Summary: The complainant, whom I will call Mrs X, complains about the domiciliary care provided to her father, Mr Y. The Ombudsman finds the absence of some care records creates uncertainty about the care provided. But the available records show that Mr Y’s care was not always provided in accordance with his support plan. We also find fault with the care provider’s communication with Mrs X and its handling of her complaint. The provider will pay £150 to Mrs X and undertake the other actions listed at the end of this statement.

The complaint

1. The complainant, whom I will call Mrs X, complains about the domiciliary care provided to her Father, Mr Y. She says the care provider failed to:
• provide an acceptable standard of care to Mr Y
• communicate appropriately with the family; and
• respond adequately to her complaint
2. Mrs X says that she and Mr Y have suffered injustice because Mr Y has not received the care he is entitled to and the family have experienced distress as a result.

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The Ombudsman’s role and powers

3. We may investigate complaints from a person affected by the matter in the complaint, or from someone the person has authorised in writing to act for him or her. If the person has died or cannot authorise someone to act, we may investigate a complaint from a personal representative or from someone we consider suitable to represent the person affected. (section 26A or 34C, Local Government Act 1974)
4. 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)
5. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
6. If we are satisfied with a care provider’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)

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How I considered this complaint

7. During my investigation I have:
• discussed the complaint with Mrs X and considered any information she submitted;
• made enquiries of the care provider and considered its response;
• consulted any relevant law and guidance, cited where necessary in this statement; and
• issued a draft decision statement and considered any comments received before making a final decision.
8. 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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What I found

9. Mr Y received a package of domiciliary care from ‘Key 2 Care Limited’ which I will refer to as ‘the provider’. Mr Y’s support plan said that he required one 30-minute care call each morning, and one 15-minute care call each teatime. Each Friday the teatime care call would be 60 minutes to allow time for additional cleaning.
10. The support plan said that carers should undertake the following tasks during Mr Y’s morning calls:
• open curtains and light fire, if needed
• make Mr Y’s bed
• help Mr Y with a full body wash and help to change his clothes. If Mr Y refuses personal care, his daughters are to be notified so they can help persuade Mr Y to accept help with personal care
• check Mr Y’s skin and apply medicated cream as necessary
• empty and rinse the urine bottle in Mr Y’s bedroom
• give any necessary medication and record on the Medication Administration Record (MAR) chart
• prepare breakfast. Also prepare a sandwich and drink ready for lunch
• ensure Mr Y has access to his ‘care link’ wristband
• empty the bins
• check laundry and place on wash cycle if needed
• ensure all work areas are clean and tidy. Work surfaces in kitchen to be cleaned with anti-bacterial spray.
11. During the teatime calls, the support plan said carers should:
• apply medicated cream to Mr Y’s skin as necessary
• ensure Mr Y has access to his ‘care link’ wristband
• wash dirty crockery and tidy kitchen
• empty the bins
• prepare a microwave meal or salad for Mr Y’s evening meal
• prepare a cold drink for Mr Y
• lock door on exit
12. On a Friday teatime calls, carers should also:
• thoroughly clean Mr Y’s bathroom and kitchen. Brush and mop floors
• empty bins
• vacuum all carpets
• damp dust furniture in lounge
• wash dirty crockery. Also check kitchen drawers and cupboards for dirty items
• change bedding

Mrs X’s complaints

Regular carers

13. One of Mrs X’s complaints is that the provider failed to meet her request for Mr Y to have regular carers. It is understandable that, due to Mr Y’s diagnosis of Alzheimer’s Disease, he felt more comfortable and at ease with carers familiar to him.
14. I have reviewed the email correspondence between the provider and Mrs X. These emails show Mrs X raised concerns about the turnover of care staff and the provider’s inability to ensure that Mr Y received care from only those he was familiar with.
15. The provider tried to meet Mrs X’s request, but this was not always possible due to staff sickness, staff turnover and other rota commitments. The provider arranged for two carers to shadow Mr Y’s preferred carer to help familiarise them with Mr Y and to ensure consistency, should the preferred carer be unable to attend any of Mr Y’s calls.
16. Mrs X continued to raise concerns. The provider agreed to contact Mrs X before any care calls if the carers scheduled to attend were not Mr Y’s preferred or regular carers. However, despite making this agreement, the provider did not always contact Mrs X before any such calls. It has apologised for this failure in communication.
17. The provider served the required 14 days’ notice to end Mr Y’s contract in March 2019 because, due to operational constraints, it considered it was not possible to assign specific carers to Mr Y as per his preference.
18. The ‘Welcome and Information Pack’ shared with service users makes the following clear, “Whilst we will endeavour to ensure that you have a regular carer assigned to you, we cannot guarantee that it will be the same face on every visit…. If you are receiving more than one call a day it is likely that you will meet several carers”
19. While I appreciate the reasons for Mrs X’s request, I cannot say the provider’s refusal to fulfil that request amounts to service failure. I do however agree the provider’s communication around the matter was sometimes lacking, but for this it has already apologised. I will not recommend any further remedy.

