The Ombudsman's final decision:
Summary: The Council should have ensured the action plan which it agreed with the care provider Springfield (acting on its behalf) was followed. The Council will now apologise to Mrs A for the anxiety caused by its failure to ensure the care plan was delivered, and offer a sum to recognise her distress.
- Mrs A (as I shall call the complainant) complains that the Council has not properly responded to her concerns about the care service provided to her elderly mother Mrs X.
The Ombudsman’s role and powers
- We have powers to investigate adult social care complaints in both Part 3 and Part 3A of the Local Government Act 1974. Part 3 covers complaints where local councils provide services themselves, or arrange or commission care services from social care providers, even if the council charges the person receiving care for the services. We can by law treat the actions of the care provider as if they were the actions of the council in those cases. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act)
- 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)
How I considered this complaint
- I considered the written information provided by the Council and Mrs A. I spoke to Mrs A. Both Mrs A and the Council had an opportunity to comment on an earlier draft of this statement and I considered their comments before I reached a final decision.
What I found
- The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area.
- Section 27 of the Care Act 2014 gives an expectation that local authorities should conduct a review of a care and support plan at least every 12 months. As well as the duty to keep plans under review generally, the Act puts a duty on the local authority to conduct a review if the adult or a person acting on the adult’s behalf asks for one.
- The Council assessed Mrs X’s needs for care services when she was discharged from hospital after a fall in 2016. Mrs X was also diagnosed with dementia. Her care plan from January 2016 says, “has mild short term memory problems which do affect her ability to recall information and use information provided to make decisions. She is able to understand and make simple decisions but for any more complex issues she requires support which is provided by her daughter (Mrs A). Her retention of information is limited.” The care plan went on to say that Mrs X did not like having carers in her house as she found it intrusive.
- The care and support plan provided for one 20-minute call every morning for carers to offer a strip wash; assist Mrs X with dressing if required; prepare breakfast and help her to eat it; prompt her to take medication with her food, wash pots and empty bins. The care plan noted that previous carers (from the reablement service) had made Mrs X a sandwich for lunch but she had not always eaten it; she was offered help with preparing other meals but refused; the GP had prescribed supplement drinks which she also refused.
- Mrs A complained to the Council in October 2017. She said the carers were not leaving a sandwich lunch as agreed; they had not emptied the bin regularly or washed the dishes; out of date food was being left in the fridge.
- The Council responded to the complaint after a social worker had visited Mrs A and they had looked at the carers’ notes in Mrs X’s house. It partially upheld the complaint as it said there was evidence the care provider had not consistently followed the care plan, although it said some tasks were difficult to complete because of the nature of Mrs X’s dementia. It said the social worker would update and review the care and support plan with the care provider and monitor how it was implemented.
- The Council says, “(Mrs X)’s care plan had been updated following the review in November 2017. The review had been completed as a result of the initial informal complaint. The updated care and support plan does indicate that the concerns had been acted upon, and the new plan had been more personal to (Mrs X).”
- In February 2018 Mrs A complained again. She said the care service had improved for a short time but had deteriorated again. She said she had numerous examples of poor service and quoted an instance when a carer had written in the notes that she had checked the food for out-of-date food and recorded it was “all okay” - Mrs X said there was a salad in the fridge which was nearly out of date at the time of the note, which was still there five days later. The social worker asked if Mrs A had considered changing care providers. Mrs A said she had wanted to maintain continuity but thought her mother should no longer pay for a poor service and she wanted to complain.
- In March Mrs A met representatives of the care provider Springfield, the social worker, the Council’s commissioning officer and the complaints officer. The complaints officer wrote to her on 7 March and agreed there would be more spot checks of the carers at Mrs X’s house; a task list would be drawn up for the carers; a manager from the care provider would contact Mrs A weekly to check if there were outstanding concerns; and the Council would consider Mrs A’s request for reimbursement of fees. Mrs A agreed to remain with this care provider as there were few agencies who offered short calls.
- Mrs X was admitted to hospital shortly after the meeting.
- In May Mrs A complained again – she said the actions agreed at the meeting had not been implemented.
- The Council said it had looked at her concerns about the carers’ time-keeping but found that the length of calls they had logged on the electronic monitoring system were within the parameters of the contract. It said other actions would be reviewed when Mrs X started to receive a service again. It said however if Mrs A had concerns about the “quality of the service provided to your mother and tasks not being performed” she should complain to the care provider direct.
- Mrs A complained to us. She said the carers did not encourage her mother to eat and she had lost weight as a result. She said the carers were supposed to prompt her mother to take her medication but on occasions she had found pills on the floor. She said the bins were not being emptied but were sometimes overflowing. She said the carers were failing to empty the fridge of out-of-date food.
- Mrs A said she had found it very stressful to have to monitor the carers’ actions all the time. She said Springfield had not provided the service which was being paid for and the Council had failed to monitor it properly.
- The Council says it issued an apology and drew up an action plan after the first complaint. It said it had found that the carers were completing the length of calls stipulated and it had directed Mrs A to the care providers’ own complaints procedure about the quality of care. It said it did not think reimbursement of fees was appropriate as there was evidence it had responded appropriately to the complaints, and Mrs A had not chosen to change care providers.
- The Council now accepts that it was not appropriate to direct Mrs A back to the care provider with complaints about the quality of the care. It acknowledges it should have taken better action to monitor the overall quality of care itself.
- Mrs A says the Council’s failure to monitor the poor care properly caused her a considerable amount of stress.
- The Council took action following the first complaints to meet the care provider and draw up an action plan. However, it appears that did not improve the service provided for very long.
- It is not sufficient for the Council to say Mrs A should direct complaints about quality of care to Springfield, and the Council now acknowledges that. The Council arranged the care and remains responsible for its quality. There is evidence that the care plan was not being followed by the care provider. It was not solely for Mrs A to monitor the way in which the care was being delivered to her mother.
- Of particular concern is the failure by carers to raise concerns about Mrs X’s refusal to eat. It was poor practice for the Council simply to say it was “difficult” because of Mrs X’s dementia: other strategies should have been considered.
- Reimbursement of the care charges does not seem appropriate as a way to recognize the failings here: the care provider did provide a service to Mrs X although it was not always of the quality expected or that stipulated by the care plan. The Council should offer some recognition of the injustice caused by its failings, however.
- Within one month of my final decision the Council will apologise to Mrs X and Mrs A for the poor quality of care provided to Mrs X;
- Within one month of my final decision the Council will consider how it can better monitor the success of action plans for improvement in the delivery of care services, and advise the Ombudsman accordingly;
- Within one month of my final decision the Council will offer Mrs X and Mrs A the sum of £500 which recognises its failings in ensuring the care plan was followed, and the additional stress caused to Mrs A by the failure to ensure an improvement in the service.
- There was fault on the part of the Council which caused injustice to Mrs A and Mrs X.
Investigator's decision on behalf of the Ombudsman