An elderly woman with communication difficulties was left “severely malnourished” and lost a third of her body weight in a care home where social workers placed her but failed to check on her wellbeing.
The woman’s plight triggered a response only after she fell and broke a hip and was admitted to hospital more than three years after she entered the care home in Wokingham, Berkshire, an inquiry by the local government ombudsman has found.
In a stern reminder to councils of their duty to monitor the care and welfare of people they fund in residential homes, ombudsman Jane Martin said that “when contracting out services to third parties, they cannot contract out the accountability for those services”.
Her inquiry report warns: “Any failure by the care home and care provider is failure by the council.”
Councils and NHS commissioning groups have clear and specific responsibilities for the wellbeing of people for whom they arrange care and support. But this in practice can amount to little more than signing regular cheques to the care provider.
In the Winterbourne View scandal in 2011, it emerged that a number of NHS commissioners had been paying an average £3,500 a week for people with learning disabilities and/or autism to be cared for at a private hospital near Bristol, but had failed to detect the abuse routinely taking place.
The Wokingham case involves a woman, who is not identified but is said to be in her 90s, who has arthrtitis, osteoporosis and aphasia, which affects comprehension and speech usually after a stroke.
When in 2010 her daughter could no longer care for her because of her own health problems, Wokingham council arranged for the woman to live at Murdoch House, a care home in Wokingham then run by Southern Cross, the care-home chain that subsequently collapsed.
The home’s records show that on admission she weighed more than 61kg and had a body mass index of 20, the accepted “healthy” range being from 18 to 25. When she was taken to hospital in 2013, she was found to weigh 41kg with a body mass index of 15.
As well as finding that nutritional care was inadequate, the ombudsman said insufficient activities were provided for the woman, care planning and risk assessment were lacking, and there were no annual reviews of her wellbeing by the council.
In 2012 her daughter complained to the council about the quality of care at the home. Although this was registered as a safeguarding concern, and a telephone call was made to the home, it was not followed up and social workers did not visit to check on the woman during her entire stay.
The council told the ombudsman there had been an “administrative error” in transferring the case between teams, but admitted it had not informed the daughter that she could contact officers if she had further concerns.
Although the Care Act 2014 has since further tightened the rules, those pertaining between 2010 and 2013 stipulated care reviews of frequency “proportionate to the circumstances of the individual” and recommended a minimum of a first review four-to-six weeks after initial placement, then annually.
Martin said the woman and her family had suffered because the council had neglected its duty to them. “In this case the woman was bored, lost a considerable amount of weight and her wellbeing was not promoted.”
Following her hospital admission and treatment for both the hip fracture and malnutrition, the woman was discharged two months later to a different home where she has since regained weight to within the healthy range.
Simon Bottery, policy director at charity Independent Age, which provides advice on care issues affecting older people, described the case as shocking example of a council’s failure both to fulfil its duties and then to deal with a family’s concerns, so that the ombudsman had become involved.
“I would like to say that this is an isolated case, but in reality we hear regularly of councils failing their social care duties,” Bottery said. “Lack of money and low staffing levels are fundamental problems, yet councils can’t simply rely on these excuses when people are let down so badly.”
Wokingham council has accepted the ombudsman’s criticism in full and agreed to pay the woman £3,500 and her daughter £500 by way of remedy. It says it has already made changes in line with both the report’s recommendations and the Care Act.
Julian McGhee-Sumner, the council’s lead member for health and wellbeing, said: “We are profundly sorry for the poor care provided in this case, and for the distress this caused our client and her family. The care she received was below the standard we expect from our care providers and we apologise that we did not identify these problems.”
Murdoch House has been run since 2012 by the Four Seasons care group and currently has a “good” inspection rating from the Care Quality Commission.
Four Seasons said in a statement: “We are sorry for any failings in the management of [the woman’s] weight and regret any distress caused to her family. However, we are disappointed that the report by the … ombudsman does not fully reflect the detailed information we provided.”
The woman’s weight and diet had been reviewed regularly by a visiting GP and her meals had been fortified with extra cream and butter, the statement said. Her weight loss had continued in hospital, it claimed.
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