Summary: Mrs C complains about the quality of care the Council provided to her late husband. There was fault in the way care records were recorded and maintained. The Council has agreed to apologise and make a payment to Mrs C to remedy the injustice caused. It has also agreed to remind its care provider about the importance of maintaining accurate records.

The complaint

1. Mrs C complains about the quality of care the Council provided to her late husband, Mr C. She complains that:
• Carers failed to provide care in accordance with Mr C’s care plan, and often arrived late or left early.
• Carers could not lift Mr C from the toilet, leaving him there for three hours until paramedics arrived.
• The Council delayed installing a bed guard to Mr C’s bed, resulting in him falling from his bed.
• An assessment by an Occupational Therapist (OT) was delayed, meaning Mr C stayed in his bed for 10-12 weeks.
• The Council put pressure on Mrs C to sell her property to fund care for Mr C.
• A carer assaulted Mrs C’s son.

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What I have investigated

2. I have investigated all of Mrs C’s complaints about the care Mr C received and her complaint that the Council put pressure on her to sell her home.

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The Ombudsman’s role and powers

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. 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)
5. 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)
6. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

7. As part of the investigation, I have:
• considered the complaint and information received from Mrs C; and
• reviewed and considered information received from the Council; and
• spoke with Mrs C about the complaint.
8. I also sent a draft version of this decision to both parties, and invited their comments.

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What I found

Legal background

9. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
10. Where local authorities have determined that a person has any eligible needs, they must meet these needs
11. Councils which are local housing authorities have a duty under the Housing Grants, Construction and Regeneration Act 1996 to provide a Disabled Facilities Grant to disabled people who need certain home adaptations.
12. Before approving a DFG, the council must be satisfied the work is necessary and suitable to meet the needs of the disabled person, and that it is reasonable and practicable to carry out the work.
13. Usually an Occupational Therapist (OT) or Occupational Therapy Assistant (OTA) will assess the disabled person’s needs and the best way to meet them. The local housing authority must consult the social care authority, and have regard to that advice, but it will decide whether to approve the DFG and the type of adaptations that should be provided.

Care provider standards

14. There are standards for safety and quality care providers need to meet: The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the Regulations). The Care Quality Commission (the CQC) has written guidance to help care providers meet these standards: Guidance for providers on meeting the regulations (March 2015) (the Fundamental Standards).
15. Under the Regulations and Fundamental Standards, care providers need to make sure:
• They securely maintain accurate, complete and detailed records in respect of each person using the service. (Regulation 17)
• They take all reasonable steps to make sure that people who use services are not subjected to any degradation or treated in a matter that may reasonably be views as degrading, making sure people are left on the toilet for long periods and without the means to call for help. (Regulation 13).

What happened

16. In 2017, Mr C, who was in his seventies, had a stroke leaving him with multiple medical issues, including problems with mobility.
17. The Council subsequently approved a Disabled Facilities Grant (DFG) for alterations to Mr C’s property, including the installation of a stairlift. The Council appointed a contractor to carry out the works.
18. Records show that in April 2018, Mr C had a fall at home resulting in him fracturing his hip. After seven weeks of hospital treatment and rehabilitation, Mr C returned home.
19. In May 2018, the Council assessed Mr C’s care needs and implemented a Support Plan, comprising of two carers visiting Mr C to assist him moving from his bed four times per day.
20. The Council has a contract with Mayfair, a company that the Council has commissioned to provide adult social care on its behalf. Mayfair were commissioned to provide Mr C’s care needs.
21. The Council made the decision to put the DFG funded alterations on hold, until it was clear that Mr C would be able to make use of them. Records show that this was explained to Mrs C at the time. The Council did however provide a bed and equipment to assist moving Mr C, for when he returned home.
22. Mr C returned home in June, and the Councils Occupational Therapist (OT) visited him three days later. The OT recorded that Mr C was happy with his sleeping arrangements. The OT also discussed installing a ramp to the property to make access easier.
23. The OT subsequently contacted Mrs C to arrange an assessment of the property with a view to installing a ramp. During this conversation Mrs C asked if a guard could be fitted to Mr C’s bed, as he keeps falling out of bed.
24. Records show that one week after Mrs C’s request, the OT carried out a risk assessment and the guards were ordered. The guards were delivered and installed one week later.
25. During the period when Mrs C requested the bed guards, and the time they were fitted, there are no records on the Council’s systems to suggest that Mr C fell from his bed again.
26. Carers records show that on 15 July 2018, carers attended Mr C’s home and assisted him onto the commode. However, the were unable to assist him back onto his bed resulting in Mrs C having to call paramedics to assist. The records show carers left the property after 50 minutes with Mr C still on the commode
27. In its response to Mrs C’s complaint, the Council told Mrs C that Mayfair had said that the carers were at the property for well over an hour and had tried to move Mr C from the commode for 45 minutes. The Council said that carers ensured Mr C was a comfortable as possible and not at risk before they left.
28. The OT visited Mr C two days later and the carers attending Mr C informed her of their issues moving Mr C and said that until an OT assessment was completed, he would need to stay in bed.
29. The OT attempted to assist Mr C in moving to the commode. However, was unsuccessful after Mr C became tired. The OT suggested to Mrs C that she should try again later, and Mrs C agreed.
30. One week later, a new bed was installed for Mr C and the OT trialled techniques for moving him to and from the bed. However, these techniques were again unsuccessful.
31. The OT contacted a moving and handling specialist and asked them to attend Mr C’s property to assess techniques for moving him. On the first appointment Mr C became too tired to complete the assessment. On the second appointment, they were able to move Mr C by using a hoist. The OT informed the care provider of their findings
32. The care provider attempted using the hoist to move Mr C but contacted the OT to say they had been unsuccessful.
33. The OT visited Mr C and tried to assist him into a chair. However, they found that he was unable to sit upright and was slipping forward. The OT made the decision for a rehab programme to be implemented to build Mr C’s tolerance to sitting. However, on 13 August, Mr C was admitted to hospital, before the rehab programme could be implemented.
34. The Council carried out a review of Mr C’s Support Plan while he was in hospital. It detailed how Mr C could be moved from his bed using two carers and with the support of a rehabilitation and reablement team.
35. Mr C was discharged from hospital on 17 September. The Council’s case notes record that Careline’s carers again struggled to transfer Mr C from his bed, and the OT attended his home and gave advice to the carers.
36. Records show that they were successful in transferring Mr C on at least one occasion. However, nine days after Mr C was discharged, he was readmitted to hospital. Sadly, three weeks later Mr C died in hospital.
37. During her visits to Mr & Mrs C, the OT recorded that she asked Mrs C if she would consider moving somewhere more accessible. Mrs C said that it would be difficult as she owned the property but would discuss it with her son. The OT subsequently left the family some information on accessible housing.
38. The Ombudsman asked the Council to provide care records for between the time Mr C was discharged from hospital in June until he was readmitted to hospital.
39. Although the Council provided care records for July, it said that Mayfair did not have records for June, August and September as they were still at Mr C’s property. However, Mrs C has said no carer records remain at her property.
40. The front page of the care records for July, state that records should be returned the office every month. Each page of the care record says that if any needs or problems are identified, the carers should record these and report them to the office immediately.

Analysis

Quality of care provided

41. When a council commissions care services for a person it remains liable for any service failures of the care provider. Council’s should ensure care providers keep proper daily care records, including the care given and start and end time of visits so it can be assured that the service is reliable and timely.
42. Timely visits to vulnerable people in their own homes are an important part of meeting individual needs and ensuring their wellbeing.
43. Mrs C says that carers often turned up late, left early or did not carry out the tasks listed in Mr C’s care plan.
44. Mayfair have been unable to produce care records for three of the four months it provided care for Mr C. Mayfair says it left the records at Mr C’s property, Mrs C disputes this.
45. Carers should have been returning care records to the care providers office every month, they did not, meaning that the care provider has failed to securely maintain its records. This is fault.
46. Poor record keeping means there is uncertainty about some of what happened. It is for this reason I am unable to say the degree to which Mayfair carers provided Mr C with an acceptable level of care; however, the comments Mrs C has made suggest the standard of care and timeliness of visits fell beneath the required standard on occasion. The uncertainty caused by the missing records causes additional distress and frustration for Mrs C, as it means she has not received a full investigation into her complaints.

Carers leaving Mr C

47. Mrs C complains that carers left Mr C on the commode for three hours, until paramedics arrived, because they were unable to transfer him back to his bed.
48. In its response to Mrs C’s complaint, the Council said the carers were at Mr C’s property for well over an hour, had tried to transfer Mr C from the commode for 45 minutes and that he was as comfortable as possible and not at risk.
49. However, the care records show that carers were at the property for 50 minutes. There is also no record how long they tried to transfer Mr C, or the level or comfort or risk he was subject to when carers left.
50. There is also no mention of what alternative action the carers considered, or if they contacted the Careline’s office to make alternative arrangements. Furthermore, the carers should have contacted the Council immediately to inform it they had been unable to meet one of his care needs. However, there is also no record that it did no.
51. The failure to record details of this incident accurately is further evidence of fault likely to have created more distress and frustration for Mrs C. Furthermore, whilst it is not possible to know exactly Mr C was on the commode, I do consider that by doing so this also amounted to a loss of dignity for Mr C.

Occupational Therapist assessment

52. Mrs C says that after carers faced difficulty moving Mr C, a decision was made for him to stay in his bed until the Occupational Therapist could complete an assessment. Mrs C says this meant Mr C stayed in bed for 10-12 weeks.
53. Records show that when carers told the Council that they had not been able to transfer Mr C from his commode, the Occupational Therapist made several visits to Mr C, consulted specialists and assessed different types of equipment to try to find a safe way for carers to transfer Mr C from his bed.
54. After four weeks it was decided that Mr C would undergo physiotherapy to increase his strength, which would aid his movement. However, shortly after Mr C was admitted to hospital.
55. It is unfortunate that the carers faced difficulty transferring Mr C. However, although this meant Mr C remained in his bed for four weeks, the evidence shows that the Council took steps to try and resolve the issue to ensure Mr C could be transferred from his bed safely. I therefore do not find fault in how it handled this matter.

Installation of bed guards

56. While Mr C was in hospital, the Council ordered a bed for his home which was delivered prior to his discharge. Records show the Social Worker visited him at home and Mr C reported he was happy with the bed.
57. Shortly after Mrs C reported to the Social Worker that Mr C kept falling from the bed. Within two weeks of this the Social Worker had carried out a risk assessment, ordered the guards and the Council had fitted them.
58. During this two-week period, there are no records on the Council’s system that Mr C fell from his bed again. I therefore do not find that Mr C suffered injustice as a result of the time taken to order the bed.

Disability facilities grant assessment

59. Mrs C complains that alterations approved to Mr & Mrs C’s home, under a DFG application in 2017 never materialised.
60. Before the alteration works could be started Mr C was admitted to hospital. Upon being discharged from hospital, records show that the Occupational Therapist concluded that these alterations should be put on hold until it was clear Mr C could make use of them.
61. Unfortunately, records indicate that Mr C’s condition deteriorated after his discharge with him being bedbound for long periods and him being readmitted to hospital. I do not find fault with the Council’s decision to suspend the alterations, as his change in health meant they were not suitable to his needs.

House sale

62. Mrs C feels that the Council put pressure on her and Mr C to put their home up for sale. The Council dispute this and say that they have never received a complaint about this matter.
63. Having reviewed the Council’s records I have seen evidence that the Council discussed the possibility of the family moving to a more suitable property and that further information about accessible housing was left with the family. I have seen no evidence to suggest that the Council pressured the family into making a decision.

Conclusion

64. The faults identified in this report have caused Mrs C distress. The Ombudsman’s remedy guidance explains that distress cannot generally be remedied by a payment, so we seek a symbolic amount to acknowledge the impact of the fault on the payment.
65. The remedy guidance says that any remedy should reflect the circumstances of the case, including the severity of the distress and the length of time involved. It says payments are often between £100 and £300.
66. I consider that the distress caused to Mrs C was significant. It is for this reason I consider it appropriate for the Council to offer Mrs C a remedy payment at the higher scale of £250. I also consider it appropriate that the Council Mayfair about the importance of securely maintaining accurate care records.
67. The failure to keep proper records and decision to leave Mr C on the commode are matters that might amount to a breach of the CQC’s fundamental standards for care providers, which is why I am sharing this decision with that body.
68. In her complaint to the Ombudsman, Mrs C suggested the poor level of care provided by the Council contributed to his death. However, I have not found any direct causal link between the faults I have found, and Mr C’s death.

Agreed action

69. 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 Mayfair, I have made recommendations to the Council.
70. Within one month of the date of this report the Council has agreed to:
• Pay Mrs C £250 for the distress caused by the faults identified in this decision.
• Send Mrs C a formal written apology for the faults identified in this decision.
71. Within three months of the date of this decision, the Council has also agreed to remind Mayfair about the importance of securely maintaining accurate care records.

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Final decision

72. I conclude my investigation with a finding of fault which caused Mrs C an injustice.

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Parts of the complaint that I did not investigate

73. I have not investigated Mrs C’s complaint that her son was assaulted by a carer. This is because it is a criminal matter and the Police are therefore better placed to deal with it.

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Investigator's decision on behalf of the Ombudsman