Summary: The care provider failed to ensure that Mrs A received a proper standard of care and treatment.

The complaint

1. Mrs X (as I shall call the complainant) complains that carers employed for companionship for her elderly mother (Mrs A) neglected her, falsified timesheets, discussed other clients in front of her and verbally abused her.

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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). 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

3. I considered all the information provided by Mrs X and by the care provider. Both parties had an opportunity to comment on an earlier draft of this statement, and I considered their comments 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 10 says that service users should be treated with respect.
7. Regulation 13 says that service users must not be subjected to degradation or treated in a manner that might reasonably be viewed as degrading, such as being ridiculed in any way.
8. Regulation 14 says the nutritional and hydration needs of service users must be met.

What happened

9. The care provider began to provide care for Mrs A and the late Mr A in 2013. When Mr A died, the care provider continued to provide a service to Mrs A. Mrs A has dementia. She requires help with preparing meals, prompting to take her medication and companionship either at home or at the clubs she attends.
10. Mrs X says after Mrs A started calling her and her sister several times a day sand was obviously distressed, she decided to install a recording device in her mother’s home. She says the two regular carers knew she had also installed a CCTV camera outside her mother’s front door in 2017. She says she was shocked when she heard the recordings, where the carers told Mrs A she was “bitter” and would be a “lonely old woman”. In the two hours of the carers’ presence at Mrs A’s house, Mrs X says they spoke to Mrs A for less than 5 minutes.
11. Mrs X complained to the care provider. As well as sending the recordings, she also said the timesheets which had been completed by the two main carers had been falsified, as the times of arrival and departure did not tally with the CCTV recordings. On some occasions one or other of the carers had signed in on the care provider’s electronic system but had not arrived. On one of those occasions Mrs X said her mother had telephoned her worried because the carer had not arrived and she had missed lunch. On the same day the CCTV showed one carer arriving late, taking Mrs A out in the car without recording where she had gone. She cited numerous other evidenced examples of late calls, early calls and missed meals.
12. The Care Manager met Mrs X and her sister and removed the two main carers from Mrs X’s rota of care with immediate effect after their meeting. Mrs X wrote to the care provider and asked how the agency intended to ensure that in the future the calls would be properly monitored. She said they expected a refund for the missed calls.
13. The care provider’s records show that the care provider interviewed the two main carers in early December and dismissed them both. The care provider also submitted the necessary notification of abuse to the CQC.
14. At the end of January the managing director of the care agency wrote to Mrs X to apologise for the way in which Mrs X had been treated. He said both employees had now been dismissed. He said because the care manager had been off sick for some time the complaint had not been handled as it should have been. He offered two weeks’ care free of charge by way of compensation for the missed calls.
15. In March Mrs X complained to the Ombudsman. She said Mrs A had trusted her carers, but out of 106 calls carried out by the two main carers there were 100 time discrepancies. She said there had been a significant delay in handling the complaint which they had not realised until the managing director wrote to them with a copy of the complaints procedure in January.
16. The care provider says he did not hear from Mrs X again after he wrote with the offer of two weeks free care and offered to meet. He says the family ended the care contract without adhering to the usual notice period.
17. The care provider has provided details of the improvements in the complaints process, as well as details of staff dementia training and medicines training. He says, “The Pass [electronic monitoring] system is being looked at to give guarantees of attendance and times of visits. As we progress with this, I will keep you informed. Pass refresher training has been given during May 2019 and we are installing tags in customer homes to assist with connection to the system and provide more certainty with details.”
18. Mrs X says the PASS system which the care provider uses is not developed to record accurately time and duration of carers’ visits. She also says none of the carers has asked for the timesheets to be signed (as the care provider’s information says it should be) for at least the last two years.
19. The care provider has now given more updated information about the PASS system: “NFC tags (android phones) and QR codes (I phone 6 and above) are now in customer homes and our staff scan on arrival a departure when notes are completed. This can be evidenced on Pass and is viewed in our office. Any alerts red or amber are flagged up and dealt with daily.”
20. Mrs X says the family relied on the information recorded on the PASS system and thought Mrs A was confused when she said carers had not been or had come at a different time. She says how cruel and unforgiveable that was.

Analysis

21. The care provider failed to monitor the way in which carers delivered care to a vulnerable elderly person. Instead the carers frequently arrived late, left early, handled the call together when not on duty, took Mrs A out at least once without notification, missed meal-time calls. That was fault which caused Mrs A injustice.
22. The care provider also acknowledges it did not process the complaint through its own procedures as it should have done: that caused delay and distress to Mrs X.
23. The care provider has taken some remedial action by reviewing its complaints procedure and improving its electronic time-keeping system. It has also offered a period of free care for Mrs A and waived the notice period.

Agreed action

24. The care provider has now provided the Ombudsman with its proposals for improving the electronic timekeeping system to ensure carers keep accurate records;
25. Within one month of my final decision the care provider will offer a payment to Mrs A of £1500 in recognition of the missed care and distress caused to her by the actions of its carers.

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Final decision

26. The actions of the care provider caused injustice to Mrs A.

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Investigator's decision on behalf of the Ombudsman