Incontinence pads
8. Mr O complains the Home did not change his mother’s incontinence pads regularly and she would often have a wet pad when he came to visit her in October 2021. In its response, the Home stated it always tries to maintain the privacy and dignity of the people who use its service as much as it can, and it would not have let his mother walk around without an incontinence pad or with a wet incontinence pad.
9. The Home stated Mrs O did have some capacity to make informed decisions relevant to her health and care needs. The Home stated, if Mrs O asked them not to do something, staff were encouraged to ask her if she understood what the risks were, and she could explain that she might risk affecting her skin. The Home stated it could not force Mrs O to do anything, and it had care plans and strategies in place to encourage Mrs O to accept the care she needed.
10. Paragraphs 168 and 169 of the National Framework outline that individuals should be encouraged to play an active role in their care, be provided with information or guidance to enable them to make informed choices and be supported to make their own decisions. It also outlines that the individual should have a suitable personalised care plan, and the agreed care and support package should meet the individual’s assessed health and associated care and support needs and the agreed outcomes.
11. The Home noted in her care needs records that Mrs O denied she needed pads to help with her continence. It stated staff should always maintain her privacy and dignity, and when prompted, she would wear pull-up pads. It stated staff should explain to her she could still use the toilet even though she had a pad on, as the pull-up pads were difficult to put on Mrs O due to her behaviour. This shows the Home was aware Mrs O did not like to wear incontinence pads, but with prompting she would wear pull-up pads.
12. We have looked through Mrs O’s records from the Home for October 2021 and found no evidence her incontinence pad was not changed regularly, or that she was left for a long time with a wet incontinence pad. An example of how the Home recorded its management of Mrs O’s continence needs is as follows. On 13 October 2021 there are multiple entries in the records to show Mrs O’s pad was changed. It was noted at 8.31am her pad needed changing and she was content; at 9.29am her pad needed changing; her pad was changed at 10.18am and 11.18am; and her pad was changed at 1.58pm.
13. There are frequent examples on various different dates throughout the month that show Mrs O’s continence needs were being met and her pad was changed frequently. This shows the Home was regularly checking Mrs O, either with or without an incontinence pad. There is no evidence in the records to show she was left with a wet incontinence pad for an unreasonable period of time.
14. While we are not saying Mrs O did not have a wet incontinence pad at any stage, we are unable to identify from the records how long she would have been left with a wet pad.
15. We have not found any signs of failings in how the Home managed Mrs O’s incontinence pad needs in October 2021.
Application of Sudocrem
16. Mr O says the Home staff failed to apply Sudocrem to Mrs O’s thighs to treat her rash in October 2021, even though the GP had prescribed it to manage her rash. In its response, the Home stated Mrs O was prescribed Sudocrem and a short course of Daktacort (another cream used to treat rashes) to relieve the itching and soreness. The Home stated the nursing team supplied this and kept it in the clinical room fridge, as per the manufacturer’s guidelines.
17. The topical medicines application record shows Mrs O was prescribed ProShield cream (a medication used as a moisturiser to treat or prevent dry, rough, scaly, itchy skin and minor skin irritations such as nappy rash or skin burns from radiation therapy) to treat her rash.
18. The topical medicines application record states Mrs O was to have the cream applied twice a day, and it shows staff tried to apply the cream twice each day.
19. The record shows staff applied the cream to Mrs O several times during the month, although at times she would refuse it. For example, the Home noted on 1 October at 9am staff applied the cream, but when they tried to apply it again at 1.30pm, Mrs O refused it. From 28 to 31 October, the records show staff successfully applied the cream to Mrs O. There were times when Mrs O would refuse the cream, but the records show staff were able to apply the cream later in the day. For example, on 27 October Mrs O refused the cream in the morning, but staff could apply the cream in the evening.
20. It was noted on 12 October staff applied cream to Mrs O’s groin area, and on 13 October they checked her skin integrity and she was content. On 8 October it was noted staff applied the cream to Mrs O’s groin area. On 7 October it was noted staff had helped Mrs O apply the cream the night before.
21. We know at times Mrs O would refuse the cream, and the Home staff could not force her to have it if she did not want to. Mrs O was prescribed the cream to treat a rash, and there is no evidence in the Home’s records that the rash became worse. Mr O has not claimed a specific impact as a result of the cream not being applied. We consider the Home acted in line with paragraphs 168 and 169 of the National Framework, as set out above.
22. We were very sorry to learn of the concerns Mr O has brought to us. After careful consideration of the issues Mr O has raised, we have not found any signs of failings.