Summary: Mr C complained about the care his father received at his care home. He said that, as a result, the family had no other option than to immediately move him to another home. We have found there was some fault, for which the care provider has agreed to apologise. It will also share the lessons learned with its staff.

The complaint

1. The complainant, whom I shall call Mr C, complained to use on behalf of his father, whom I shall call Mr X. Mr C complained the care home where his father stayed:
• Failed to listen to concerns the family raised between 21 and 28 January 2022, that his father had a flare up of his Gout and would need his medication (Colchicine). He said this resulted in him having difficulties mobilising and being in severe pain during this period.
• Failed to carry out required actions to minimise the risk of Covid spreading amongst its residents. He said this resulted in regular and lengthy lockdowns; 8 weeks out of the 3 months that Mr X stayed there. As a result, the family could often not visit him.
2. Mr C said that, as a result of this, and other issues related to missing clothes and lack of activities, the family did not have any other choice than to immediately move his father to another care home, because it had lost the trust in the care home to take care of their father, take effective action when there is a medical concern and protect him from the risk of Covid-19. It says his father should therefore not have to pay the care home fees for the duration of the notice period.

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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. 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

6. 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

7. 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:
8. Regulation 12 (Safe care and treatment) is about providing care in a safe way for service users. As such, a care provider must ensure that it actively engages with other professionals who are responsible for the service user’s care and treatment, to ensure timely care planning for the health, safety and welfare of the service user.

The complaint about Mr X’s medical care

9. Mr C stayed at the care home from 1 November 2021 until 11 February 2022. He has a condition called Gout, which is a common form of inflammatory arthritis that can be very painful. There are times when symptoms get worse, known as ‘flare ups’. The NHS says that Colchicine is a medicine for treating inflammation and pain. It can be used to treat flare-ups (attacks) of gout.
10. When asked, the care provider told me it carries out an assessment before someone moves into the care home. The purpose of this is to assess if the care home can meet their needs and how best to do this. The home’s pre-admission assessment said: arthritis to knees, able to verbalise and localize. PRN Ibuprofen medication prescribed. History of gout. No recent are up.
11. Mr X’s care plan said:
• He is living with pain caused by arthritis in both knees. It said he has a history of Gout, but he hasn't had a flare up for over a year.
• He has Colchicine tablets for his Gout, which we hold in stock when he has a flare up.
• Staff should ask Mr X daily how he is feeling and if he is in pain. Staff should administer PRN medication Ibuprofen as prescribed.
12. While there were no records that specifically stated, every day, if Mr X was in pain, there were regular interactions throughout the day and staff recording he was ‘content’.
13. Mr C said that:
• His sister had explained to staff, on admission, that her father has gout attacks, how to spot this, and what to do.
• His father had a flare up at the care home before the episode in January 2022, during which the home treated him with Colchicine. As such, the home should have known how to spot the flare up in January 2022 and how to respond.
• Instead, the home failed to spot it, failed to respond to the family raising concerns, and therefore failed to act in a timely manner.
14. The records show that:
• On 26 November 2021, the home had a conversation with Mr C. Mr C was concerned about his father’s knees, which may be due to arthritis / gout. It was agreed the home would start to use the ibuprofen gel and pain relief (paracetamol) to see if it would help his knees. It also put him on the GP list.
• Mr X also received Colchicine. The Nurse Practitioner (NP) assessed Mr X and concluded he had Gout.
• The above showed the care home responded to Mr C’s concerns, involved the relevant health professionals, and followed their advice.
15. On 16 December 2021, Mr X complained of his leg hurting and said it was painful to walk. The home discussed this with the nurse on duty. The care provider said the GP prescribed Colchicine for his Gout, which arrived the next day. It said the GP did not prescribe Ibuprofen Gel, as Colchicine was considered the effective treatment for Gout. This showed again the care home responded to a concern about Mr X appropriately, by involving the relevant health professionals, and following their advice.
16. The home discussed with the NP on 21 December 2021 what it could do to try and prevent flare ups. The nurse suggested to change his diet to prevent flare ups and give him Colchicine three times a day for three to four days if he has a flare up.
17. Mr C says he told staff on Friday 21 January 2022 that his father had knee pain and needed his gout medication. He said the staff told him the home would look into that. However, Mr C says there is no evidence the staff / care home recorded his concerns or did anything in response to this. He would have expected the home to have immediately contacted the GP to say Mr C had suspected gout in his knee, explain his symptoms, and request a repeat prescription of his gout medication.
18. Mr C also said his sister visited the home the next day. He said she saw staff had not taken action and her father was clearly struggling to walk / mobilise. She also asked staff to arrange for her father to receive his gout medication. However, he said there is again no evidence the staff / care home recorded her concerns or did anything in response to this.
19. The care home’s record had, in the past, recorded conversations with Mr X’s family. However, I have seen no evidence in the records there was such a conversation on 21 or 22 January 2022.
20. Furthermore, there is no evidence in the records of an issue / concern this time, with regards to pain in Mr X’s knee or leg. Instead, the only issue mentioned at this time was a new issue, namely that staff noticed on 24 January 2021 that Mr X had problems moving his left fingers and they were swollen. The home immediately notified the GP surgery and received a call from the NP. The record states that:
• The NP thought it could be arthritis or gout, but that he never had gout in his hand before.
• She would prescribe Ibuprofen gel and tablets and asked to give Paracetamol for pain if needed. If the swelling would not go down in a few days, the NP would talk to the GP.
21. Mr C said that:
• He spoke to a nurse or the NP on 25 January 2021.
• When it took two days (and counting) for the ibuprofen gel to arrive, the care home should have gone to the pharmacy and get ibuprofen, which he did on 27 January 2022.
• On Friday 28 January, his sister called the GP and was able to immediately get a prescription for Colchicine (gout medication). She delivered this to the home who gave it to him. He improved within 24 hours of receiving this medication and the ibuprofen.
22. The care provider told me
• There is no record of Mr C meeting with a nurse / NP at the home, and what was discussed.
• The GP prescribed Colchicine tablets on 28 January, which the family collected and delivered to the care home. The care home also started Paracetamol that evening.

Analysis

23. There was an error in Mr X’s care plan, which said the care home has Colchicine tablets in stock. The care provider has told me this was incorrect as Colchicine was only prescribed by the GP as a specific course to be taken and completed, via the Pharmacy.
24. Furthermore, in accordance with the care plan, staff should have asked Mr X and recorded every day if he was in pain. There was no evidence in the records that staff did this and/or recorded this. This is fault.
25. On two previous occasions when Mr X had gout, the care home responded appropriately by discussing it with health professionals and obtaining Colchicine tablets via the GP/ Pharmacy. I found this was in line with Regulation 12.
26. Until late January 2022, Mr X only ever had gout in his knee / leg. I did not see evidence in the records that Mr X, staff or his family were concerned about a flare up of Mr X’s Gout in his knee, between 21 and 31 January 2022. Instead, the concern at this time was a pain in Mr X’s fingers. As such, the records show it was not immediately clear to staff and health professionals if this was Gout. The records show the home immediately discussed this with the GP surgery (NP) and the NP was not sure if it was Gout. The NP prescribed Ibuprofen gel and said she would talk to the GP if the swelling would not disappear. There was subsequently a delay in the care home receiving the Gel.
27. Furthermore, I did not see evidence the staff monitored and recorded, after the call with the NP, if there were changes in the swelling or that it updated the NP about this. I found this was fault and not in line with Regulation 12. This could have resulted in the GP surgery prescribing the Colchicine medication earlier.
28. In the end, the GP prescribed Colchicine medication, because the family contacted the surgery on 28 January as the family was concerned that no treatment had started yet.

The complaint about the way the home managed Covid-19

29. Mr X’s care plan said the home would test him for Covid-19 every four weeks, as he would be at risk if he had Covid-19 without the care home being aware of this. His care plan said that staff would do a Lateral Flow Test after any external visits on return to the home.
30. Mr C said his father tested positive on 13 January 2020. However, when he asked in January 2022 when he could visit his father again, the care home said his father’s isolation period would end on 20 January. However, Mr C said the government guidance at the time was for care residents to isolate for 14 days.
31. Mr X tested positive for Covid-19:
• On 1 November 2021. The home told the family he needed to isolate for two weeks.
• On 13 January 2022 Mr X was showing signs of Covid-19. Guidance in England changed on 17 January to say that people could end their self-isolation after 5 full days if they test negative on day 5 and day 6.
32. Mr C said the care home was in lockdown for 8 weeks out of the three months his father stayed there. In response, the care provider said the care home was in lockdown as per UKHSA guidelines and advice, from 6 to 24 December 2021 and again from 6 January to 5 February 2022. During this time, Mr C was able to visit Mr X as he was an essential care giver. The home also encouraged phone calls and zoom meetings between service users and family members.
33. Mr C said staff members told him they were not aware of the Covid Guidance.
34. In response, the care provider told Mr C that:
• It consulted with, and took the advice from, the United Kingdom Health Security Agency (UKHSA) and the council at all times. They advised what the home should do to protect residents, as soon as the home told them of the COVID outbreak.
• Staff used PPE appropriately and the home took all necessary measures to avoid the spread.
• The home tested all service users and staff regularly throughout the lockdown as advised, and staff completed LFTs before each shift.
• It made all staff aware of the COVID guidance through meetings and one to one support. As Mr C has not provided a name, the care home cannot clarify this further.
35. Mr C said the care home should have contained the spread of Covid-19 by keeping residents in their own rooms. However, the care home has explained that it can only encourage residents to stay in their rooms, it cannot force them. Some residents with dementia were not able to understand the requirement to self-isolate.

Analysis

36. I did not find fault with the issues Mr C identified with regards to Covid-19.

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Agreed action

37. I recommended the care provider should, within four weeks of my decision:
• Apologise for the fault identified in paragraph 27 and any distress this caused Mr X or his family.
• Share the lessons learned with relevant staff.

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Final decision

38. Mr C said the family had no other choice than to immediately move Mr X to another home. It is clear the family was unhappy with some aspects of the care support Mr X was receiving and therefore decided to move him to another home.
39. However, I found that, while there was some fault with the actions of the care provider with regards to record keeping and the way in which they handled Mr X’s swollen fingers, there is no indication to suggest the situation required an immediate move to another home to safeguard Mr X. The family was not happy with aspects of his care and as such were entitled to give notice and move their relative to another home. For reasons explained above, I did not find there were grounds to conclude the home should wave the fees for the notice period.
40. Under our information sharing agreement, I have shared this decision with the Care Quality Commission.

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Investigator's decision on behalf of the Ombudsman