Source · PSOW (Public Services Ombudsman for Wales)

A Care Home

PSOW (Public Services Ombudsman for Wales) Upheld Reference PSOW-202106081 Category Care homes Decided 30 October 2023

Full decision

Mrs A complained about the actions of Aneurin Bevan University Health Board (“the Health Board”) in relation to the care provided to her late mother, Mrs B. Specifically, Mrs A complained that Mrs B’s needs (as set out in her Care Plan) were not met, there was a failure to ensure appropriate assessments were undertaken in a timely manner and her return to her own home was inappropriately and unreasonably delayed, all of which impacted on her health and welfare.

In addition, Mrs A complained about the care Mrs B received from a care home in the Health Board area (“the Care Home”) in that, between 1 and 28 November 2020, the Care Home did not meet Mrs B’s needs (as set out in her Care Plan) and did not ensure its staff used Personal Protective Equipment (“PPE”) appropriately and in-line with legislation and guidance.

The Ombudsman found that there were some shortcomings on the part of both the Health Board and Care Home, in meeting the needs set out in the Care Plan, but that this was largely due to measures needed to stop transmission of the COVID-19 infection. The Ombudsman did not uphold these complaints. The Ombudsman found that although appropriate assessments were completed, there were avoidable delays in the assessment and discharge process and so, to that extent, upheld this complaint. The Ombudsman also found that for a period of time while Mrs B was in the Care Home, and while she was nursed in a bed, the Care Home did not to adhere to her Care Plan.

The Ombudsman also found that although it was not possible to say the extent to which this was the case, the correct PPE was not appropriately worn consistently in the communal areas of the Care Home. The Ombudsman upheld this complaint.

The Ombudsman recommended that, within 1 month, both the Health Board and Care Home apologise to Mrs A for the failings identified.

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Other decisions involving A Care Home

Reference Date Summary Outcome
PSOW-202409769 20 May 2025 Mrs A complained about fees charged by the Care Home for her father’s care. The Care Home had charged from … Resolved / Early Resolution
PSOW-202202308 26 Jan 2024 Mrs A complained about the care and treatment that her late mother, Mrs B, received during the final weeks of … Upheld
PSOW-202104529 06 Jun 2023 Mr X complained about aspects of care provided to his late father Mr Z, by the Care Home between April … Upheld
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