H&W Trust failed to ensure his father was provided with appropriate care and support in his home following his discharge from hospital on 14 January 2022
15. Mr and Mrs D say a care package was not arranged for his father in his home after he was discharged and he was left without care and medication. They say this led to him being admitted to hospital very soon after this discharge with a UTI.
16. The records indicate Mr F’s family called H&W Trust several times on the morning of 15 January 2022 as nobody had attended to assess or provide care for him since he had been discharged from hospital. The family understood that after he was discharged from hospital he would receive 4 daily visits from H&W Trust’s neighbourhood team to provide this care.
17. In its response to this point of complaint H&W Trust said:
‘Mr F was discharged on 14 January 2022 with his care transferred to the Neighbourhood Team who were aware Mr F would require four calls per day from them. Mr F was seen at home at 8.30pm on 14 January 2022 by our evening service for a ‘make safe’ visit and the team supported him with his medication and he was made comfortable.
The Neighbourhood Team had planned for a further assessment to be completed the following day on 15 January 2022 by a senior intensive support nurse to understand exactly what intensive support Mr F would require now that he was back home. The assessment visit took place at 2:00pm. As soon as the team were aware that no one had been to visit Mr F for his morning call, they made prompt arrangements for him to be visited by two members of the team.
(We) are sorry that Mr F missed the one morning visit on 15 January 2022, however, this did not result in his re-admission to hospital on 28 January 2022 as there were nearly 2 weeks between these dates.
There was a robust package of care in place and this was provided by the Neighbourhood Team until 25 January 2022 (when the care agency took over his care). (We) could not identify any care issues, apart from the missed visit on 15 January 2022, that indicated the Neighbourhood Team did not deliver the standard of care that would have been expected.’
18. We do not uphold a complaint if we can see that the organisation has already identified the issues. We have seen from the complaint response that H&W Trust has identified it missed the initial morning visit on 15 January 2022 and has apologised to Mr and Mrs D for the impact this failing had. We think this is a reasonable outcome to this failing as it is likely the missed visit caused distress for Mr F and his family. This initial missed visit would also have caused a delay in Mr F receiving the medication and care interventions in his care plan on that day.
19. The records confirm H&W Trust attended Mr F’s home at 2:00pm the same day to complete the assessment of his needs and provide care and support. Our community nurse adviser said there is no evidence in the records to indicate the missed morning visit and subsequent delay before H&W Trust attended to him had a negative impact on his clinical condition. The record of the initial assessment did not raise any concerns about his condition, no signs of deterioration were identified and his care was not escalated at this time.
20. The GMC guidance says:
‘You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must:
• adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient
• promptly provide or arrange suitable advice, investigations or treatment where necessary.’
21. The record of the initial assessment says the nurse who carried out the assessment could not take a full record of observations as the equipment was not available to allow for some of the checks. Our community nurse adviser said there is no evidence to indicate the lack of a full record of initial observations had an impact on Mr F’s condition and the information in the records shows that his condition remained stable throughout this period. However such observations would form part of a robust initial assessment
22. We acknowledge it is not always possible to carry out a full record of observations due to the availability of the equipment. Although we found no evidence in the records to indicate this had an impact on the care Mr F needed, his clinical condition or the care H&W Trust provided, it would have been in line with the GMC guidance to record his full initial observations either during the first visit or at the next available opportunity.
23. Prior to his admission to hospital Mr F had a home care package with a care agency where he was visited 4 times a day for personal care to provide support with his activities of daily living such as hygiene, skin care, support with nutrition and medication. The record of the initial assessment on 15 January 2022 indicates the nurse put in place a care package consistent with his previous care package.
24. The records indicate H&W Trust arranged 4 visits per day from two nursing staff from its neighbourhood care team to provide care and support for Mr F to start on 15 January 2022 and continue until his previous care agency could take over his care once again.
25. Our community nurse adviser said the care provided by H&W Trust was to support Mr F with his regular medication, hygiene care, skin care (to prevent pressure sores), repositioning and mobility care, catheter care and support with his fluid and nutrition. Our community nurse adviser said there is no evidence in the records to indicate the care put in place and subsequently provided by H&W Trust was inadequate to meet his needs or that any of his needs went unmet.
