Summary: Mr X complained about the quality of care his wife, Mrs X received whilst staying temporarily at the care home. This caused significant stress to Mrs and Mr X. We find fault by the care provider. The care provider has agreed to apologise, make a symbolic payment and remind staff of relevant guidance.

The complaint

1. The complainant, Mr X, complains about the quality of care his wife Mrs X received whilst staying at Hallmark Care Homes (Banstead) Limited, the ‘care provider’. He says the care provider:

• failed to provide Mrs X with sufficient exercise during her stay.
• failed to give Mrs X sufficient socialisation at the home.
• failed to provide Mrs X with enough staff interaction during her stay.
• failed to offer Mrs X opportunity to have a bath at the home.

2. Mr X said he has had to pay the full amount of £6,650 for Mrs X’s respite stay despite her only staying 9 out of 28 days.

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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. 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.
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 any documents provided by Mr X and the care provider.
8. Mr X and the care provider had an opportunity to comment on my draft decision. I considered their comments before making my final decision.

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What I found

What should have happened?

9. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers which meet the fundamental standards of care, inspects care services, and reports its findings. It can also enforce against breaches of fundamental care standards and prosecute offences.
10. 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 CQC had guidance on how to meet the fundamental standards.
11. Regulation 16 says any complaints received must be investigated and necessary and proportionate action must be taken in response to any failure identified by the complaint or investigation.
12. Regulation 17 says care providers should “maintain securely an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided.”
13. Regulation 19 says care providers must make written information available about any fees, contracts and terms and conditions, where people are paying either in full or in part for the cost of their care, treatment, and support.

What did happen?

14. This section sets out the key events in this case and is not intended to be a detailed chronology.
15. Mrs X has dementia. The care home completed a pre-admission assessment with her on 4 April 2022. It said Mrs X knew she could receive respite care if her and Mr X were unable to manage her support needs at home independently. It said Mrs X should be supported using her walking frame at all times when mobilising, would like a bath or shower and would need support. It also noted Mrs X needed help and support with sleeping and rest time routines.
16. Mrs X went into the care home on 11 April 2022. The contract noted this was for a 28-day respite period.
17. Mrs X’s care plan said she may be at risk of social isolation, sometimes preferring to sit in her room and not socialise with other residents or team members. It said the team can help Mrs X by giving her a weekly activity planner and reminding her of available activities during the day.
18. The care home completed assessments with Mrs X between 11 and 13 April 2022. It said Mrs X needed full assistance with personal care from one team member.
19. Between 11 and 19 April 2022, the care homes activities of daily living chart noted Mrs X declined personal care on four occasions.
20. The progress notes during Mrs X’s stay at the care home noted Mrs X was checked during the night and settled.
21. The care home completed an assessment on 14 April 2022. It said to manage the risk of constipation the team must encourage Mrs X to maintain a proper exercise routine and good food and drink intake on a daily basis, while always upholding health and safety standards.
22. The care home completed further assessments between 15 and 18 April 2022. It said the team were to encourage Mrs X to participate in activities and should update her throughout the day on activities taking place. It also said the team should take the time to talk to Mrs X when she felt anxious or scared.
23. The care home’s notes stated between 14 and 18 April 22, the team invited Mrs X to seven activities. It said Mrs X attended two.
24. The care home’s daily records during Mrs X’s stay noted she had her meals out in the dining room on one day only. The rest of the time she had meals in her room.
25. The care home completed an assessment on 19 April 2022. It said it had spoken with Mr X who said Mrs X would be returning home the following day as she could not stand to be there any longer.
26. Mr X complained to the care home in the same month. He said his main area of concern was the lack of an appropriate respite care facility. He requested a partial refund.

Analysis

27. The care home provided weekly planner charts for the duration of Mrs X’s stay which include a variety of activities Mrs X could have attended between Monday and Sunday. While it is Mrs X’s decision as to whether she would have liked to attend activities, her care plan noted she may be at risk of social isolation. It said the team can remind her of available activities throughout the day. The care home’s notes stated it invited Mrs X to seven activities between 14 and 18 April 2022. We cannot criticise it for doing so. But there is no evidence to suggest it did so on the remaining four days of Mrs X’s stay. This is fault. But as Mrs X attended only two of the seven activities offered, if this fault had not occurred, I cannot say whether this would have encouraged her to attend more activities.
28. Mr X complained to the care provider in April 2022. The care provider considered his complaint under its stage one and stage two complaints process. It reviewed the relevant documents and recognised there was little evidence to demonstrate it supported Mrs X to have a bath or shower. It said moving forward it would learn from this by creating a system that ensures its team are aware to make several attempts to support a resident with their personal care and for preferences on the preadmission assessment to be communicated to all team members caring for the resident.
29. While we recognise the care provider did investigate Mr X’s complaint and take action, this did cause injustice to Mr X. The pre-admission assessment and care plan stated Mrs X would like a bath or shower and would need support with this. It said the team should encourage Mrs X to have personal care daily. The care homes activities of daily living chart noted Mrs X declined personal care on four occasions. The notes do not state what personal care was offered but said Mrs X was either already dressed or declined continence care. There is no evidence that Mrs X had a shower or a bath during her stay, nor that it was offered to her. This is fault and not in line with CQC guidance. Record keeping is a basic principle of providing care. Under Regulation 17, the care provider is required to maintain accurate, complete and detailed records. The absence of this, combined with the concerns raised by Mr X creates significant uncertainty about whether staff properly managed Mrs X’s personal care.
30. The assessment completed on 14 April 2022 said the team must encourage Mrs X to maintain a proper exercise routine to manage constipation. The care home has provided no evidence to suggest this was carried out. This is fault. The absence of this record would also cause further uncertainty to Mr X about whether Mrs X was encouraged to maintain proper exercise during her stay.
31. Mr X told us the care home failed to provide Mrs X with enough staff interaction during her stay. The care home said team members engaged with residents during mealtimes, when personal care is delivered and when residents observations are taken in addition to the formal activities. Mrs X’s care plan says the team should take the time to talk to her when she feels anxious or confused. The documents provided by the care provider stated a care worker invited Mrs X to sit down and discuss her interests on 14 April 2022, but it said Mrs X was actively seeking out her husband before she would engage. There is no further evidence of any communication with Mrs X recorded. While I understand the care home would not record all communication, there is no record of what further efforts the care home made to try and engage Mrs X in conversation or activities.
32. In respect of the refund of care fees, Mr X removed Mrs X without notice. The contract states no refunds would be given. Mrs X did receive some care during her stay and the care home completed various assessments. But due to the insufficient record keeping it is not known if Mrs X received all the care specified in her care plan and assessments.

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Agreed action

33. To address the injustice caused by fault, within one month of my final decision the care provider has agreed to:

• Apologise to Mrs X and Mr X for the faults identified in this statement.
• Pay Mr and Mrs X £200 to recognise the uncertainty and distress caused to them by the provider’s failure to keep records of the care provided to Mrs X.
• Remind staff about the importance of keeping proper records to evidence that care has been delivered in line with care plans.

34. The care provider should also provide evidence that it has followed the recommendations above.

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Final decision

35. There was fault by the care provider. The actions the care provider has agreed to take remedy the injustice caused. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman