Summary: Ms X complained a care home arranged by the Council failed to provide suitable care for her mother. We found fault with the care home failing to provide the full care detailed in Ms X’s mother’s care plan, delaying getting a prescription medicine and issues with complaint handling. The Council has agreed to apologise to Ms X and pay her £250 for hers and her mother’s distress and inconvenience.

The complaint

1. Ms X complained a care home arranged by the Council failed to provide suitable care for her mother. Ms X says the care home allowed harm to come to her mother through bruising, failing to provide her daily personal care and failing to provide legal staffing levels.
2. Ms X complained the Council and care provider failed to follow their safeguarding procedures.
3. Ms X also complained the care provider failed to follow its complaints procedure timescales.

Back to top

The Ombudsman’s role and powers

4. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
5. We also 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. In this decision, we again use the word fault to refer to these. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C & 34H(4))
6. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended
7. 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)
8. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share our final decision with the CQC.

Back to top

What I have and have not investigated

9. I have investigated Ms X’s complaint about the care home’s failure to complete the daily personal care detailed in her mother’s care and support plan.
10. I have not investigated Ms X’s complaints about the bruising caused to her mother, the staffing levels or the failure of the care home or council to adhere to safeguarding procedures. This is because North Tyneside is the Council of the subject of this complaint. While North Tyneside is the responsible authority for placing Ms X’s mother at the care home, the care home is situated in the Newcastle Council local authority area. This means that Newcastle Council is the responsible council for safeguarding and quality assurance at the care home. Since Newcastle Council is the responsible council, Ms X would need to raise any complaint about these matters with it.
11. I cannot address a complaint about Newcastle Council as part of an investigation into North Tyneside Council.

Back to top

How I considered this complaint

12. I have considered all the information Ms X provided. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
13. Ms X and the Council had opportunity comment on my draft decision before I made my final decision.

Back to top

What I found

Rules and Regulations

14. The Care Act 2014 and accompanying statutory guidance set out how the council must assess an individual’s care needs. That assessment must decide what care needs the council must meet. The council must then prepare a care and support plan which explains how those needs will be met.
15. When a care and support plan details that a person’s needs are best met in a care home, the Council retains responsibility for provision of the care provided under the care and support plan through the care home.
16. There may be some cases where a council considers it proper for the person’s care and support needs to be met by providing accommodation in another council area. Section 39 to 41 of the Care Act and the regulations set out what should happen in these cases. They specify which council is responsible for the person’s care and support when they are placed in another council’s area. The principle is the person placed ‘out of area’ is considered to continue to be ordinarily resident in the first or ‘placing’ authority area and so does not get an ordinary residence in the ‘host’ or second authority. The council which arranges the accommodation, therefore, keeps responsibility for meeting the person’s needs.

Care home’s complaints procedure

17. The care home’s complaints procedure says it will provide a response within 21 days of acknowledging receipt of a person’s complaint.
18. The care home says it will provide guidance to a person within its complaint responses, including information about the Local Government and Social Care Ombudsman, as the final stage for their complaint.

What happened

19. Ms X’s mother had a care plan with the Council before moving into the care home. This care plan detailed Ms X’s mother needed assistance with:
• Taking daily medications.
• Cutting nails and applying cream to legs.
• Daily showering and hygiene to keep good skin integrity.
• Having her hair blow dried every other day.
20. In August 2023, Ms X’s mother moved into the care home placement found by the Council. Ms X agreed to the residency agreement for her mother which detailed the cost of her mother’s care and the care home’s responsibilities. Notably, the care home was responsible for providing care to Ms X’s mother as set out in her care plan and for any liaison with relevant professionals such as Ms X’s mother’s doctor.
21. The care home completed a move in assessment of Ms X’s mother. The care home completed a body chart which confirmed no issues with Ms X’s mother’s legs but did note a rash on her torso that needed a topical ointment. The care home noted Ms X’s mother’s hair should be blow dried once per week. The care home noted it needed to monitor Ms X’s mother’s skin integrity and support her in her personal care to maintain skin integrity.
22. Following the move in assessment of Ms X’s mother the care home produced a care plan for Ms X’s mother. The care home detailed the medications Ms X’s mother needed and that she would need support to take these. The care home also noted Ms X’s mother needed support for daily morning showers to clean and dry her lower half. And, the care home committed to completing monthly body maps and to check skin integrity of Ms X’s mother regularly.
23. On 29 November 2023, during a visit from Ms X to see her mother at the care home, Ms X raised concerns about her mother’s skin being dry causing her to scratch it risking the integrity. The care home made a note in its daily record to contact Ms X’s mother’s doctor so a cream could be prescribed.
24. Ms X made a formal complaint to the care home on 8 December 2023. Within Ms X’s complaint she raised concerns about the care home stating her mother was independent with her personal care and asked about cream for her mother’s legs.
25. On 13 December 2023, the care home contacted Ms X’s mother’s doctor to seek a check on the eczema on her legs. The District Nurse responded on 15 December 2023 to ask for photos of Ms X’s mother’s legs. The care home provided photos the same day which prompted the District Nurse to advise the red patches on Ms X’s legs did not need any particular attention, but they should obtain a prescription topical ointment from the doctor. The care home ordered the prescription topical ointment the same date and updated Ms X’s mother’s care plan to reflect the need for this ointment.
26. The care home got the prescription topical ointment on 21 December 2023 and began applying it from this date.
27. On 28 December 2023, the care home provided its first complaint response to Ms X. The care home said:
• It had spoken with senior staff who have confirmed they are aware that Ms X’s mother needs support with her personal care.
• It had chased up the ointment for Ms X’s mother several times but it had failed to ensure this ointment was delivered in a suitable time frame. The care home apologised for this delay.
28. Ms X sought consideration of her complaint further on 10 January 2024. Ms X said:
• The lack of personal care provided by the care home had led to a deterioration of the skin integrity to both of her mother’s lower legs.
• She had repeatedly asked the care home to get an emollient at the start of December 2023 to moisturise her mother’s dry skin on her legs but despite repeat assurances this did not turn up.
• Her mother’s hair often went long periods without washing, often five days at a time.
29. The care home acknowledged the complaint on 17 January 2024 and promised a response within 21 days.
30. In January 2024, Ms X’s mother moved out of the care home.
31. On 12 March 2024, the care home provided a complaint response. The care home said:
• Ms X’s mother’s care plan confirms that it would assist with Ms X’s personal care and all staff were aware of this.
• It has followed the care plans provided for Ms X.
• Its investigation found the ointment was prescribed for Ms X and went to the chemist but despite it following up with the chemist it was not delivered in a suitable timescales. It apologised for this delay.
32. On 27 March 2024, Ms X asked for consideration for financial compensation and agreed a timescale of response up to 30 April 2024. The care home responded on 30 April 2024 to advise it would not provide financial compensation and considered this matter closed.

Analysis

Failing to provide suitable personal care

33. The Council was ultimately responsible for ensuring the care home it placed Ms X’s mother at provided the personal care detailed in her care and support plan.
34. Ms X has specifically complained about the lack of showering, towelling and hair care provided for her mother and the care home’s statements that her mother was independent in her personal care.
35. The care home has already addressed the complaint about saying Ms X’s mother was independent in her personal care by confirming that its staff were aware this was not the case. This response is supported by the care logs produced by the care home which show a general understanding of the care that needed to be provided for Ms X’s mother. However, I can consider whether the care home suitably provided Ms X’s mother’s personal care in line with her care plan.
36. I have reviewed the care logs and care notes produced by the care home which details the care it provided to Ms X’s mother daily in line with her care plan.
37. The care home has shown that it provided Ms X’s mother with suitable support for her diet, fluid intake and daily medications. The care home’s records also show it completed daily skin integrity checks and monthly body maps of Ms X’s mother during her time in the care home. I cannot find fault with the care home’s provision of this care as it acted in line with the care plan.
38. The care home was responsible for providing daily assisted showering for Ms X’s mother. The care records, up to the date the care home received the prescription ointment, show it completed assisted showering/full body washes on 114 out of 130 days. Of the remaining days, Ms X’s mother declined showers/full body washes on 6 says. It is also of note that in the nine days preceding 29 November 2023, when Ms X’s mother’s leg eczema was first noticed by Ms X, the care home only missed one day of showering. Overall, the care home has missed less than 10% of the showering detailed in Ms X’s mother’s care plan. Although the care home only missed a relatively small proportion of showering, this was still fault. However, I cannot draw a direct causal link between the lack of this showering and Ms X’s mother developing eczema. This is because she only missed one day in the previous nine before developing the eczema on her legs.
39. Ms X also complained about her mother’s hair not being kept suitably washed. The care plan before Ms X’s mother entered the care home stated her hair should be washed and blow dried every other day. On entering the care home, it noted this should be done weekly. The care plan the care home created did not reference washing and blow drying Ms X’s mother hair at all. The care records show Ms X’s mother received assisted hair care on 38 out of 130 days, amounting to twice per week on average.
40. Overall, there was a failure by the care home to meet the levels detailed in the pre-existing care plan for hair care and the care home did not provide daily showering. This was fault. However, this level of care was not significantly below the standards detailed in the care plan to cause a significant personal injustice to Ms X’s mother. But, the care home should provide an apology to Ms X for this.

Delay in obtaining prescription ointment

41. The care home has acknowledged it was at fault for delays in obtaining the prescription ointment for Ms X’s mother’s legs in both of its complaint responses.
42. The care home detailed within Ms X’s mother’s residency agreement that it was responsible for liaising with relevant professionals such as Ms X’s mother’s doctor. The care plan also detailed the care home should provide Ms X’s mother’s medication and apply creams to her legs.
43. The delay in getting this prescription ointment was fault through both a failure to get the ointment and failure to provide relevant medications. This fault began on 29 November 2023, when Ms X brought this to the attention of the care home, and continued until 21 December 2023; a period of three weeks.
44. This fault caused Ms X’s mother an injustice through delays in receiving treatment for her leg eczema. Leaving eczema untreated can cause further complications and extend the length of time treatment is then needed for to resolve it. The care home has already apologised to Ms X for this delay. I have detailed my proposals in paragraph 50 for how the Council should remedy any remaining personal injustice caused.

Care home complaints handling

45. Ms X made her first complaint to the care home on 8 December 2023. The care home issued its first complaint response on 28 December 2023. This was within 21 days of Ms X’s complaint and therefore within the care home’s complaint timescales. I do not find fault with this.
46. However, the care home failed to direct Ms X to the Ombudsman in line with its complaints procedure. This was fault and delayed Ms X being able to approach the Ombudsman with her complaint.
47. The care home acknowledged Ms X’s second complaint on 17 January 2024 but only provided a response on 12 March 2024. This was five weeks outside the care home’s complaint timescales. This was fault. Again, the care home failed to direct Ms X to the Ombudsman in this complaint response; this was also fault.
48. Following Ms X’s contact on 27 March 2024, the care home agreed to consider her request for financial compensation by 30 April 2024. The care home met this deadline and directed Ms X to the Ombudsman on this date. I do not find fault with the care home for this response.
49. Overall, the care home failed to direct Ms X to the Ombudsman on two occasions and delayed by five weeks outside its complaint timescales. This caused Ms X avoidable frustration. I have detailed my proposals in paragraph 50 for the Council should remedy this personal injustice.

Back to top

Agreed action

50. Within one month of the Ombudsman’s final decision the Council should:
• Provide an apology to Ms X’s mother for the care home failing to provide the full care detailed in her mother’s care plan for daily showering and hair care and for failing to adhere to its complaints procedures.
• Pay Ms X £250 for the distress caused to Ms X through the care home’s delay in obtaining the prescription ointment and complaint handling and for the potential risk of harm to her mother’s legs for the delay in obtaining the prescription ointment for her legs.
51. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

52. There was fault by the Council as the Council has agreed to my recommendations, I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman