Summary: Mrs X complained about the poor quality of care provided to her mother, Mrs Y, during a stay at Elworth Grange Care Home and that Mrs Y was overcharged for the stay. The care home’s records of personal care were poor, there was a lack of activities offered and Mrs Y was overcharged for her stay. The care provider Ideal Care Homes Ltd should apologise to Mrs X and make a payment to acknowledge the distress and frustration caused. It should refund the over charge to Mrs Y and remind staff of the importance of accurate record keeping.

The complaint

1. Mrs X complained about the poor quality of care provided to her mother, Mrs Y, during a stay at Elworth Grange Care Home, a home run by Ideal Care Homes Ltd. Mrs X said the issues caused her distress and frustration. In addition, Mrs X said her mother was overcharged for the stay.

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The Ombudsman’s role and powers

2. 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. If they have caused an injustice we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
3. 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)
4. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share the final decision on this complaint with CQC.

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How I considered this complaint

5. I have considered the information provide by Mrs X and discussed the complaint with her on the telephone. I have considered the care provider’s response to my enquiries and the relevant law and guidance.
6. I gave Mrs X and the care provider the opportunity to comment on a draft of this decision. I considered any comments I received in reaching a final decision.

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What I found

The relevant law 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. This includes:
• providers must make sure that people who use their services have adequate nutrition and hydration to aid good health. People must be provided with appropriate food and drink and any support they may need to achieve adequate nutrition (regulation 14); and
• providers must securely maintain accurate, complete and detailed records about each person using their service (regulation 17).

What happened

8. Mrs Y has dementia and other health conditions. She moved into the care home in late September 2022 with the aim of potentially living there permanently. Mrs Y was a self-funder, meaning she was responsible for paying her own care fees. Mrs X and another relative manage Mrs Y’s finances on her behalf. Mrs X says when Mrs Y moved in, they were told that the home held daily activities.
9. Mrs X signed the contract on Mrs Y’s behalf. The contract stated “the first four weeks of admission from the date of admission shall be regarded as a trial period”. It went on to say “if you are a self-funding resident, either you or the company may terminate the contract during the trial period by giving at least one week’s notice to the other (subject to a minimum term of two weeks)”.
10. Mrs X visited Mrs Y regularly. She had concerns that no activities were taking place, the jug in Mrs Y’s room was not filled and Mrs Y indicated she was not showering regularly.
11. Mrs X employed a private social worker who met with the care provider in October 2022. The notes of the meeting record the care provider said there had been issues with some agency staff who had not been delivering care to the standard that was expected. It had put measures in place with daily floor walks by senior staff. It had been recruiting and new staff were starting shortly. The care provider advised it had put measures in place to ensure activities were taking place in the morning and afternoon and had recruited a new activities coordinator. It explained plenty of drinks were available during the day and at mealtimes and it monitored all residents’ fluid intakes.
12. The social worker passed on Mrs X’s concern that other residents entered Mrs Y’s room. The care provider advised that this may happen as people with dementia forget where their rooms are. The social worker also met with Mrs Y and thought she seemed very settled.
13. Mrs X remained unhappy with the quality of care and gave notice to the care home within the four week trial period. Mrs Y left the care home to move elsewhere. Her stay lasted 37 days.
14. Mrs X complained to the care provider about the care provided and advised she was not prepared to pay the full amount owed as the care provided was not what was promised. The care provider responded in late November 2022. It found:
• personal care was provided and detailed in the care records every day but one;
• Mrs Y did take part in activities but these could have been more frequent. Since the meeting with the social worker new activities staff had commenced posts;
• Mrs Y had a good fluid and food intake throughout her stay, her weight was monitored and only fluctuated very slightly.
15. Mrs X remained unhappy. She complained she served notice within the 4 week trial period but had been overcharged. Mrs X did not receive a reply and so wrote again. She detailed her concerns including that:
• Mrs Y said she had washed herself and it was unclear if she received a shower;
• a soiled incontinence pad was left on a shelf in Mrs Y’s bathroom and were left in the pedal bin three times, on two occasions for over 24 hours;
• there were no activities and Mrs Y could not watch her TV without assistance to turn it on or change channel;
• Mrs Y did not receive her breakfast until late as she was last on the medication round list.
16. She advised she was taking her concerns to the Ombudsman and complained to us.
17. The care provider responded that it understood Mrs X was not happy and would wait for the Ombudsman to investigate and advise of the outcome.
18. In response to our enquiries, the care provider supplied copies of Mrs Y’s care records. These show:
• on all but one day she received a wash or shower/bath;
• on at least eight occasions the records noted Mrs Y had a bath, shower and washed independently at the same time;
• Mrs Y’s food intake was good. Mrs Y was regularly offered hot drinks and juice and staff noted this and her intake, which was also good;
• staff regularly checked on Mrs Y during the night and recorded she was settled;
• Mrs Y participated in four activities during her 37 day stay;
• the records noted Mrs Y had breakfast between 9.45 and 10.15. Prior to this she was washed and dressed and provided a hot drink around 8am.
19. The care provider also said the invoice for care charges was accurate and Mrs Y was charged for a 48 day stay.

Findings

20. The care provider told Mrs X that activities took place at the care home daily and yet the records show Mrs Y only took part in activities on four occasions. The records do not show if additional activities were offered and refused. The care provider raised Mrs X’s expectations about the activities on offer and the failure to deliver these caused her frustration. As reported during the meeting with the social worker, the care provider has now recruited additional activities staff which should increase the activities on offer. I have therefore not made a recommendation to prevent the fault occurring again in future.
21. Mrs X complained Mrs Y’s jug was not filled in her room. This was poor practice as it meant Mrs Y was unable to help herself to a drink when she wanted one. However, the records show she was regularly offered and accepted drinks throughout the day and had a good fluid intake so although this was frustrating for Mrs X, it did not cause her a significant injustice.
22. The records show Mrs Y was washed/showered every day but one. However, it is unclear on some days whether Mrs Y washed independently or had a shower or bath as all three were recorded as happening at the same time on the same day. The failure to keep accurate records was fault. This caused Mrs X uncertainty over whether Mrs Y was being left to wash independently or did receive a shower or bath.
23. Mrs X raised issues about incontinence products being left on Mrs Y’s shelf and in her pedal bin. The failure to dispose of incontinence products properly was fault and caused Mrs X distress.
24. The records show Mrs Y ate well, was checked on regularly through the night and the care provider had no concerns about her weight while at the care home. The social worker also reported that Mrs Y was settled at the care home so there is no evidence the faults set out in paragraphs 20 to 23 caused Mrs Y distress.
25. The records show Mrs Y regularly received breakfast late morning but that in itself is not fault. She received personal care and a hot drink beforehand and there is no evidence receiving breakfast late caused Mrs Y distress.
26. Mrs Y stayed at the care home for 37 days. The care provider charged Mrs Y for a 48 day stay. This was fault. Mrs X gave a week’s notice to the care home within the four week trial period so should only have been charged for the length of her stay which was 37 days.

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Recommended action

27. Within one month of the date of this final decision I recommend the care provider takes the following actions:
1. Apologises to Mrs X and pays her £200 to acknowledge the distress, uncertainty and frustration caused by the faults identified.
2. Refunds Mrs Y for the eleven days of care it has overcharged her.
3. Reminds staff to ensure care records are accurately completed in relation to the personal care carried out, particularly whether the person received a bath, shower or washed independently.
4. Reminds staff of the need to dispose of incontinence products correctly.
28. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

29. I have completed my investigation. There was fault leading to injustice for which I have recommended a remedy and service improvements.

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Investigator's decision on behalf of the Ombudsman