Summary: We will not investigate this complaint about management of diabetes within a care home. The Care Provider has accepted fault and will improve practice. It is unlikely an Ombudsman investigation would achieve anything further.

The complaint

1. Ms D says the Care Provider did not properly manage her mother’s (Ms E’s) diabetes. Ms D says when the Care Provider recorded unacceptable blood glucose levels, it assumed it knew the reason for hyperglycaemia so did not need to provide extra monitoring or seek treatment. Ms D says the Care Provider did not carry out extra blood glucose monitoring or test for ketones in the blood or urine when levels rose from 22.8mmol/l to 28.2mmol/l nor did it summon any help or advice from an external appropriate health care professional. Ms D says this resulted in hyperglycaemia progressing unnoticed and unchecked into diabetic ketoacidosis. Ms E died shortly after.
2. Ms D says it has been stressful getting answers from the Care Provider and she worries for the safety of diabetic residents.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• the injustice to the person who complained is not significant enough to justify our involvement, or
• it is unlikely we could add to any previous investigation by the care provider, or
• it is unlikely further investigation will lead to a different outcome.

(Local Government Act 1974, sections 34B(8) and (9))

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How I considered this complaint

4. I considered information provided by the complainant.
5. I considered the Ombudsman’s Assessment Code.
6. I considered the Care Quality Commission’s fundamental standards. These are the standards below which care must never fall. The Care Quality Commission is the independent regulator of health and adult social care in England. They monitor, inspect, and regulate services and have powers to improve services.

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My assessment

7. Ms E lived at Harrier Lodge, a nursing home run by Care UK (the Care Provider).
8. The Care Provider says Ms E’s blood sugar levels varied, and it was normal for Ms E to regularly record levels of more than 20 mmol/l.
9. When blood sugar levels are too high it can cause hyperglycaemia. Very high blood sugar levels can lead to a serious problem called diabetic ketoacidosis (DKA). Your body starts to break down fat for energy when there's not enough insulin, which leads to a build-up of acid (ketones) in your blood. It can be life threatening and should be treated in hospital.
10. The NHS website says you should check for ketones if your blood glucose level is higher than 11mmol/l.
11. The Care Provider accepts it failed to do this, and confirmed it will do so in future. The Care Provider will also seek advice from the Diabetic Nurse in future cases where blood sugar levels are high.
12. Ms D wants the Care Provider to use a device for measuring ketones in the blood. The Care Provider says it does not need this because it uses urinalysis sticks. The NHS website says you can use either method, so the Ombudsman cannot criticise the Care Provider’s decision to test urine rather than blood.
13. I understand Ms D is left with uncertainty over whether the outcome for her mother might have been different had the Care Provider taken different action, and that it has been stressful and upsetting for her.
14. The Ombudsman cannot say the Care Provider’s actions caused Ms E’s health to decline or that the outcome would be any different. The NHS website says DKA can develop quickly over a few hours. When the Care Provider noticed a change in Ms E’s health it called an ambulance, which was appropriate action to take.

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Final decision

15. We will not investigate Ms D’s complaint because it is unlikely we could add to the Care Provider’s investigation or achieve a different outcome. The Care Provider has accepted it should have checked Ms E’s ketone levels; it will change its future practice in this area which will improve service to its residents.
16. The Care Provider’s failure to properly monitor Ms E’s ketone levels may be a breach of the Care Quality Commission’s fundamental standards. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we have shared this decision with CQC.

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Investigator's decision on behalf of the Ombudsman