Summary: We will not investigate this complaint about a care provider allegedly failing to meet the complainant’s mother’s care needs while in residential care. The complainant says her mother was neglected and that her weight declined significantly leading to her being admitted to hospital where she later died. There is insufficient evidence of any of the care provider’s action falling short of the CQC’s Fundamental Standards for care, or Mrs Z being caused an injustice.

The complaint

1. The complainant (Mrs Y) complains on behalf of her deceased mother (Mrs Z) who lived in residential care at a home managed by Kingsley Healthcare (Birmingham) Limited (the Care Provider) between July 2023 and February 2024. Mrs Y complaints the Care Provider failed to:

• Carry out to carry out adequate observations of Mrs Z’s rapid weight loss following her stroke which resulted from her not eating and drink enough.
• Treat her with dignity and respect regarding her toileting.

2. In summary, Mrs Y says the alledged failings resulted in Mrs Z being neglected in the care home and that he needs were not met. As a desired outcome, Mrs Y wants the issues raised to have a thorough review and for the Care Provider to be held accountable for its failings, as well as providing misleading information.

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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. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:

• the action has not caused injustice to the person complaining; or
• the injustice is not significant enough to justify our involvement; or

(Local Government Act 1974, sections 34B(8) and (9)).

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How I considered this complaint

6. I considered information provided by the complainant and the Care Provider. I also considered the Ombudsman’s Assessment Code.

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My assessment

Weight loss and food and fluid intake

7. I note from Mrs Y’s complaint documents that while some staff at the Care Provider’s home fed Mrs Z, others did not and simply left meals at the table. Mrs Y says that because Mrs Z had dementia and poor coordination, as well as not being able to see and hear well, she clearly required support in taking nutrition during meals. Further, Mrs Y says Mrs Z’s weight declined by 8kg from December 2023 to February 2024 when she died. She says the Care Provider failed to observe the situation and enable her to take food and drink.
8. The Care Provider says it uses the Malnutritional Universal Screen Tool (MUST) to regularly monitor a person’s weight loss. It explains that when concerns emerge, these are discussed with a doctor. The Care Provider’s record of weight shows that from December 2023 to February 2024, there was a rapid decline in Mrs Z’s weight which fell by 8kg. It is noted that Mrs Z was admitted to hospital in December 2023 having suffered a stroke, though returned to the care home the same month. The Care Provider’s MUST records from September 2023 to Janaury 2024 scored Mrs Z a ‘zero’ which represents a low risk. In February 2024, the Care Provider says this changed and Mrs Z had a MUST score of ’three’ which shows she was high risk. The Care Provider relayed its concerns to a doctor who later visited and assessed Mrs Z. This resulted in changes being made to her diet, as shown by Mrs Z’s care plan.
9. I have read Mrs Z’s care plans which document Mrs Z being able to make basic decisions including what she would like to wear and eat. Following her stroke, the care plan records Mrs Z as having reduced and mobility and need for greater support, but that she was still able to communicate her needs and preferences at a basic level. It further states that Mrs Z may require support with some tasks which should be given while also encouraging her to be independent to ensure all her wishes are respected. I consider the Care Provider sought to give effect to these areas. This is evidenced in care plan entries made in the final months Mrs Z was in residential care. These report Mrs Z was capable of bathing herself and that there, including that there had been incidents of outbursts by Mrs Z where care staff tried to give support. It is also recorded that around this time Mrs Z was refusing assistance to help manage her care needs and that the Care Provider contacted a doctor to visit and assess her.
10. I have also reviewed the Care Provider’s records of Mrs Z’s fluid and food intake for the period between December 2023 and February 2024. The Care Provider says some foods or drinks may have been missed and not entered into the system due to human error. In any event, my assessment is that a range of food was consistently offered to Mrs Z throughout each day of this period. It is largely reported that Mrs Z either ate very little or declined despite encouragement being given. Some entries report Mrs Z being agitated by being offered food and that she had strongly vocalised she did not want to eat. The fluid charts record care staff consistently offering Mrs Z fluid thorough the day and the consumed amount.
11. On the available evidence, I am satisfied the Care Provider consistently sought to support Mrs Z with her food and fluid intake. The evidence also shows the Care Provider maintaining accurate records as to Mrs Z’s weight and seeking medical attention from a doctor when concerns arose. Mrs Z’s care plan was updated to reflect changes in her health and needs. It is clear that Mrs Z’s weight declined rapidly from December 2023 when she returned to the care home from hospital after suffering a stroke. However, the evidence supports this was due to Mrs Z declining food consistently offered to her, or eating very little.
12. The evidence shows Mrs Z was able to express herself and make basic decisions. Other than provide encouragement, the Care Provider could only respect Mrs Z’s choices in these circumstances. I recognise Mrs Y says more should have been by assisting with physically feeding her. However, the records show on many occasions that Mrs Z immediately and repeatedly declined food. The Care Provider must respect a service user’s choices and cannot proceed to try and feed someone where food has been expressly declined. To do so could be considered a serious violation of their autonomy.
13. Mrs Z complains the Care Provider failed to give a nutritionally supplemented milkshake which had been prescribed for her by the hospital on her discharge back to the care home. The Care Provider says it was unaware of this as Mrs Z did not return with any supply of this. The care plan records all medication which Mrs Z had been given when returning to the home and this did not include the supplemented milkshake. In any event, the records shows there was regular contact between the Care Provider and a doctor who visited Mrs Z to take any appropriate action. In any event, the care records show there was regular contact between the Care Provider and Mrs Z’s doctor following her return to the care. The doctor visited Mrs Z at the home and took appropriate action based on her presented care needs. The care plan also documents medication reviews being carried out by Mrs Z’s doctor when concerns were relayed by the Care Provider.

Neglect and Inadequate Care

14. In addition, Mrs Y says that Mrs Z’s needs were not met when she returned to the care home following her stroke. She also says that Mrs Z was neglected, though does not refer to any specific incidents of neglect. There is one incident where Mrs Y complains a care staff member picked Mrs Z up from her trouser waistband in order to lift her out of her seat. Mrs Y says the care worker failed to properly support Mrs Z’s back. The Care Provider says it investigated the incident and a witness reported during an interview that they saw two members of care staff assisting Mrs Y in standing out of the chair and using the palm of their hand to support her posture. There is clear conflict of accounts here, however, there is no evidence of this incident causing serious loss, harm or distress. To that end, there is insufficient evidence of a sufficient injustice being caused.
15. In my view, the available evidence shows the Care Provider making sure all its care home staff being made aware of Mrs Z’s changed care needs following her stay in hospital as these changes were updated in her care plans. I have not seen any evidence of the Care Provider’s actions falling short of the fundamental standards which are regulated by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, or any action causing an injustice.

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Final decision

16. We will not investigate this complaint. This is because the restrictions I outline at paragraph five (above) apply.

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Investigator's decision on behalf of the Ombudsman