Summary: Mr X complains the Council’s care provider, Sentinel, failed to deal properly with concerns he raised at a meeting on 26 October 2018, resulting in one of its carers victimising him and Sentinel giving notice on the contract for his care. Sentinel did not respond constructively to the concerns raised by Mr X, causing him unnecessary distress. The Council needs to apologise, pay financial redress and work with Sentinel to improve its working practices.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains the Council’s care provider, Sentinel, failed to deal properly with concerns he raised at a meeting on 26 October 2018, resulting in one of its carers victimising him and Sentinel giving notice on the contract for his care.

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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. 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, sections 30(1B) and 34H(i), as amended)
4. 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)

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How I considered this complaint

5. I have:
• considered the complaint and the documents provided by Mr X;
• discussed the complaint with Mr X;
• considered the comments and documents the Council has provided in response to my enquiries; and
• invited comments on a draft of this statement from Mr X, Sentinel and the Council, for me to consider before making my final decision.

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What I found

What happened

6. Mr X has weakness in his lower limbs which, according to his assessment, means he cannot stand or walk. He uses a wheelchair and needs practical help around the home. The Council commissioned Sentinel Care Services (Sentinel) to provide that help from January 2018.
7. Sentinel and Mr X’s Social Worker visited him on 26 October to review his care needs. Sentinel’s record of the visit says Mr X identified these areas as needing improvement: communication; meeting needs; carers; and punctuality. The sections of the form for listing “the things that we can improve” are all blank. Mr X says he raised concerns about Carer A and asked Sentinel not to share his comments with her. The Council has confirmed this to be the case. Mr X says he raised concerns about Carer A:
• not making the bed properly;
• not leaving after completing care tasks but often spending time sitting on his stairs.
8. The Social Worker’s record says, after discussing the care package, they agreed to reduce it to two 30-minute calls a day, mornings and evenings.
9. Carer A next visited Mr X on 29 October. She stayed 32 minutes.
10. Sentinel did a field-based quality observation with Carer A when she was visiting another client on 1 November. Sentinel denies telling Carer A about Mr X’s comments.
11. Carer A visited Mr X on 4 November, staying 32 minutes. When she visited on 5 November she noted Mr X asked her to leave early (after 11 minutes). This happened again on 7 November (after 20 minutes) and Carer A noted this was because he wanted to make a phone call. Each time, this was after she had completed all the care tasks.
12. On 8 November Mr X called the Council to complain about a lack of respect from Carer A during her visit the day before. He said she put on an apron, gloves and a face mask, which neither she nor any of the other carers had done before. He said he was upset by this and it undermined his dignity. He said he had contacted Sentinel, but it had not got back to him. The Council said it would ask Sentinel to contact him to let him know what it was doing. As agreed, the Council contacted Sentinel.
13. Carer A’s record of her visit on 9 November says Mr X asked her to leave early (after 13 minutes). This was after she had completed all the care tasks.
14. Sentinel told the Council Mr X was being rude to the carers, who were finding him “intolerable” and were refusing to visit him. Mr X told the Council Sentinel must have told Carer A about his concerns over the mask, as she now had an attitude with him. He said he asked Carer A to leave when she had completed her tasks, as she was using her phone in his kitchen. He said she told him “at this rate you won’t have any carers, you are a nasty dirty man and there is nothing wrong with you”. Mr X says someone else in his home witnessed this.
15. On 12 November, Sentinel told the Council there had been another incident between Mr X and its carers. It said the carer had answered back. It said it now had no carers willing to visit Mr X and was giving notice with immediate effect. The Council reported this to its Commissioning Team.
16. Mr X told the Council Sentinel had no carers to visit him that evening. The Council said its Commissioning Team would contact him that afternoon.
17. The Commissioning Team told Sentinel it had to give 14 days’ notice, which it did that day. Sentinel said its Carers were only visiting Mr X for 15 minutes to empty his commode. It suggested he should be using the toilet if he could get upstairs.
18. Mr X sent the Council one of Carer A’s posts on social media from August. This included a photograph of her reclining on his stairs, wearing no uniform, with the caption “When you get to have a workout whilst at work …!”. According to Sentinel, Carer A took the photograph after she had completed all her tasks, but Mr X said she could not leave. Sentinel says Mr X often asked carers to do tasks which were not in his care and support plan.
19. On 13 November Mr X sent the Council further examples of Carer A’s posts on social media while she was visiting clients, pointing out they had been deleted since 12 November.
20. When Carer A visited Mr X on 16 November he would not let her in and asked her to leave. He asked if she had come to take selfies of herself on his stairs or verbally abuse him again. She noted he must be referring to her social media posts. Sentinel says Mr X had consented to Carer A’s visit.
21. Mr X sent a formal complaint to Sentinel on 17 November. He said:
• contrary to his request, Sentinel had not kept information he provided about Carer A at the meeting on 26 October confidential, as she referred to his comments when she next visited;
• when Carer A visited on 7 November she behaved oddly, as she wore protective clothing before emptying his commode, despite never having done this before, which made him feel degraded;
• when Carer A next visited she verbally abused him and told him there was nothing wrong with him, despite having previously accepted he was suffering from depression;
• Carer A often used her mobile phone while at clients’ homes, taking photographs of herself and posting them on social media (since deleted) which was accessible to the public;
• Sentinel had failed to provide care for him on several occasions with little or no notice;
• Sentinel had withdrawn his care package on 12 November with immediate effect, after he raised concerns about Carer A.
22. Sentinel stopped visiting Mr X on 19 November. Its Carer’s records of their visits show these Carers visited Mr X between 26 October and 18 November:

