The Ombudsman's final decision:
Summary: Ms X complains Bluebird Care provided a carer with no experience of working with people with Alzheimer’s, who was unable to meet her father’s needs and did not complete the household chores associated with her father’s needs. Bluebird care has been unable to adequately evidence the care provided to Ms X’s father. The failure to maintain detailed care records for Mr Y from 19 to 22 September 2016 which demonstrate Carer 1 provided the agreed care and support to Mr Y amounts to fault. As does Bluebird Care’s failure to respond to Ms X’s complaint. These faults have caused an injustice.
- The complainant, whom I shall refer to as Ms X complains Bluebird Care failed to provide a carer with experience of working with people with Alzheimer’s and dementia. She states the carer’s inexperience meant he was unable to meet her father’s care needs. Ms X also complains the carer did not complete the household chores associated with her father’s care. She asserts the family should not have to pay for the four days when he did not provide the agreed care and support.
- In addition Ms X complains Bluebird Care failed to respond appropriately to her complaint.
The Ombudsman’s role and powers
- 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 34H(3) and (4), as amended)
- If we are satisfied with a care provider’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)
- Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC
How I considered this complaint
- As part of the investigation, I have:
- considered the complaint and the documents provided by Ms X;
- made enquiries of the care provider and considered the comments and documents the care provider provided;
- discussed the issues with Ms X;
- sent a statement setting out my draft decision to Ms X and the care provider and invited their comments. I have considered their responses.
What I found
- Ms X’s father, Mr Y has been diagnosed with Alzheimer’s. So that he could continue to live at home with Mrs Y, the family arranged for Bluebird Care to provide a care package. The care plan states the carer will support Mr Y with his personal care, visits to the toilet and meals daily and support him on a weekly basis with household chores.
- The service began in November 2015, and Bluebird Care initially provided a live-in carer. This changed in March 2016, but the live-in service resumed in July 2016. Bluebird Care used a number of carers to provide this live in service.
- The complaint relates to the service provided by Carer 1, who supported Mr Y from 19 to 22 September 2016. Ms X complains Carer 1 was inexperienced in dealing with people with Alzheimer’s or dementia and was unable to support Mr Y’s needs. She states Carer 1 told Mrs Y on 20 September 2016 he could not provide Mr Y’s care and wanted to leave. Ms X also complains Carer 1 refused to carry out the household chores set out in the care plan.
- As a result, Mrs Y had to support Mr Y with his care needs. Mrs Y has her own health concerns and was recovering from surgery at the time. Having to assist Mr Y and carry out the household chores had a detrimental impact on Mrs Y’s health.
- Bluebird Care arranged for another live-in carer, Carer 2 to take over the service on 23 September 2016. Bluebird Care subsequently advised the family that given Mr Y’s aggressive behaviour, it would need to increase the care package to ensure its staff safety. Bluebird Care suggested there should be a second carer present when providing Mr Y’s personal care.
- Ms X contacted Bluebird Care on 26 September 2016 to raise concerns about Carer 1. This email is not headed as a complaint, but sets out the issues she is unhappy with. It also states the family wishes to contest Bluebird Care's charges for the period Carer 1 was there as he did nothing to assist Mr Y, and admitted to Mrs Y that he had worked with the elderly but not people with Mr Y’s condition. Ms X also sent photographs showing unwashed dishes and dirty gloves and sanitary items that Carer 1 had not disposed of.
- Bluebird Care acknowledged Ms X’s emails the same day and apologised that Carer 1 did not appear to have met the standards of service they would expect. It confirmed the registered manger would investigate Ms X’s concerns, take any action necessary and respond formally. It also explained why it wanted to increase the care package and the increase cost of this.
- The registered manager contacted Ms X later that day to check whether Ms X would agree to the increase care package. This email did not refer to Ms X’s concerns about the level of support provided by Carer 1. Ms X did not agree to this increase so Bluebird Care ended the service on 26 September 2016.
- Ms X states Bluebird Care have not responded to her complaint. The only correspondence the family has received relates to the charges for Mr Y’s care. The family have paid all charges save for the period when Carer 1 was the live-in carer. As these fees remain outstanding Bluebird Care have instructed recovery agents.
- Ms X has asked the Ombudsman to investigate her complaint. Ms X is also concerned that Bluebird Care have shared her father’s confidential information with the recovery agents. She has received an email from the agent which states:
“The delay in replying was caused by my waiting for, then reading, a substantial and at times distressing file.
I should first say that I am acutely and personally aware of how very difficult your family's position must be with your parents' suffering in different ways.”
- In response to my enquiries Bluebird Care states it has not received a formal complaint from Ms X. It considered Ms X’s email of 26 September 2016 was an attempt not to pay for a service received and that it should focus on the safety of its staff in delivering the care package.
- In terms of Carer 1’s experience, Bluebird Care states he was specifically recruited with Mr X’s care package in mind. Carer 1 was experienced in the role of a carer having worked with elderly customers with dementia, Multiple Sclerosis, and Parkinsons. This was Carer 1’s first assignment for Bluebird Care but he had completed full induction training which included basic Dementia Refresher training.
- Bluebird Care has provided copies of Carer 1’s care notes for the period he was supporting Mr Y. It states the notes are of poor quality in terms of layout and description, but this is typical of a carer during the probation period. This would have been picked up and corrected during the first week supervision.
- The notes are dated 20 and 21 September 2016. There are no records for the 19 or 22 September 2016. The notes of 20 September 2016 state Mr Y initially refused to get up but was prompted to get up and have a shower. Carer 1 helped with Mr Y’s personal care. Mr Y then had breakfast and rested before going to the day centre. Between 10am and 12pm Carer 1 records that he cleaned and tidied the home. He then went shopping between 12 and 2pm. When Mr X returned home from the day centre Carer 1 records he was aggressive.
- On 21 September 2016 Carer 1 records that Mr Y was aggressive when he assisted him to get up in the morning. Mr Y went to the day centre at 9:30 am and returned at 4pm. The records do not state what Carer 1 did during this period. Carer 1 records that on returning from the day centre Mr X was again aggressive.
- Bluebird Care has also provided copies of Carer 2’s case notes. These notes are much more detailed in terms of support provided and the household chores completed.
- In response to the draft decision Bluebird Care has also provided recordings of telephone calls between its staff and Ms X, her sister (Ms Z), and with Carer 1. The calls show Carer 1 advised a Customer service manager (Officer 1) on 21 September 2016 that Mr Y had been aggressive towards him and that he could not carry out his personal care alone. Carer 1 confirmed Mrs Y had to assist him with Mr Y’s care. Carer 1 did not feel he could provide the care alone and that the family would prefer someone different.
- Officer 1 then contacted Ms X to discuss Carer 1’s concerns. Ms X suggested Mr Y did not like Carer 1. He was not normally violent, and she was surprised by his actions. She also said Carer 1 had told Mrs Y that he did not think he could do the job. Officer 1 agreed to look for a replacement carer.
- On 22 September 2016 Officer 1 advised Ms Z they had arranged for a carer to attend that evening, but could not arrange for anyone to attend the following morning. Ms Z expressed her concerns about Carer 1’s service and Mrs Y having to provide Mr Y’s care. Officer 1 confirmed they would speak to their manager to see what could be done financially. They apologised and said Carer 1 had come to them with glowing references and experience, but for whatever reason could not do it.
- There were a number of telephone calls between Officer 1 and Ms Z on 26 September 2016. These related to the need to have a second carer present during Mr Y’s personal care, given his recent violent behaviour. The family were unable to afford this and Ms Z suggested it would not be necessary if Bluebird Care provided suitably qualified and experienced carers. Officer 1 disagreed, and Bluebird Care withdrew its service.
- There is also a recording of a call between Officer 1 and Carer 1 on 26 September 2016 to discuss the placement. Carer 1 denied telling Mrs Y he could not cope with Mr Y or that he had not worked with people with dementia. This was a different type of service to what he had experienced and he did not have experience of working with violent people on a one to one basis. Carer 1 said he had not agreed to Mrs Y’s suggestion to use force to hold Mr Y’s hands tightly when he became violent.
- In addition Carer 1 said he had completed the agreed domestic chores for Mr Y, but had not washed the rest of the families dishes. He had tried to keep the bathroom clean, but the family had not provided sufficient or appropriate products, such as bin liners.
- These recordings are automatically collected on Bluebird Care’s telephone system and do not form part of a customer’s care record. Bluebird Care do not tell customers the calls are being recorded and they have asked that the recordings are not shared with Ms X.
- There is no evidence to suggest Carer 1 would be unsuitable for the role as Mr Y’s live in carer. Carer 1’s employment profile shows that he has experience of working with people with dementia. He also satisfied the preferences Ms X and the family had expressed for live-in carers.
- There are differing accounts of what Carer 1 advised Mrs Y about his experience of working with people with dementia. As there are only references to, but no record of this actual conversation I am unable to confirm what was said or the context. Bluebird Care has now provided recordings of telephone calls detailing Carer 1’s concerns about the placement and his ability to carry out the care package. And its subsequent discussion with Ms X and Ms Y. These confirm there were concerns about whether and how Mr Y’s needs were being met.
- As these phone calls directly relate to Mr Y’s care I would expect to see reference to/ notes of the calls in his care records so that the information is available to all those involved in his care. It is not sufficient that they are stored on the Bluebird Care’s telephone system and not linked to the customer.
- Carer 1’s records of the support he provided Mr Y are inadequate. This may have been Carer 1’s first assignment with Bluebird Care, but as an experienced carer he should have been aware of the need for detailed care notes. Further if Bluebird Care have identified poor record keeping is a common problem with new employees, this should be addressed in their induction process.
- Bluebird Care highlight that it has not charged Mr Y for four full days care. The fees are from 12 noon on 19 September when Carer 1 arrived, to 9:30 am on 22 September 2016 when he left. The invoice provided claims for 10 hours on 19th September and 9:30 hours on 22nd September. I would expect to see records of the care and support provided during these periods. But there are none. This is clearly inadequate.
- Bluebird Care has suggested Mr Y may not have needed care on the morning of 22 May 2016. But the call records confirm Officer 1 advised Carer 1 he could leave that morning, when Mr Y went to the day centre. Mr X would have needed personal care and support to get ready for the day centre on 22 September 2016. If Carer 1 provided this care, there should be a record.
- The failure to have detailed care notes, formal records of any concerns Carer 1 or the family raised, or Carer 1’s request to leave amount to fault.
- In the absence of clear, complete care records we cannot be satisfied that Carer 1 provided Mr Y with the care and support set out in his care plan for the period in question. Particularly given Carer 1’s reports that he had had to ask Mrs Y for assistance. Carer 1 may have provided some care and support during this period, but the burden of meeting any shortfall in service will have fallen on Mrs Y.
- Bluebird Care has since updated its care management system for live-in carers which has improved the monitoring of visits, tasks and care notes.
- Ms X’s email of 26 September 2016 may not be headed as a formal complaint, but it is clear from the content that she is complaining about the level of support Carer 1 provided. As Bluebird Care acknowledge Ms X’s concerns about the standard of service and advise her it would investigate the matter and get back to her, it would be reasonable to assume it is treating the matter as a complaint.
- Clearly where changes to the service are needed it is appropriate to raise them. But discussions about changes to the future provision of services, or the termination of the service do not absolve a care provider of the need to address the issues raised about past care.
- Bluebird Care’s failure to investigate or respond to Ms X’s complaint is fault. This has led to frustration and anxiety and put Ms X to unnecessary time and trouble. Had Bluebird Care responded to Ms X’s complaint in a timely manner it is possible the issue of outstanding fees could have been resolved without the involvement of recovery action.
- As Bluebird Care is unable to demonstrate it provided the agreed level of care and support for 19 to 22 September 2016, I recommend it waive 50% of these fees plus any additional costs incurred as a result of the recovery action. This would leave a balance of £201.09. This should be done within one month of the final decision.
- I also recommend Bluebird Care apologises and pays Ms X £200 in recognition of the unnecessary time and trouble she has been put to by its failure to respond to her complaint. This payment should be made within one month of the final decision.
- Bluebird Care’s failure to maintain detailed care records for Mr Y from 19 to 22 September 2016 which demonstrate Carer 1 provided the agreed care and support to Mr Y amounts to fault. In the absence of complete care records we cannot be satisfied Carer 1 provided Mr Y with the care and support set out in his care plan. Bluebird Care’s failure to respond to Ms X’s complaint also amounts to fault. These faults have caused an injustice.
Investigator's decision on behalf of the Ombudsman