Christies Care Ltd (18 009 871)

Category : Adult care services > Domiciliary care

Decision : Not upheld

Decision date : 01 Apr 2019

The Ombudsman's final decision:

Summary: Mr B complains Christies Care failed to provide regular carers with suitable experience/qualifications to meet his mother’s needs during 2018 and failed to update her care/support plan when asked. Christies Care accepts there was little continuity over the carers provided and it could have communicated better with Mr B over his mother’s care. However, there is not enough evidence of injustice to justify recommending a remedy.

The complaint

  1. The complainant, whom I shall refer to as Mr B, complains Christies Care failed to provide regular carers with suitable experience/qualifications to meet his mother’s needs during 2018 and failed to update her care/support plan when asked.

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The Ombudsman’s role and powers

  1. We investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(4), as amended)

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How I considered this complaint

  1. I have:
    • considered the complaint and the documents provided by Mr B;
    • discussed the complaint with Mr B;
    • considered the comments and documents Christies Care has provided in response to my enquiries;
    • shared a draft of this statement with Mr B and Christies Care, and taken account of the comments received.

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What I found

  1. Mr B’s mother, Mrs C, has dementia. In January 2018 Christies Care was providing live-in carers for her on an “introductory” basis, which meant they were self-employed. Mr B used other care agencies to provide carers whose visits enabled the live-in carer to take a break.
  2. Christies Care’s provided 19 carers during 2018. Each stayed for up to three weeks at a time. If for any reason a carer had to leave early, Christies Care provided a replacement. Carer A visited four times and Carer B visited twice, otherwise the carers only visited once. Mrs C’s family provided comments on the carers. During the year Mr B provided negative comments on Carer E and Carer R. He said Carer E lacked experience of dealing with people with dementia. He described Carer R as “a very nice person” but remote and a potential risk to vulnerable clients. The family provided positive comments on seven of the carers. Mr B said they would prefer “native English speakers” but agreed Carer I could return although she was not.
  3. Mrs C’s 9 January 2018 care plan says she would often be confused and anxious. It says carers were to help Mrs C with personal care, provide meals, do the cleaning, watch out for urinary tract infections and encourage her to do her exercises. Christies Care updated Mrs C’s care plan on:
    • 25 January – to reflect changes in the times of the visits by other agency carers;
    • 29 January – to remove “Confirmation of boiler service and installation of carbon monoxide detector required”;
    • 9 March – to add information about a disabled parking badge;
    • 8 May – advising the live-in carers: to leave the house when the other carers arrived; Mrs C shadows carers, is repetitive and sound sensitive; to help keep Mrs C stay calm and how to do this; about Mrs C’s food likes/dislikes; not to do the cleaning when Mrs C is up; how to manage Mrs C’s mood swings; to eat with Mrs C; about financial risk; about a boiler service due in May; to prompt Mrs C to brush her teeth; and not to wash her hair in the shower. Christies Care removed other information, presumably because it was no longer relevant;
    • 17 May – to identify the need to check Mrs C’s skin and report any concerns;
    • 16 October – advising the live-in carers: Mrs C may enjoy listening to the radio; she is registered as severely sight impaired; to be supportive and encouraging if a visiting carer is trying to take Mrs C out; of the details for online shopping and to buy good quality food and treats; of the Wi-Fi code; how to judge and manage Mrs C’s mood swings; how to manage continence care; and to remove information about the exercise regime;
    • 15 November – to update the information on fall risks and the need to watch Mrs C when moving.
  4. In April Mr B raised concerns about his mother’s regular carers not returning, apart from Carer A, but noted she would stop visiting when they moved from an introductory to a managed service. Christies Care told Mr B many carers had said they did not want to return to Mrs C. It said only two carers wanted to return and it was trying to find others who would understand his mother’s condition. It said it could not identify anything they could change which would encourage more carers to return, as the issue was down to “personality”. However, shortly afterwards it suggested the possibility of Mrs C going to a day centre (to give the carers more of a break). Mr B said he would discuss this with his brother but noted his mother did not like leaving her home.
  5. Mr B noted Christies Care’s fees were increasing from £150 to £450 a week. He asked when they would see a roster of more regular and experienced carers. Christies Care discussed the concerns with Mr B. He said going to a day centre would not work for his mother as she is agoraphobic. After Christies Care told him the going rate was “£600 plus”, Mr B said they could consider increasing the carer’s wages to £600-£650 a week, rather than move to a managed service. He confirmed the carers could give Mrs C a sedative which her GP had prescribed to be taken when needed. Mr B decided to increase the carer’s pay to £540 a week. They discussed changes to Mrs C’s care plan and risk assessments.
  6. In May Christies Care told Mr B what it would expect the carers to do with medication (i.e. follow the instructions on the packaging or dosette box). As a private client, it said it was up to him to decide whether to provide written instructions but noted this would not reflect best practice. Mr B asked what they all needed to do to get regular carers. Christies Care identified these actions:
    • booking carers with experience of progressive dementia and limiting bookings to three weeks;
    • providing honest explanations of the challenges carers would experience;
    • passing feedback from carers to Mr B;
    • consider increasing the fee further;
    • list high water foods to help reduce urinary tract infections.
  7. It said Mr B was:
    • providing longer breaks (now 20 hours a week);
    • increasing pay to £540 a week;
    • removing the toilet seat; and
    • rewording the care plan regarding the bucket in the wardrobe and agoraphobia.
  8. Mr B complained to Christies Care on 4 September. He said:
    • the level of service had gone down since their regular Booker had left;
    • not one carer had returned a second time since Christmas 2017, despite increasing their pay;
    • he did not know if changes made to the documentation had been implemented;
    • they had heard nothing about the action needed to ensure carers came back.
  9. Christies Care did not respond to Mr B’s complaint until after he contacted us. When Christies Care replied on 4 October, it accepted there had been problems and apologised. It agreed to:
    • send the most up-to-date support plan and risk assessments;
    • visit Mrs C with Mr B to review her care;
    • discuss increasing the pay to “remain competitive”.

It noted Mr B’s wish for carers to have had training in dementia and some experience, and to have a particular Booker back when she returned to work.

  1. Mr B e-mailed Christies Care as he was not happy with its response. When Christies Care replied it said:
    • it had no record of a complaint in April 2018;
    • it would take time to implement the action plan;
    • communications should improve as his preferred Booker had returned;
    • recruiting carers was becoming increasingly difficult;
    • as an equal opportunities employer it could not meet his request for an English heritage carer with English as their first language;
    • his mother had never been at risk as she had always had a carer who had completed dementia training;
    • Mr B could look for another care agency, if that is what he wanted to do.
  2. Mr B wrote again to Christies Care. He said a Manager had accused him of escalating the situation by complaining to us. He said the relationship appeared to be deteriorating. He complained about Carer R (see paragraph 5 above). He said he did not want to swap firms but assumed Christies Care would “dump” them as troublesome clients. He said they would therefore ask other firms to assess his mother so they had a fall-back, but asked Christies Care to allow them until February to find an alternative.
  3. Christies Care stopped providing carers for Mrs C on 16 January 2019. It accepts:
    • there was little consistency over the carers it provided during 2018;
    • some of its communications with Mr B could have been better handled;
    • the concerns Mr B raised in April/May 2018 should have been referred to a senior manager.
  4. It puts the lack of consistency down to many of the carers not wanting to return to Mrs C. It says it could have provided more consistency if it had not been providing an introductory service, but that would have meant losing the preferred carers, who would only work as self-employed. It says Mr B’s decision not to move to a managed service in May, when plans were in place to do this, also had an impact on the rota.
  5. Christies Care accepts that not all the carers it provided for Mrs C had experience of working with people with dementia. But they will all have received its induction training for carers, which includes sessions on dementia. It has provided evidence which shows that 16 of the 19 carers it provided during 2018 had experience of working with people with dementia. Mr G complained about one of those who didn’t but praised the other two.

Did the care provider’s actions cause injustice?

  1. There is no dispute over the fact Christies Care did not provide continuity of carer during 2018. However, I cannot say that was down to fault by Christies Care. It is not responsible for the fact self-employed carers did not want to return. It appears many of them did not want to return because of the demands involved in meeting Mrs C’s needs.
  2. The evidence does not support the claim that any problems were down to sending inexperienced carers. Some of the less experienced carers coped well, according to Mr B’s feedback, even if they did not want to return. Christies Care could not guarantee to provide native English speakers.
  3. The evidence does not support the claim that Christies Care failed to update Mrs C’s care plans, as it updated them eight times in 2018.
  4. Christies Care accepts its communications with Mr B could have been better. There was little contact with Mr B after May, despite the promises made and the fact there was no improvement in the consistency of carers. It was left to Mr B to make a formal complaint, which did not receive a response until after Mr B contacted us. However, Christies Care has apologised for this already. There is not enough evidence of injustice to justify making further recommendations.
  5. Christies Care is registered with the Care Quality Commission (CQC) to provide personal care via its managed care services. I understand its activities as an introductory agency are not registered. However, given that it:
    • produced care plans for Mrs C and updated them;
    • was effectively providing a rota of carers; and
    • provided replacement carers if one had to leave early;

we will notify CQC, so it can consider whether its activities as an introductory agency need registering.

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Final decision

  1. I have completed my investigation as there is not enough evidence of injustice to warrant making any recommendations.

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Investigator's decision on behalf of the Ombudsman

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