Summary: There was fault in the way the agency, funded by the Council, provided care and support to Mr B. The Ombudsman has recommended the Council apologises to Mr B and waives the outstanding invoice.

The complaint

1. Mr B complains about Mayday Homecare Agency which was providing him with care and support at home. He says the carers were often late and provided him with a poor service.

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The Ombudsman’s role and powers

2. 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)
3. 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)
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 have discussed the complaint with Ms C and have considered the documents she and the Council have sent and the relevant, law, guidance and policies.
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I found

Law and guidance

7. The Health and Social Care Act 2008 (Regulated Activities) Regulations set out the requirements for care providers. The CQC has provided guidance on the regulations. The guidance says that:
• The care and treatment of service users must be appropriate, meet their needs and reflect their preferences (regulation 9).
• Service users must be treated with dignity and respect (regulation 10).
• Service providers must maintain accurate, complete and contemporaneous records in respect of each person using the service, including a record of the care provided (regulation 17).

Agency’s policies

8. The agency has its own policy which sets out what carers are expected to do. This says:
• If a carer is going to be late, they must inform the office immediately so the office can contact the client to inform them. This allows the office to reassure the client and to offer them a replacement carer or wait for their regular carer.
• The carer must complete the green/white communications sheets before leaving the property.

Council’s contract with the agency

9. This says the visit time must take place within 60 minutes before or after the agreed visit time.

What happened

10. The Council assessed Mr B’s needs in September 2017. Mr B had left sided paralysis because of a stroke. He was unable to wash himself, get dressed, clean or cook without assistance.
11. Mr B also suffered from anxiety and depression. He had tried to commit suicide in the past and was supported by the community mental health services. He had no family or friends and was socially isolated because of his anxiety. He was stressed if he was in the company of more than two people.
12. The assessment said that Mr B’s anxiety was extremely high in crowded situations and he cried when he was in a shop with too many people so he had to do his shopping at midnight. Therefore, he needed support from a carer to access the community.
13. Mr B told the social worker who assessed him: ‘I am depressed and have anxiety. I get agitated and frustrated as I like to keep clean. I feel worthless and feel that no one listens to me.’
14. Mr B’s care plan said he would receive care at home every day. The schedule was:
• Monday and Wednesday: 1 hour (shower, dress, make breakfast and make bed).
• Tuesday: 2 and a half hours (strip wash, dress, make breakfast, make bed and assist access to the community).
• Thursday, Saturday and Sunday: 30 minutes (strip wash, dress, make breakfast and make bed).
• Friday: 3 hours (shower, dress, make breakfast, make bed and assist access to the community).
15. The weekly cost of the service was £131 which was paid by the Council with a contribution of £86 per week from Mr B.
16. The agency provided support to Mr B from 3 October 2017 to 18 October 2017 when Mr B cancelled the support.
17. The agency has provided me with a spreadsheet of the start and end times of the visits. My understanding was that the start time of the visits was 10:00 am. The spreadsheet shows that 8 visits were carried out within about 15 minutes of the start time of 10:00 am. Two visits were marked as ‘cancelled call no notice’. There were a few occasions when the carer was half an hour late and two occasions when she arrived at 11:00 am.
18. The carers were also meant to complete a communication sheet for every visit. This recorded the date, start and end time, record of the visit, the name of the person attending and their signature.
19. I have obtained the communication sheets from Mr B as the agency did not have a copy of the sheets. It said it normally retrieved the records on a four-weekly basis, but, as Mr B cancelled the care after two weeks, this did not happen in this case.
20. The communication sheet was filled in on 12, 15, 16 and 17 October 2017. The communication sheet for 15 October 2017 showed the carer arrived at 11:00 am and that Mr B refused the call. However, the agency’s spreadsheet said the carer attended at 10:00 am.
21. Ms C contacted the Council on 10 November 2017. She said Mr B had cancelled the service by the agency because of the poor service he received from them. He did not agree with paying the full contribution because he did not get a full service.
22. The Council invoiced Mr B for his contribution for the 15 days of care which totalled £197. Mr B did not pay the contribution.

The complaint

23. Ms C made a formal complaint to the Council on 29 March 2018. The complaint was:
• The carers began arriving very late, sometimes up to one hour late turning up at 11:00 am.
• The carers made Mr B feel uncomfortable and an inconvenience. They asked: ‘What do you want doing?’ and told him they were in a rush.
• He did not want to pay the full contribution because the service had been poor.
• He was reluctant to have another agency provide care because of the experience.
24. The agency provided its response on 31 May 2018 and said:
• It upheld the complaint that carers arrived late as it said carers arrived at 11:00 am on two occasions. It said this was still within the compliance range set by the Council which was 90 minutes.
• It said it had not been made aware that Mr B had felt uncomfortable and an inconvenience. If it had been raised earlier, it would have taken measures to ensure it would not happen again.
• It would not waive the charge for the care.
25. Ms C wrote to the Council in June and July 2018 as she was not satisfied with the agency’s response. She provided more information on the complaint. She said:
26. Mr C expected carers to arrive at the time they said they would arrive, give or take 10 minutes.
27. The carers often did not complete the communication sheets and the entries they made were sometimes inaccurate, recording that they arrived earlier than they did.
28. One carer said: ‘I haven’t got a lot of time so what do you want doing?’ Mr B said the carers should know what they should do, but the carers said they did not. On another occasion a carer arrived an hour late and then had to rush home. She also did not know what she should be doing.
29. The agency responded on 15 August 2018 and said it would credit Mr B for the two late visits as a goodwill gesture. It is my understanding this did not happen.

Analysis

30. The agency was acting on behalf of the Council so I have investigated its actions.
31. The agency has already upheld the fault that the carers attended an hour late on two of the visits and I agree this was fault. This lateness was not within the Council’s tolerance level, as the agency claimed as the Council set this at 60 minutes, not 90 minutes.
32. Also, from the communication sheet, it appears that there was at least one other visit where the carer arrived at 11:00 am. This was further fault but it is also concerning that the agency’s spreadsheet and the communication sheet held different information.
33. In my view there was further fault in the poor record keeping and communication. The carers had a duty to arrive on time, to alert the agency when they were going to attend late and to record the details of the visit in the communication sheet.
34. From the records I have seen, the carers failed to keep proper records as only four visits were recorded. There should be at least 14 records. The record keeping was therefore not in line with the agency’s own policy or the expectations of the CQC.
35. Mr B also says the agency never rang him to let him know that the carer was running late. This was further fault. The agency’s own policy said the agency would ring the client if the carer was running late. This would be even more important with a client like Mr B who suffers from mental health problems and anxiety.
36. Mr B says the carers made him feel like a burden. He says they did not know what the care plan was as they asked him what he wanted them to do.
37. It is not unusual, of course, for a carer to ask the client what support they should provide. That does not necessarily mean that the carer is not aware of the care plan, but rather that the carer wants to make sure they are providing a service that the client wants and needs for that particular day. There may be days when the client does not want a shower, or has already had his breakfast so it would be odd if the carer did not ask some basic questions about how they could best support the client on the day.
38. However, the care plan shows that Mr B’s needs were not only practical, but also related to communication and socialisation to allow him to go back into the community. Mr B was isolated in his home and had little human contact because of his mental health problems. The carers should have been aware of these issues. From Mr B’s accounts, it does appear that there were at least two occasions when the carer’s communications with him fell below good practice standards. This was probably made worse by the fact that the carer was late and therefore very rushed.
39. This would be poor practice for any client, but was particularly difficult for Mr B because of his anxiety and depression. Sadly, it has meant that he has refused to have carers in the house again and has left him further isolated and without support.
40. Also, there is no record the carer ever helped Mr B access the community. It may be, of course, that this happened on days when the care was not recorded.
41. Mr B has suffered an injustice through the fault. He has suffered distress because of the late appointments, the failure to keep good records, the lack of communication about the delay and the communication with him about his needs.
42. The Ombudsman normally recommends a financial remedy between £100 to £300 for distress although it can go higher in exceptional circumstances. I am of the view that a remedy of around £200 would be appropriate in this case. As Mr B still has an invoice of £197 which has not been paid, I suggest that this bill is waived.

Agreed action

43. The Council has agreed to take the following actions within one month of the final decision:
• Apologise to Mr B in writing.
• Waive the outstanding invoice of £197.
• Ask the agency to remind its staff of the relevant policies regarding time keeping, record keeping and adhering to the care plan.

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Final decision

44. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

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Investigator's decision on behalf of the Ombudsman