Summary: Mr Y’s personal care was not in line with his preferences and did not respect his dignity, particularly on the day of a video call with his relative Ms X who has complained to us. Mr Y has now died and so we will not remedy his injustice. Within one month of my final decision, the Care Provider should apologise to Ms X for her avoidable distress. Its apology should be in line with our published Guidance on Remedies.

The complaint

1. Ms X complained about her late relative Mr Y’s care in Clumber House (the Care Home), owned and managed by United Care (North) Ltd (the Care Provider). She complained:
1. Mr Y did not have his hearing aids or glasses;
2. He was unkempt and unshaven with dirty hair, particularly during a video call on 31 December 2020;
3. There was a failure to identify symptoms of a urine infection in January 2021 and delay in securing medical advice and starting medication; and
4. Communication with managers was poor.
2. Ms X also complained about matters relating to Mr Y’s care between 2018 and early 2020 including:
1. The bedroom window not closing properly;
2. His hearing aids not working;
3. A lack of hair washing in 2019;
4. not arranging for Mr Y to see a dentist;
5. Not ensuring he had toiletries;
6. Only having one bath a month;
7. About administering laxatives inappropriately;
8. Not having enough staff;
9. Failing to observe lesions to the scalp which needed hospital treatment. ( Not ensuring he had prescribed ointment after 2018.)
3. Ms X said this caused avoidable distress.

Back to top

The Ombudsman’s role and powers

4. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

5. Ms X complained to us about Mr Y’s care in January 2022 before his death in April. We decided not to investigate her complaint because other relatives had power of attorney allowing them to act for Mr Y in health and welfare matters. We decided Ms X was not a suitable person to act as Mr Y’s representative in a complaint made on his behalf.
6. Ms X made the same complaint to us again in August 2023 after Mr Y’s death. We decided to accept her complaint for investigation as she was an executor for Mr Y’s estate and we consider this legal role makes her a suitable person to complain.
7. The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6)
8. The Care Provider told us Ms X had not complained to it in writing, only verbally. It said it did not want to provide a formal written response to Ms X’s complaint now. We decided it was not reasonable for it to respond through its internal complaint procedure, given the passage of time.
9. 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)
10. 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 care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
11. It is our decision whether to start, and when to end an investigation into something the law allows us to investigate. We may not investigate historic allegations. (Local Government Act 1974, sections 24A(6) and 34B(8), as amended)
12. 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)
13. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

Back to top

What I have and have not investigated

14. As set out in paragraph 10, unless there are good reasons, we won’t investigate complaints about things which a person has been aware of for more than 12 months.
15. I have investigated the complaints in paragraph one from the end of December 2020. Earlier matters are late with no reason for the delay contacting us.
16. I have not investigated the complaints in paragraph two. As set out in paragraph 11, events between 2018 and 2020 are likely to be prejudiced by the lack of reliable evidence to establish facts. I have taken into account that the Care Provider has stated that some records have been water damaged due to a flood.

Back to top

How I considered this complaint

17. I considered the complaint to us, the Care Provider’s response to the complaint and care records set out in this statement. I discussed the complaints with Ms X.
18. Ms X and the Care Provider had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

What should have happened

19. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the requirements for safety and quality in care provision. The Care Quality Commission (CQC) issued guidance in March 2015 on meeting the regulations (the Guidance.) We consider the Regulations and Guidance when determining complaints about poor standards of care. I have summarized those relevant to the complaints I am investigating:
1. People using care services should be treated with dignity and respect including ensuring privacy and autonomy. (Regulation 10)
2. Care and treatment needs to be appropriate and meet a person’s needs and reflect their preferences. Care providers should carry out an assessment of needs and preferences and design a care plan to meet needs and preferences.
3. A care provider must provide care and treatment in a safe way including by working with health professionals to ensure the health and welfare of residents. Regulation 12(i)

What happened

Care plans

20. Mr Y’s care plans said:
• Mr Y loved having a whirlpool bath and could wash himself. Staff needed to support him to get in and out of the bath.
• Mr Y was weight bearing and could walk with a frame though he sometimes forgot to use the frame.
• From March 2021, Mr Y was nursed in bed (due to a decline in his condition). He needed two staff to support him with personal care and was often unsafe to sit in a wheelchair. Staff were to ensure he looked smart and shaved.
• He had a degenerative eye condition and wore glasses. The care plans I have seen do not say anything about hearing aids.

