Midshires Care Ltd (19 000 115)

Category : Adult care services > Domiciliary care

Decision : Upheld

Decision date : 11 Oct 2019

The Ombudsman's final decision:

Summary: Ms X complained about the quality of domiciliary care provided to her mother Ms Y by Helping Hands. There were faults as there was a lack of continuity of carers, last minute rota changes and a carer carried out shorter visits than scheduled. This caused Ms Y some distress. The care provider also delayed responding to Ms X’s complaint causing Ms X frustration. The care provider has agreed to pay Ms Y £250 and Ms X £100 to acknowledge the injustice caused by its faults. It has also agreed to remind staff of its complaints’ procedures and the need to accurately record the time of visits.

The complaint

  1. Ms X complained about the quality of domiciliary care provided to her mother Ms Y by Helping Hands. She says carers were ill prepared and inexperienced, there was a lack of continuity of carers, calls were not spaced out properly and some carers carried out shorter visits than scheduled. In addition, the care provider delayed responding to the complaint and provided poor responses to the complaints raised. Ms X says this caused Ms Y distress and confusion and caused Ms X the time, trouble and the inconvenience of having to change care companies.

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The Ombudsman’s role and powers

  1. 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)
  2. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
  3. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended) Ms Y received support from the care provider from April 2016 to January 2019. I have considered what has happened since April 2018 which is 12 months from when Ms X complained to the Ombudsman.
  4. 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

  1. I have considered the information supplied by Ms X and have spoken with her on the telephone. I have considered the care provider’s response to my enquiries.
  2. I gave Ms X and the care provider the opportunity to comment on a draft of this decision.
  3. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share a copy of the final decision with CQC.

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What I found

  1. 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. Regulation 16 says all care providers must have an effective complaints’ handling process and regulation 17 requires providers to have effective governance in place. The care provider’s complaints policy sets out that it will respond to complaints in full within 20 working days.

What happened

  1. Ms Y is elderly and lives in her own home. Her memory is poor, she has poor mobility and continence issues and needs support with daily tasks including personal care, toileting, medication, cooking, laundry and housework. Ms X is Ms Y’s daughter. She has a camera set up in Ms Y’s home so she can monitor Ms Y and ensure her safety.
  2. Since 2016 Ms Y has received domiciliary care support from the care provider. Ms Y received an hour’s visit each morning and 30 minute visits at lunchtime, teatime and bedtime.
  3. In early July 2018 Ms X raised a concern with the care provider that there was no entry in the daily records for a morning visit to Ms Y. Because of the camera she was aware a carer had visited. She raised concerns about the care visit and the carer’s apparent lack of knowledge of the care plan. The care provider agreed not to charge Ms Y for the morning call and advised they would be meeting with the carer regarding the call.
  4. Ms X emailed the care provider raising concerns about changes to the planned rota (there were six calls that week which were not carried out by the planned carer) and about inexperienced carers visiting Ms Y without having shadowed regular carers.
  5. Ms X met with the care provider in July 2018 and raised a formal complaint about some aspects of the care provided and administration issues.
  6. The care provider emailed Ms X and said a new carer would shadow regular carers. They said they had also spoken to the care coordinators and told them to inform Ms X about changes to rotas once they have been sent out.
  7. The care provider sent Ms X a letter acknowledging her complaint and setting out it would respond no later than 20 working days.
  8. Ms X emailed the care provider in August 2018 as it was over 20 working days and she had not received a response to the complaint. She also raised concerns about the number of different staff on the rota, with ten different carers attending that week, and that some new carers had shadowed regular carers and others had not. Ms X also asked for one carer to be removed from the rota as she was unhappy with the care provided. The care provider agreed to the request, apologised for the delay in responding to her complaint and advised a manager was dealing with it.
  9. Ms X contacted the care provider again at the end of August requesting a response to the complaint. The care provider advised the officer dealing with the complaint had left. It apologised as it believed Ms X had received a response. It agreed to deal with the complaint.
  10. In October 2018 an officer met with Ms X to review Ms Y’s care and support. At the meeting Ms X raised concerns that her complaint was not dealt with and raised issues about a carer
  11. The care provider contacted Ms X and arranged a meeting between her and a manager to discuss the concerns. The notes of the meeting record Ms X was happy with the care provided but she found the administration of the company “appalling”, with too many different carers attending and carers attending who had not carried out any shadowing. The notes record Ms X was happy that permanent carers were now in place. She also raised a new complaint regarding a carer leaving early but writing down the times they were meant to be visiting Ms Y rather than the actual time of the visit. In addition, the carer had picked Ms Y up after a fall without following correct manual handling techniques. The care provider agreed to refund Ms X for the time missed by the carer.
  12. Following the meeting the care provider sent Ms X an acknowledgement of her complaint, confirming it would respond within 20 working days.
  13. The care provider emailed Ms X a response to the new complaint in November 2018. The letter set out that it had investigated the actions of the carer who would undergo further manual handling training. The carer would be excluded from further calls. It accepted the carer had left calls early and agreed to refund an amount for when the carer had not delivered the full call times.
  14. Ms X remained unhappy. She complained the refund was at a lower rate than the rate they had paid for Ms Y’s care. In addition, Ms X said she had not received a substantive response to the complaint she made in July 2018. She set out that one of her main concerns was the lack of continuity of carers with days when four different carers carried out the visits and with ten different carers scheduled for the week.
  15. The care provider refunded Ms X for the missed care calls at the correct rate. A senior manager emailed Ms X in late November and asked that she outline what her outstanding concerns were. They also said the manager who met with Ms X and her partner was ‘alarmed by behaviours displayed by your partner towards [them] and the language used in the last face to face meeting that you had’ so asked that Ms X’s partner no longer contact the manager and that concerns were raised by the named next of kin only.
  16. Ms X responded by email. She was unhappy the manager had said they felt intimidated during conversations with Ms X and her partner when that same manager had not responded to her July complaint. She also complained about the unprofessional manner in which the manager spoke to Ms X’s partner during a phone call.
  17. A senior manager from the care provider responded that they were still unclear what issues remained unresolved. They apologised if Ms X felt the manager’s behaviour was unprofessional but they had felt intimidated during conversations with Ms X and her partner. In the best interests of all they said the manager should not be contacted. They asked Ms X to bullet point the issues which needed resolving.
  18. Ms X responded in early December 2018 setting out her concerns regarding inexperienced, unprepared carers turning up, the number of different carers attending, rotas changing regularly at short notice, being asked to cover visits when staff were not available, an individual not completing the daily records and the spacing out of visits with visits being too close together. She also reiterated her concerns about the manager’s failure to respond to the complaint and their behaviour. Ms X gave four weeks’ notice to the care provider.
  19. Ms X emailed the care provider over Christmas to complain a carer spent 42 minutes during a morning visit and not the full hour and had not emptied the bin which contained a soiled continence pad or mopped the floors.
  20. Ms X contacted the care provider in mid-January 2019 requesting a response to the formal complaint. She said they would not pay the outstanding invoice pending the outcome of the complaint.
  21. The care provider responded to Ms X regarding the carer visit over Christmas. The care provider had investigated and the carer apologised for not carrying out the full call. They had intended to empty the bin but had forgotten to. The care provider said it would address this through supervision and additional training. It had also reimbursed Ms X for the call.
  22. Ms X contacted the care provider in early February 2019 chasing a response to her outstanding complaints. A senior manager responded to the points Ms X had raised. They advised Ms X had received the refund for short care calls. They did not uphold the complaint that carers were inexperienced as staff undertook robust recruitment procedures and training which included shadowing.
  23. The senior manager upheld Ms X’s concerns about rotas changing at the last minute, her being asked to cover calls and no continuity of care. They stated high carer sickness contributed to this. They upheld Ms X’s complaint about a carer not completing the call log and partially upheld her concern about the spacing of visits. They said to ensure care was delivered, rotas were changed to manage carer availability. They acknowledged her concerns about the continuity of carers and that this was not in line with its standard of practice. However, calls continued to take place. They had investigated why this was happening and found it was impacted by carer sickness. They advised a new branch manager was in place and a new carer team. They apologised for the experience Ms X received and advised they had taken steps to address the concerns as promptly as possible. Ms X remained unhappy and complained to the Ombudsman.

Findings

  1. There were instances where carers were not adequately prepared to support Ms Y either because they had not shadowed regular carers or because they had not read Ms Y’s care and support plan. This is fault.
  2. Ms X provided evidence of carers not staying for the scheduled hour of the morning call. This is fault. Ms X paid for an hour of care and so expected Ms Y to receive this. Although there is no evidence Ms Y did not receive the personal care she required or was caused harm, the short calls meant other domestic tasks were not always completed.
  3. When Ms X raised complaints about the actions of individual carers, the care provider acted appropriately and investigated the concerns, removing the carer from Ms Y’s rota and providing staff training or supervision as appropriate. It also made refunds when the care was not satisfactory or for short calls.
  4. Continuity of carers helps promote the delivery of person-centred care. The care provider accepts there were a high number of carers covering the calls, there were changes to the rotas and a lack of continuity of carers. There were also five occasions between June and July 2018 where Ms X covered the call. The care provider acknowledged this was not up to its usual standard and said this was affected by staff sickness. Ms Y’s behaviour was affected by unfamiliar faces and the lack of continuity of carers is likely to have caused her some distress.
  5. The care provider’s complaint process says it will respond to complaints within 20 working days. It did not do so in this case and that is fault. The delay in responding caused Ms X frustration.
  6. Ms X was also unhappy with the way in which a manager spoke on the phone and insinuated she was intimidated by Ms X’s partner. I cannot comment on how either party felt in relation to a conversation I was not party to and a meeting I was not present at. I will not investigate this further.
  7. Ms Y received care and from the records I have seen, the majority of care provided was appropriate and in line with her support plan. Ms X was not charged for care calls she covered and received a refund for short calls. However, the faults are likely to have caused Ms Y some distress and inconvenience and caused Ms X time and trouble and frustration in pursuing the complaints.
  8. Ms X says she was caused further time and trouble when she had to change providers because she was unhappy with the level of care. This was a decision Ms X was entitled to make under the terms of her contract with the care provider. and it is not for the Ombudsman to comment on it.

Agreed action

  1. Within one month of the final decision on this complaint, the care provider has agreed to pay Ms Y £250 to acknowledge the distress and inconvenience caused by the failings in the care it provided. It has also agreed to pay Ms X £100 to acknowledge the inconvenience and frustration caused by the delays in it responding to her complaints.
  2. Within two months of the final decision on this complaint, the care provider has agreed to remind staff of:
    • its complaints procedures and the requirement to respond to complaints in line with this; and
    • the need to record the actual time of care visits and not the scheduled time to ensure visits accurately reflect the care provided.

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Final decision

  1. I have completed my investigation. I have found evidence of fault causing injustice, which the care provider has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman

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