DSAR and definition of " notes"

[Getitdone]

↵Hi
my father who has moderately severe dementia has been resident in a care home since April after a period of hospitalisation due to a fall secondary to COVID
we ( my mother, myself and my husband) have been concerned that they haven't been consistently meeting his care needs since he went to live there
We have contacted the manager and discussed this with other staff on many occasions however there's been very little improvement.
In July I discovered that NHS podiatry had been treating my father for a pressure ulcer on the end of his right great toe for approximately 4 weeks. They'd attended to carry out a routine annual foot check as requested by his GP and discovered the ulcer along with a sock stuffed into the toe of the right shoe
The invasive treatment ( removal of dead and calloused skin to expose healthy tissue at the base of the ulcer using a scalpel)was carried out weekly for approximately 12 weeks.
We contacted the manager by email because wes b and she suggested that we make a formal complaint as this would allow her to investigate the matter .

We asked when and where the injury / problem with his toe was identified by staff ( we presumed prior to podiatry identifying it) and why we weren't informed
Essentially the response was that podiatry didn't inform card hoje staff and staff weren't aware that they'd been visiting weekly to treat him There was nothing at all regarding the time period prior to podiatry identifying the ulcer and when we responded regarding this we were told she has nothing to add.

I've since submitted SARs to podiatry and the community nursing team ( they were involved briefly ) and the Podiatry notes clearly show that staff at the care home were informed about the ulcer when it was discovered and at the following visit .

I then submitted a SAR to the home requesting the notes for my father , however they've only produced the records that carers document regarding care given . Some of these are handwritten but the majority are print outs from some sort of electronic system which they have now and there aren't any times that the care was given . It doesn't even specify whether it's day or night shift.

They haven't provided any assessment documents ( eg the assessment of his needs that they undertook prior to going to live there) , care plans ( original care plan was manually written but this new system they have I'd now used to create a card plan) , nor copies of notes made by the manager regarding discussions we've had regarding the quality of care ,nor copies of communication with us or healthcare professionals.
Additionally the " hourly wellbeing check" notes that were in my father's room for a period of time not long before the ulcer was noted by podiatry are also missing. These hourly checks were instigated by the manager after we raised issues regarding his card at that time.

I've gone back and requested that they produce all of the data they hold and they're treating it as a new SAR.

As an ex nurse my understanding of " notes" in relation to health and social care is that it includes everything concerning the cars of the patient/ client and as such should have been provided anyway
Would anyone like to comment on that or provide any other definition ?

I'm particularly interested in this because yesterday we received a letter from the manager inviting us to a meeting to discuss our intimidating and aggressive attitude to the staff and how best we can move forward to ensure my father receives the best care and to avoid termination of the contract.

This was following a face to face discussion with a carer, senior carer and the manager on Saturday during which ( whilst we and dad were seated and the 3 staff were standing ) we challenged the care they'd provided in relation to 3 of his care needs ( 3 that we've addressed on numerous occasions in the past)
during this conversation the manager mentioned that perhaps we had "unreasonable expectations" regarding her staff fulfilling dad's care and that perhaps he needed a reassessment of his needs to see if he had continuing healthcare ( nursing ) needs. The home don't provide nursing care, but I'm aware how difficult is to secure CHC funding for people and there's absolutely no way that he has nursing needs which would require him to be in a nursing as opposed to residential home.
I stated that his needs were no different to when he was admitted to their care so perhaps the staff didn't carry out the assessment correctly and in fact they've never been able to meet his needs , in which case they're in breach of the Care Act .

We've decided that were going to move dad anyway, but given her allegations against us and the lack of resolution regarding the pressure ulcer I'd like to try and ensure that we have all the information regarding the SAR before he leaves.

Any info' / advice would be greatly appreciated

We are also considering

1 Raising a safeguarding concern with the LA
2. Taking legal advice regarding the pressure ulcer ( once dad's no longer resident there so its not really at the forefront of our minds currently)

[atticus]

I am going to try to keep this simple. Please let me know if this is too simplistic.

A Subject Access Request is a request for your personal data held by tge body to whom the request is made. That is what has to be provided - personal data. It is not about notes or how you define that word. It is about whether personal data is provided, irrespective of what you call the records on which that data is recorded.

A request to comply fully with a SAR should not be treated as a new SAR.

[Getitdone]

@attic

[Getitdone]

Apologies previous post was an error
atticus thank you and that's absolutely fine and is what I thought.
Is personal data defined as anything at all that relates directly to a particular person ?
On November 15th I emailed the manager and asked if there was a form I needed to complete for a SAR to get copies of his notes. She replied and told me she would review my request and get back in touch.
On November 17th I received an email from someone who signed themselves off as the Data Lead for the charity who own the home. They told me they would review my request and respond by December 13th and provided
My initial email request was brief because I was expecting them to provide a form to complete. The NHS SAR request form asked which notes I was requesting ( eg inpatient, community nursing, podiatry etc) date ranges required and a brief description of the reason for the request, plus photographic ID for my father along with his signed consent ( I don't have POA for health and welfare)

The charity have never asked for any of this rather on Nov 29th I received a further email from the data lead asking if I wanted printed copies of all of my father's notes from when he was admitted ( in April)
OR an email attachment of all appointment related notes recorded on file relating to the pressure ulcer in June

I was surprised that a "Data lead " would ask that question as surely they'd have a good working knowledge of what a data SAR is.
I replied saying I wanted the printed notes and these were made available for me to collect from the main office of the Charity on Dec 5th.

