The Ombudsman's final decision:
Summary: Mr B says the Council failed to take action following a previous Ombudsman investigation to ensure the care he received was improved. The Council failed to monitor the care provided to Mr B properly which resulted in similar problems to those identified in the previous complaint. Further monitoring, spot checks, an apology, payment to Mr B’s sisters who complained on his behalf and reducing Mr B’s arrears of client contribution is satisfactory remedy for the injustice caused.
- The complainant, whom I shall refer to as Mr B, complained the Council failed to ensure care providers improved the care provided to him following a previous Ombudsman complaint.
The Ombudsman’s role and powers
- 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)
- 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
- As part of the investigation, I have:
- considered the complaint and Mr B's comments and comments from his sister;
- made enquiries of the Council and considered the comments and documents the Council provided;
- considered Mr B’s sister’s comments on my draft decision; and
- gave the Council an opportunity to comment on my draft decision.
What I found
- Mr B receives a package of care which the Council has commissioned. Mr B has learning difficulties and other medical conditions. Mr B receives four care visits a day. At each of those visits carers must prompt him to take medication, help with washing, prepare meals, clean after themselves and throw away food gone past its sell by date. Carers must also change his bed linen weekly. A previous Ombudsman investigation found fault by the Council which I will refer to later in this statement. Since March 2018, when the Ombudsman concluded the previous investigation, Mr B has received care from three different care agencies. Mr B’s sisters report similar problems with those care agencies to those identified in the previous Ombudsman investigation.
- The Ombudsman investigated a complaint from Mr B about the care he had received from various care agencies between 2016 and 2017 under complaint reference 16 009 383. The Ombudsman ended that investigation in March 2018 and found the Council at fault for failing to keep proper records of the care provided and to monitor the service. The Ombudsman decided poor record-keeping had led to doubt about what happened during the period but recorded it was clear Mr B had experienced some short care visits and poor care. As remedy for that complaint the Council agreed to monitor the records kept by carers for three months, starting one month after the date of the Ombudsman’s final decision and for the Council only to stop monitoring if it was satisfied the care agency had kept full records, the care visits were long enough to meet Mr B’s needs and the details recorded showed carers had carried out the necessary tasks. Mr B’s sisters say Mr B has continued to receive poor care from various agencies. I have therefore considered the Council’s actions since March 2018 and the documentary records it has provided.
- The Council says it monitored the care provided to Mr B. As evidence of that it refers to eight review meetings which it says took place between 26 April 2018 and 26 November 2018. However, the Council has only provided notes from the reviews on 21 May, 30 July, 13 August and 26 November. Without notes from the other review meetings I am not satisfied they took place. In any event, the recommendation the Council agreed to was to monitor the records kept by carers for a three month period which should have begun in April 2018. Other than reference to reviewing three weeks records during the review meeting on 21 May 2018 I have seen no evidence the Council monitored care records between April and July 2018 as it should have done. The care agency providing care during that period no longer provides care to Mr B. So, I cannot check those records to see whether carers provided the appropriate length of visits and the care set out in Mr B’s support plan. I therefore cannot reach a safe conclusion about whether the care provider continued to provide short visits or failed to provide the care set out in the support plan between April and July 2018. However, failure to monitor the records kept by carers during that period and to record the outcome of that monitoring is fault.
- I have considered the care records provided by the Council which concern the period 18 July 2018 and 25 September 2018. That again means there are missing records for October and November 2018. The records I have considered for the period 18 July-25 September 2018 though show similar issues to those recorded as part of the investigation into the previous complaint. It therefore seems likely, on the balance of probability, Mr B has continued to receive short calls on occasion, although there are also some occasions where calls have been longer than planned. There is also some evidence of calls not taking place far enough apart which again was an issue identified in the previous investigation. I recognise it is not always possible for carers to arrive exactly on time. However, there are occasions where calls have been very late, particularly in the morning, which has a knock-on effect on the medication given to Mr B.
- As well as that, I remain concerned about the lack of information recorded in the care records. For instance, there is little evidence in the care records of carers changing Mr B’s bed once a week. The recordings also do not consistently record whether carers have given Mr B a shower and changed his clothes. So, I am not satisfied the fault identified in the previous investigation has been resolved. I consider it likely the Council would have identified some of these issues if it had carried out monitoring of the records kept by carers for a three month period as it agreed to do. Indeed, given the issues with the care records I have seen I consider it likely the Council would have had to extend the monitoring for a longer period as it is unlikely it would have been satisfied matters had been resolved. Had it done that this might have resolved the issues.
- The Council says despite issues with recording the length of visits and some visits being shorter than scheduled it is satisfied carers have provided care to Mr B in line with his support plan. The Council says where carers have not undertaken some of the tasks such as changing Mr B’s clothes this is due to Mr B not complying or asking the carers to leave early. I have noted some difficulties recorded about comments Mr B has made towards various carers from the care agencies that have withdrawn from the contract. However, the daily care records do not record any difficulties carers experienced in completing some of their tasks. Given that, I could not say carers had not undertaken some tasks due to Mr B refusing to cooperate. Nor could I say carers had cut visits short at Mr B’s request. Given the lack of detail in many of the care records I also could not safely say Mr B received all the care he should have received during visits which were shorter than those scheduled.
- I cannot, however, reach a safe conclusion about whether carers washed Mr B on a dirty toilet rather than in the shower as his sisters claim. Not all the care records refer to carers washing Mr B in the morning. I have already said failing to keep satisfactory records is fault. I am satisfied though Mr B’s support plan refers to carers completing a wash down/shower/shave each morning. I am therefore satisfied this does not necessarily mean Mr B will receive a shower every morning. A wash down in the bathroom would also meet his needs. Nevertheless, it is fault to fail to record the tasks undertaken for the morning call.
- I cannot reach a safe conclusion about whether carers cooked meals for Mr B correctly. As I understand it, Mr B’s sisters have cooked most of the meals for him and those meals are then frozen for the carers to microwave. The documentary records though do not give any detail about how those meals were cooked. I therefore cannot reach a safe conclusion for this part of the complaint.
- Mr B refers to the Council failing to ensure carers cleaned before leaving the property. As I said earlier, the carers records often do not provide any detail about the care provided. There are some occasions where carers have recorded wiping kitchen tops or mopping the floor but there are many occasions where nothing is recorded. This may relate to inadequate record-keeping. However, it may also relate to carers failing to carry out the cleaning required. Although there is no expectation for carers to clean the entire property as that is not part of their role, they are expected to clear up after themselves and that is made clear in the support plan. Failure to do that or to record when that has been done is fault.
- Mr B’s sisters say carers have not received training to deal with Mr B’s complex needs. However, as I understand it, the care agencies the Council contracts with all employ carers who have a care certificate which includes training on various subjects. I further understand those carers also receive regular update training. As that is the case I could not say the Council had allocated carers which cannot deal with Mr B’s complex needs.
- As in the previous investigation, poor record keeping leaves uncertainty about whether Mr B received the full package of care he should have between March 2018 and November 2018. It is again clear Mr B has experienced some short care visits, late visits and poor care. This has added to Mr B’s sisters’ frustration and has led to them having to go to time and trouble to pursue a further complaint. I am particularly concerned the fault identified in the previous investigation has not been resolved despite the Ombudsman’s recommendations.
- I note the Council is intending to undertake a care monitoring framework for the agency providing care for part of the period. I welcome that. I also welcome the Council’s decision to carry out regular reviews of the new care provider. However, given the previous reviews did not resolve the matter I do not consider that adequate. As with the previous investigation, I recommend the Council carry out monitoring of the records kept by carers for a three month period. The Council should record its view on whether those records now show Mr B is receiving the care set out in his support plan and that carers are attending as close to the scheduled time as possible and are not leaving until all tasks are completed. If at the end of that three month period the Council is not satisfied the care agency has been able to demonstrate that it should extend the period of monitoring until it is satisfied it has. The Council has agreed to that. The Council has also agreed to arrange with the care provider for somebody to carry out spot checks during that three month period while carers are in the property or shortly after they leave to establish provision is in place to reflect what is in Mr B’s support plan. The Council has agreed to pay Mr B’s sisters £250 each to reflect the time and trouble they have had to go to and their distress and frustration. The Council has agreed to deduct £250 from Mr B’s arrears to reflect the care he is likely to have missed out on during the period.
- Within one month of my decision the Council should:
- apologise to Mr B and his sisters for the faults identified in this statement;
- deduct £250 from Mr B’s arrears of client contribution;
- pay Mr B’s sisters £250 each;
- monitor the records kept by carers for a three month period and extend that period of monitoring if the Council is not satisfied the records show Mr B is now receiving care in line with his support plan; and
- arrange with the care agency for someone to carry out spot checks after carers visit during that three month period to verify they are carrying out the care identified in the support plan.
- I have completed my investigation and uphold the complaint.
Investigator's decision on behalf of the Ombudsman