The Ombudsman's final decision:
Summary: There is no evidence that the actions of the care provider Step Ahead caused any injustice to Mrs X or her daughter Ms A.
- Ms A (as I shall call the complainant) complains that the care provider invaded her mother’s privacy by taking photographs; failed to work the hours specified and paid for; did not have a care plan; and did not respond to her complaint.
The Ombudsman’s role and powers
- We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
- We have powers to investigate adult social care complaints in both Part 3 and Part 3A of the Local Government Act 1974. Part 3A covers complaints about care bought directly from a care provider by the person who needs it or by a representative, and includes care funded privately or with direct payments under a personal budget. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act)
How I considered this complaint
- I considered the written information provided by both the care provider and Ms A. I spoke to Ms A. Both Ms A and the care provider had an opportunity to comment on an earlier draft of this statement and I considered the comments before I reached a final decision.
What I found
- The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
- The guidance says (in connection with regulation 10) that staff must treat service users with dignity and respect at all times.
- The guidance also says that any complaint received must be investigated and necessary and proportionate action taken in response to any failure identified.
- The care provider’s complaints procedure says “every effort will be made to resolve the complaint and to provide a full response to the complainant within 28 working days”.
- The care provider says “It is standard procedure for Step Ahead to issue the following forms when a service user is referred to us via a third party (as opposed to coming to us directly); Service User Consent forms, Service User Guide Acceptance, Medication Permission Form and a Customer Agreement. All of these had been signed off on by both Step Ahead and (Ms A), on behalf of her mother. All had been agreed upon, detailed the type of care that was to be provided, the terms and conditions of our services and were binding.” Step Ahead has provided the Ombudsman with the signed copies of all these agreements.
- The care provider began providing care for Mrs X in May 2017: her care was funded through Direct Payments made by the Council. Mrs X suffered from poor mobility and short-term memory problems but was deemed to have capacity to make her own decisions about her care. On her behalf Ms A signed the service user consent form which gave the care provider permission to take photographs, video or audio recordings of her for her care file or to provide evidence in any case of abuse.
- Mrs X’s care plan was to provide personal care at morning, afternoon, and evening visits; and to give daily showers every morning. On Tuesdays, Thursdays and Saturdays staff helped her prepare dishes of her choice. Staff helped Mrs X apply prescription creams on her knees in the evening, and helped her to change into her night wear. Staff helped Mrs X with changing her prescribed pain patch once a week and monitored her skin health.
- The care provider says that at the end of March 2018, a carer reported that Mrs X had been very distressed when she visited, refused to eat, and had said that Ms A was mistreating her. The care provider says Ms A had also made complaints about time-keeping and consumption of food. The care provider arranged a meeting with Mrs X and Ms A, and the carers who looked after Mrs X. The care provider said she thought the concerns were resolved at that meeting.
- Ms A says the care provider staff took photographs of Mrs X without her consent, claimed false hours but did not provide a proper service, and did not give Mrs X the food which had been left for her, so wasting a lot of food. She says she sent emails and left messages but without response.
- The care provider says care staff and Ms A continued to make complaints and it was decided to arrange a further meeting but with Mrs X’s social worker present. She says before the meeting could proceed, Ms A made a formal complaint and then terminated the service.
- Ms A emailed the care provider on 27 April 2018. She said she had tried to raise her concerns before but now wanted to make a formal complaint. She said there was no agreed care plan. She said the carers were not spending the full allocation of time with Mrs X. She complained that staff had taken photographs of Mrs X. She said when she provided lists for care staff to follow about food and different routines they complained they were being treated as though they did not know what they were doing.
- The care provider says Ms A called the local manager the same day about the complaints and the manager gave verbal confirmation she had received the complaints, which would be investigated. The care provider says they did not email confirmation of receipt as a result.
- On 30 April Ms A emailed the care provider again. She wrote, “After the problems we keep having regarding my mum's care which you have not responded to and dealt with as expected, I would like to end the calls with effect from tomorrow Tuesday 1 May 2018”.
- Ms A continued to ask for a response to the complaint. On 8 May the care provider contacted Mrs X’s social worker and asked whether they should respond to the complaint now the service had been terminated. The social worker responded that he didn’t know but the care provider might need to resolve the complaint with Ms X as she remained unhappy.
- On 14 May the care provider wrote to Ms A apologising for the delay in responding and explaining that they had been in contact with the social worker. The care provider said they would consider the impact of her concerns on a company-wide basis as Mrs X was no longer a service user.
- Ms A emailed the care provider again on 25 May to say she intended to complain to the Ombudsman as the care provider had failed to address her concerns about falsified hours, and had sent a further invoice.
- The care provider says “If she [Ms A] is able to detail which specific hours have been falsely claimed for we would happily look into this for her and amend the invoice accordingly, however she has never indicated what/when we have falsely claimed for”. She adds (in response to Ms A’s complaints that the carers had taken evidence from the house) that the care files were the possession of the care provider and so were removed when Ms A terminated the contract.
- In respect of the photographs about which Ms A complains, the care provider says, “These photos were not taken with the intent of disgracing her privacy or her dignity but were taken with the express purpose of providing evidence of (Mrs X)’s distress regarding (Ms A). On a different occasion our carers found (Mrs X) not at her house, but at a nearby bus stop without her shoes. Our carers took a photo of this in order to provide (Ms A) with evidence of the incident.”
- Ms A says the care provider would not issue a new care plan even though Mrs X had deteriorated. She says as the care provider removed their files from the house when the contract was terminated she cannot prove her belief that carers were falsifying their hours.
- There was signed consent for the care provider to photograph Mrs X: there is no evidence of fault by the care provider which caused any injustice.
- There was a signed care plan in place from the start of the agreement. The next review by the care provider was scheduled for May 2018 (but Ms A had terminated the contract before then). If there was a significant deterioration in Mrs X’s condition then it was for her social worker to consider a reassessment.
- Ms A has been unable to detail which times she believes were incorrectly claimed for. It was not fault for the care provider to remove their files form Mrs X’s home once the contract was terminated.
- The care provider began to investigate the formal complaint but could not do so properly within the time scale set by Ms A before she terminated the contract. Attempts had been made to resolve the complaints informally already.
- There is no evidence that the actions of the care provider caused any injustice to Mrs X.
Investigator's decision on behalf of the Ombudsman