26. The records for the period 15 to 25 January 2022 indicate there were no further missed visits and the care to support Mr F was provided on each occasion. Our community nurse adviser said the records indicate he remained in a stable condition during the period the care was provided by H&W Trust’s neighbourhood team and his care was handed over to his care agency without any complications. The records also indicate the care agency did not raise any concerns about Mr F’s condition on handover and his care was not escalated at that time.
27. We carefully considered Mr and Mrs D’s complaint and the supporting information they have provided. We also considered the information in the records, the guidance and the advice we have received. We acknowledge Mr and Mrs D’s concerns about the care and support provided by H&W Trust during this period.
28. We accept H&W Trust missed the initial morning visit on 15 January 2022 and it has acknowledged this failing and apologised to Mr and Mrs D for the impact it had. We think this is a reasonable outcome to address the impact this failing had on Mr F and his family.
29. We found H&W Trust did not record all Mr F’s baseline observations during the initial home care needs assessment on 15 January 2022 or on any of his subsequent visits. Although we consider this to be a failing, and we partly uphold this complaint, we do not recommend any further action as there was no impact on Mr F or his family as a result of the failing.
30. We found no evidence to indicate the care and support provided by H&W Trust to Mr F in his home between 14 and 25 January 2022 was inadequate or detrimental to his condition. We found no evidence to indicate the care he received from H&W Trust contributed to his admission to hospital on 25 January 2022.
WAH Trust discharged his father from hospital without an adequate care plan on 7 February 2022
31. Mr and Mrs D say WAH Trust did not have a care package planned at the time of his discharge and as a result he was left without care, food, drinks and medication. They say this led to his father being admitted to hospital on 18 February 2022 with sepsis.
32. In its response to this point of complaint WAH Trust said:
‘When Mr F was discharged from Ward 5 a package of care was set up to support him from 7 February 2022. The provider of Mr F’s ongoing care was not available to commence until 9 February 2022, so the H&W Trust’s neighbourhood team were asked to utilise their intensive support team from the point of discharge; the ward team were assured that they would be there to meet him on arrival. Agreement by the neighbourhood team and social services was documented and the neighbourhood team attended that evening with an increased team to support Mr F, including support with eating. Alongside this provision the district nurses were also contacted to provide catheter and wound care.
When Mr F was discharged from Ward 5, he was given all the medications required to support him. From the understanding of the ward Mr F was able to take these medications independently and therefore did not require further assistance. With regards to not receiving antibiotics on discharge, the course of antibiotic that Mr F was given during his admission to Ward 5 was completed on 5 February 2023 and all infection markers had reduced from admission, so therefore at the point of discharge it was not deemed that these were required.’
33. The discharge guidance says: ‘When it becomes apparent that someone may need support from social care services to aid their discharge and recovery, NHS trusts should inform the relevant local authority of this need as early as possible in the person’s hospital stay, to allow local areas to co-operate on the person’s discharge planning. This should be the case in every instance where it is considered someone may have ongoing social care needs.’
34. Mr F was discharged on the evening of 7 February 2022, however his previous care agency advised WAH Trust that it could not restart his usual care package until 9 February 2022. The records indicate WAH Trust referred him to the neighbourhood team at H&W Trust and the local social services to provide the care he needed at home during this period. The records indicate H&W Trust agreed to provide the care and asked WAH Trust to phone the neighbourhood team when he left hospital so they could meet him at home.
35. Our nurse adviser said in such circumstances WAH Trust would expect the neighbourhood team to assess his needs at the point he arrived home and then provide the care needed to meet those needs. The records indicate WAH Trust contacted the neighbourhood team on the evening of 7 February 2022. The records also indicate the H&W Trust neighbourhood team attended to Mr F in his home that evening.
36. We carefully considered Mr and Mrs D’s complaint and the supporting information they have provided. We also considered the information in the records, the guidance and the advice we have received. We found no evidence to indicate WAH Trust discharged Mr F from hospital on 7 February 2022 without an adequate care plan. We found the discharge planning was in line with the discharge guidance.
H&W Trust failed to ensure his father was provided with appropriate care and support in his home following his discharge from hospital on 7 February 2022
37. Mr and Mrs D say a care package was not arranged for his father in his home after he was discharged. They say when they visited him on 12 February 2022 they found he had been left without care, food, drinks and medication. They say this lack of care led to him being admitted to hospital on 18 February 2022 with sepsis. Mr and Mrs D say H&W Trust failed to hand his care over to appropriate services in the community which lead to him developing sepsis.
38. In its response to this point of complaint H&W Trust said:
‘Mr F was discharged home again on 7 February 2022 and he received a bedtime call from the Neighbourhood Team on this date and four visits with two Healthcare Assistants (HCAs) on 8 February 2022. When the HCAs visited for the morning call on 9 February 2022 his previous care agency had resumed their care and therefore any questions relating to your concerns about 12 February 2022 and Mr F being left without care, food, drinks or medication when you visited him on this date, will need to be directed to the care agency as the Neighbourhood Team were no longer providing his care.’
39. The records indicate H&W Trust provided care to Mr F between the evening of 7 and the morning of 9 February 2022 when his care was taken over by his care agency. Prior to his admission to hospital Mr F had received home care from his care agency of 4 visits a day for personal care to provide support with his activities of daily living such as hygiene, skin care, support with nutrition and medication.
40. The records indicate the neighbourhood team attended Mr F’s home once they received notification from WAH Trust that he had been discharged from hospital. The records indicate 2 nurses from the neighbourhood team attended Mr F’s home at 8.11pm however he had not yet arrived at home. The 2 nurses returned at 10.25pm to assess Mr F and provide his care.
41. The note of the initial assessment on the evening of 7 February 2022 indicates the nurse who assessed Mr F reviewed his hospital notes, carried out an assessment of his condition and care needs and provided his initial care. The note does not provide a full record of initial baseline observations. Our community nurse adviser said there is no evidence to indicate the lack of a full record of initial observations had an impact on Mr F’s condition and the information in the records shows that his condition remained stable throughout this period. However such observations would form part of a robust initial assessment
42. Although there is no evidence in the records to indicate this had an impact on the care Mr F needed, his clinical condition or the care H&W Trust provided, it would have been in line with the GMC guidance to record his full initial observations either during the first visit or at the next available opportunity.
43. The record of the initial assessment on the evening of 7 February 2022 indicates the neighbourhood team put in place a care package of 4 visits per day from two nursing staff to provide care and support until his previous care agency could take over his care once again.
44. Our community nurse adviser said the care put in place by H&W Trust was consistent with Mr F’s condition at that time and aimed at providing support with his regular medication, hygiene care, skin care, repositioning and mobility care, catheter care and support with his fluid and nutrition. Our community nurse adviser said there is no evidence in the records to indicate the care put in place and subsequently provided by H&W Trust was inadequate to meet his needs or that any of his needs went unmet during this period.
45. The records indicate the neighbourhood team attended to him on 4 occasions on 8 February 2022 to provide his care. The records indicate the neighbourhood team provided Mr F with food and drinks when they visited him on the evening of 7 February 2022 and then at 10:00am, 13:10pm and 17:30pm on 8 February 2022.
46. Our community nurse adviser said the records indicate he remained in a stable condition during the period the care was provided by H&W Trust’s neighbourhood team and his care was handed over to his care agency on 9 February 2022 without any complications. The records also indicate the care agency did not raise any concerns about Mr F’s condition on handover and his care was not escalated at that time.
47. We carefully considered Mr and Mrs D’s complaint and the supporting information they have provided. We also considered the information in the records, the guidance and the advice we have received. We acknowledge Mr and Mrs D’s concerns about the care and support provided by H&W Trust during this period.
48. We found H&W Trust did not record all Mr F’s baseline observations during the initial home care needs assessment on 7 February 2022. Although we consider this to be a failing, and we partly uphold this complaint, we do not propose any further action as there was no impact on Mr F or his family as a result of the failing.
49. We found no evidence to indicate the care and support provided by H&W Trust to Mr F in his home between 7 and 9 February 2022 was inadequate or detrimental to his condition. We found no evidence to indicate the care he received from H&W Trust during this time contributed to his admission to hospital with sepsis on 18 February 2022.