23. Apart from Carer A, there is nothing in the Carers’ records of their visits to suggest they had any problems with Mr X. It appears Carer B had a good rapport with him, as she often referred to chatting to him. Apart from four of Carer A’s visits, three when Mr X asked her to leave, they all lasted around 30 minutes. There were two missed calls over the weekend of 3-4 November.
24. Sentinel acknowledged Mr X’s complaint on 19 November and said it allowed 28 days to investigate complaints.
25. Sentinel replied by post to Mr X’s complaint on 12 December. It said:
• Breach of confidentiality – it had found no evidence to support Mr X’s claim;
• Suffering indignity due to Carer A’s actions – Carer A always wore her uniform, but on one occasion did not have it zipped up – Carer A had the right to wear protective equipment and it was compulsory to wear a uniform in the prescribed manor – wearing protective equipment did not affect Mr X’s dignity;
• Suffering verbal abuse from Carer A – Carer A denied Mr X’s allegation – there was no supporting evidence – Mr X had raised no concerns for six months;
• Breach of company policy / data protection – it had reminded Carer A of its social media policy;
• Cancelling visits with little or no warning – it could not respond to this without being given times and dates;
• Withdrawal of service with no communication – it had tried to explain that whatever carers may have said to Mr X, they were saying different things to Sentinel and had reported “unacceptable behaviour” on his part – Mr X had not been prepared to resolve issues so it had no choice but to terminate the care package – it had agreed to provide carers while the Council found another care provider.
26. Mr X did not receive Sentinel’s response, so he chased it on 3 January 2019. Sentinel then e-mailed a copy of its response to him.

Is there evidence of fault by the Council which caused injustice?

27. All the evidence shows the relationship between Mr X and Carer A broke down. I don’t have any evidence to say Sentinel told Carer A what Mr X had said about her. Carer A visited Mr X twice after 26 October without any apparent incident. It was only on the third visit that Mr X asked her to leave early. It seems likely this is what prompted Carer A to wear protective clothing when she next visited. However, I can find fault over a carer wearing protective clothing, even if they had not worn it before.
28. The records do no support Sentinel’s claim that there was a general problem between Mr X and his carers. Nor do they support its claim that Carers were only spending 15 minutes with Mr X. The records show all the Carers were meeting his needs and it was possible to do this in less than 30 minutes.
29. When the relationship between a carer and a client breaks down, there are two possible actions. Either try to rebuild the relationship or take the carer off the rota. But Sentinel did neither of these things, which was fault for which the Council is accountable (see paragraph 4 above). It sent Carer A to visit Mr X, even after giving notice. This caused unnecessary distress to Mr X.
30. Sentinel tried to cancel Mr X’s visits with no notice. That was also fault which caused further distress to Mr X. People should not have their care packages cancelled when they raise concerns about the care being provided. After the Council intervened, Sentinel provided carers, even in the evening of 12 November despite having said no one would do this, until the Council arranged for another care provider to take over.
31. There is no dispute over the fact the photographs Carer A posted on social media were inappropriate. But I cannot say the photograph from Mr X’s home caused him significant injustice.

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Agreed action

32. 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 Sentinel, I have made recommendations to the Council.
33. I recommended the Council:
• within four weeks, writes to Mr X apologising for the problems he experienced with its care provider Sentinel and pays him £150 for the distress he has been caused and the trouble he has been put to in pursuing his complaint;
• within eight weeks, draws up an action plan with Sentinel on how to improve the way it deals with concerns/complaints about its carers.

The Council has agreed to do this.

34. Under the terms of our Memorandum of Understanding and information sharing protocol, I will send the Care Quality Commission a copy of my final decision statement.

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Final decision

35. I have completed my investigation as the Council has agreed to take the action I recommended.

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Investigator's decision on behalf of the Ombudsman