Summary: Mrs X complains about the level of care provided to her father and, in particular, frequently missed visits. The care provider is at fault for missing calls. The caused avoidable distress to family members. It has agreed to pay Mrs X £250 for the avoidable distress caused and to waive outstanding fees of £181.

The complaint

1. Mrs X complains about the care provided to her father, Mr F, and particularly about a large number of missed visits. She says this caused distress and inconvenience to family members, who had to provide extra help for Mr F at little or no notice. She also complained the care provider did not respond to her complaint.

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The Ombudsman’s role and powers

2. 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)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. 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)
5. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

7. I spoke to Mrs X and considered the information she provided. I considered the care provider’s replies to my enquiries. I considered the information provided by the local council where Mr F lives. I considered relevant law and guidance as set out below and our guidance on remedies.
8. I gave the Mrs X and care provider the opportunity to comment on my draft decision. I considered their comments before making my final decision.

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What I found

9. The Care Quality Commission (CQC) regulates care providers. It’s “fundamental standards” set out the basic requirements for care providers, including regulation 9, which says people should have care tailored to their needs and regulation 16, which says all care providers must have an effective complaints handling process.
10. This care provider’s complaints policy says it will log the complaint and refer it to a manager, who will:
• contact the person complaining;
• send an acknowledgement within 3 working days;
• investigate the complaint; and
• respond in writing within 20 working days.

If it is not possible to respond within 20 working days the manager will send a “holding letter” every 7 days until a formal response is sent.

What happened

11. Mr F has dementia. Mr F cannot manage any of his personal care needs. He lives at home with his wife, Mrs F, who also has health issues and is no longer able to care for him. His daughter, Mrs X, engaged the care provider to provide care at home from early September 2017. Initially it provided a sitting service two mornings a week but over time additional calls were added. From December 2017, the care provider made an evening call daily to get Mr F ready for bed. From late March 2018, a lunch-time call was added and from mid May, a morning call was added at weekends to help Mr F with his personal care.
12. Mrs X says problems first occurred around April 2018. She says there was a change in management and the service deteriorated significantly.

Missed calls

13. Mrs X has provided details of calls missed, which show 50 missed calls between January and September 2018. She says this is not a complete list. She says initially the care provider would tell her or her sister in advance if it could not make the scheduled call. But later the care provider did not always inform them. She says the care provider told her it did not need to do this because it did not consider Mr F was vulnerable.
14. The care provider accepts calls were missed and agrees the support was not “at an acceptable level”. It says it offered to give notice to stop the contract in August 2018 but the family was unable to find an alternative care provider. It agrees Mr F was vulnerable. It says this is why a manager worked closely with the family to cover as many calls as it could. It tried to recruit carers to cover more calls but it was difficult to find carers and Mr F did not accept some of the new carers.
15. I have reviewed the daily records for the period December 2017 to November 2018. I have identified 56 days on which one or more calls were missed in that period. I have no information about when the care provider told the family in advance it could not make the call. I also note that on some occasions Mr F was verbally or physically aggressive towards his carers, particularly when they were carrying out personal care. I understand Mr F was prescribed medication that did reduce the aggression.
16. Mrs X said a safeguarding referral was made to the local council where Mr F lives due to concerns about the level of care provided. I have asked the local council about the referral and have seen its safeguarding records. The local council made enquiries with the family and with the care provider. It found the care provider was having difficulty fulfilling the contract because some carers refused to care for Mr F because he could sometimes be aggressive and other carers were not acceptable to the family. It found no evidence of poor care when carers attended and decided Mr F was not at risk. It considered whether it could commission care for Mr F but the family were not satisfied its proposals would meet the family’s needs so this was not progressed.

Dementia care

17. Mrs X says the staff who visited did not appear to have sufficient training to care for those with dementia and did not know how to support Mr F. She says one carer, carer 1, was constantly complaining about what he was expected to do and walked out on one occasion. She says he rushed the personal care, which led to Mr F becoming agitated. She says another carer, carer 2, told her mother Mr F should go into a care home. On another occasion, the care provider wanted Mrs X to leave work to change Mr F’s soiled pad.
18. The care provider says all carers receive Skills for Care Training, which includes dementia training. I have seen an outline of the course contents. The care provider says further training is available but it is not clear how many of Mr F’s carers had received further training.
19. The daily notes show carer 1 walked out on a lunch time call on 30 June 2018, after Mr F had “smacked” the carer around the head. I note one of the daughters helped Mr F with his personal care that evening as it was unclear whether a carer would attend. There is no record of a carer attending that day.
20. The complaint records show on 3 August 2018 carer 2 was providing personal care when Mr F poked him, following which he said he would report the matter to the office and left without changing the soiled bed cover. The daily record states Mr F had hit the carer in his “privates”.
21. I have not seen any records relating to a carer saying Mr F should go into residential care nor asking Mrs X to leave work to change a soiled pad. I have seen references in the daily records to carers asking Mrs F to help even though she has health issues of her own and should not have been providing care for Mr F.

Complaints handling

22. Mrs X’s sister, Ms S, formally complained to the care provider on 23 July 2018. The care provider did not reply, although Mrs X says it signed for the letter. She complained again on 13 August 2018.
23. The care provider’s records show a complaint was logged on 8 August. It made some enquiries and sent a letter to Ms S on 24 August. It accepted the complaint was substantiated. It said it had carried out an audit of missed calls and it acknowledged staff needed more training.

My findings

Missed calls

24. I have identified 56 days on which one or more calls were missed in the period December 2017 to November 2018. This is fault.
25. Mrs X says the care provider gave them advance notice on some occasions but I have no information about how many times advance notice was given and how often no notice was given. The failure to provide personal care for Mr F caused the family avoidable distress and inconvenience as one of the daughters, both of whom work and have their own families, had to help out at short notice or no notice at all. The missed calls did not generally cause an injustice to Mr F, whose care needs were met either by the care provider or his family. However, there were some missed calls the family could not cover and Mr F was left in a soiled pad for several hours. Mr F has now died so I cannot recommend a payment for this injustice but the care provider has agreed to waive outstanding costs of £181.
26. Mrs X has confirmed the care provider has not charged for missed calls as far as she is aware. I have seen emails querying with the care provider where missed calls may have been charged for and understand refunds were made as appropriate. I have checked a random sample of the potentially missed calls as indicated by the daily logs against the invoices, and found that charges were made for four calls across three days in April and May 2018 for which there was no daily log. The charges for these calls was £50.40 in total. I do not know whether those particular charges were challenged and refunds made. However, I am satisfied that there is no significant issue with the charging of calls.
27. I have seen a record of a telephone call with Mrs X’s sister in which the care provider did offer to give notice in August 2018 because it recognised it was not able to meet Mr F’s needs and this was appropriate. However, it says carried on covering as many calls as it could to assist the family as they had not been able to find an alternative care provider. Mrs X says the family did not agree to cover calls as they were not always able to do so. I note there is a dispute about what was agreed in August 2018. It would have been better if the care provider had given notice since it was not able to deliver the service it was contracted to provide. That said, I understand it was trying to assist the family because at that stage they had not found an alternative provider. It would have been better if it had confirmed in writing its understanding of what was agreed. On balance, I think the care provider did alert the family to the fact that it could not cover all the calls from August 2018 onwards.

Dementia care

28. The care provider has explained that all carers have basic training in dementia care. However, it is not clear whether Mr F’s carers have received further training in dementia care. Mr F’s dementia was becoming advanced and resulted in him being aggressive on occasion, usually when carers were providing personal care. I cannot say whether the training given was sufficient to enable them to cope with the challenges Mr F presented on those occasions. These were difficult situations for all those involved and, whilst it may be those situations could have been handled better, on the information I have seen there is no evidence the care was inadequate.

Complaints handling

29. I understand Mrs X’s sister, Ms S, formally complained on 23 July 2018. The care provider logged a complaint on 8 August. Ms S complained again on 13 August. The record says someone with power of attorney was contacted on 14 August but does not state who (I understand both sisters have power of attorney). There is no record of an acknowledgement letter.
30. The care provider investigated the complaint and sent a formal response on 24 August 2018. This was 24 working days after the complaint was sent. It accepted the complaint was substantiated and explained what action it was taking to put matters right. It suggested a meeting with the family.
31. Also in August 2018, the care provider offered to give notice because of its difficulties in fulfilling the contract but the family was not able to find an alternative care provider at the time.
32. Although the care provider appears not to have sent an acknowledgement letter and sent its response slightly late, I do not consider this is sufficient to make a finding of fault. The care provider did investigate the concerns raised and responded to them within a reasonable time.

Agreed action

33. The care provider will, within one month of the final decision:
• Apologise to Mrs X for the missed calls;
• Waive outstanding costs of £181.03; and
• Pay Mrs X £250 to recognise the avoidable distress caused to the family of the missed calls.

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Final decision

34. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman