Summary: Mrs X complains about a care provider’s handling of her father’s care. She complains the care provider did not assess her father’s care needs properly, did not arrange a suitable care package, and did not check the carer’s notes before she left. The Ombudsman finds fault with the care provider for failing to provide appropriate care and for its poor record keeping. We recommended the care provider apologise to Mrs X, pay her a financial remedy, and improve its procedures and practices.

The complaint

1. Mrs X complains about Independent People Homecare Services (IPHS) handling of her father’s care. She complaints IPHS:

• did not asses her father’s care needs properly;
• did not arrange a suitable care package as IPHS only sent one carer when two was needed;
• did not check the carer’s notes before she left the country, and;
• sent an unsuitable carer.

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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)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))

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How I considered this complaint

4. I spoke with Mrs X and considered the information she provided.
5. I made enquiries with IPHS and considered the information it provided.
6. I sent a draft decision to Mrs X and IPHS and considered their comments.

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What I found

7. The Care Quality Commission’s (CQC) fundamental standards set out the standards which care must never fall below.
8. Regulation 9: Person-centred care – to ensure that people using a service have care or treatment that is personalised specifically for them based on an assessment of their needs and preferences. Providers must work in partnership with the person and provide support to help them understand and make informed decisions about their care and treatment options. Providers must make sure that they take into account people's capacity and ability to consent, and that either they, or a person lawfully acting on their behalf, must be involved in the planning, management and review of their care and treatment.
9. Regulation 10: Dignity and respect – to ensure people using the service are treated with respect and dignity at all times while they are receiving care and treatment.
10. Regulation 12: Safe care and treatment – to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Providers must assess the risks to people’s health and safety during any care or treatment and make sure staff have the qualifications, competence, skills and experience to keep people safe.
11. Regulation 14: Meeting nutritional and hydration needs – ensuring people who use services have adequate nutrition and hydration to sustain life and good health. Providers must make sure that people have enough to eat and drink to meet their nutritional and hydration needs and receive the support they need to do so.
12. Regulation 17: Good governance – providers must securely maintain accurate, complete and detailed records in respect of each person using the service.
13. Regulation 20: Duty of candour – to ensure providers are open and transparent with people who use services, or those acting on their behalf, in relation to care and treatment.

What happened

14. Mrs X’s father, Mr G, had a terminal illness and needed palliative care. In November 2018, Mrs X contacted IPHS to find out whether it could provide her father with live-in care to start as soon as possible.
15. In December 2018, Mrs X met a representative from IPHS at her father’s hospital. Mrs X said the representative asked her questions about Mr G’s needs regarding care and medicines. She said she did not know the answers to some of these questions and had to ask the medical staff at the hospital. Mrs X said the representative did not visit her father. IPHS agreed to provide a carer to start the next day.
16. Mrs X said the carer was unaware her father was immobile and told her she needed help to move and wash him. Mrs X said she told IPHS her father was immobile. IPHS said its policy was that a team of two staff were needed to move or transfer a customer who was bedbound.
17. Mrs X arranged for an additional carer to assist the IPHS carer, provided by the NHS. The NHS carer visited once to assist the IPHS carer. Mrs X also provided the district nurse’s number to the IPHS carer and told her to call the nurse if her father was in pain and needed his morphine. Mrs X said she also told the carer to call her if she needed anything. Mrs X’s father was cared for by the IPHS carer overnight.
18. The next morning, Mrs X said she called the carer to ask how her father was. Mrs X said the carer told her she had a bad night as Mr G had been awake, trying to remove his catheter, and complaining until the early hours of the morning. The carer then found Mr G unresponsive. A doctor confirmed his death later in the day.
19. Mrs X made a complaint about IPHS’s handling of her father’s care. This included a complaint about the IPHS representative and his disinterest in meeting her father, and why the carer had not called her or the district nurse during the night. IPHS told Mrs X it was not able to provide an explanation for why the carer had not called her or the district nurse because it could not contact the carer as she had left the country.
20. IPHS told Mrs X the representative had explained he had visited Mr G in the hospital before she had arrived. In a record of the representative’s response to the complaint, he contradicts this account. The representative instead said he had asked the hospital staff if he could see Mr G but was told to wait for Mrs X. He also said he asked Mrs X three times if he could see Mr G at the hospital but that she had declined.
21. IPHS said the carer it provided to care for Mr G was an experienced carer who had passed their assessment and training program.

Risk assessments, care plan, and other records

22. IPHS completed several risk assessments for Mr G. These completed by the IPHS representative and on the same day the representative met Mrs X in the hospital. Two of these risk assessments noted he had mobility problems and could not get out of bed. The care plan also set out that Mr G had mobility problems and would need help dressing and washing. In its complaint response, IPHS accepted it had been aware Mr G was bedbound.
23. Mr G needed his medication four times a day. The carer should have given Mr G medication twice in the time she cared for him. Administration of medication are recorded in the medication administration record (MAR). Similarly, any food or fluids are recorded in a food and fluid chart. There are no set times for the carer to give Mr G food and fluids.
24. IPHS provided blank copies of the MARs and food and fluid charts. IPHS said it was unable to provide the completed records because the notes had been left at Mr G’s home. IPHS said it was acceptable to leave the notes to allow the family to examine them. IPHS said Mrs X did not return the records. Mrs X said no records were left with her and she has never seen these records.

Analysis

Assessment of Mr G’s care needs

25. Mrs X had complained about the IPHS representative she met at the hospital. She said he had not visited her father at the hospital.
26. The representative has provided two different accounts of his actions at the hospital. In one account, he stated he had visited Mr G before Mrs X arrived at the hospital. In another account, he stated he had asked hospital staff if he could see Mr G but was told to wait for Mrs X before doing so. He also said he asked Mrs X three times to visit Mr G but that she had declined.
27. Mrs X has said the representative did not visit her father while in hospital. This suggests he had not asked her if he could visit Mr G. Therefore, on balance, I find it was more likely the representative did not visit Mr G while at the hospital.
28. One of CQC’s fundamental standards is that care should be person-centred. It highlights that providers must work in partnership with the person to provide support to help them understand and make informed decisions about their care and treatment options. Providers must make sure that they consider people's capacity and ability to consent, and that either they, or a person lawfully acting on their behalf, must be involved in the planning, management and review of their care and treatment.
29. Therefore, the evidence suggests the actions of IPHS was not in line with Regulation 9 of the CQC’s fundamental standards as the assessment was not person centred. While IPHS had spoken to Mrs X about Mr G’s needs, it did not consult with Mr G about his care and treatment options. As IPHS had not considered whether Mr G had capacity, the assumption must be that he did have capacity. Therefore, IPHS should have involved Mr G in the planning of his care and treatment. This is fault.
30. The identified fault caused Mr G an injustice because he was not given the opportunity to input into his care and treatment.

Care provided

31. It is clear IPHS has accepted it knew Mr G was bedbound. It said its policy states two carers are needed to move or transfer customers. Despite knowing Mr G was bedbound, IPHS only arranged for one carer to care for Mr G. This was fault.
32. I find the fault identified did not cause an injustice to Mr G. This is because Mrs X arranged for an NHS carer who attended and assisted the IPHS carer with washing Mr G. Therefore, the evidence suggests Mr G received appropriate care when the NHS carer attended to assist.
33. However, the fault did cause an injustice to Mrs X. This is because IPHS should have provided the second carer and Mrs X should not have had to arrange an additional carer to assist with caring for her father. While I have not seen any evidence Ms X had to pay for the additional carer, she was nevertheless inconvenienced by the time and trouble she took to arrange the second carer.

Record keeping

34. IPHS could not provide completed MARs and food and fluid records. This was because the carer had left the records at Mr G’s property.
35. Good governance is one of CQC’s fundamental standards. It notes that providers must securely maintain accurate, complete, and detailed records in respect of each person using the service. Therefore, IPHS should have kept accurate and up to date records of the care it provided to Mr G. This is fault. This also demonstrates IPHS did not check the carer’s notes or collect important documents from her before she left Mr G’s property.
36. I cannot say whether, on balance, Mr G was provided with his medication, or food and fluids. Therefore, the fault identified caused Mrs X an injustice because she is left with uncertainty about whether the IPHS carer provided Mr G with safe care and treatment, and adequate nutrition and hydration, in his final hours. This is highly distressing to Mrs X.

Appropriate carer

37. Regulation 12 of CQC’s fundamental standards state that providers must make sure staff have the qualifications, competence, skills and experience to keep people safe.
38. Having reviewed Mr G’s care plan, I can see there was no request, or requirement, for any specific carer. IPHS has confirmed it considered the carer to be suitable for the placement. Therefore, as there is no evidence to suggest the carer was unsuitable to care for Mr G, I do not find fault with IPHS for the carer it provided.

Recommended action

39. In order to remedy the identified faults, IPHS should complete the following:

• provide a sincere and meaningful apology to Mrs X for the faults identified, and;
• pay Mrs X £1000 to remedy the distress, uncertainty, and time and trouble caused by the faults identified.

40. IPHS should complete the above remedy within four weeks of the final decision.
41. IPHS should also review its processes and explain how it will make improvements to ensure completed MARs, food and fluid records, and any other relevant care records, are documented and filed at the end of each carer’s shift. IPHS should provide evidence of the improvements identified and the steps it will take to make improvements. If no improvements can be made, IPHS should explain the reasons why.
42. IPHS should complete this remedy within three months of the final decision.

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Final decision

43. I find some fault with IPHS for their failure to consult with Mr G about his care arrangements, arranging an unsuitable care package, and poor record keeping. I do not find fault with IPHS for the carer it provided. I have completed my investigation.
44. I have shared a copy of my final decision with the CQC in line with our information sharing agreement.

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Investigator's decision on behalf of the Ombudsman