Summary: Mrs X complains about the quality of care her father received, decisions the Council made about who provided that care, and that the Council handled her complaint poorly. She says the poor care caused her father, Mr D, unnecessary distress. The Ombudsman finds fault for the quality of care on one occasion. This caused Mr D injustice. The Council will apologise, make a payment to reflect the injustice, and undertake a service improvement. The Ombudsman does not find fault with the Council for the other parts of the complaint.

The complaint

1. The complainant, who I refer to here as Mrs X, complains on behalf of her father, Mr D. Mrs X:
1. disputes that the Council’s REACH (Reablement and Community Home support) team did not have capacity to provide a care package to Mr D;
2. complains that REACH decided to stop providing care to Mr D, and changed his care provider to New Hope;
3. complains that New Hope provided substandard care; and,
4. complains that the Council handled her complaint poorly.
2. Mrs X says the poor care caused Mr D distress. She says the family ended up caring for him, and he did not want to be cared for by his children.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
5. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
6. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

7. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

8. Mrs X is Mr D’s daughter. She represented the complaint to the Council on behalf of Mr D, who passed away. I consider that Mrs X is a suitable person to represent this complaint on Mr D’s behalf.
9. I considered the information and documents provided by Mrs X and the Council. I spoke to Mrs X about the complaint. Mrs X and the Council had an opportunity to comment on an earlier draft of this decision. I considered all comments before making my final decision.
10. I have considered the relevant legislation and policies, set out below.

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What I found

What should have happened

Care provision

11. The Care Act 2014 says that local authorities must meet an adult’s care and support needs if they meet certain eligibility criteria.

Summary/explanation of the services involved in this complaint

12. Reablement and Community Home support (REACH) is a Council-run service that offers short term support for eligible people. The REACH service is usually only needed for a short, intensive period of time and aims to support the person to a level of independence.
13. The Council has a ‘Better at Home’ contract with New Hope, a care provider. ‘Better at Home’ is an initiative which aims to get people the treatment, care and support they need in their own home (or a nursing/residential home if appropriate), rather than stay in hospital unnecessarily.
14. New Hope is a home care agency. The Council has an agreement with New Hope to provide home care where REACH is not appropriate and/or is unable to provide care because of its workload.

The Council’s Adult Social Care complaints procedure

15. The Council’s procedure says the service involved will look into the complaint. It says it aims to provide a detailed written response within 20 working days.
16. The procedure says if the investigation will take longer than 20 days, the Council will notify the complainant of the delay.

What happened

17. In March 2019, a referral was made to REACH to provide support for Mr D, Mrs X’s father, because he was in hospital and would need care after he was discharged. REACH said it was not able to provide Mr D’s care because it did not have the capacity to do so. Another Council department was asked to find a care agency. Later the same day, REACH accepted Mr D’s case.
18. Mr D was discharged from hospital in April. REACH started its package of care. A week later, provision of Mr D’s care was transferred to New Hope, a care agency commissioned by the Council.
19. Ten days later, Mr D’s social worker noted that his well-being had greatly improved.
20. On 7 May, Mr D went back into hospital. A few days later, Mr D’s family asked that New Hope restart the care package because he was back at home.
21. On 16 May, the family told New Hope that the carer had not turned up that morning. New Hope accepted this was their fault and apologised.
22. On 20 May, Mr D went back into hospital. He was discharged the next day. The hospital had not notified the Council of Mr D’s discharge, so a care package was not in place when Mr D left hospital.
23. Interim care was provided on 22 May. On 23 May, New Hope re-started the care package.
24. On 29 May, the district nurse reported that Mr D was refusing a lot of care visits because the carer was too young. By 5 June, Mr D was accepting care from New Hope. Mrs D said that Mr D had a good relationship with the carers.
25. On 8 June, New Hope agreed to extra care visits for Mr D.
26. On 11 June, a carer was late which meant one care visit followed straight on from the previous one. Mr D was left on his side, in pain, and frightened. District nurses attended. They treated and reassured Mr D.
27. On 12 June, Mr D’s social worker reported the incident from the day before to the Council. She also noted her concerns about a carer’s poor English skills.
28. On 13 June, New Hope stopped providing Mr D’s care because a different Council-run service (Enhanced REACH) took over the whole care package.
29. On 18 June, Mr D passed away.
30. On 27 June, Mrs X complained to the Council about its decision to change Mr D’s care provider to New Hope. She said this was not discussed with the family. She complained that the care provided by New Hope was substandard, carers were late, and that New Hope did not react to Mr D’s changing needs in a timely manner.
31. On 31 July, the Council told Mrs X that there was a delay in responding to her complaint.
32. On 6 September, the Council sent its response to Mrs X’s complaint. It apologised for the delay and explained that the delays had been due to the complex nature of the complaint.
33. The Council said the care plan showed the intention to use REACH for a short time then move to New Hope as part of the ‘Better at Home’ contract. It said the care plan was discussed with the family, but it was not clear whether this change of provider was discussed with the family. The Council partly upheld the part of Mrs X’s complaint about not being fully consulted about the care provider.
34. The Council said there were no recorded concerns about the care provision until 16 May. It said this first concern was about a carer not turning up, not about the quality of care. It said the second concern was about a carer being too young, which was resolved. It said on 5 June Mrs D said Mr D had a good relationship with New Hope carers.
35. The Council said the third concern was about two issues. The first issue was the language skills of a carer. It said New Hope said the carer was fully trained and her language skills were good. It noted that Mrs X and the social worker disagreed with this. The second issue was carers being late on 11 June which ultimately left Mr D distressed and uncomfortable. It said district nurses made Mr D comfortable and reassured him. The Council partly upheld Mrs X’s complaint about the quality of care.
36. Mrs X then complained to the Ombudsman.

Analysis

REACH’s capacity

37. Mrs X disputes that REACH did not have capacity to provide a care package to Mr D (part a of the complaint).
38. The Council says the initial decision that REACH did not have the capacity to provide Mr D’s care was an operational decision based on REACH’s volume of work at the time.
39. I have seen nothing to suggest that REACH had capacity to provide Mr D’s care at that time. Also, I note that the Council decided on the same day that REACH did have capacity. REACH then began providing Mr D’s care.
40. For these reasons, I do not find fault with the Council.

Care provision

41. Mrs X complains that REACH decided to stop providing care to Mr D, and changed his care provider to New Hope (part b of the complaint).
42. Mr D’s care plan, dated early April, says REACH is a short-term service, after which Mr D would be assessed and if ongoing care was required, it would be commissioned from an agency. This is what happened.
43. It is therefore clear that the Council’s intention was always that Mr D’s care would be initially provided by REACH and would then move to an agency if needs be.
44. The Council has an agreement with New Hope to provide home care when REACH is not appropriate and/or REACH cannot provide a person’s care because of its capacity.
45. I find that the Council was entitled to provide Mr D’s care (through REACH) in the short-term and then commission care provision from a care agency (New Hope) for the longer-term. Mr D’s family may not have known about this, but it is written in Mr D’s care plan.
46. In any event, the Council is entitled to change care provision. For this reason, I do not find the Council at fault.

Substandard care

47. Mrs X complains that New Hope provided substandard care to Mr D (part c of the complaint).
48. The Council upheld parts of Mrs X’s complaint about poor care provision. However, it did not consider the impact of this on Mr D or his family, and it did not apologise or explore ways to remedy the injustice caused by the poor care.
49. I find that there is one documented incident (11 June) where the care was clearly poor because Mr D was left on his side, in pain, and frightened. This is fault. This fault caused Mr D and his family injustice, because it caused unnecessary distress.
50. Mrs X complains that New Hope failed to provide oral care to Mr D. New Hope says it did not receive any complaints about this.
51. Mrs X also complains about New Hope failing to reassess Mr D when his needs deteriorated rapidly. New Hope says it did not receive any complaints about that.
52. There is a lack of records on both sides. Mrs X says that Mrs D complained over the phone to New Hope. New Hope does not have any records of complaints about lack of oral care and lack of reassessment. However, New Hope’s records show that Mr D’s social worker contacted New Hope after speaking to Mrs D.
53. The records show that on four occasions Mrs D said she had no complaints about carers, but did mention they were too young, inexperienced, and there were some communication issues because a carer could not speak English.
54. New Hope says when its manager called Mrs D about the communication issue, Mrs D said she did not want that carer removing from her care duties with Mr D.
55. I cannot make a finding about Mrs X’s complaint about lack of oral care and lack of reassessment because there is insufficient evidence on both sides. I have seen nothing that persuades me that complaints were made, and that New Hope failed to act on those complaints.
56. Mr D’s social worker raised issues with New Hope managers to seek improvements. I find that there was insufficient opportunity for these improvements to have been implemented, given that New Hope stopped providing Mr D's care shortly afterwards.

Complaint handling

57. Mrs X complains that the Council handled her complaint poorly (part d of the complaint).
58. Mrs X says the Council did not acknowledge her complaint. The Council says that Mrs X submitted her complaint through Mr D’s social worker. It sent an acknowledgement to the social worker.
59. The Council’s complaints procedure does not say it will acknowledge a complaint. While I find that it may have been best practice to have sent Mrs X an acknowledgement there is no requirement for it to do so, according to the procedure.
60. Mrs X says there were delays in the Council’s handling of her complaint.
61. Mrs X complained in June. The Council notified Mrs X of a delay at the end of July. It then did not contact her until it sent its response in September. This was 50 working days after Mrs X complained.
62. The Council’s procedure says if a complaint investigation takes longer than 20 days, it will notify the complainant. The Council did this. While I find that it may have been best practice for the Council to have provided a subsequent update to Mrs X on when she might expect to receive the Council’s response, I find that the Council ultimately acted in line with its procedure.
63. For this reason, I do not find the Council at fault.

Agreed action

64. Within four weeks of this decision, the Council has agreed to apologise to Mrs X and Mr D’s family for the unnecessary distress caused by carers leaving Mr D on his side, in pain, and frightened.
65. Within four weeks of this decision, the Council has agreed to make a payment to Mrs X of £250 to reflect the impact of this injustice. This is in line with the Ombudsman’s published guidance on remedies.
66. Within three months of this decision, the Council has agreed to remind those responsible for responding to complaints that they should consider the impact of any fault found, and consider a way to remedy that injustice.
67. The Ombudsman will need to see evidence that these actions have been completed.

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Final decision

68. I have completed my investigation and uphold part c of Mrs X’s complaint because I have found fault causing injustice. The Council has agreed to take action to remedy this.
69. I do not uphold parts a, b or d of Mrs X’s complaint. This is because there is no fault.

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Investigator's decision on behalf of the Ombudsman