Summary: The Ombudsman upholds Mr X’s complaint about the way a care package for his wife, Mrs X, was ended. The care provider did not follow the correct process to end its involvement and as a result Mrs X was left without care for two weeks. In addition, there were times care was late or calls were short. The Council agreed to apologise to Mr and Mrs X and pay them in recognition of the distress this caused. It will issue a reminder to care providers about the correct way to end their involvement with a service user. It will also advise them on what to do if they are having difficulties delivering the agreed package of care.

The complaint

1. Mr X complains the Council’s contracted care provider ended services for his wife, Mrs X, with little notice and without giving a valid reason. He says the provider did not communicate with him about its decision. As there was a delay in sourcing alternative care, he had to deliver personal care to his wife for three weeks. Mr X also complains about the quality of care delivered to his wife, saying the carers missed calls and often turned up late. He is unhappy the provider told another provider his wife had bitten a carer, which he says did not happen. Mr X also complains that carers said he did not always let them into the property, whereas he says the written care logs support that he did. Mr and Mrs X have been left distressed by their experience.

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The Ombudsman’s role and powers

2. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
3. 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)
4. 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)

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How I considered this complaint

5. I considered the complaint made by Mr X and the documents he provided.
6. I considered the Council’s comments about the complaint and the documents it provided in response to my enquiries.
7. I gave Mr X and the Council an opportunity to comment on my draft decision and I considered their responses.

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What I found

Background

8. Under the Care Act 2014, councils have a responsibility to assess people in their area who may have care and support needs, and their carers. Those who are eligible for services should be given a plan showing how those needs will be met.
9. Councils can arrange for an organisation other than itself to provide a service to meet needs. In this decision, these organisations are referred to as ‘care providers.’ There should be a contract in place between the council and the care provider. Councils remain responsible for the quality of the care provided, even when it is through a care provider.
10. Care providers can give notice on a contract however, they should consider the risk and give enough notice for a replacement service to be arranged.
11. The Council’s Living Well at Home contract says providers are not expected to terminate care plans other than in exceptional circumstances. It says before a package of care can transfer to another service, the provider must discuss this with the Council, the service user and their carer. The provider must complete a Care Transfer Plan when transferring to another provider unless to do so would not be in accordance with good practice.

What happened

12. Mrs X has a progressive condition which causes muscle weakness. She also has some cognitive impairment affecting her ability to understand her care needs. The Council assessed her as needing two care calls a day, one in the morning and one in the evening. The purpose of the calls was to support Mrs X with washing, dressing and maintaining her nutrition.
13. The care and support plan completed in February 2018 said the care calls should last for 30 minutes four days a week, and 45 minutes on the other three days to allow time to support Mrs X with having a shower. Morning visits were not to be before 9am except when Mrs X attended a day service and needed to be ready a little earlier.
14. The Council also assessed that Mr X would benefit from support as a carer. It recommended Mrs X attend a day service and a sitting service come into the home to provide Mr X with some respite. The sitting service was scheduled to last for four hours once a week and was delivered by the same care provider.
15. On 7 June 2018 the care provider contacted the Council to say it would no longer be providing the care package. Mr and Mrs X were on holiday at the time. It said Mr X was not allowing carers into the home and when carers had been in, Mrs X had declined their support. The provider said it was too far for its staff to go to not be able to deliver care, and so it had decided to end the contract. It said its last visit would be on 17 June.
16. The provider says it called Mr X on 11 June to tell him it would not be providing a sitting service that day due to staff shortages. It also told him it had given notice on the care package.
17. Mr X disputes this version of events. He says a carer who attended on 9 June told him the sitting service would be ending. He says when he phoned on 11 June to complain about this, the care provider told him it had cancelled the whole package of care.
18. On 14 June, the care provider wrote to the organisation which acted on behalf of the Council in arranging packages of care. The letter said Mr X was letting carers in on “about one visit a day” and Mr and Mrs X were regularly declining care. The letter said the care provider would continue delivering care for an extra week, up to 24 June.
19. A social worker reassessed Mrs X on 14 June. During the reassessment, Mr X said he had refused access to a couple of carers in the past. He felt carers were not always using the best approach with Mrs X to encourage her to accept support. Mr X suggested a second day at the day service would be better than reinstating the sitting service.
20. The outcome of the reassessment was that Mrs X remained eligible for support. Her care calls were extended to an hour each and the social worker recommended a second day at the day service.
21. The care provider’s last call took place on 24 June. It did not complete a Care Transfer Plan.
22. The Council identified a new care provider on 28 June. After carrying out its own assessments, it began delivering care on 9 July. Mr X says he is very happy with the care currently being delivered.

