Summary: the care provider did not always update Mr X and Ms A about the care of their elderly father Mr B, as it promised. However, that failure did not cause injustice to Mr B.

The complaint

1. Mr X (as I shall call the complainant) says the care provider failed to give regular information about Mr B to himself and his sister Ms A, as requested.

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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)

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How I considered this complaint

3. I considered the information received from Mr X and from the care provider. Both parties had an opportunity to comment on an earlier draft of this statement before I reached a final decision.

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What I found

Relevant law and guidance

4. 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.
5. Regulation 9 (“person-centred care”) says care providers should enable and support relevant persons “to make, or participate in making, decisions relating to the service user’s care or treatment to the maximum extent possible”.

What happened

6. Mr B has dementia. He lives alone and needs help with bathing and dressing, meal preparation, and prompting with taking his medication as well as domestic tasks. Mr X and Ms A both live many miles away from Mr B.
7. Extra Hands agreed the contract for Mr B in June 2017. Tasks included three care calls a day, and extra prescription collection. Mr X arranged and signed the contract. The contract said “If Extra Hands has to withdraw the service we will provide you with 4 weeks’ notice in writing unless the safety or wellbeing of either parties of the contract are put at risk”.
8. The care provider’s notes show Mr B began to refuse care and become “agitated” with the carers. On occasions this was reported to the office by neighbours. Incidents were nearly always reported to Ms A or Mr X. The record of Mr B’s review in December 2017 notes “review completed with daughter no issues”. The care provider says reviews were carried out by telephone to avoid upsetting Mr B.
9. By April 2018 the reports of Mr B’s refusal of care and agitation with carers were increasing. The care provider notified Ms A and Mr X. Ms A contacted Mr B’s GP who contacted the local mental health services. The care provider’s notes show it notified Ms A, Mr X or both when carers reported incidents with their father.
10. In October 2018 Ms A visited her father. She emailed the care provider afterwards. She asked if as few carers as possible could attend her father. She also asked if (“as previously discussed”) they could continue to receive weekly updates so they were aware of their father’s progress. The manager emailed back to say she would look into it.
11. In December Mr X emailed the care provider again. He said they had spoken on numerous occasions during the year but despite requesting weekly updates, they had only received two. He said they could not rely on the carers’ notes as they could not visit regularly and it would be useful to have a regular update instead of just notification of incidents. The manager said she would try and update more regularly and he was welcome to telephone whenever he wanted.
12. At the 2018 review, the care provider noted “Family feel there are more updates regarding (Mr B’s) care needs required but have already addressed this issue by email and it is being attended to”. The care provider’s records show the manager began to send regular updates in January 2019.
13. On 4 March 2019 Mr B put his hands round a carer’s throat without warning when she offered him his medication. The carer left the house and reported the incident to the office. She asked not to go back. The care provider reported the incident to the local social services, to the GP and to Ms A and terminated the contract with immediate effect.
14. On 17 March Mr X formally complained to the care provider about the conduct of the office staff. He said they had not made any attempt to update Mr B’s family regularly as requested and only gave vague information about his status. He said too many carers had visited his father which was confusing for him. He said he had asked for one local carer to be his father’s main carer but this had been refused.
15. The care provider’s director of care responded. She said it was not possible for the carer he named to attend more often because of her own circumstances. She said it was unfortunate he had not chosen to escalate his concerns about a lack of communication previously. She apologised that the regular reports which had been requested, and which could easily have been made available by email, had not been sent.
16. Mr X complained to the Ombudsman. He said the care provider had failed to provide a responsive service to the family and they had not been involved in any meaningful discussion about Mr B’s care.
17. The director of care acknowledges that although a weekly report had been requested more than once, that did not happen. She says there was a regular carer who usually worked at least two shifts a day with Mr B but for personal reasons did not work evenings. She says over a total of 504 visits, 13 different carers attended Mr B and she does not consider this excessive. She says the contract was terminated immediately after Mr B “grabbed” a carer by the throat.

Analysis

18. The care provider did not respond to the family’s reasonable requests for regular updates on their father’s care and progress. The care provider has apologised for that omission. In my view that is sufficient remedy for any injustice caused to Mr X and Mrs A. There was adequate notification of any incidents. The care provider has explained it has taken action in respect of the failure of the office staff to act on requests for more information.
19. The care provider’s staff rota shows the majority of care calls were made by three particular staff.
20. The care provider was within its rights to terminate the contract immediately according to the terms of the contract.

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Final decision

21. Some injustice was caused to Mr X and Ms A, but the care provider has already taken appropriate action in response.

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Investigator's decision on behalf of the Ombudsman