Summary: There was a discrepancy between the complaints made by Mrs A about her father’s care and the wishes of Mr X. The care provider attempted to resolve the complaints, offered to change the carer and offered a fee reduction as a gesture of goodwill, but without success.

The complaint

1. Mrs A (as I shall call the complainant) complains that the live-in carer who looked after her father Mr X had a poor standard of English and was not capable of carrying out her role. Mrs A says the care provider should refund the fees.

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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)

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How I considered this complaint

3. I considered all the information provided to me by Mrs A and the care provider. Both parties had an opportunity to comment on an earlier draft of this statement before I reached a final decision.

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What I found

4. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
5. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
6. Regulation 19 says that people must have the qualifications, skills experience and competence to carry out the caring role required of them.

What happened

7. Mr X is an elderly man who had become anxious living alone. He needs some assistance with personal care.
8. Mrs A says because of her father’s anxiety about living alone she decided to engage a live-in carer for him. She says the agency told her the carers it employed came from abroad but spoke English, were trained and experienced and able to manage running a household as well as helping with personal care.
9. The care plan which the agency drew up for Mr X said he had full capacity to make his own decisions and describes his memory as very good. Both his daughters (including Mrs A) were involved in writing the plan,
10. Mrs A says within hours of the carer’s arrival on 26 September, she was concerned that she would not be able to cope with looking after Mr X. Mrs A says she personally stayed overnight for the first few nights to help out and so witnessed what was happening. She says the carer had poor English and was not capable of running the household by herself. Mrs A says the carer admitted she had little experience and says she did not understand how to keep house, or plan meals.
11. Mrs A complained to the agency on 29 September. She said the carer’s grasp of English was poor and she did not understand what was said to her and was unable to read cooking instructions. She said the carer had overslept on the first morning and Mr X had to ask her to make him some tea. She was concerned about her father’s safety as she did not think the carer was competent to look after an elderly person.
12. His family says Mr X had capacity to make his own decisions, but he was suffering with anxiety which sometimes caused him to be stressed. They say, “In view of this, he did not feel safe alone and needed someone to take charge of day to day household duties, make his meals and be there to reassure him. The carer provided was very friendly and usually willing, but her lack of skills and experience and poor quality of English was unsuitable and not as provided for in the care agreement.”
13. A manager from the agency visited on 01 October to find out what was wrong. Mr X said he did not want to change carer. The manager says the house was clean and tidy and there were no problems with the carer’s language skills.
14. Mrs A complained again. She said the carer had disappeared for long periods of time over the weekend and not had the foresight to call and let the family know where she was. She said the house was clean and tidy because she herself had spent a long time cleaning it. She said the carer’s grasp of English was improving because she had spent time with her teaching basic vocabulary. She said she was disappointed the agency would not offer a fee reduction. Mr X’s family also says he enjoyed teaching the carer English and did not want to acknowledge the negative aspects of her employment.
15. The care provider says it logged a complaint and began to look for a replacement carer. On 4 October the care provider notified Mrs A of a carer who could start on 8 October. Mrs A refused the change in carer as she said her father wanted the first carer to stay. A manager from the agency visited Mr X at home on 5 October. Mr X said he wanted the carer to stay as they got on well. His family says, “The family had to honour Mr X’s wishes despite their misgivings. The financial reduction was sought to address the inadequate care provision which Mrs A and her sister believe to be fully justified.”.
16. The care provider wrote to Mrs A on 5 October and reported back on her visit to Mr X. The care provider said Mr X had capacity to make his own decisions which they respected. She offered a discount of £200 on the fees as a thank you for taking the time to orientate the carer on her arrival and for any anxiety caused by her absence on her first weekend.
17. Mrs A continued to complain. She said she and her sister had signed the contract so she did not know why the care provider only asked her father’s views. She asked again for a fee reduction as she said she did not think the care provider had fulfilled its contract. Further complaints followed from Mrs A’s sister and the family decided to withhold payment (£1370) for the last 12 days of the contract.
18. The carer left on 12 December and the family agreed with the care provider to termiate the contract then.
19. Mrs A complained to the Ombudsman.
20. The care provider says it carries out rigorous checks on carers before it employs them. It has provided evidence of the carer’s induction training and her competence in English. It says, ‘(Mr X) was happy with the carer and did not want her to leave. We spoke to (Mr X) on every occasion the complainants raised an issue. (Mr X) did not have the same concerns. (Mr X) has full capacity and we respected his wishes in line with the MCA2005 and because it was the right thing to do’.
21. Mr X’s family say, “The family disputes that paper evidence of training and skills and English competency is an accurate reflection of the standard displayed by the carer. Since the complaints were made by Mrs A on behalf of Mr X, it is hard to understand why the only party to whom the care provider spoke was Mr X, a vulnerable elderly man.”

Analysis

22. The care provider has evidenced that the carer employed was trained and competent to its expected standards. Mrs A spent some time helping the carer improve her English and learn how the family liked basic tasks completing. The care provider discounted the fees by £200 in recognition of that, which seems to me to be a reasonable response. The care provider offered a change of carer but Mr X refused.
23. The care provider pursued the complaints which Mrs A made but they were not substantiated by Mr X, who was the client and who was able to make his own decisions.

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Final decision

24. No injustice was caused to Mr X by the actions of the care provider.

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Investigator's decision on behalf of the Ombudsman