Analysis

Quality of care delivered

23. The care records from 1 April to 24 June 2018 suggest carers gained entry to Mr and Mrs X’s home on over 80% of morning and evening calls. Mrs X accepted support on less than half of the morning visits and on only three evening visits. The sitting service was delivered four times.
24. There is some dispute about whether Mr X refused entry to carers on the calls that weren’t documented. At first, the care provider said he did. However, in its response to my enquiries the Council said Mr X did not refuse entry to carers. It said the care provider said he did but later clarified that he was allowing access but regularly did not want carers to provide support. Mr X denies preventing access to carers, however as noted in paragraph 19 the social worker has documented that he did turn some away.
25. Some calls were missed due to Mr and Mrs X being away. The care provider said it never missed any calls, but it also acknowledged there were occasions when carers could not attend due to the weather. It said it always tried to let Mr X know if it would be late or unable to attend but he did not always answer his telephone. Mr X denies this.
26. It is not possible for me to say with any certainty whether the scheduled calls for which there are no records were missed due to the actions of the care provider or Mr and Mrs X.
27. Over a third of the morning calls started after 9.30am, however as the care plan suggested ‘no earlier than 9am’ I cannot find fault in this.
28. Three of the evening calls were late by at least hour. The sitting service visits, scheduled to last four hours, lasted between two hours and fifteen minutes and three and a half hours. As the records show some calls were late or short, the package of care was not always delivered as expected and this was fault.

Cancelling the care

29. The Council now accepts the care provider did not follow the correct procedure when ending the care package for Mrs X. It says more discussion between the Council and the provider should have taken place before it allowed the package to end.
30. The Council accepts this will have caused anxiety to Mr and Mrs X and it should have communicated with them more effectively to explain why the care package was ending.
31. There is evidence in the reassessment referred to in paragraph 19 that Mrs X’s care and support needs had not changed. Indeed, her care calls were extended to an hour each. There appeared to be no pressing need for the package to end before a new package of care was found and doing so potentially left Mrs X vulnerable to not having her needs met.
32. The decision to cancel the care package appeared to be prompted by the fact Mr and Mrs X had gone on holiday without telling the provider and so carers were arriving to find they were not there. However, Mr X says he told carers he would be away. It is not possible for me to say whether Mr X or the care provider is correct.
33. The care provider has not provided any evidence that it raised concerns with the Council about Mr and Mrs X declining care before it decided to cancel the care package. There is also no evidence it discussed its decision with Mr and Mrs X in advance. It did not complete a Care Transfer Plan as required by the Council’s Living Well at Home contract.
34. There was fault in the way the provider ended the package of care and this meant Mr X had to support Mrs X for two weeks without any help.
35. I have been unable to find any evidence the care provider said Mrs X had bitten a member of staff. Mr X said the social worker told them about this allegation when she visited after the provider had decided to cancel the care package. The provider said it had no knowledge of any biting incident. There are no written records to support either account so I cannot make a finding on this part of the complaint.
36. The Council suggested the injustice to Mrs X of the package ending was minimal because she often declined the care anyway. However, her needs assessment coupled with the comments from Mr X about the ineffective approach of some carers suggests she had needs that went unmet both while the care provider was delivering the package and once it ended. In addition, Mr X was already under pressure as a carer, as identified in his own needs assessment, and ending the care package will only have added to this.

Agreed action

37. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of the care provider, I have made recommendations to the Council.
38. Within one month of this decision, to remedy the injustice caused by the faults identified, the Council has agreed to:
• apologise to Mr and Mrs X; and
• pay them £300 in recognition of the pressure put on them by the lack of care both during the delivery of the care package and in the two weeks before the new provider started.
39. Within one month of this decision, the Council will also:
• remind all care providers it contracts with about the correct process for terminating and transferring a care package.
• advise all care providers it contracts with what they should do in the event a service user or their carer is routinely declining care.

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Final decision

40. I uphold Mr X’s complaint about the termination of the care package and the quality of care delivered for the reasons set out in the Analysis section of this decision.

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Investigator's decision on behalf of the Ombudsman