Decision Report 201606614

Summary

Mr C complained to us about the psychiatric care and treatment his daughter (Miss A) had received from board staff. Miss A was subject to compulsory measures in a care home under mental health care legislation.

Mr C complained that the board had failed to consider the family's requests for Miss A to be moved to a different care home. We took independent advice from a consultant psychiatrist. We found that the board had acted reasonably in relation to the family's requests for Miss A to be moved. We found that the issue was discussed with the family and that attempts were made to identify and understand Miss A's views on the subject. We also found that the board had made reasonable efforts to listen to and respect the family's views. We did not uphold this aspect of the complaint.

Mr C also complained that the board had failed to provide Miss A with adequate psychiatric care while she was in the care home. He considered that this led to her admission to a psychiatric hospital. We found that there were no significant failings in the psychiatric care provided to Miss A in the care home. Her care plan had been reasonable and she had received adequate psychiatric care and supervision during the relevant period. Additional attempts to monitor or supervise Miss A would not have changed the outcome and board staff had acted reasonably in relation to this. Although we did not uphold this aspect of Mr C's complaint, we found that Miss A's records about her care plan were not of an adequate standard and we made a recommendation in relation to this.

Recommendations

Sector: health

Subject: clinical treatment / diagnosis

Decision: not upheld, recommendations

• Summary
• Mr C complained to us about the psychiatric care and treatment his daughter (Miss A) had received from board staff. Miss A was subject to compulsory measures in a care home under mental health care legislation.
• Mr C complained that the board had failed to consider the family's requests for Miss A to be moved to a different care home. We took independent advice from a consultant psychiatrist. We found that the board had acted reasonably in relation to the family's requests for Miss A to be moved. We found that the issue was discussed with the family and that attempts were made to identify and understand Miss A's views on the subject. We also found that the board had made reasonable efforts to listen to and respect the family's views. We did not uphold this aspect of the complaint.
• Mr C also complained that the board had failed to provide Miss A with adequate psychiatric care while she was in the care home. He considered that this led to her admission to a psychiatric hospital. We found that there were no significant failings in the psychiatric care provided to Miss A in the care home. Her care plan had been reasonable and she had received adequate psychiatric care and supervision during the relevant period. Additional attempts to monitor or supervise Miss A would not have changed the outcome and board staff had acted reasonably in relation to this. Although we did not uphold this aspect of Mr C's complaint, we found that Miss A's records about her care plan were not of an adequate standard and we made a recommendation in relation to this.
• Recommendations [1]

What we said should change to put things right in future:

• Care plans in care programme approach documentation should be clear and the objectives should be focussed and specific, with responsible persons or agencies identified. There should also be a clear discussion of the outcomes of each objective recorded at each crae programme approach review. Where the board is working with another care provider, there should be a clear record of the discussion around care plan objectives allocated to such care providers and the attempts to meet these objectives.

We have asked the organisation to provide us with evidence that they have implemented the recommendations we have made on this case by the deadline we set.