Daily charts

21. The Care Home’s care staff filled in a daily chart which summarised the care given to Mr Y. I have looked at charts the Care Provider has retained. As set out above, some records were damaged during a flood.
22. The charts do not generally indicate Mr Y had a shave. Staff gave Mr Y a daily bed bath or strip wash. The section of the form called ‘hair’ is generally ticked, which I have assumed means his hair was brushed or combed. There is no record of Mr Y receiving a bath or having his hair washed or having support to clean and put in hearing aids. He had glasses and staff noted when these were cleaned and put on. There is one record of him having a haircut (on Christmas day in 2020).
23. There are occasional video calls with Ms X and Mr Y had contact from other family members.
24. The Care Provider has not disclosed the medicine charts for January 2021 when Mr Y had a urine infection. The daily care chart for 7 January says he saw a GP as he was presenting as unwell and the GP prescribed antibiotics for a urine infection. The daily charts note a poor food intake for the first part of January 2021.

Comments from Ms X and the Care Provider

25. Ms X told us:
• She had a video call with Mr Y on 31 December 2020 and was concerned about him being listless and having greasy hair.
• She video called him again the next day and he was withdrawn and obviously unwell. A carer told her he was ‘fine’.
• On 6 January, another relative who had seen Mr Y said he was very poorly. On the 7th, a carer rang her to say Mr Y hadn’t been well for the last four days and he was agitated, confused and restless. She was told staff had not been able to get a urine sample.
• On 7 January, the Care Home sought a medical opinion. The clinician who attended said he was feverish and had low oxygen levels.
• Antibiotics were prescribed to treat a kidney infection, but there was a delay getting them and they were not started until 8 January.
• Managers were generally hostile and defensive.
26. The Care Provider told us Mr Y’s dementia progressed at the start of 2021 and he could no longer weight bear and was less communicative and more confused. The GP said he was at the palliative care stage and other relatives who were his attorneys were happy with his care. The Care Provider told us the attorney (a different relative) was the first point of contact for the family and that Ms X would not accept calls or respond to any messages staff left.

Findings

Mr Y did not have his hearing aids or glasses

27. There is no reference to Mr Y having hearing aids in any of the available records. There is no written evidence either way to suggest the Care Provider knew Mr Y had hearing aids during the period I have investigated. There is not enough evidence to indicate any fault in the hearing aid part of the complaint.
28. The records available indicate Mr Y generally had his glasses and staff cleaned them. So we do not uphold this complaint.

Mr Y was unkempt and unshaven with dirty hair

29. Ms X refers to a video call in December 2020 when she alleges Mr Y’s personal appearance was not smart and he looked unclean. The care records indicate Mr Y did not have his hair washed and did not often have a shave, so we uphold this complaint. The Care Provider’s care was not in line with Regulations 10 and 9 and this was fault. It caused Ms X avoidable distress seeing Mr Y presenting this way.

There was a failure to identify symptoms of a urine infection in January 2021 and delay in securing medical advice and starting medication

30. Ms X suggests Mr Y became unwell sooner than staff recognised. There is not enough evidence to conclude this because the daily charts in the days before 7 January do not record any unusual signs or symptoms of illness. The Care Provider arranged for the doctor to attend on 7 January when staff noted Mr Y appeared unwell and the doctor prescribed antibiotics. The Care Home has not retained records of when the antibiotics began. If the doctor did not attend until the evening, it is likely that the medication was not started till the next day, but this is not fault. And even if the antibiotic did not start for 12 hours after the doctor wrote the prescription, I cannot say there was an adverse consequence for Mr Y. On balance, care was in line with Regulation 12(i) and so we do not uphold this complaint.

Communication with managers was poor

31. We expect care staff to liaise with a resident’s power of attorney for health and welfare. For resource reasons, it is not reasonable for staff to be ringing round other relatives giving updates. There is no evidence of communication with Ms X, but she was not Mr Y’s attorney. Staff were entitled to limit updates to the attorney. The expectation would be that the attorney shared information about Mr Y’s health and care with other family members, so I do not uphold this complaint.

Back to top

Agreed action

32. Mr Y has now died and so we will not remedy his injustice. Within one month of my final decision, the Care Provider should apologise to Ms X for her avoidable distress. Its apology should be in line with our published Guidance on Remedies.
33. We do not uphold complaints about communication or a failure to identify signs of illness.
34. The Care Provider should provide us with evidence it has complied with the above actions. United Care (North) Limited, which is still trading at the time of this final statement, no longer runs Clumber House. Harbour Healthcare Ltd has taken it over. However, the Directors of both companies are the same people and are still Directors. One of the Directors should provide the apology.

Back to top

Final decision

35. Mr Y did not have baths, have his hair washed or have a shave frequently. Care was not in line with his preferences and did not respect his dignity, particularly on the day of a video call with his relative Ms X who has complained. He has now died and so we will not remedy his injustice. Within one month of my final decision, the Care Provider should apologise to Ms X for her avoidable distress. Its apology should be in line with our published Guidance. Guidance on remedies - Local Government and Social Care Ombudsman
36. We completed the investigation.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman