A care home in the Lincolnshire area

5. Mr A is unhappy about the time his wife was in the Care Home between July and December 2019. He complains:

• the hygiene care his wife received was poor and she was often covered in vomit • she was not fed properly, and this was left up to him and other visitors • the facilities and environment were not suitable and dirty as there was construction work ongoing • the Care Home discriminated against him by putting in place a policy that two staff members had to be present when he wanted to speak to someone • they did not follow his wishes to contact him before she passed away • the Care Home appointed a Relevant Person’s Representative (RPR is a representative for the person who has lost some of their liberty) and did not consult with him about a Deprivation of Liberty Safeguards (DoLS is an assessment to decide whether losing some of their freedom is in a person’s best interest) • the Care Home raised a safeguarding referral against him to social services • the Care Home unnecessarily contacted the Office of the Public Guardian (OPG is a public body that controls the activity of those with powers to represent the interests of others).

6. Mr A says the Care Home did not provide care for Mrs A and she died alone due to its actions. He says this has caused him and his daughter great distress. He says he has been unable to work.

7. Mr A also says he was isolated by the Care Home’s behaviour towards him and felt like his opinion on Mrs A’s care was not listened to. He says the Care Home’s false allegations led to him being investigated by social services regarding the care of his daughter.

8. Mr A wants an apology for the way he was treated, a thorough investigation of the complaint and for the Care Home’s staff to be held responsible for their errors.

9. Mrs A was a resident of the Care Home from 3 July 2019. Mr A held Power of Attorney (POA) for Mrs A, which means he had the authority to act for her in specified or all legal or financial matters.

10. Mrs A stayed in the Care Home until she died in December 2019.

Hygiene care

15. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong.

16. CQC (the independent regulator of health and social care in England) has standards for providers to follow. The standards include that service users must be treated with dignity and respect and care must reflect their needs.

17. Mr A is unhappy with the level of care his wife received when she was at the Care Home. He says the hygiene care she received was inadequate and she was often covered in vomit. He feels this was caused by a lack of staff to attend to his wife.

18. The Care Home disagrees that the level of care was poor or that there was a lack of staff. It said its staff regularly checked on Mrs A and would make sure she was clean.

19. Our adviser considered the records and felt there was evidence the hygiene care provided was in line with CQC standards.

20. We have carefully considered the observation records and progress notes for Mrs A’s stay. The notes say Mrs A was to be checked hourly for the bed rails and every three to four hours for pressure sores.

21. We can see from the records that care staff checked on Mrs A roughly every hour, 24 hours a day. There does not seem to be any gaps significantly longer than one hour that would indicate care staff were unable or not available to attend to her. The staff appear to have consistently completed these observation records and made more detailed notes multiple times a day. We think this evidence, along with our adviser’s opinion, shows Mrs A was cared for in line with the CQC standards.

22. We know Mr A is concerned about Mrs A being covered in vomit and this must have been very upsetting for him to see.

23. Our adviser explained that vomiting was an unfortunate symptom of Mrs A’s illness, and we can see she was prescribed anti-sickness medication. Our adviser explained there would have unavoidably been times Mrs A vomited between observations by care staff. Our adviser says there were several notes that showed staff delivered care when these incidents happened.

24. We think the evidence and advice received shows the Care Home delivered hygiene care in line with the CQC’s standards.

Feeding and hydration

25. We have again compared what should have happened with what did happen. We have not found signs that the Care Home did anything wrong in the way it managed Mrs A’s nutrition and hydration.

26. CQC’s standards include, ‘service users’ nutritional and hydration needs must be met.’

27. Mr A says his wife was not fed and hydrated properly. He says he and other friends and family had to feed her. He has provided witness statements from Mrs A’s friends that say they were not comfortable doing this as there was no supervision and were concerned Mrs A would choke.

28. The Care Home says it provided Mrs A with meals and made sure water was available. It explained staff would ask if visitors wanted to feed Mrs A as a sociable activity, this was not done for any other reason and staff would have been on hand.

29. Our adviser reviewed the records and felt they showed Mrs A’s nutrition and hydration was managed in accordance with CQC guidance.

30. The Care Home explained Mrs A put on around 7kgs of weight during her stay, showing her nutrition needs were being met. The records of 24 December support this as a doctor reviewed Mrs A and noted ‘supplements were not required as well nourished’. We think this is a clear indication the Care Home managed Mrs A’s nutrition and hydration in line with CQC guidance.

31. We understand Care Home staff would ask if the friends and family were able to help feed Mrs A. We understand they were not comfortable with this and felt it was due to staff shortages.

32. We think the records show care staff attended to Mrs A on a regular basis and met her needs during these hourly checks. The consistency that care staff checked on her shows that there would have been staff available to feed her if necessary.

33. Our adviser explained having friends and family help to feed a person in care is a positive and sociable way to include them, and residents often respond well to being fed by someone who is familiar to them. The Welsh government’s report ‘Creating a positive dining experience for care home residents’ says mealtimes can be an opportunity for family and friends to be involved in the care home community.

34. We think this is encouraged in the care setting and was the reason the Care Home asked Mrs A’s loved ones to be involved in feeding her.

35. We consider that Mrs A’s nutrition needs were met, in line with CQC guidance, and do not think the Care Home did anything wrong in asking her family to feed her.

Facilities due to construction work

36. There are occasions where we may decide not to investigate a complaint further. For example, where we do not think an investigation is practical or likely to provide a satisfactory conclusion.

37. Mr A says there was construction work ongoing when Mrs A moved there. He says this was unsuitable for a care home as it was loud and dirty, and some areas were inaccessible.

38. The Care Home explained necessary refurbishments were ongoing during the time Mrs A moved to the home. It explained Mr A was aware before she moved and did not raise the issue at the time.

39. We do not think there is any evidence we could consider that would allow us to come to a decision on the cleanliness of the Care Home during construction work, which finished at the time Mrs A was there. There are unlikely to be any relevant standards to set out if or where construction work should take place.

40. We will not take any further action on this part of the complaint.

Discrimination as two staff members present

41. Our ‘Principles Of Good Administration’ say organisations should communicate effectively with people in ways that is appropriate for their circumstances.

42. Mr A is unhappy that the Care Home would have two members of staff present when they were communicating with him. He says this showed staff discriminated against him.

43. The Care Home explained there were some issues with communication where Mr A challenged what he had previously been told by staff. It therefore often had two staff members present to ensure good communication. It said it was not its intention to overwhelm Mr A and apologised if it did so.

44. Our adviser explained there are no specific guidelines on how many people should be present when communicating with a patient or family member. Our adviser did feel it would be good practice to have an extra staff member present to witness or contribute to what was being said.

45. We know from his complaint and speaking with him that Mr A feels the Care Home failed to adequately communicate with him. It therefore makes sense that the Care Home wanted to ensure communication was as clear as possible. We think the Care Home’s approach in making adjustments to communicate effectively with him is in line with our Principles.

46. We are very sorry to hear Mr A felt discriminated against. Considering all the evidence, including our adviser’s opinion, we have not seen clear signs this was the intention of the Care Home. We think it tried to communicate with him as well as it could, in line with guidance. We will take no further action on this part of the complaint.

Not following through with his wishes

47. The NMC Code says nurses must offer help in an emergency situation and arrange for emergency care to be provided promptly.

48. Mr A says when Mrs A died the Care Home failed to follow their care plan and her wishes. He says its staff should have notified him as soon as they were aware she was dying so he could be there. He says he only lived a couple of minutes away and could have been there very quickly.

49. The Care Home says it was a very short time between staff noticing something was wrong and Mrs A dying. It says its staff did not have time to notify him before Mrs A’s death.

50. We can see that in Mrs A’s care plan, Mr A asked the Care Home to contact him straight away should her condition get worse, so he could be there for her.

51. The nursing notes tell us during a routine check, care staff notified the nurse that Mrs A’s breathing had changed. The nurse called for a second trained clinical staff member and while trying to give medication for seizures, saw Mrs A take her last breath. After they performed the required checks after death, the nurse contacted Mr A.

52. Our adviser reviewed this information and felt there was no opportunity for the nurse to have contacted Mr A between Mrs A’s breathing changing and her death. They explained the nurse had to prioritise care for their patient.

53. There was an extremely short period of time between Mrs A’s breathing change and death, and we can see the nurse was trying to help Mrs A by giving her medication. We think the actions taken by the nurse were in line with NMC guidance.

54. We do understand how important this was for Mr A and are very sorry he was not able to be there in his wife’s final moments.

Appointment of RPR and DoLS assessment

55. SCIE guidance ‘Deprivation of Liberty Safeguards at a glance’ explains DoLS is used when a patient does not have the ability to approve their own care and treatment in order to keep them safe from harm.