Quality of care

20. Mrs X raised the following general concerns about the care provided to Mr Y:
• carers sometimes ended calls too soon, leaving Mr Y without the full care he was entitled to
• carers sometimes attended the teatime calls too early
• carers sometimes failed to follow Mr Y’s support plan and did not undertake all tasks as needed
21. I have considered the available daily care notes and the call-logging data which shows the times which carers entered end left Mr Y’s property. Unfortunately, the provider has not shared daily notes for the whole period of Mr Y’s care; notes for calls made after 3 December 2018 were not included in the provider’s response to my enquiries. Therefore, it is not possible for me to review the whole period.
22. From the notes I have reviewed, it appears the care provided to Mr Y was not always in line with his support plan. For example, on some occasions the notes do not evidence that carers always:
• prepared and left meals or drinks when needed
• emptied bins, cleaned surfaces and tidied
• made Mr Y’s bed after washing the linen
• ensured Mr Y took his medication at the required times
• contacted Mrs X or her sister on occasions when Mr Y refused personal care
23. The call log data shows times when Mr Y’s care calls ended early. However, it also shows many times when Mr Y’s calls were longer than they should have been. Overall, the data shows that Mr Y received more time than what was specified in his support plan. Mrs X has not said that she has been charged for this additional time.
24. Furthermore, the records show at least ten occasions when Mrs X cancelled care calls. Mrs X says she sometimes cancelled calls when the carer who attended was not known to Mr Y. It was not contractually agreed that Mr Y could only receive care from certain carers, although the provider had agreed to try and meet that preference. Mr Y’s terms of contract did however state that cancelled calls require 48 hours’ notice. The provider reserved the right to charge in full for calls cancelled without the required notice but did not do so in Mr Y’s case.
25. Although some of the care provided to Mr Y was not in accordance with his support plan, I have not recommended any financial remedy, either for quantifiable loss or distress. This is because the provider has not pursued some costs it was entitled to. These costs amount to more than what I would have recommended.

Record keeping

26. Although Mrs X has not complained specifically about record keeping, it is apparent from the provider’s response to my enquiries that it has not retained satisfactory records for Mr Y. As mentioned previously in this statement, the daily care records do not cover the whole period of care. The provider says it has not been able to locate the records in question.
27. Mr Y’s support plan is clear that any medication, including his medicated skin cream, is to be administered and recorded on a MAR chart. The provider has not provided any completed MAR charts to the Ombudsman.
28. An email exchange between Mrs X and the provider on 25 March 2019 refers to a completed MAR chart. Mrs X says the chart was taken from Mr Y’s home by a carer after the last care call in March 2019. The provider responded to say that Mr Y’s new care provider would need to create their own chart. Whilst I have not seen the completed MAR chart, it is evident from the emails that one did exist.
29. Although the administration of Mr Y’s medication is sometimes recorded by carers in the daily care notes, these notes do not provide the same detail as a MAR chart would. This is because MAR charts must detail the following:
• which medicines are prescribed for the person
• when they must be given
• what the dose is
• any special information, such as whether to be given with or without food.
30. As Mr Y’s MAR chart has not been provided to the Ombudsman, it is not possible for me to review and establish whether Mr Y’s medication was always administered as needed. This is fault. Regulation 17 of the ‘Health and Social Care Act 2008 (Regulated Activities) Regulations 2014’ says that providers must, “maintain securely an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided”
31. The absence of these records creates uncertainty. If fault causes injustice in the form of uncertainty, the Ombudsman may recommend a financial remedy. However, for the reasons explained in the above section of this statement, I have decided that it would not be appropriate to recommend a payment in this case.
32. The provider should, however, provide evidence to show it has procedures in place to safely retain the records of its service users in line with the requirements of the Care Act.

Communication and complaint handling

33. Email exchanges between Mrs X and the provider show that Mrs X started raising formal complaints from October 2018. Despite some general email correspondence, there is no evidence to show the provider investigated and formally responded to the complaints made. This is fault.
34. The provider’s own policy says that every complaint it receives is acknowledged within 5 working days. It then investigates all complaints within 14 working days and aims to respond within 28 days of the complaint being made. In complex cases, the provider says it will issue a ‘holding letter’ to the complainant.
35. The template complaint response letters included in the provider’s policy make no reference to the Ombudsman. This is also fault.
36. I consider the provider’s failure to respond to Mrs X’s complaint in line with its own complaint policy caused her avoidable time and trouble. This is because the provider delayed in issuing its response, failed to investigate the issues raised and did not explain how Mrs X could escalate her complaint further. The provider will remedy Mrs X’s injustice with the actions referred to in the section below.

Recommended action

37. Within four weeks of my final decision, the provider will evidence to the Ombudsman that it has:
• amended its complaint response template letter to signpost complainants to the Local Government and Social Care Ombudsman upon the final stage of the provider’s complaints procedure; and
• paid £150 to Mrs X for the avoidable time and trouble caused by the fault in its complaint handling.
38. Within eight weeks of my final decision, the provider will evidence to the Ombudsman that it has:
• internal procedures in place to ensure it securely maintains an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken about the care and treatment provided.

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Final decision

39. I have completed my investigation with a finding of fault causing injustice for the reasons explained in this statement. The actions I have recommended provide a suitable remedy for the injustice caused by fault.

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Investigator's decision on behalf of the Ombudsman