Summary: There is no evidence Mr X suffered any injustice as a result of the carer’s actions.

The complaint

1. Mr A (as I shall call the complainant) says the carer from Eclipse Homecare failed to take prompt action when his father Mr X became unconscious. He complains that the care provider should not have employed this carer as a sole carer for a vulnerable adult.

Back to top

What I investigated

2. I have investigated the complaint as described above. I explain at the end of this statement why I did not investigate other matters.

Back to top

The Ombudsman’s role and powers

3. 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)

Back to top

How I considered this complaint

4. I considered the information provided by the care provider and by Mr A. I spoke to Mr A. Both Mr A and the care provider had an opportunity to comment on an earlier draft of this statement before I reached a final decision.

Back to top

What I found

Relevant law and guidance

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 12 says that providers must work with others to ensure care and treatment remains safe.
7. Regulation 16 says that any complaint received must be investigated and any necessary and proportionate action taken in response to any failings identified.
8. Regulation 19 says that persons employed to care for service users must be of good character, have the skills, training, competence and experience to carry out the necessary tasks, and be able by reason of their health to carry out properly tasks for which they are employed.
9. A council must make necessary enquiries if it has reason to think a person may be at risk of abuse or neglect and has needs for care and support which mean he or she cannot protect himself or herself. It must also decide whether it or another person or agency should take any action to protect the person from abuse or risk. (section 42, Care Act 2014)

What happened

10. Mr X is an elderly man who has vascular dementia. Mr X funded his own live-in care while living at home. His care was shared between carers from Eclipse and a personal assistant (PA) employed by his family, who was also a trained nurse. The Eclipse carer on duty during the incident which is the subject of this complaint had already handed in his notice the previous week.
11. On 12 November 2018 Mr X was being visited at home by members of his family (including Mr A) when he appeared to have a transient ischaemic attack MR A says this initial diagnosis was ruled out during investigations). Mr X was described as ‘difficult to rouse’ and then ‘struggling to stay awake’. His family was concerned and Mr A telephoned the GP to visit the following day. Mr A says the carer wanted to put Mr X to bed straightaway, but the family persuaded him to give Mr X something to eat and drink first.
12. Mr X’s GP visited him on the morning of 13 November, when the PA was on duty. The GP did not suggest any treatment or that Mr X should go to hospital. He told the PA to contact him again if there were any recurrences. The PA relayed that advice to the carer when he arrived on duty mid-afternoon. A neighbour was visiting Mr X when the carer arrived. Mr A says the neighbour was concerned about Mr X but the carer took no action. The carer says the neighbour left, and Mr X started to fall asleep.
13. The carer says Mr X’s teenage grandson arrived at about 4pm. Mr X had now fallen asleep and could not be roused by the grandson or the carer. The grandson reported that when he arrived, Mr X was asleep and the carer was ironing ‘in front of a blank TV screen’. The carer telephoned the GP surgery following the earlier instruction. As there was no answer to the phone calls to the surgery, the grandson said he would run there to tell the doctor. The carer says shortly after the grandson left, he was able to speak to someone at the surgery and was advised to ring 999. He did so. Paramedics arrived, as well as Mr A and his wife. Mr X was taken to hospital.
14. Earlier that afternoon, Mr X’s relative had telephoned the care provider with concerns about the carer. She said he had confided in her that he had suffered some mental health problems and was a reformed alcoholic. The care manager had decided to visit to follow up the concerns and arrived shortly before the paramedics. His report of the incident says, ‘Paramedics decided to admit (Mr X) to hospital, not because they were concerned at the time but because they were informed by (Mr A) of at least one other similar 'absence'.
15. Mr X’s dementia deteriorated in hospital and he was unable to return home, although Mr A says this was principally because of his poor mobility and not his dementia. Mr A says it was the hospital staff who advised the family to contact the safeguarding team. Mr X became resident in a care home.

The complaint

16. Mr A complained to the care provider in December. He said the carer was an alcoholic and should not have been employed to look after his father. He said the carer had not sought medical attention for Mr X despite other similar episodes which the carer told him had happened. He said the carer was unresponsive to Mr X’s deteriorating health.
17. The care provider asked Mr A for copies of the daily logs and also for the PA’s daily notes. He wrote to Mr A on 24 December and said without the documents he had requested he could not investigate the complainant. He asked for confirmation of how Mr A knew the personal details about the carer.
18. The care provider says Mr A did not send the documents: Mr A says he has handed in all the records at the care provider’s office.
19. In January the care provider wrote to Mr A. He said he had concluded the investigation without the benefit of the documents. He had interviewed members of staff about the incident. He had also reviewed the staff file, noted that all recruitment and training procedures were correct and the DBS checks completed. The carer had said he had confided in one family member that he had previously suffered some mental health problems and was a reformed alcoholic who had not drunk alcohol for over a year.
20. The care provider did not uphold Mr A’s complaints. There was no evidence the carer’s personal life had affected his care of Mr X. There had been no lack of action in seeking medical attention for Mr X on 13 November. There was no evidence of other similar episodes which had gone unrecorded, and no concerns expressed by the trained nurse who was Mr X’s other carer. The care provider wrote to Mr A on 7 January with the outcome of his investigation.
21. Mr A appealed against the finding of the investigation. The care provider, in accordance with the company complaints policy, asked an independent complaint advisor (ICA) to consider the complaint and appeal.
22. The ICA examined all the relevant documentation and interviewed members of staff. He wrote to Mr A (and to the care provider) in February with his findings. He said he found no evidence why Eclipse should not have employed this carer. He found no evidence of a lack of action on the part of the carer which could have led to Mr X’s hospitalisation. There was no evidence of previous incidents which had gone unreported. The carer had not been unresponsive to Mr X’s deteriorating health. He did not uphold the appeal.
23. Mr A complained to the Ombudsman. He said the carer should not have been employed by Eclipse. He says the whole episode has been very upsetting for his teenage son.
24. The care provider says the PA employed by the family has not raised any concerns. The local council opened a safeguarding enquiry but says there was insufficient evidence to proceed to an investigation.

Analysis

25. There is no evidence of a delay in seeking medical attention when Mr X appeared unwell. A GP saw Mr X earlier that day when Mr X was eating, drinking and talking coherently, and he did not raise concerns.
26. There is nothing to suggest a failure to act on the part of the carer led to Mr X’s admission to hospital or that there is evidence of significant delay. Mr X had fallen asleep after the neighbour’s visit but it was only when the grandson arrived it became apparent Mr X was difficult to rouse.

Back to top

Final decision

27. There is no evidence that the actions of the care provider caused injustice to Mr X.

Back to top

Parts of the complaint that I did not investigate

28. Mr A also complains about unrelated incidents when he says the carer failed to answer the door when his father’s friend visited. As that has no relevance to the complaint under investigation I have not included it.

Back to top

Investigator's decision on behalf of the Ombudsman