The most recent response from the data lead treating it as a new SAR coincides with the letter from the manager regarding the termination of the contract etc.

So should I reply and tell them that they were obliged to provide all the personal data they held as part of the original SAR and that the new 28 day time frame isn't acceptable?

On the hand written notes they've redacted the signatures attached to notations and also the name of a GP who is mentioned at the regular multi disciplinary team meeting which is always attended by a GP from the practice that covers the home.
I stated that as far as I was aware they couldn't redact the signatures / names of people who are paid to provide care when the SAR relates directly to that care.
The DL replied and stated that it's their policy to redact names for confidentiality purposes and refused to provide the name of the GP
From a missing data point of view I'm not too concerned about this as neither the carers not the manager hold any professional accountability and I can submit a SAR to the GP practice .
It is concerning that they don't seem to have a handle on things.

[atticus]

I used google to find a definition of personal data on the Information Commissioner's website: https://ico.org.uk/for-organisations...personal-data/

[Getitdone]

wanted to provide an update re the SAR
They've responded and provided the plans of care.
Regarding the carer documentation made when they were carrying out hourly wellbeing checks back around the time that the injury to the toe occured, they say those notes were " just to help the care staff" and not part of the normal care notes. As such they've been securely destroyed .
Regarding internal care home emails or any between the care home and healthcare professionals , they state that the carers don't have access to these emails therefore they don't form part of the notes .

They haven't provided a copy of the pre contract assessment of needs which they carried out where we outlined all of his care needs .
They then say they consider the request closed .

My father came to live back at home with my mother on Tuesday 10th.
My husband and I are providing the care they need , aside from a care company providing a visit at lunchtime starting next week.

We noted 2 dressings when we showered Dad on Wednesday 11th.
We knew nothing about either of them but didn't disturb them.
My father's notice period contract ends on Jan 18th and he's paid in advance until 23rd January.
I emailed the manager on Wednesday and asked about them and haven't had a response.

I'd been in touch with the Community nursing team in advance of dad coming home so that we could get a hospital bed etc and had also requested that they carry out a pressure ulcer prevention assessment either immediately before he came home or just after.

A community nurse attended yesterday.
The dressing on his chest was covering a large abscess and the one on his buttock was covering a grade 3 , 4 cm diameter bloody pressure ulcer.
She's also said that there are signs of healed pressure ulcers on his buttocks.
I believe that this community nurse is from a different locality team than the the team who were going into the residential home.

She was appalled that we knew nithi g about these wounds and also at the state they were in, ie infected and dirty. Pressure ulcers have their own guidelines when it comes to safeguarding .
I was angry and upset , as were my mother and my husband.

I'm wondering what our legal options are regarding this abuse ( in the form of care omissions that have caused moderate harm)?
I'm aware of The Care Act and that they're ( care home and possibly the NHS community nursing staff) in breach of this.

The Care Quality commission were aware of the pressure ulcer on his toe as I provided feedback to them back in September. I didn't receive any communication from them
They've very recently inspected the home and rated them " Good"
They spoke to select residents and relatives during the inspection .

I'm not sure what the situation would be regarding contract law from the point of consumer rights . It seems grossly unfair that dad's paid approximately £33,000 to suffer moderate harm at the hands of inadequate care.
The contract is fairly brief and basically outlines the charges and the terms for termination of the contract .

Presumably as they're a CQC registered and regulated residential care home the Care Act , their assessment of his needs pre contract and the care plans would form the basis of their part of the contract?
I'm a little concerned that they haven't produced the pre contract assessment, however I sat down with a carer shortly after Dad's admission and helped them write the care plan and most of his needs are documented and in the more recent care plan ( from August , after he suffered the ulcer on his toe) his needs are documented more fully.


I've seen definition of residential / social care which states " care which would reasonably be required by an elderly person"
Not very useful really .
I'm keenly aware of how difficult it is to get funding for Continuing Healthcare needs ( CHC) ie following a CHC funding application the NHS carry out an assessment and agree to fund a number of hours based on what they see as " nursing needs " as opposed to "social care needs"

Immediately prior to my father moving into residential care following 6 weeks in Intermediate care ( step down care following discharge from hospital following a fall secondary to COVID ) he was assessed by a hospital social worker who's professional opinion was that he didn't require 24/7 care in a residential care setting but that his needs could be met by domiciliary carers visiting 4 times during the day.

As usual , any advice is very gratefully received.