycroft Residential Care Home (Abbeycroft) for three years. His contract says:
• “If the Service User is admitted to Hospital the Proprietor will retain the room for six weeks and thereafter upon request provided always that the normal weekly fee is paid.”
• “If the Service User leaves the Home without giving the required notice fees will be charged at the normal weekly rate for the unexpired period.”
• “The home normally requires a period of 4 weeks notice for any resident who wishes to leave the home. If a resident does not return following an agreed temporary period of absence, the home might seek to terminate this arrangement.”
7. Abbeycroft kept records of the care provided to Mr Y. There are too many to list here so I refer to the key contents below.
8. In November 2018 Mr Y had an itchy rash all over his body which was bleeding due to scratching. His care plan said to apply a cream prescribed by a Nurse Practitioner for two weeks and to wash his clothes separately with no detergent. When the rash did not clear up, the Nurse Practitioner took photographs and referred Mr Y to his GP. It appears the GP referred Mr Y to a Dermatologist. The care plan was still in place in January 2019. His January medication records refer to Betnovate ointment, which had been prescribed in November, and say “course finished”. It appears staff were applying E45 cream to Mr Y’s legs twice a day when he would let them.
9. According to his care plan, Mr Y had episodes of confusion which could lead him to be abusive towards staff when they tried to care for him. Mr Y spent a lot of his time in his room, sleeping on and off.
10. On 7 January Mr Y was agitated and angry when staff gave him a strip wash and applied creams.
11. On 9 January Mr Y was covered in blood due to his skin complaint. When staff offered to help with personal care he swore and threatened them.
12. On 11 January Mr Y shouted and swore at staff. He pulled the bar off a fire door when trying to leave the home. He calmed down and sat with staff, to whom he apologised.
13. On 13 January Mr Y became aggressive towards staff when they delivered personal care.
14. On 20 January Abbeycroft contacted an out of ours GP, as Mr Y could not pass urine. The GP said to ring 999 and an ambulance took him to hospital. He returned to Abbeycroft at 01.30 the next morning with a catheter and medication to treat an enlarged prostate gland.
15. On 21 January Mr Y was confused, swore at staff and refused to take his medication. He settled down after Mrs X visited.
16. On 24 January Mr Y was found asleep “covered in his own blood, ½ dressed”. When staff tried to help with personal care he was violent and verbally aggressive for about 20 minutes. He remained verbally aggressive when staff approached him the next day.
17. Mr Y shouted and swore at staff on 27 January when they offered help.
18. At 02.00 on 28 January Mr Y shouted, swore and hit a member of staff.
19. At 04.00 on 29 January Mr Y had removed his catheter. When staff went to help he was aggressive, swore at them, called them names and tried to hit them with a pillow. Later that day, Abbeycroft referred him to the Mental Health Team over his “aggressive outbursts”.
20. On 30 January staff found Mr Y in his room wearing only a bloodstained top (from his skin). He was physically and verbally violent when staff offered assistance.
21. On 1 February Abbeycroft contacted NHS 111 as Mr Y had very dark urine. NHS 111 advised contacting his own GP within two hours as it was urgent. There is no evidence it did this.
22. On 2 February Mr Y was shouting and hitting staff. His catheter contained “large amounts of blood and dark urine”. Abbeycroft contacted NHS 111 which arranged for an ambulance to take him to hospital. Mr Y returned to Abbeycroft at 11.35. He did not look well and refused personal care.
23. Mr Y remained unwell on 3 February, refusing personal care and medication.
24. On 4 February Mr Y ate well, accepted personal care and was “very pleasant”.
25. On 5 February Mr Y got up for breakfast but then went back to his room and refused personal care but took his medication.
26. Mr Y went to hospital on 6 February, having had a fall. He returned later that day.
27. At 15.00 on 7 February staff found Mr Y on the floor “distressed and confused”. Paramedics took him back to hospital at 16.20. Abbeycroft’s records say: “Due to [Mr Y’s] needs becoming increasingly difficult to manage, Ward informed that we would need an assessment of needs before [he] could be accepted back. [Mrs X] informed and in agreement”. Regency Healthcare says the Manager told Mrs X that, if Mr Y was assessed as having nursing needs, it would not be able to take him back.
28. Mrs X says Abbeycroft’s Manager told her they would not have him back because of his behavior, which was upsetting other residents. She says she asked if she needed to clear his room but was told there was no urgency, as they did not need the room yet.
29. Mrs X says Mr Y was diagnosed with varicose eczema in hospital. According to the NHS website, varicose eczema is a long-term condition which can be treated with a combination of self-help techniques; moisturisers; topical corticosteroids; and compression stockings.
30. Abbeycroft’s record for 13 February says: “Spoke with nurse regarding us being unable to meet [Mr Y’s] needs”. The hospital records say Abbeycroft “have refused to take him back”. The hospital referred Mr Y for an assessment by a Social Worker, which resulted in an alternative placement being identified for him.
31. Mr Y died in hospital on 9 March. Mrs X is the Executor for his estate.
32. Mrs X emptied her uncle’s room at Abbeycroft on 10 March. She took pictures of the room which show some furniture was being stored there.
33. According to Regency Healthcare’s records, Mr Y owed £7,661.96 for the cost of his room when he died on 9 March. However, on 20 March it invoiced Mrs X for £6,974.10 up to 1 March. When Mrs X received the invoice she wrote to complain.
34. The Director of Regency Healthcare invited Mrs X to a meeting on 5 April to discuss her concerns. The meeting only lasted a few minutes. Mrs X left accusing the Director of talking over her. The Director disputes this.
35. At our request, Regency Healthcare replied to Mrs X’s complaint on 3 June. It said:
• Abbeycroft’s Manager told Mrs X they would not be able to accept Mr Y back if he was assessed as needing nursing care, as it isn’t registered as a nursing home;
• Mr Y’s contract provided for fees to be paid even if someone went into hospital;
• Mr Y’s skin condition had been seen by “many professionals such as District Nurse, Nurse Practitioner and correspondence with GP, he was also referred to Dermatology department”
36. Regency Healthcare says Mrs X called in June 2019 and they “resolved everything amicably and consequently she was very satisfied and happy to settle the account”.

Did the care provider’s actions cause injustice?

37. It is clear Mrs X was not “satisfied” in June 2019 as she had already complained to us. Since then she has confirmed that she wants to pursue the complaint against Regency Healthcare and Abbeycroft.
38. Regency Healthcare is right that only an assessment of Mr Y’s need for nursing care could determine whether he needed to move to a nursing home or could, in principle, return to Abbeycroft. However, it is clear from its record for 13 February that it believed it could no longer meet Mr Y’s needs. This is reflected in the hospital’s record, which understood Abbeycroft would not take Mr Y back. That is why an alternative placement was found for Mr Y. It appears Abbeycroft did not want Mr Y back because of his behaviour. Within that context, Regency Healthcare was wrong to charge for Mr Y’s room until 1 March 2019. It needs to refund the money paid for the room from 13 February to 1 March 2019.
39. The records show Abbeycroft sought medical attention for Mr Y. He was seen by Nurse Practitioners and Abbeycroft contacted the NHS as his condition declined. This resulted in Paramedics visiting and regular visits to hospital. This does not support the claim that Abbeycroft did not care for Mr Y properly.

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Recommended action

40. I recommend Regency Healthcare within four weeks refunds the money paid for Mr Y’s room from 13 February to 1 March 2019.
41. Under the terms of our Memorandum of Understanding and information sharing protocol with the Care Quality Commission, I will send it a copy of my final decision statement.

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Final decision

42. I have completed my investigation on the basis Regency Healthcare will take the action I have recommended to remedy the injustice it has caused.

Parts of the complaint that I did not investigate

43. I have not investigated events before March 2018 because of the restriction in paragraph 4 above. Mrs X did not contact us until April 2019 and it is clear the complaint was primarily motivated by more recent events. There are no good reasons to investigate the earlier events now.

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Investigator's decision on behalf of the Ombudsman