Summary: Mr C complained about the care his (late) mother received at the care home she lived. He said this resulted in distress to him and his mother. We found there was a delay by the care home in ensuring Ms X had heating in her room, and the staff did not regularly change her bedding during a three-month period. The care provider will apologise to Mr C for the distress this caused and reimburse part of the care home fees for these periods.

The complaint

1. The complainant, whom I shall call Mr C, complained to us on behalf of his (late) mother, whom I shall call Ms X. Mr C complained that:
• Since his mother went into the care home in 2018, there had been over 100 days where she experienced inadequate room facilities.
• The care home failed to tell him and his mother in advance that there would be construction work next to his mother’s room, which would mean that his mother would have to be outside of her room during the day.
• His mother was not allowed to go into her room during this period (on 6 days from the early morning until 4pm), which was inconvenient to her.
• The manager of the care home stopped providing monthly updates to residents and their families.
• His mother was without heating between 1 and 26 October 2021. As a result, she was very cold and uncomfortable during most of those days and nights.
• There was an unreasonable delay during the weekend of 20 March 2021 to fix his mother’s ensuite toilet. As a result, she had to walk (at night) to a toilet that was further away, which put her at risk of falls.
• His mother did often not receive her weekly shower/wash when she should have, during 2021.
• His mother did often not get her bed sheets changed when staff should have (on the days she has a shower).

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What I have investigated

2. I have investigated all the aspects of Mr C’s complaint, except the first one.

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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 injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)
4. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. 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/care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
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 the information I received from Mr C and the care provider. I shared a copy of my draft decision statement with Mr C and the care provider and considered any comments I received, before I made my final decision.

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What I found

Background legislation and guidance

8. 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. We consider the 2014 Regulations and the Fundamental Standards, as well as a provider’s policies and procedures, when determining complaints about poor standards of care. The following regulations are relevant to this complaint:
9. Regulation 9 (Person-centred care) says each service user should receive care that is personalised specifically for them, that meets their needs and reflects their preferences.
10. Regulation 15 (Premises and Equipment) is about ensuring that premises and/or equipment used to deliver care and treatment is clean, stored securely and suitable for the intended purpose.

The complaint about the construction work

11. Ms X had lived at the care home since 2018 and passed away in January 2022.
12. Mr C complained:
• The care home failed to tell him and his mother in advance that there would be construction work next to his mother’s room from 8 December 2021 onwards, and that this would mean that his mother could not be in her room during the day.
• His mother was not allowed to go back to her room on six days. He said his mother always liked to go back to her room when she wanted to use her toilet and after lunch to clean her teeth etc. However, between 8 and 17 December 2021 there were six days where she was not allowed to return to her room until 4pm. This was inconvenient to her.
13. The care home has already previously acknowledged and apologised to Mr C, in response to his complaint, that it failed to tell him in advance that it would carry out building works, and what effect it would have on his mother.
14. Ms X kept a diary, which mentioned on 6 days that: She had to stay downstairs all day and couldn’t come / was not allowed to go back to her bedroom.
15. The care home has previously told Mr C, in response to his complaint, that:
• On a few occasions, care staff asked his mother to leave her room earlier than normal, due to the building work. As such, care staff provided personal care to her before 930am (her preferred time) on three occasions.
• Care staff explained to Ms X that, due to the noise, it would be less disruptive for her to come to the lounge earlier than usual, and she consented to this. The care home apologised for any distress this may have caused. Although she was not entirely happy, she understood it would be better to come to the lounge.
• After lunch, Ms X was out of the home on most days until around 4pm, when the builders would generally finish work.
16. In response to my enquiries, the care home said that:
• It tried to keep disruptions to a minimum and the rooms affected were still accessible.
• It explained every day to the affected residents that if they remained in their rooms, it may be noisy and dusty. It did not tell the residents that they were not allowed back in their rooms and one of the residents chose to remain in her room on several days.
• If Ms X had asked to return to her room at any time to clean her teeth and or lie down, she would have been able and allowed to. Ms X did not ask for this.
• The builders were experienced in working in care home settings and were happy to stop work and move their tools to allow access when required.
• The daily notes show Ms X was quite happy and content to remain in the lounge during this period of work.
17. Staff said Ms X would usually go to the lounge every day in the morning and would go out with her son every day in the afternoon. Before she would go out, she would go back to her room to get ready: use the toilet and get her coat and shoes. She would then return at 4.30pm.

Analysis

18. The care home says it only advised Ms X that it would be best not to return to her room during the day, on those six days. However, it is clear from Ms X’s diary notes that she was under the impression that she was not allowed to go back to her room until 4pm, and therefore did not. As such, I found the care home failed to clearly communicate with Ms X and Mr C around this at the time.
19. The care home has already apologised for the inconvenience the building works caused Ms X, which I found an appropriate remedy for any distress and inconvenience she may have experienced during those six days.

The complaint about communication

20. Mr C complained to the care home in December 2021 that the manager of the care home stopped providing monthly updates to residents and their families. He said these updates were important for him, and other relatives, in light of Covid-19, the building works going on etc.
21. In response to Mr C’s complaint, the care home said it would ask all relatives if they would like these monthly updates again.
22. The care home manager told me that:
• She became manager in March 2021 and personally called all relatives to introduce herself. During this call, she said they could contact her via email or telephone with any concerns.
• The home always displays information posters at the front door so visitors can see them. These would have information about building work, visitor guidance and any other important information, such as if the home was closed due to an outbreak of disease. Mr C visited his mother every day and would therefore always see the posters and latest information.
• During his visits, staff would often provide him with updates and inform him of any changes to the service or his mother.

Analysis

23. While there is no requirement to provide monthly updates to the relatives of those in a care home, it is important to keep them updated in an appropriate and timely manner about issues that may affect them or their relatives in the home.
24. Based on the information provided above, I found that, even though it had stopped the monthly updates, the care home did enough to keep Mr C updated.

The complaint about heating

25. Mr C complained his mother was without heating between 1 and 25 October 2021. He said his mother’s diary showed she was very cold and uncomfortable on many occasions. He said the issue was related to:
• Staff not being able to turn the central heating in her room on.
• Staff removing, and not replacing, her portable electronic heater during this time.
26. Mr C provided records that showed:
• He emailed the manager to say his mother, and most of the care workers told him, they could not turn the thermostat in her room on. As a result, she did not have heating.
• He explained the electric heater, which had been taken away two weeks ago, had been in a safe position. It had not been on a chair but on a low table without the wire being a trip hazard. He suggested to attach an electric heater to the wall as a safe solution.
• It took until 25 October before the home put an electric heater on the wall.
27. I reviewed Ms X’s diary notes. She recorded on 9 October 2021 that she wanted a heater because “the big heater does not work”. She first recorded she was cold the following day, when she wrote she was cold, and it was horrible. She also complained in her diary about the heating not being on, on 12 / 15 / 22 / 24 and 25 October 2021.
28. In response, the manager told Mr C:
• On 9 October that the maintenance person had assured her he had explained to Ms X how to turn the radiator on and off.
• On 12 October 2021 that she would try and source a wall mounted heater for his mother.
• On 25 October that a plumber had fixed his mother’s radiator and a maintenance worker had also fitted a wall mounted electrical heater.
29. The care home told me that:
• During this period, the heating throughout the home was working, the environment was warm, and Ms X was not left in a cold room.
• However, taking Mr C’s feelings into account, and his request for reimbursement, the home would like to offer a discount of 20% on fees for the 14-day period when the heating was not fully functional. Ms X continued to receive all other services during this period of time.
30. The records show that Ms X’s room was cold, and the care home apologised for this at the time. It also told Mr C the plumber had found that an element in the boiler had gone.

Analysis

31. Ms X did not have all her care needs met during this time, and there was an unreasonable delay to put measures in place to address this. This was not in line with Regulation 15.
32. The care home has offered a 20% reduction in fees for the period affected and has said it has put stricter procedures in place to respond to immediately investigate any faulty service facilities. I find this is an appropriate remedy.

The complaint about Ms X’s toilet

33. Mr C complained there was an unreasonable delay during the weekend of 20 March 2021 to fix his mother’s ensuite toilet. He said that, as a result, she had to walk (at night) to a toilet that was further away, which put her at risk of falls.
34. The toilet stopped working on the evening of Friday 19 March 2021. Mr C says the home told his mother to use the toilet in the room next door. A plumber came on Monday afternoon and fixed the problem.
35. The care home has since explained to Mr C there is a contract in place for 24hr emergency plumbing call outs. However, it said that due to there being many other toilets available and working in the building, the home felt this did not constitute an emergency and could wait till Monday.
36. In response to my enquiries, the care home provided a copy of Ms X’s mobility care plan from 19 April 2021. It said Ms X could walk independently with a Zimmer frame and remained independent with toileting at night. It also sent a copy of a general falls risk assessment from 19 March 2021 that said Ms X was at low risk of falls.
37. The care home told me that Ms X could walk independently to and from the lounge, which is much further than the walk to the communal toilet.

Analysis

38. The home repaired Ms X’s toilet within a reasonable timeframe. Based on the records available from that time, including falls risk assessments, this did not result in Ms X being left at risk of falls during the night during those days.

The complaint about having a weekly shower and change of bed sheets

39. Ms X’s care plan said that staff should give her a choice each day if she wanted a strip wash, shower or bath. It also said that it was her preference to have a shower and bed change every Thursday morning and that this routine was important to her.
40. However, Mr C complained that:
• His mother did often not receive a shower/wash and bed change when she should have.
• The home put an instruction on to his mother’s pad on 14 August 2021 that said: “If you want a shower or bed change you must ask”. He did not agree with this because, due to his mother’s dementia, she did not have the ability to remember to ask staff every Thursday that she would like to have a shower.
• As a result, he had to call his mother every Thursday to tell her to remind staff to give her a wash and change of her bed sheets.
• Even so, this did not always happen.
41. Mr C sent an email to the manager to explain why his mother would not be able to ask staff for a shower or bed change. As such, he asked the manager if his mother could simply have this again on every Thursday.
42. In response, the home manager told Mr C that: Ms X is still able to provide consent with regards to her care and make simple decisions herself. The staff are aware of Ms X’s request for a shower every Thursday, including a change of bed sheets, and this is reflected in her care plan. On reviewing her care notes, this does happen every Thursday. Staff change her bed linen more frequently if required. The home manager also invited Mr C to his mother’s care review and invited to discuss any remaining concerns there.
43. Mr C told the care home manager in response that he did not agree that the staff were aware that it should give his mother a shower every Thursday, because of the recent note that said Ms X needs to ask if he wants a shower or bed change.
44. According to records kept at the time by Mr C:
• 14 October: His mother did not have a shower nor a bed change.
• 25 November: His mother did not have a shower or bed change.
45. I reviewed a sample of the daily care records for two months. They showed that (showers):
• Ms X had a shower on Thursday 2, 9, 16 and 30 September and 7, 21 and 28 October.
• She also had a shower on 22 September and 10 and 18 October.
46. In response to my enquiries, the home manager said the home worked to a model of person-centred care. This meant staff would ask residents every day if they wanted a shower/bath or wash, and residents could ask staff on any day. Care is no longer prescriptive, whereby residents are allocated a day for a shower/bath. However, she agreed at the time she would remind staff that Ms X’s preference was for a shower once a week on a Thursday. This is recorded in her care plan. The timeline shows that Ms X received a weekly shower. The care home is a large home, and this means that due to certain pressures or emergencies on the day, routines may need to be flexible at times to ensure everyone is cared for and safe.
47. The care provider has since added that Mr C called his mother every day. However, there is no evidence that staff would not have offered a shower without this. There is also evidence that Ms X declined a shower on Thursdays on several occasions. SMs X also accepted offers for a shower on days when Mr C did not ask for one.
48. The care provider sent me a report that highlighted the days on which staff marked on the system they changed Ms X’s bedding, during 2021. According to the report, the home changed Ms X’s bed linen about once a week. However, there was no change of bed linen recorded between:
• 8 January and 10 February
• 2 July and 6 August
• 27 August and 21 September
• 23 September and 9 October
49. The care provider told me this was due to staff not always recording they had changed the bed linen. However, as the care home did not record this happened, I have no evidence to conclude it did happen.

Analysis

50. Ms X’s care plan said she would like a shower every Thursday. According to the records, Ms X received a shower on most Thursdays and about once a week. This was in line with regulation 9 (personal care). It is not clear to what extent these showers (only) happened because Mr C called his mother every Thursday to remind staff to give her a shower. I have no reason to doubt that Mr C felt he needed to do this, and the care home should apologise for that and the inconvenience it caused him.
51. The daily care records showed staff did not change Ms X’s bed linen during three lengthy periods. This is fault and not in line with Ms X’s care plan. The frequency of cleaning her bed linen during those periods, would also not have been enough to ensure her bed linen was sufficiently clean. This is not in line with regulation 9 (personal care). Clean bed linen is important to prevent older people from infections and diseases. They are also important for maintaining their general wellbeing, which can be affected by bad smells.
52. To remedy this, the care provider should apologise and refund 5% of the weekly care home fees during the four periods mentioned above.

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Agreed action

53. The care provider will, within four weeks of my decision:
• Apologise for the faults identified above and the distress these caused Mr C and his mother.
• Refund a part of the care home fees (see paragraph 32 and 52)
• Put a system in place that ensures and monitors that all residents have their bed sheets cleaned, at least once a week, or more if required.

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Final decision

54. For reasons explained above, I found fault with regards to some of the care support Ms X received. As such, I have upheld Mr C’s complaint.
55. Under our information sharing agreement, I have shared this decision with the Care Quality Commission.

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Parts of the complaint that I did not investigate

56. I did not investigate Mr C’s complaint that his mother did not have appropriate room facilities on more than 100 occasions, since 2018, as these events happened more than 12 months ago (see paragraph 5). If Mr C was unhappy about this at the time, and unhappy about the way the care home responded to any complaints he made about that at that time, he should have referred this to the Ombudsman sooner.
57. I have however investigated the two significant issues Mr C made an official complaint about with the care home, and which happened in 2021: the lack of heating in October 2021 and the lack of access to the room during the day in December 2021.

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Investigator's decision on behalf of the Ombudsman