Royal Borough of Windsor and Maidenhead Council (18 002 106)

Category : Adult care services > Domiciliary care

Decision : Upheld

Decision date : 04 Jun 2019

The Ombudsman's final decision:

Summary: Mr C complained about the home care support his sister received. He said carers were often turning up late or not at all. The Ombudsman found fault with regards to the support his sister received. The Council has agreed to provide an apology, pay a financial remedy to Mr C’s sister and his mother, and ensure the lessons learned are shared with relevant staff.

The complaint

  1. The complainant, whom I shall call Mr C, complained to us on behalf of his sister and her family. Mr C complained about the homecare suppport his sister received (whom I shall call Ms X) between July 2017 and July 2018. In particular: carers were either arriving late or not at all, as a result of which his mother (and sometimes his other sister) had to provide the care support.

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The Ombudsman’s role and powers

  1. 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)
  2. 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)

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How I considered this complaint

  1. I considered the information I received from Mr C and the Council. I also interviewed a staff member of Optalis.
  2. The care agency who provided the actual care (Care Watch) was only able to provide care records from 2018; they were unable to retrieve care records from 2017.
  3. I shared a copy of my draft decision statement with all stakeholders and considered any comments I received, before I made my final decision.

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What I found

  1. The Council has a contract with Optalis, which is a company who the Council has commissioned to provide adult social care on the Council’s behalf. Optalis is, amongst others, responsible for carrying out needs assessments, arranging care support and overseeing the quality of the support provided.
  2. Mr C’s mother, whom I shall call Mrs M, lives together with Ms X and her other daughter. Ms X previously received homecare support from two Personal Assistants (PAs), through a Direct Payment. However, one of the PAs left in November 2016 and the other one in January 2017. Since then, her care support has been provided via a care agency. Ms X attends a day centre five days a week, where she receives one to one support. This aspect of her care is jointly funded with the NHS.
  3. In the morning, Ms X needs one hour of support by two carers, to ensure she is ready on time for the transport to take her to the day centre. The carers need to provide support with personal care and hoisting. As such, it is very important that both carers arrive on time. If carers arrive too late in the morning, it means Ms X’s mother and her sister need to do the work instead, to ensure Ms X is not late for her transport.
  4. In the afternoon, when Ms X returns from the day centre, two carers need to help her with hoisting, having a shower and other personal care. If carers arrive late, it would mean there would be a delay in changing her wet pad, cleaning her, making her comfortable and ensuring she eats on time. This would cause Ms X distress and becoming agitated.
  5. The first homecare agency started in January 2017. However, the Council told me the care agency terminated its support in June 2017, after Mrs M had made several complaints. The package was then handed over to the Council’s commissioned Home Care Provider “Care Watch”.
  6. Mr C and his family are unhappy about the care that was provided by Care Watch. Mr C says:
    • Too often, one or both carers arrived late, only one carer arrived, or no carer at all. This meant his mother (and sometimes his sister) had to help with completing the tasks.
    • The family repeatedly asked the Council to switch the care package to another care agency. However, it failed to this for a long time, despite acknowledging and apologising on several occasions about the poor quality of the care his sister was receiving.
  7. In July 2017, Mrs M complained to the social worker, that she was not receiving the relief support she needed. Although the carers were doing a great job, their timings were not good. She said:
    • Carers were arriving late and did often not arrive at the same time.
    • Carers regularly changed, and she does not know who would come.
    • She would give the care agency two weeks to improve.
  8. The social worker discussed the concerns with Care Watch. However, Mrs M called the social worker again in August 2017 to complain that things had not improved. As such, Mrs M asked the social worker to change her care agency. The social worker organised a meeting with Mrs M and the care provider to discuss her concerns. At the meeting, Mrs M also asked for additional relief support on Saturday afternoons. Mrs M said she wanted this additional support to be provided by Care Watch, because her daughter was used to the carers. This indicates that Mrs M had changed her mind, at that time, about switching care provider.
  9. However, Mrs M complained again to the social worker in September 2017. She said things had not improved and she wanted a change in care provider. At the interview, Optalis told me that: if a client wants to change care provider, its social worker has to:
    • Ask the client if they would like to have a direct payment. This will enable the client to recruit their own PA to provide the support.
    • Ask the Optalis Care Brokerage Team to ask Care Watch if any of the other five care agencies can take on the care package.
    • If the other five care agencies are unable to take over the care package, the Brokerage Team needs to get permission to go ‘off contract’; find a care agency that is different to Care Watch or the other five care agencies it can sub-contract.
  10. The social worker told Mrs M the following day, that:
