Summary: The care provider charged the fees for the notice period in accordance with the contract which Mrs X signed. The care provider acknowledges there were some inadequacies in the decoration of Mr X’s room and the operation of the call buzzer, and there are some discrepancies in the response to Mrs X’s complaint about the standard of care. The care provider has already written off a portion of the fees and no further remedy is required.

The complaint

1. Mrs X (as I shall call her) complains about the standard of the care in the care home where her husband Mr X was resident for some months.

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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 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)
3. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

4. I considered the information provided by the care provider and by Mrs X. Both parties had an opportunity to comment on an earlier draft of this statement, and I considered their comments before I reached a final decision.

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What I found

Relevant law and guidance

5. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.

6. Regulation 10 says service users must be treated with dignity and respect.
7. Regulation 14 says the nutritional and hydration needs of service users must be met.
8. Regulation 15 says “All premises and equipment used by the service provider must be—

(a) clean,

(b) secure,

(c) suitable for the purpose for which they are being used,

(d) properly used

(e) properly maintained, and

(f) appropriately located for the purpose for which they are being used.”

9. The contract the home agreed with Mrs X says (1.3) “in the case of the temporary absence of the service user from the home, the fees payable during the absence shall be 100% of the full”. The notice period was four weeks.

What happened

10. Mr X became resident at the care home in March 2023 after discharge from hospital, where he had been admitted in December 2022. He was deemed by a hospital assessment to be at ‘high risk’ of falls and had a crash mat next to his bed. He had previously had surgery on his right knee.
11. The care provider carried out a pre-admission assessment. It notes that Mr X was unable to weight-bear, and that he needed an ‘easy to chew’ diet with no bread, given while he was sitting upright and when he was fully alert.
12. Mrs X says her husband was discharged alone from hospital to the care home. The care home note indicate that Mr X remained unsettled in the home, was very ‘vocal’ and there are several reports that he put himself on the crash mat trying to get out of bed.
13. Mrs X says the tv in Mr X’s room was not working, the room was dirty and in ‘a terrible condition’. She says the call buzzer did not work and she discovered it was not connected: she says although he was then given a hand-held alarm, she visited to find it had been put out of reach by the carers so he wouldn’t use it too much.
14. Mr X began to complain of pain in his knee. The GP arranged for him to be seen by the orthopaedic team and he was admitted to hospital on 13 June. Mrs X says she gave notice to the home on 14 June.
15. On 16 June the care provider wrote to Mrs X confirming Mr X would not be returning to the home and enclosing a final statement of account including the payment for four weeks’ notice.

The complaint

16. Mrs X emailed the care provider on 19 June. She said Mr X’s room was only decorated several weeks after he moved in after she complained about its condition. She said the tv did not work for weeks and the call buzzer was unattached. She said she had seen Mr X wearing wet trousers in the communal lounge and the carers had not noticed it and only changed his clothes when she pointed it out. She said the care staff had started giving Mr X sandwiches despite the ’no bread’ stipulation made by the hospital Speech and Language Therapy (SALT) staff. She said there was a failure to tell her personally about the problem with his knee. Finally she said Mr X had been sent to hospital alone without any care staff accompanying him. She said for those reasons she was not prepared to pay for any more care after he left the care home to go to hospital.
17. The care home manager that she would investigate Mrs X’s concerns, but the bill remained to be paid.
18. The care home manager wrote to Mrs X again in July. She said there had been a problem initially with the tv signal which was rectified. She said the remote then went missing but another was purchased. She said it had not been possible to decorate Mr X’s room before he arrived as the hospital team was pressing for his discharge, but she said the room had been cleaned before his arrival. She said there were hourly checks of Mr X and the call buzzer should have been checked during those.
19. In respect of Mr X’s diet, the manager said a referral had been made by the care home to the SALT team in early May as Mr X kept asking for sandwiches. She said the SALT team had advised the care home’s nursing staff could review it themselves until the SALT team was able to visit and update the documentation. She said the SALT team visited on 1 June and advised that Mr X could have a normal diet including bread, as the care team had started. In respect of the hospital admission, she said as Mr X was being admitted direct to a ward, it was not the home’s normal policy to send staff as well.
20. Mrs X wrote again disputing the points made by the manager. The manager suggested a face-to-face meeting, but Mrs X declined and asked for the complaint to be escalated.
21. In August the compliance manager wrote to Mrs X. She said a tv was placed in the room and was left in working order on 23 March. She said the cleaning records indicated the room had been cleaned before Mr X’s arrival. She referred to the care notes specifically for 7 March and noted that Mr X had been using the call buzzer on that day, evidencing that it was working at the time.
22. The compliance manager said the care staff had asked the SALT team to review Mr X in early May, as he was “requesting bread, sandwiches, toast, he is verbalising to try. (Mr X) shouts and demands all the above-mentioned diets. Please can further referral be completed due to his improved presentation.” She noted the SALT team had updated the care plan from 1 June to allow a normal diet including bread.
23. Mrs X complained to the Ombudsman. She says there were inconsistencies in the care provider’s responses – for example, about the tv and the cleaning of Mr X’s room. She said it was the day before the SALT team reviewed Mr X that she visited him and found him eating sandwiches and believes the dining-room team did not know he should not eat bread. She says no harm came to him as a result.
24. The care home notes show the care provider appropriately contacted the GP with concerns about Mr X’s knee, which was initially treated with antibiotics. The notes are clear that the GP was arranging Mr X’s admission to the orthopaedic ward to assess his knee, but Mrs X says the hospital contacted her after Mr X had been left in A and E for some hours.
25. The care provider says the appropriate transfer documentation, including a respect form, was provided with Mr X. She says however that the care home did not receive a letter from the GP for admission to the hospital, as the communication regarding admission was between the GP and the hospital directly.
26. The care provider explains that they have already written off £965.60 from the final invoice as a gesture of goodwill to show their wish to reach an amicable resolution.

Analysis

27. The compliance manager has provided the cleaning records for Mr X’s room but as Mrs X witnessed its condition first hand, on the balance of probabilities it seems to me likely it was not left in an acceptable condition for his admission. Similarly, there is one note to say the tv was working whereas Mrs X is adamant it was not working for several weeks. The call buzzer should have been working at all times but I note the care provider’s records that show Mr X was being monitored on an hourly basis when in his room.
28. It was not fault for the care home staff to act on the advice of the SALT team and review his needs in advance of the SALT visit. Mrs X accepts no harm was done.
29. The care provider acted promptly and appropriately to obtain medical advice about Mr X’s knee. It was the GP who arranged hospital admission to the ward and not the responsibility of the care provider to provide accompanying staff, but it appears paramedics took Mr X to A and E instead of to the appropriate ward. That caused Mr X some distress and was also a concern for Mrs X when the hospital contacted her. The care home ensured a proper record accompanied Mr X to the hospital.
30. There is no reason for the care provider to waive the notice period charges.
31. The care provider has already written off a substantial sum from the bill and it is not appropriate to recommend a further sum.

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Final decision

32. I intend to find the actions of the care provider caused some injustice to Mr and Mrs X but has already remedied any consequent injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman