Summary: the complainant says the Care Provider failed to provide notice or an explanation for suddenly deciding it could no longer offer care for a resident and offering help in finding alternative care. The complainant says the Care Provider returned the resident’s powered wheelchair in disrepair and could not explain its condition. The Care Provider recognises it failed to properly prepare the family for the move and did not keep proper records of a care review meeting. The Ombudsman finds injustice and accepts the Care Provider’s offer to waive the final care invoice to address the injustice caused.

The complaint

1. The complainant whom I shall refer to as Mrs X complains that when dealing with the end of care for her mother, Mrs Y, the Care Provider failed to:
• Give proper notice and an explanation for ending Mrs Y’s care;
• Properly consider reducing the charges levied at the end of the contract to reflect the swift ending of care;
• Prevent damage to Mrs Y’s powered wheelchair and offer compensation and replacement for damaged parts or refer the claim to its insurers.
2. Mrs X says this caused distress for Mrs Y and her family and wants the Care Provider to waive the final invoice charged.

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The Ombudsman’s role and powers

3. 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. (Local Government Act 1974, sections 34B and 34C)
4. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. We normally name care homes in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home. (Local Government Act 1974, section 34H(8), as amended)
6. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

7. In considering this complaint I have:
• Spoken with Mrs X and read the information presented with her complaint;
• Put enquiries to the Care Provider and studied its response and care records;
• Researched the relevant law, guidance, and policy;
• Shared with Mrs X and the Care Provider my draft decision and reflected on any comments received.

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What I found

8. Mrs X says Mrs Y entered the Care Provider’s Dukes Court Care Home, Wellingborough in 2016.I have read the care records showing how the Care Provider’s staff supported Mrs Y throughout that time.
9. At a care review meeting on 5 July 2019 involving Mrs Y’s family, including Mrs X, the Care Provider told the family it did not accept the local authority elderly person’s rate. Therefore, should the family need local authority funding they would need to top up any shortfall between the Care Provider’s charges and the local authority rate.
10. The family told the Care Provider that Dukes Court had become Mrs Y’s home over the last three years and that they wanted her to receive end of life care there. They say the Care Provider’ staff agreed to this assuring them a specialist nurse could attend Mrs Y to help her pass comfortably. The family say it came as a shock therefore to receive a call from the Care Provider on 10 July 2019 in which the Care Provider said Mr Y must now leave the home. The Care Provider said they had a place at another home which Mrs Y could move to. Mrs X and other family members took the following day of work to look for an alternative placement for Mrs Y.
11. Mrs X says the family does not understand why the Care Provider did not discuss the need to move Mrs Y at the care plan meeting. In responding to my enquiries, the Care Provider says at the meeting on 10 July 2019 the Care Provider’s staff believed Mrs Y needed more care than the care home could provide. In its view Mrs Y’s needs had increased significantly and she now needed a nursing home placement. The Care Provider recognised it failed to take notes of the care review. In commenting on my draft decision, the Care Provider says it did not intend to give notice at this point. The Care Provider says it has learned lessons from this complaint. It says staff will not only keep better records but take care to ensure clearer communication to avoid causing similar upset.
12. The Care Provider says when it met with Mrs Y’s family for the review in July 2019 the SALT team had not yet assessed Mrs Y. The assessment found Mrs Y at high risk of choking which needs specialist nursing to use suction equipment. The Care Provider does not have this support at Dukes Court and so decided it could no longer meet Mrs Y’s assessed needs.
13. The Care Provider said it had not given formal notice. Had it done so the Care Provider says it would have supported Mrs Y and her family through the move. It had however told the family the care home could no longer meet Mrs Y’s needs and that resulted in the family believing they had to arrange another placement.
14. In responding to my enquiries, the Care Provider says:

“The meeting…on 10 July 2019 could have been more detailed and a clearer explanation provided to the family that nursing care may be required in the future but unfortunately the letter sent to the family did not detail this sufficiently.”

15. The Care Provider says it has learned from the mistakes and never intended to cause distress to Mrs Y or her family. It offers an apology and to waive the final invoice for £2,155.07.
16. Several months after Mrs Y moved into the care home, her family took in a powered wheelchair and left this in her room. However, the Care Provider says Mrs X never used the wheelchair. The family says they witnessed other residents using the wheelchair. When Mrs Y moved out the family say the Care Provider returned the wheelchair in poor condition. The family say the wheelchair had parts missing making it unsafe and unusable. The Care Provider says it does not know how this happened because they never used it for any other resident. However, the Care Provider decided not to charge the family its usual dilapidation charge of £495.00 levied when Mrs Y left the home to compensate for the damage. The family say that does not cover the damage and the Care Provider refused to put their claim to its insurers.
17. In response to the family’s complaint the Care Provider wrote a short letter on 27 September 2019. This said Mrs Y presented with a high risk of choking and therefore the care home no longer met her needs. The letter explained the GP decides whether it should give Mrs Y medication in solid or liquid form. The letter says the Care Provider did not know Mrs Y had a powered wheelchair. The Care Provider recognises this letter gave the impression Mrs Y must leave without giving her formal notice under the contract with her. The Care Provider says it had not intended to give notice. The Care Provider apologised for the lack of notes and the poor drafting of the letter. The Care Provider says its manager did not know when taking up the post staff had stored a powered wheelchair in the home. Again, the Care Provider says it has learned lessons from this complaint.

Analysis – has there been fault causing an injustice?

18. My role is to consider how the Care Provider decided it could no longer meet Mrs Y’s needs and how it considered their concerns. If it acted with fault causing an injustice, I must consider what it should do to put that right.
19. Record keeping is essential to showing how the Care Provider decided to end Mrs Y’s care. The Care Provider failed to keep contemporaneous notes of the Review Meeting or how it told the family it could no longer care for Mrs Y. The Review Meeting should have resulted in a letter setting out the points covered in the meeting, agreed action or what the Care Provider intended to do. The letter could make it clear decisions made may change once the SALT team completed its assessment. The Care Provider should have covered whether it may have to end the care contract and give its reasons. The Care Provider should not present the family with shocking news like this over the telephone or without proper explanation and time to consider their choices.
20. I find the Care Provider failed to keep proper records of the care review decision. I find the Care Provider failed to give proper advance notice that Mrs Y’s increasing needs meant the family should consider moving her to another home.
21. Telling Mrs X and the family Mrs Y could remain with the Care Provider until end of life before a crucial assessment unfairly raised expectations. Those it then dashed shortly afterwards. This caused avoidable distress to the family who wanted Mrs Y to remain in what had become her home. The Care Provider has no record of who gave such an assurance. This poor communication left the family with this impression. I find this caused avoidable distress to the family.
22. I cannot decide who or what caused the damage to Mrs Y’s wheelchair making it in the family’s view unsafe and unusable. However, again poor record keeping meant the Care Provider said it had not been aware Mrs Y had such a wheelchair. The care home should have an inventory of property with which a resident enters the home or which they buy while at the care home. The Care Provider should have properly stored the wheelchair so nobody else could use it or come to harm through using it. It should have records showing when Mrs Y received it and when it had the wheelchair PAT tested to ensure it met the Care Provider’s safety standards. I find the Care Provider at fault for not properly recording the presence of the wheelchair and ensuring it remained within Mrs Y’s room and in usable condition.
23. In response to the complaint about the wheelchair, the Care Provider waived the dilapidation charge. That charge concerns payment for any decline in the condition of a resident’s room on leaving the home. The Care Provider conflated two different issues. The Care Provider should have passed the claim for the damaged wheelchair to its insurers for consideration. If the insurers then refused the claim, the family could follow that up in the small claims court. However, I recognise the Care Provider believes under the contract it had the right to levy the dilapidation charge. It decided not to as a means of compensating the family. I find the Care Provider acted in error causing confusion. If the family can show the repairs to the wheelchair exceed this charge the Care Provider should consider refunding those costs or passing the claim to its insurers.
24. I find the Care Provider caused injustice by causing avoidable distress to the family at a difficult time. The only way the Care Provider can address that distress is for the Care Provider to offer an apology and payment. Under the contract the Care Provider can charge the care fees set out in its final invoice. The Care Provider has agreed to waive that invoice and that in effect is a payment to the family because it means they do not have to pay those fees or dispute them in court.

Recommended and agreed action

25. To address the injustice arising from the faults found in this investigation I recommend, and the Care Provider agrees to within four weeks of my final decision:
• Send a written apology to the family for the avoidable distress caused confirming the Care Provider has learned lessons from the complaint;
• Includes in the letter containing the apology confirmation it has cancelled the invoice for £2,155.07 and that clears all remaining charges;
• Shares with staff a copy of this decision as part of staff training, learning, and promoting better practice in future especially in record keeping.

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Final decision

In completing my investigation, I find the Care Provider caused injustice to Mrs Y and her family while she lived at Duke’s Court Care Home, Wellingborough.

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Investigator's decision on behalf of the Ombudsman