Summary: Mr X complains Key2Support failed to care properly for his mother, Mrs Y, putting her at risk of harm. Mrs Y was often left waiting for Care Workers to arrive, unable to get up or take her medication. Key2Support also sent a Care Worker with COVID-19 symptoms, despite agreeing this should not happen. It needs to apologise, pay financial redress and prevent similar problems from happening again.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains Key2Support failed to care properly for his mother, putting her at risk of harm.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(4), as amended)

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How I considered this complaint

3. I have:
• considered the complaint and the documents provided by Mr X;
• discussed the complaint with Mr X;
• considered the documents Key2Support has provided; and
• shared a draft of this statement with Mr X, Lancashire County Council (the Council) and Key2Support, and taken account of the comments received.

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What I found

Key facts

4. Mr X’s mother, Mrs Y, cannot walk and has limited mobility in her shoulders. She uses a wheelchair to get around and has a hoist for transfers. She has a car for accessing the community but needs someone to drive it for her. She receives direct payments from the Council to meet her eligible needs for care and support. She was using them to help pay Key2Support to meet her needs.
5. Key2Support produced a care and support plan for Mrs Y in February 2018. It said she “likes to go out every day for dinner, shopping”. It also said it was important to Mrs Y that people turn up on time. It listed her medication, which included morphine for pain relief.
6. By July 2020 Care Workers were scheduled to visit:
• Mondays to Fridays – 6 hours from 08.00 – 30 minutes at 16.30 – 1 hour at 22.00
• Saturdays / Sundays – 4 hours from 08.00 – 30 minutes at 16.30 – 1 hour at 22.00
7. According to the records of their visits between July and September 2020, the Care Workers helped with:
• Mornings – getting up, washing, dressing, toileting, preparing meals, cleaning and other domestic tasks, shopping when needed, medication and accessing the community (rarely)
• Tea-time – preparing a meal, tidying up and medication
• Bed-time – preparing a meal, washing up, medication, toileting, undressing and getting to bed
8. On 28 July Care Worker B, who was wearing a mask, told Mrs Y she had flu. Mrs Y said she did not want her in her home. Mrs Y called Key2Support which asked to speak to Care Worker B using Mrs Y’s phone and advised her to do some housework downstairs. According to the records, Care Worker B checked Mrs Y’s blood sugars and gave Mrs Y her medication. Mrs Y asked Care Worker B to do this because she was in pain. Care Worker B also prepared breakfast, washed up, took food out of the freezer for dinner and did other household tasks. She left after an hour and a half. Care Worker C arrived about 15 minutes later to help Mrs Y with personal care and left after an hour and 15 minutes.
9. Mrs Y’s family called Key2Support that evening to complain that Care Worker B had visited her while having COVID-19 symptoms and Key2Support had not told her to self-isolate and to get tested. Key2Support said Mrs Y’s main Care Workers had not been available so it had no one else to send.
10. On 2 August Mrs Y’s family called Key2Support to complain that Care Worker B was scheduled to visit Mrs Y the next morning. Key2Support agreed Care Worker B should not be in work until she had received a negative COVID-19 test result.
11. However, on 3 August Care Worker B went to visit Mrs Y at 08.29. Mrs Y said she didn’t want her to visit until she had a negative test for COVID-19. Mrs Y told her family Care Worker B was not wearing PPE (personal protective equipment). Nevertheless, Care Worker B gave Mrs Y her medication, checked her blood sugar level and stopped with her for an hour. Key2Support suggested Care Worker B do some housework. Another Care Worker arrived at 09.44 and gave Mrs Y her breakfast and stayed with her until 10.55.
12. Mr X complained to Key2Support.
13. When Key2Support replied on 5 August, it said:
• it accepted there had been problems since April 2020, when Mrs Y’s main Care Worker had left, as it had been unable to recruit a replacement who could drive;
• it put the problems down to COVID-19;
• it accepted Care Workers had twice arrived much later than scheduled in the mornings and put this down to staff phoning in sick, no longer having floating Care Workers and the need to provide people who understood Mrs Y’s needs;
• it could find no evidence of missed calls but had offered extra support and answered Mrs Y's lifeline when she had pressed it;
• it accepted there had been disagreements between Care Workers over issues such as cleaning, which it had tried to resolve but, nevertheless, one Care Worker had left;
• it accepted a Care Worker had once eaten a slice of Mrs Y’s bread without asking and had wiped her face with a tea-towel;
• Mrs Y had asked her Care Workers not to wear PPE but it had told them not to comply with such requests;
• Mrs Y had confirmed that she had “no issues” and felt safe while being supported;
• Care Worker B did not have COVID-19 symptoms (cough or high temperature) but a cold or hay fever (runny nose), and subsequently tested negative for COVID-19; and
• it had arranged cover for Care Worker B and removed her work “as a precautionary measure”.
14. Mr X raised his concerns with the Care Quality Commission, which passed them on to the Council to consider as safeguarding concerns. The Council partially upheld the safeguarding concerns.
15. Key2Support terminated its support for Mrs Y. It told the Council of its decision but not Mrs Y. It says it did this because the Council was indirectly funding her care (i.e. by direct payments). Mrs Y only learned of this when no Care Workers’ names appeared on the schedule of visits Key2Support sent to her. Key2Support’s last visit to Mrs Y was in the evening of 18 September. Mr X arranged for another care provider to meet his mother’s needs from 19 September.
16. Mr X continued to pursue his complaint with Key2Support and his mother refused to pay the final invoice. In October Key2Support apologised and agreed to pay Mrs Y for the cost of the food a Care Worker had taken from her. Mr X then confirmed they were no longer disputing the billing and his mother would pay the final invoice.
17. Key2Support has provided the records of the Care Workers’ visits from 1 July to 18 September. There were no significant problems with the tea-time or night-time calls. There were also some unscheduled calls to help Mrs Y with continence issues. However, the average length of the morning calls was 57 minutes less than they should have been. There are no records for five of the scheduled morning calls. It appears that on six occasions Care Workers failed to log in when they arrived in the morning, so it is not possible to say how long those calls lasted. Half of the morning visits started more than 30 minutes later than scheduled. A third were over an hour late.

Did the care provider’s actions cause injustice?

18. Key2Support was unable to fulfil Mrs Y’s care package, resulting in a significant number of morning calls which were late and, on average, much shorter than agreed. It will have been distressing for Mrs Y waiting for Care Workers to arrive in the morning to help her get up and giver her medication, which included pain relief. It also meant she could not access the community as much as she would have wanted. Key2Support has put the problems down to COVID-19 and Care Workers being off sick or self-isolating with little or no notice, the need for Care Workers who were familiar with Mrs Y and the difficulty in recruiting someone who could drive Mrs Y’s adapted vehicle.
19. When it knew it could not meet Mrs Y’s needs in the way that had been agreed, Key2Support should have reviewed her support plan. This would have helped to manage expectations and identify how to meet Mrs Y’s priority needs and minimise any distress to her caused by the problems arising from COVID-19.
20. Key2Support did not have robust arrangements in place to make sure its Care Workers self-isolated when they had possible symptoms of COVID-19. Despite agreeing Care Worker B should not be visiting people it still sent her to visit Mrs Y again before she had a negative test result. It has tried to justify this by saying she did not have COVID-19 symptoms, but that was clearly not the case. This put Mrs Y, and possibly others, at risk of harm. Fortunately Care Worker B tested negative for COVID-19.
21. Key2Support did not give Mrs Y proper notice of its decision to terminate her contract, causing further avoidable distress. It did not have a contract with the Council for her care so there was no reason to tell the Council of its decision. It should have advised Mrs Y to contact the Council if she wanted any help in sourcing another care provider, or seek her consent to do so on her behalf.

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Recommended action

22. Key2Support has written to Mrs Y apologising for the failure to meet all her care needs properly and pays her £500 to remedy the injustice caused by its failings, as I recommended.
23. I also recommend Key2Support produces an action plan within eight weeks aimed at ensuring:
1. it gives notice for terminating contracts to the correct person; and
2. it reviews care packages when it has problems delivering them.
24. Under the terms of our Memorandum of Understanding and information sharing protocol with the Care Quality Commission, I will send it a copy of my final decision.

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Final decision

25. I have completed my investigation on the basis that Key2Support has taken action to remedy the injustice it has caused Mrs Y and will take action to prevent similar problems from happening again.

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Investigator's decision on behalf of the Ombudsman