56. It explains the care home must complete a form to request a DoLS and send it to the supervisory body (in this case the local authority) when a person needs to be deprived of their liberty. If the DoLS is granted, a vital safety measure is the person must have a representative. It says the supervisory body must pay someone to perform this role if no-one else can.

57. Mr A is unhappy that the Care Home raised a DoLS assessment without consulting him. He is unhappy that a RPR was appointed without his agreement or knowledge. He says he should have been consulted and allowed to make these decisions.

58. The Care Home explains it was required to raise the DoLS. It says it had no part in appointing the RPR. It feels it communicated with Mr A and the family as it should have.

59. Our adviser explained it is standard procedure for a care home to raise a DoLS assessment when a person is kept in a care unit and cannot leave of their own free will. We can see the application in the records and can see this is in line with SCIE guidance.

60. An advocate from Total Voice (a local advocacy service) was appointed as Mrs A’s RPR and visited the Care Home on 8 October and 19 November. The visiting records of 8 October show the advocate was there on the request of the DoLS team to act in Mrs A’s best interests.

61. We believe the local authority DoLS team, rather than the Care Home, appointed the RPR. We do not think the Care Home had any involvement in this or has done anything wrong.

62. The records show the Care Home did inform Mrs A’s family that a DoLS assessment was requested. Our adviser also felt communication was adequate and we think this is in line with our Principles. As it appears the Care Home did not appoint the RPR, it does not appear necessary that it would be responsible for explaining this to Mr A.

63. We have not found any signs the Care Home has failed to act in line with guidance and will not take any further action on this point.

Safeguarding referral to social services

64. As explained above, we may choose not to investigate a complaint if we do not think we can do a practical investigation or reach a conclusion.

65. Mr A says the Care Home raised a safeguarding referral to social services about him. He says the Care Home told them that his daughter was not being fed and they had to provide her with meals. He says he had social services investigate him at what was an already incredibly difficult time.

66. The Care Home deny having raised a safeguarding referral against Mr A. It says its staff did not record any concerns about his daughter. It notes the advocate from Total Voice spoke with one of its staff members twice. It feels if the staff member mentioned providing her with a meal this was taken out of context, as it happily gave Mr A’s daughter food while she was visiting.

67. We have spoken with the local authority child safeguarding team who completed the safeguarding report for Mr A’s daughter. They confirmed their adult safeguarding team started the child safeguarding investigation.

68. We have seen the safeguarding report. It appears that the adult safeguarding team had some concerns based on its discussions with the Care Home staff while carrying out the DoLS assessment. While this includes comments from the Care Home, there are also other concerns about her home life that would have been unlikely to be based on comments from Care Home staff.

69. We have spoken with Mr A and he has confirmed his complaint is only about the Care Home and he does not want to complain about social services or the local authority.

70. It seems clear to us that the Care Home did not raise the referral. We can understand Mr A may also be unhappy with the comments it provided.

71. Without considering the actions of the referral and the evidence it considered, we do not think we could reach a final decision. We would need to review whether the safeguarding team properly considered the comments that were made, and whether this was the reason for the referral. It would also be difficult for us to come to a decision on whether the comments were taken out of context.

72. We do not think we can properly consider this component at this time. We will therefore take no further action.

Contacting the OPG

73. Mr A says the Care Home contacted the OPG with concerns about his POA. He thinks it tried to have his POA withdrawn.

74. The Care Home says it did not contact the OPG about Mr A or his POA.

75. We contacted the OPG and it confirmed it did receive concerns about the POA, but the Care Home did not raise this concern. The OPG confirmed it only spoke to the Care Home as part of its investigation.

76. We will take no further action on this matter.

77. We acknowledge what a deeply distressing time this was for Mr A and his family. We hope our comments and considerations bring him some answers about the care his wife received.

1. The Parliamentary and Health Service Ombudsman has carefully considered Mr A’s complaint about the care his wife, Mrs A received from a care home in the Lincolnshire area (the Care Home). We are sorry to hear about Mrs A’s illness and death and how difficult this was for Mr A and their family. We understand he feels the actions of the Care Home made this time even more difficult.

2. We have decided not to investigate the issues about the construction work and safeguarding referral further. This is because we do not think we can come to a decision that will reach a satisfactory end.

3. For all other parts of the complaint, we have seen no signs the Care Home has failed to act in line with the relevant standards. We will therefore not take any further action on the complaint.

4. We understand this may be a disappointing outcome for Mr A. We hope our statement below clearly explains how we reached our decision.