    • Care Watch would not be able to provide carers to cover support on Saturdays. Mrs M had not accepted an offer for Ms X to try overnight respite care stays at the weekend.
    • Care Watch admitted they have failed in their proposed support, due to a shortage of carers, which they are trying to resolve.
    • Mrs M did not want to have a PA through a Direct Payment again.
    • She (the social worker) did not have any other means of ensuring that Ms X’s could continue to be supported at home.
    • If she was unhappy with her actions, she could make a complaint to the Council.
  11. Mrs M did not find overnight respite care for Ms X a suitable solution, because this was only available on some weekends and had to be booked in advance.
  12. Mrs M remained unhappy with the care she received and made a complaint to Care Watch. In response, Care Watch said at the end of October 2017 that:
    • The carers have been told to be on time and inform Mrs M when they will be late.
    • Coordinators will ensure that any agency care workers will be fully informed about the care they have to provide, before their visit.
    • Ms X has three regular care workers and four that change. Care Watch was trying to recruit an additional 30 carers before Christmas.
  13. The social worker arranged a placement for Ms X on Saturdays at a day care centre, which started in December 2017. The Council says this took longer than expected, because it took some time to receive the additional funding from the NHS.
  14. Mrs M told the social worker in November 2017, that she did not feel that changing the care agency was needed at this stage, because her daughter had become acquainted to her current carers. The two regular carers were good at their job. However, the two of them were not enough and she would need additional care staff.
  15. Mrs M reported on 18 January 2018, that her relationship with the Care Agency had broken down. The social worker subsequently contacted the Brokerage Team to say Mrs M wanted a different care agency. The Brokerage Team contacted Care Watch. When Care Watch is unable to provide the support, they can sub-contract a care package to five other care agencies. However, none of them covered the area where Ms X lived. Despite a further meeting between the social worker and Care Watch, things did not improve.
  16. Mrs M received a letter from Optalis’ Head of Statutory Services in May 2018. It said that, taking things into account, the Placement Team would be asked to approach alternative care providers (other than Care Watch and its five sub-contractors), to meet Ms X’s needs. The Placements Team would contact Mrs M to discuss this further.
  17. However, I have not seen evidence the Placement Team carried this out immediately. Even though permission had already been given (see paragraph above), a record from 26 June 2018 said the Brokerage Team: would need to get permission to go "off contract". It took until 3 July 2018, before Optalis contacted the first alternative care provider; Heritage Healthcare (an alternative provider the family liked). Heritage Healthcare said that, due to capacity issues, it would take three to four weeks until the care package could start. Other agencies were unable to take on the package.
  18. It took until mid-September 2018, before Heritage Healthcare could start the care support. Mr C told me the new provider has been reliable and knows what they are doing. However, Optalis has told me the care agency had to give notice in February 2019, because Mrs M did not allow certain care workers to come anymore. As a result, the agency did not have enough carers left to provide the support needed.
  19. According to the care records, between July 2017 and July 2018:
    • AM visits:
        1. Around 160 of 240 visits that took place had both carers arriving on time.
        2. At 15 visits both carers were late by around 15 minutes
        3. During 50 visits, only one carer attended, which meant Mrs M had to assist.
        4. At 10 visits one of the carers arrived 15 minutes or more late
    • PM visits:
        1. Both carers arrived on time at only 60 of 230 visits.
        2. Both carers were late by about 15 minutes on almost 30 occasions. On 7 times, they were both late by 30 minutes or more.
        3. At 100 visits only one carer arrived.
  20. Care Watch has said that:
    • It accepts that things had not been perfect. This was mainly due to a shortage of carers, which they tried to resolve.
    • The agency had prioritised this care package. Mrs M had very high standards and was very particular about carers arriving on time.
    • Some care workers felt that Mrs M did not treat them fairly and that she was rude to them. As such, some care workers refused to remain part of Ms X’s rota.
  21. Optalis told me that:
    • It has learned lessons from this case. In future, it will ensure there is better communication between the team that was involved, and the brokerage team. In addition, social worker will ensure they make notes of important (telephone) conversations and confirm actions by email. Staff will be reminded of the importance of record keeping in the social worker forum and supervisions.
    • There was a lack of clarity about the process that needed to be followed, and what each one would have to do, when trying to change care agency. The relationship between social workers and the Brokerage Team is now much clearer. There is more joint working and better communication.
    • Records did not properly reflect what happened on the case; there were gaps in record keeping and evidencing what had been done.
  22. Mrs M says that:
    • Carers arriving late, or not at all, meant she had to complete / carry out the care tasks instead, sometimes with her other daughter. This was distressing and frustrating.
    • It also resulted in distress to Ms X.
    • To solve the shortage of staff, Care Watch tried to involve carers from the five other care agencies. However, new care workers did not understand what support they had to provide or how to provide this (for instance hoisting).

Assessment

  1. Despite Mrs M’s repeatedly saying, between September and November 2017, that she was unhappy with the care provider and wanted it to be changed, the social worker failed to progress this through the steps identified in paragraph 15 above.
  2. Mrs M asked in August 2017 for additional support on Saturdays. However, there was a delay in providing this. Care Watch did not have enough care workers to cover this additional shift and it took until December 2017 before Ms C started to attend a day time respite centre on Saturdays. Ms X was offered an interim solution (overnight respite), which probably would only have been able to offer respite for Mrs M during some weekends. However, the family did not take up this offer at the time.
  3. In January 2018, Mrs M said again that she wanted to change care provider. However, until May 2018, Optalis only tried to move the package to any of the other five care agencies that Care Watch had a contract with. It failed to decide to go ‘off contract’’, even though Care Watch repeatedly indicated that none of its agencies could take on the package. It took until July 2018 before Optalis contacted an alternative “off contract” care agency. However, the family’s preferred agency could only start the support in September 2018.
  4. Care Watch, Optalis and the Council have all accepted that the care support Ms X received should have been better. According to the records, between July 2017 and July 2018
    • Only 67% of visits in the morning were carried out on time by two care workers.
    • 20% of the morning visits (54) were carried out by only one carer and in another 10% of all visits (25) one or both carers were late by 15 minutes. In these instances, Mrs M (and occasionally her other daughter) had to step into provide (part of) the support
    • In only 25% of all afternoon visits, both carers arrived on time. In 10% of the afternoon visits (35), both carers were late by about 15 minutes.
    • However, in almost half of the visits (102) only one carer arrived.
  5. In this specific care package, it was very important that carers arrived on time in the morning; any delay could result in Ms X missing her transport to her day care centre. With regards to the morning visits, the impact of the above was mainly on Mrs M who had to continue to regularly assist with providing Ms X’s care.
  6. With regards to the afternoon visits, the impact was mainly on Mrs M (as she had to assist on many occasions) and on Ms X (who had to wait before any wet pads could be changed and she could be cleaned/showered).

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Agreed action

  1. I recommended that, within four weeks of my decision, the Council should:
    • Provide an apology to Ms X, Mrs Y, her other daughter and Mr C, for the impact and distress the faults above have caused them.
    • Pay an amount of £500 to Ms X and an amount of £1,750 to Mrs M.
    • Ensure that Optalis has shared the lessons learned with all its social workers, including: reconfirming the process that social workers need to follow when a client wants to change care provider and the importance of recording all actions.
  2. The Council has told me it has accepted my recommendations.

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Final decision

  1. For reasons explained above, I decided to uphold the complaint. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.
  2. Under the terms of our Memorandum of Understanding with the Care Quality Commission, I have sent it a copy of my final decision statement.

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Investigator's decision on behalf of the Ombudsman

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