Date of decision: 28 April 2025
Summary
A mother complained about the treatment of her adult daughter’s tightly coiled hair during a respite care stay, as well as concerns about male care workers providing personal care. The Care Provider failed in its record keeping and its later investigation, causing distress and damage to the daughter’s hair.
What happened
Ms Y, a Black woman with tightly coiled hair and left-sided paralysis, stayed at a care home managed by Revitalise Respite Holidays for three weeks in autumn 2024. The reason for the stay was to give her mother, Ms X, some respite from her caring responsibilities for her daughter.
Ms X completed a pre-arrival assessment and admission form, before dropping Ms Y off at the care home. recalling that she instructed staff not to touch Ms Y’s hair and that Ms Y should be cared for by female staff only. Before Ms Y moved into the home, Ms X put Ms Y’s hair in a protective style made up of many small braids. She was sure she’d given the instruction to leave the hair alone because she did not feel the need to leave shampoo.
During Ms Y’s stay, she washed her hair herself within her first week. It was possible for Ms Y to do this with her braids still in.
Care workers also assisted with hair washing on several occasions, but the records detailing Ms Y’s personal care were incomplete.
The records noted that one day she complained that she had received personal care from male agency care workers the day before. One of the agency workers stated she and another female care worker had supported Ms Y on that particular day. They noted male care workers had been working but had been supporting other residents. The records of which care workers helped Ms Y the preceding day noted she received personal care from agency workers, without a specific name.
When Ms X arrived to take her daughter home, she discovered that Ms Y’s braids were removed during the stay, and she had received care from agency workers whose gender was not always clear. There was a dispute as to how the braids could have come out, given Ms Y’s left sided paralysis.
Ms X found her daughter’s hair damaged and raised concerns about heat styling and burns to her face, which the Care Provider denied, and asserted the marks were skin discolouration. The Council had found it impossible to reach a conclusion on what had happened.
The Care Provider did not provide copies of the admission or pre-arrival forms to the safeguarding investigation by Essex, despite requests from the Ombudsman and Council. It said that Ms X had not mentioned hair care in the pre-arrival assessment form or the admission form. The Care Provider has since closed down.
What was found
The Ombudsman found the Care Provider at fault for poor record keeping of the pre-arrival assessment form (breaching Regulation 17 of the Health and Social Care Act 2008), a flawed investigation, and failing to inform Ms X when Ms Y’s braids were removed. This caused Ms X uncertainty, frustration, and distress.
The lack of communication and suitable hair products led to the damage of Ms Y’s hair.
However, the Care Provider was not found at fault regarding burns or the use of heat tools, as the evidence did not support these claims. Ms Y had capacity to decide whether she wanted her hair washed so the Care Provider was not at fault for complying with her wishes.
There were conflicting accounts regarding the gender of the care workers. Consequently, the Ombudsman did not reach a conclusion on this point and stated that further investigation would not result in a different outcome.
The Ombudsman required the Care Provider to apologise to Ms X and pay £300 (£150 to Ms X for distress; £100 to Ms Y for hair damage). [It is not clear how that would happen if the Care Provider had ceased to operate by the date of the report].
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
It is not possible to be sure, but it seems that Miss Y had a care package from Essex County Council and that the respite arrangement was a personal one, perhaps with vouchers or cash provided as part of her entitlement but not something that the Council commissioned.
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires care providers to maintain accurate and complete records (Regulation 17) and to provide care that meets the individual’s needs and preferences (Regulation 9).
Associated guidance says that where a person needs intimate or personal care, care providers should make every reasonable effort to respect the preference of the person receiving care. This can include that they receive care from someone of a specified gender or sex.
Section 42 of the Care Act 2014 requires councils to make enquiries if there is a risk of abuse or neglect to a person who has care and support needs. An enquiry may range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement.
This case highlights the importance of culturally competent care, especially for Black service users, and other ethnic minority groups, with specific care needs, such as hair care as seen here. Providers must record and respect preferences, communicate effectively with families, and ensure robust complaint handling.
The Care Provider’s failure to protect Ms Y’s hair and dignity, and to communicate with Ms X, is evidence of the failure to take CQC standards fully on board, and of the failure to promote wellbeing, for which the Council is responsible as the commissioner – these duties being central to good practice under the Care Act.
It is therefore vital that providers ensure staff are trained in culturally competent care, maintain clear and complete records, and communicate promptly with families about significant changes in care. Councils should monitor providers for compliance with fundamental standards and support families in raising concerns.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Revitalise Respite Holidays (24 012 697) report. If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
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