Decision Date: 7 February 2025
Summary
A care home resident complained that the Care Provider failed to document complaints made by other residents about him and his impact on the dynamic in the care home. The Care Provider was unable to evidence the complaints that caused it to terminate the person’s residency rights. The Care Provider also failed to explain or offer the resident an opportunity to challenge this decision.
What happened
Mr X moved into Henley House (the care home), which provided for his care needs. These needs had been assessed over the phone prior to admission. The home had been chosen by Mr X privately to remain close to his family.
After admission, Mr X raised several complaints regarding the quality of care, the activities provided, and the cost of his care. Each formal complaint had been sent to the Care Provider for investigation and responded to.
Later in the year, the home manager held a meeting which addressed feedback from other residents about Mr X and his own actions. The meeting was held with Mr X and his family.
Minutes from the meeting showed that the manager discussed distress caused by Mr X to other care home residents. Mr X had made comments purportedly on behalf of other residents which the residents felt did not accurately reflect their own opinions.
The manager also raised concerns about Mr X’s responses to situations he disagreed with, which negatively affected staff and other residents. Finally, the manager noted that Mr X was obviously unhappy in the home and had lost trust in both the Care Provider and the home’s staff.
Due to the negative impact of Mr X’s behaviour and the inability of the home to collaborate with him, the home decided the situation had become untenable. Mr X offered to stay in his room and not communicate with other residents, but this was determined to be an unacceptable way to expect him to live.
Following the meeting, the Care Provider issued 28 days’ notice and terminated Mr X’s residency.
The next month, the manager met with Mr X again and offered to review his internal care plan. Mr X declined, as the home manager confirmed this would not change the decision to terminate his residency. Mr X later secured a new placement and left the home.
Mr X subsequently complained to the Care Provider about how his termination had been handled. He asserted that the reasons given for termination were vague, irrational, non-factual, and unsubstantiated. Mr X also complained that the Care Provider had failed to share information and evidence of complaints about him, that had supposedly been made by other residents.
Mr X submitted his complaint to the LGSCO because the Care Provider failed to respond.
The Care Provider did respond to enquiries made by the LGSCO. This included acknowledging that ‘feedback’ from residents had been verbal and informally recorded, so no documentation could be provided. The Care Provider also stated they had attempted to contact Mr X, but the staff member involved had left the organisation and no evidence could now be provided of that aspect.
Part 25.2.2 of the Care Provider’s Resident’s Contract stated
“We can end this agreement by giving you at least 28 days’ notice in writing, if you are in serious breach of your obligations to us, for example:
- in our reasonable opinion, or on medical, nursing or regulatory advice, we cannot reasonably give you the safe care and treatment you require at the Home, or the Home has become otherwise unsuitable for your needs and you require and alternative provision; or
- you exhibit behaviour that is reasonably considered by us to be a threat to the health or safety of you or others, pursuant to clause 17 …”
Clause 17 of the Care Provider’s Resident’s Contract stated
“We expect both you and your visitors to behave in a manner which is respectful to staff and other residents and visitors to the home. Should you behave in a manner which is illegal, threatening, abusive, or disruptive to our staff and other residents or their guests or otherwise demonstrate inappropriate behaviour, including any form of abuse, racial or sexual discrimination or harassment towards anyone, you may be asked to leave the Home.”
Clause 17.2 stated
“Before asking you to leave the Home, we will:
- make all reasonable efforts to address and manage detrimental behaviour; and
- consult with you and your representative.”
What was found
On the treatment of complaints made against Mr X:
The Care Provider failed to evidence the complaints, making it impossible to determine if they had actually been made. Informal complaints were found to be insufficient justification for termination. Complaints about a resident that were thought severe enough to lead to termination should have been properly recorded, investigated, and the outcomes reported. This also breached the Care Provider’s own policy.
Regarding Mr X’s Alleged Behaviour:
The Care Provider failed to collaborate with Mr X and did not give him a chance to change his behaviour. This violated the fundamental standards of care as well as the Care Provider’s own Resident Contract.
On Terminating Mr X’s Residency Rights:
When the Care Provider first wrote to terminate Mr X’s residency, it failed to detail the right to appeal and how it could have been exercised. Also, when Mr X responded to this and established he did not wish to leave the home, the Care Provider did not provide an opportunity to challenge the decision to terminate his residence.
On the approach to Mr X’s Complaint:
The Care Provider failed to provide evidence of any attempt to respond to Mr X’s complaint due to poor record management. As such, the Care Provider was found not to have made reasonable effort to address or contact Mr X and his complaint.
Across all these issues, the Care Provider’s actions caused Mr X unnecessary distress and uncertainty, for which the Care Provider was found to be at fault.
The Care Provider was required to review its complaint handling procedures and documentation processes. It was also advised to use this complaint as a learning example, ensuring staff received a briefing note on the importance of documentation and providing clear, written reasons for termination of residency rights.
The Care Provider issued an apology to Mr X and paid him £500 in recognition of the distress and uncertainty caused.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 establishes the fundamental standards care homes must provide. The Care Quality Commission issues guidance to help providers meet these such as treating residents with dignity, establishing a proper complaints procedure and ensuring detailed records are kept.
The CMA issues further guidance for care homes to ensure they comply with consumer law obligations regarding fairness when dealing with privately contracting clients. It offers specific guidance for care homes, including guidance on how to end a contract. This includes inclusion of terms that offer legitimate reasons for ending a contract and offering the opportunity to challenge/ appeal decisions.
The Care Provider had a policy in place to ensure legitimate termination of care home residents. However, by failing to collaborate with Mr X, they violated this policy. We think that the home is presented at least by this report as not having done enough to bring the behaviour of the gentleman within the fairly extreme terms of its policy and terms, but it is not possible to be sure, given the reticence of the investigator to provide more detail.
Furthermore, the Care Provider did have a three-stage complaints process. It is clear that it was its own failure to follow this that caused the uncertainty and distress.
This complaint evidences the impossibility of providing any legal redress for the dynamic that a clash of personalities can introduce to a group of people trying to live together as a community, and paying for management of that dynamic – because it will always depend on the management’s social skills and values, and willingness to address the sub-text of expressions of disdain for the provider’s efforts, and on the evidence as to who said what to whom, and why they may not wish, later, to admit to having spoken up, albeit privately – rather than legal principles. But it should not be overlooked that a person who is a private client in a care home has only contractual rights and rights in the law of negligence, NOT human rights for even the woolly concept of ‘respect’ for their home.
The report recorded that the Ombudsman took into account the following fundamental standards imposed by the CQC’s regulatory framework for all care homes:
Regulation 10: Service users must be treated with dignity and respect and in a caring and compassionate way.
Regulation 16: Providers must have a system in place to handle and respond to complaints. All complaints must be investigated thoroughly, and any necessary action taken where failures have been identified.
Regulation 17: Providers must securely maintain accurate, complete, and detailed records in respect of each person using the service.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Greensleeves Homes Trust (24 007 222) report.
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