Summary: Mrs D complained that the Council failed to provide suitable carers to meet her needs, failed to communicate with her properly about the difficulties in sourcing carers, and made inappropriate suggestions for alternative care. It also failed to deal with Mrs D’s complaint about the issue in accordance with its complaints procedure, causing a long delay and increasing Mrs D’s distress. We have found fault with the actions of the Council causing injustice to Mrs D. The Council has agreed to pay Mrs D £500 and improve its complaint handling for the future.

The complaint

1. Mrs D’s advocate Mrs E, complained on behalf of Mrs D that Suffolk County Council (the Council) in September 2021 failed to provide suitable carers to meet Mrs D’s care needs, suggested inappropriate support via assistive technology in an assessment, sent male carers when she requested female carers only and failed to provide sufficient funds via direct payments to enable Mrs D to employ suitable carers. The Council also failed to talk to Mrs D before responding to her complaint and failed to progress the complaint to stage two of the complaints procedure. Mrs D has also experienced some ongoing issues in 2022 regarding her care package. Mrs D has been caused distress, inconvenience and time and trouble.

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The Ombudsman’s role and powers

2. 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)
3. Service failure can happen when an organisation fails to provide a service as it should have done because of circumstances outside its control. We do not need to show any blame, intent, flawed policy or process, or bad faith by an organisation to say service failure (fault) has occurred. (Local Government Act 1974, sections 26(1), as amended)
4. If we are satisfied with an organisation’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)

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How I considered this complaint

5. I have considered the complaint and the documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided.

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What I found

The Council’s Adult and Community Services complaints procedure

6. The Council operates a one-stage complaints procedure for complaints about adult social care services. It says the law allows it six months to resolve complaints. It aims to respond to straightforward complaints within 10 working days and more complicated complaints within 20 working days. On occasion it may need to extend the deadline further.
7. If a person is not satisfied with the response the Council will talk to them about what more can be done. This may be a more thorough in-depth investigation or may involve further discussions or mediation.

What happened

8. Mrs D has multiple health conditions which affect her ability to carry out personal care tasks. She had been receiving care visits from an agency (Agency1). At the end of September 2021 Agency1 gave 28 days’ notice that it would be ending the care provision to Mrs D. It said that there had been a breakdown in the relationship between Mrs D and the carers, she had declined 24 visits in a month and was frequently out at call times. The social worker arranged to visit Mrs D to discuss her care needs on 12 October 2021, but had to cancel on the day due to illness.
9. The Council carried out several provider searches but was unable to find replacement carers. There was an agency who could do two visits a day, but the morning call would be after 10 am. Initially Mrs D considered this was too late and declined the care.
10. Mrs D’s social worker visited her on 26 October 2021 to discuss her care needs and explore if there was any flexibility in the time tasks were done and when meals were prepared. Mrs D said she was prepared to accept the late morning visit, but the care provider could no longer offer the visit. The Council contacted another 47 care providers, but none had any capacity. The Council put an internal provider (Agency2) in place on 28 October 2021 as a provider of last resort. Agency2 said it could only provide a lunchtime and an afternoon call and could not guarantee a female carer.
11. Mrs D complained the following day about there being no morning call and said the social worker was neglecting her. Mrs D refused or was absent from approximately eight care calls over the next couple of weeks.
12. The Council decided to do another care assessment and the social worker did a virtual one with Mrs D on 25 November 2021. They discussed flexibility with visits and the possibility of paying for a personal assistant with direct payments (the Council pays the service user directly so they can employ their own choice of carers). The social worker recognised that a lot of calls were not happening. Mrs D also requested a falls alarm.
13. Mrs D continued to refuse care and said the carers were harassing her. Agency2 raised concerns about Mrs D’s increasingly agitated response to the carers. Mrs D then said she no longer wished to have care. The Council said it would contact her advocate, Mrs E. The Council also sent out the new assessment recommending a direct payment for Mrs D to arrange two care visits a day.
14. On 5 January 2022 the Council spoke to Mrs E about Mrs D’s situation. Mrs E explained that Mrs D was distressed by the carers entering her property, she said they were rude to her and refused to provide personal care. She was also upset that the Council did not contact her over Christmas. The Council agreed to cancel Agency2 with immediate effect and provide a direct payment for Mrs D to purchase care to suit her needs.
15. On 31 January 2022 Mrs D submitted a formal complaint to the Council that:
• Agency1 giving notice to cease care provision.
• The failure of the Council to find a replacement for 27 October 2021 and there was a gap in care until Agency2 started on 30 October 2021.
• Agency2 visited too late in the morning and too early in the afternoon, the carers were sometimes male and did not show ID.
• The social worker had not been in touch with her since 23 November 2021.
• The assessment was inaccurate and done without Mrs D’s input. The direct payment was too low to pay for two care visits a day.
• She was still waiting for a falls alarm to be fitted.
• She requested a reassessment of her needs, an investigation into the social worker’s actions and an apology.
16. In early February 2022 Mrs D requested reinstatement of her care visits as she was struggling to manage. The Council said it could not reinstate Agency2 but would start a search for a new provider for two 30 minute visits per day, ideally in the morning and evening. But it said that Mrs D may have to show some flexibility on the timing and length of the calls. The Council said it had acknowledged her complaint and was dealing with it and the digital care team would be in touch with her about installing an alarm system.
17. Mrs E contacted the Council to ask if it would arrange a care package with a provider she had identified but was too expensive for the direct payment. The Council contacted the provider, but they were unable to provide the care.
18. The Council found a new agency (Agency3) able to start on 17 February 2022. Mrs D said to her social worker on 24 February 2022 that the package was working well.
19. The Council replied to Mrs D’s complaint on 9 March 2022. It said that:
• Agency1 had ceased providing care in the autumn due to Mrs D’s behaviour and increasing reluctance to accept care from the carers.
• It was satisfied that the Council had taken appropriate steps to source a new provider, including for an earlier morning visit but had been unsuccessful due to pressures in the social care system and a shortage of capacity.
• During the period after Agency1 stopped, Agency2 was in place offering twice-daily visits.
• There were significant delays in late November/December communicating with Mrs D and the Council did not provide any information about cancelled visits or problems with the care. It noted that it would have been advisable for the social worker to have met with Mrs D in person to discuss her care needs.
• It acknowledged that Agency 2 had not worked for Mrs D and had caused her further distress, for which it apologised.
• It noted that a new needs assessment had been done and a new care provider was now in place.
20. In conclusion it said:

“I want to apologise to you for the delays and communication difficulties that you have experienced in your care and support needs assessment and review. I want to reassure you that I have addressed this with [the Team Manager] and her practitioners in her team and this has been taken forward for learning. I apologise for the distress felt within the assessment and review process and in the access to care provision which has been affected by provider capacity within the care market.

21. On 13 April 2022 Mrs E emailed the Council to say Mrs D did not think the complaint had been investigated properly as no-one had spoken to her. She was unwell and her health had been seriously put at risk. She wanted to talk to the person who had investigated the complaint.
22. The digital care team said it had been unable to get in contact with Mrs D and raised concerns. It continued through May to discuss the provision of an alarm system with a pendant and a smartwatch.
23. On 20 April 2022 Mrs E again said Mrs D wanted to talk to the investigator about her complaint. The complaints manager asked them for their availability with a view to a meeting.
24. On 11 May 2022 Mrs E chased the Council for a response. The complaints manager chased the investigator who asked for specific details of the concerns to ensure any meeting was focussed. The complaints manager asked Mrs E to provide details of Mrs D’s concerns. Mrs E replied with the following points:
• How was the complaint investigated?
• Why was Mrs D not contacted as part of the investigation?
• Why did the investigator only look at the Council’s case records?
• There was nothing to say what Mrs D’s view was?
• She repeated that Mrs D would like to discuss the points with the investigator.
25. Mrs E chased the Council again on 1 June 2022 regarding the response to Mrs D’s concerns about the complaint response.
26. In mid-June 2022, Agency3 raised concerns about Mrs D’s mood management and engagement with the care calls. Shortly afterwards it gave 28 days’ notice that it was stopping the care due to Mrs D’s behaviour. Mrs D said she didn’t want any more care and returned the smartwatch and falls alarm pendant.
27. In August 2022 Mrs E complained to us on behalf of Mrs D. We sent the complaint back to the Council and asked it to complete all stages of its complaints procedure.
28. On 25 August 2022 the Council apologised to Mrs E for the delay in reinstating Mrs D’s care. In September 2022 the complaints manager apologised to Mrs E for the lack of progress with talking to the investigator. They agreed to try again.
29. The Council started another provider search for the same care package. It contacted 24 providers but none had capacity. The social work team manager discussed the problem of finding care with Mrs D in mid-September and suggested some flexibility with timings, food provision and direct payments.
30. A new provider, Agency4 offered a service from 26 September 2022. The Council tried to follow-up the new care package with a review but Mrs D was unavailable due to other emergency health issues and appointments.
31. Agency4 raised concerns about Mrs D cancelling visits at the last minute, blocking carers from entering and getting upset with the carers on occasion. The Council explained that Mrs D often reacted in this way with carers when she was unsure that her needs were understood and that her voice was being heard. It suggested the agency needed to get to know Mrs D and how she managed her conditions. The Council said it would ask Mrs D to let the agency know when she did not want a visit.
32. Agency4 continued to report concern about Mrs D’s response to the carers. Mrs D complained about the carers being rude, intimidating and not writing notes in her care records. Mrs E intervened to say that Agency4 held electronic case records so they would not be in the folder at her property. Mrs D raised a safeguarding concern about the carers and said her GP was very concerned about her health.
33. On 13 October 2022 Agency4 withdrew care. It said Mrs D had threatened to call the police when carers turned up for the visits. Mrs D said they were intimidating her. The Council responded to the safeguarding concern and offered a meeting with Mrs D to discuss a way forward. It also contacted Mrs D’s GP to arrange a multi-disciplinary meeting.
34. Around this time the complaints manager offered Mrs D a call with the complaint investigator. Mrs D declined as she was upset by the current care problems and frustrated with the delay in speaking to the complaint investigator. Mrs E contacted us again and asked for us to investigate. We sent it back to the Council to complete its complaints procedure.
35. The Council tried to make a wellness check by telephone but Mrs D terminated the call. The Council found a new provider, Agency5 who started at the beginning of November 2022 with three calls a day from a female carer. This package quickly broke down when the agency had to withdraw them when it discovered a male carer had not been trained or had a DBS check. Mrs D said she did not want another carer and refused to let them in. The Council spoke to Mrs D to try and persuade her to accept care. It offered a doorbell to help Mrs D with her anxiety about who was at the door. It also asked for details of the untrained carer so it could raise concerns with the agency. The Council also acknowledged to Mrs D that an historic allegation about a photo on social media must have been very distressing for her.
36. The Council found a new care provider (Agency6) on 22 November 2022 who could provide three daily visits. Mrs D accepted the package of care.
37. Mrs D complained again to us in February 2023 as the Council had still not responded to her concerns about the stage one complaint response. The Council said to us:

After liaising with Adult Services, I can advise that given the passage of time, that the Council has completed its consideration of [Mrs D’ complaint. The Ombudsman is in receipt of the substantive response from [a senior manager]. Subsequent to the response, initial arrangements for the…Manager to have a follow up meeting with [Mrs D] were commenced however the Council were advised by the advocate that [Mrs D] no longer wished to pursue this.

38. We decided to investigate the complaint.

Analysis

Care package

39. Mrs D has complex care needs which the Council has recognised through assessments and tried to meet with a package of care from a variety of care agencies. In the main I consider the Council has acted sympathetically, promptly and appropriately in trying to source care to meet Mrs D’s needs. The case notes show that the Council has a good understanding of Mrs D’s needs along with the reasons why care packages have broken down and it has tried to prevent these crises by working with Mrs D and care providers to source suitable care. It has followed up care packages promptly to review their operation and, in most cases acted quickly to source alternative arrangements.
40. However, in October 2021 it was unfortunate that the social worker had to cancel a meeting on 12 October 2021, which was not rearranged until just before Mrs D’s care was due to stop. I understand staff illness is unavoidable, but I think a new date should have been arranged sooner. This created unnecessary anxiety for Mrs D. It also led to a loss of faith by Mrs D in the Council’s ability to meet her needs.
41. The Council explained there were acute pressures on the social care sector which meant there was very little available capacity. The short notice combined with short supply meant that I have not found fault with the Council’s efforts to source care at this point: it contacted 47 providers and discussed flexibility with Mrs D.
42. But the care it arranged with Agency2 from 28 October 2021 did not meet Mrs D’s needs because one call was at lunchtime (too late to assist Mr D with washing and dressing) and the other was in the afternoon (too close to the first call and too early for getting ready for bed). This meant Mrs D had no help with getting dressed, could not go about her day as she wished, experienced significant distress and contributed to the breakdown in the care package.
43. I acknowledge that the Council kept trying to source an earlier visit but was unsuccessful due to the pressures on the sector. However, this was still fault (service failure) as Mrs D was left without appropriate care partially in November/December 2021 and completely from 13 December 2021 until she requested reinstatement in February 2022. This caused her significant distress and impacted on her health.
44. I further acknowledge during this period that the Council carried out a review of Mrs D’s care needs and offered her a direct payment to purchase her own care. However, the Council did not visit Mrs D to explain how this would work and ensure she was able to manage this process. It appears Mrs D was unable to source her own care during this period. The Council also accepted its communication was poor with Mrs D during this period which contributed to the breakdown in care arrangements and caused Mrs D frustration and inconvenience.

Complaint handling

45. The Council sent a response to Mrs D in just over five weeks which was a little outside the timescale of 20 working days for more complicated complaints. The response gave a detailed account of what had happened, accepted some fault in the communication and difficulty in sourcing appropriate care and apologised. I consider the content and format of the response was reasonable and in accordance with its published procedure. Although we consider it good practice to talk to a complainant before starting a complaint investigation, there was no requirement to do so at this stage and I consider the Council fully understood Mrs D’s complaint. The case records are detailed and contain copies of all communication with Mrs D expressing her dissatisfaction with the carers on many occasions and the reasons for her views.
46. However, I consider the Council was at fault in how it handled Mrs D’s response to the complaint response. Mrs D said on 13 April 2022 that she was unhappy with the response and wanted to talk to the investigator. Mrs E chased this request on several occasions and gave details of Mrs D’s specific concerns in mid-May 2022. The Council failed to acknowledge or respond to this request until we intervened in August 2022. It then spoke to Mrs E in September 2022 but took another month to suggest a telephone discussion between Mrs D and the complaint investigator with only one day’s notice and six months after Mrs D’s initial request. This was fault.
47. The Council should have responded in accordance with its published complaints procedure and decided which route to follow. It should have responded to Mrs D’s concerns within another month and arranged a call with the complaint investigator, offering Mrs D a more in-depth investigation or mediation if appropriate. It left Mrs D in limbo for months which contributed to her feeling that the Council was not listening to her and in turn affected her ability to engage with the care being provided.
48. I also note the Council failed to take any meaningful action after our second intervention in November 2022 leaving Mrs E to contact us again in February 2023, causing three more months of drift and delay. This was further fault which exacerbated Mrs D’s frustration and distress.

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Agreed action

49. In recognition of the injustice caused to Mrs D, I recommended the Council within one month of the date of my final decision:
• Pays Mrs D a total of £500: £300 for the impact of the lack of care and communication between late November 2021 and early February 2022 and £200 for the flawed complaint handling.
50. Within three months:
• Reminds all staff dealing with complaints to respond to dissatisfaction with complaint responses in accordance with its published procedure and to keep complainants informed of progress on a regular basis.
• Reminds all complaint staff to ensure our requests to consider premature complaints through all stages of the complaints procedure are actioned promptly.
51. The Council has agreed to my recommendations and should provide us with evidence it has complied with the above actions.

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Final decision

52. I consider this is a proportionate way of putting right the injustice caused to Mrs D and I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman