Summary: Mrs X complained the Council commissioned care provider, Burlington Homecare, failed to provide appropriate care and support to her late mother, Mrs M. In addition, the Council failed to provide Mrs X with appropriate advice and support. There were faults by the care provider including failing to ensure it met Mrs M’s care needs and failing to take action when she was not in when it visited. The Council also failed to provide advice and support to Mrs X. These faults caused Mrs X distress and worry. The Council has agreed to make a payment to Mrs X, provide evidence it has taken action to address the faults it identified through its complaint investigation and ensure the care provider reviews its procedures to consider whether action should be taken when service users do not answer or are not in when it visits

The complaint

1. Mrs X complained the Council commissioned care provider, Burlington Homecare (referred to as care provider B in this statement), failed to provide appropriate care and support to her late mother Mrs M. It missed visits, failed to ensure Mrs M received adequate food and fluid and failed to carry out basic duties. In addition, the Council failed to provide her with adequate support. Mrs X says this led to her mother’s condition deteriorating and caused her distress and worry.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
4. If we are satisfied with a council’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

5. I have considered the information provided by Mrs X and have discussed the complaint with her on the telephone. I have considered the information provided by the Council and care provider in response to my enquiries.
6. I gave Mrs X, care provider B and the Council the opportunity to comment on a draft of this decision and I considered the comments I received in reaching a final decision.
7. I considered our guidance on remedies.
8. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share the final decision with CQC.

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What I found

9. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. Where local authorities have determined that a person has any eligible needs, they must meet these needs.
10. Everyone whose needs the council meets must receive a personal budget as part of their care and support plan. The personal budget must be an amount that is sufficient to meet the person’s care and support needs.
11. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs. (Care Act 2014, section 14) Councils must assess a person’s finances to decide what contribution they should make to the personal budget for care.
12. Section 27 of the Care Act 2014 gives an expectation that local authorities should conduct a review of a care and support plan at least every 12 months. The authority should consider a light touch review six to eight weeks after agreement and signing off the plan and personal budget. It should carry out the review as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. As well as the duty to keep plans under review generally, the Act puts a duty on the local authority to conduct a review if the adult or a person acting on the adult’s behalf asks for one.
13. 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.
14. Regulation 14 says providers must make sure that people have enough to eat and drink to meet their nutrition and hydration needs and receive the support they need to do so.
15. Regulation 16 says providers must have an effective and accessible system for identifying, receiving, handling and responding to complaints.

What happened

16. Mrs M lived alone in her own home. She had dementia but was able to access the community independently.
17. In late August 2018 Mrs M’s GP contacted the Council to request a needs assessment following concerns she had lost weight and was not eating properly. The Council carried out a needs assessment and determined Mrs M needed support with the preparation of a hot meal, to ensure the bathroom was kept clean and to prompt her with washing and changing clothes. The support plan set out the needs could be met through a 30-minute visit at teatime each day. The Council carried out a financial assessment of Mrs M. The cost of the care package was less than the financial contribution the Council calculated Mrs M could afford to pay towards the cost of her care. So, Mrs M paid the full cost of the care package.
18. From September 2018 Mrs M received daily visits from care provider A. In November 2018 the Council reviewed Mrs M’s care package. It was decided Mrs M would benefit from a lunchtime rather than teatime call. The carer could prepare a hot meal and leave a sandwich in a cool bag for teatime. Care provider A could not offer a teatime call so the Council commissioned another care provider, care provider B, to deliver the care package from early December 2018.
19. The notes in the daily records show:
• Carers prepared lunch but did not always record whether they had prepared a hot lunch and did not always record whether they had made and left a sandwich for teatime.
• Carers reported Mrs M was not in for two visits made in December 2018, seven visits in January 2019, (including three Wednesdays and three Fridays) and one visit in February 2019.
• There were three Friday visits when Mrs M arrived home late after the carer had arrived.
• There were two records in December 2018 when the carer noted Mrs M had not eaten the food in the cool bag.
• There were two records in January 2019 when carers noted mouldy food in the cool bag
• In addition, there were three records in January 2019 when carers noted there was food already in the cool bag. They did not record they had changed it.
• There were four records in February 2019 when carers noted there was food already in the cool bag for later. On two of these occasions the carer recorded they tried to replace it but Mrs M refused to let them
20. Mrs X went to visit her mother in early February 2019. She found a stale sandwich and out of date yoghurt in the cool bag, the bathroom was dirty and the bins had not been emptied. There was a mouldy loaf in the front room and a bag of rubbish beside Mrs M. Mrs X complained to care provider B and a Council officer and sent photos.
21. The Council officer completed a form documenting the concerns and sent this to the Council’s quality team. Care provider B produced a revised care plan for Mrs M clarifying the support to be provided and clearly setting out the expectations of carers which it sent to Mrs X.
22. In late February 2018 Mrs X took Mrs M to stay at her home as she was concerned about her safety. She contacted the Council to seek advice around her mother’s care and sought guidance around care homes/extra care housing. The Council officer responded two days later and provided Mrs X with a directory of care homes. They said to contact them if Mrs X needed further help. Mrs M moved into a care home a few days later.
23. In March 2019 Mrs X complained to care provider B and the Council.
24. Mrs M died in May 2019.
25. The Council investigated the complaint. In June 2019, as part of the investigation, it contacted care provider B who said it had not seen the letter of complaint Mrs X submitted in March 2019. The Council met with care provider B in September 2019.
26. The Council completed its investigation in December 2019. It held an adjudication meeting in February 2020 and wrote to Mrs X following this. It found:
• when Mrs X contacted the Council officer in late February 2019, the officer was on leave but did not provide an alternative contact number on their out of office. When the officer did respond they did not offer a reassessment of needs or provide adequate support in response to Mrs X’s email. The Council would ask all staff to ensure details of who to contact were available on out of office notifications.
• The Council officer failed to record all their discussions with care provider B in the case records. It would remind staff of the importance of recording all interactions.
• The Council failed to carry out a review of the care package 6-8 weeks after care provider B started. This was also not in line with care provider B’s own procedure. It recommended care provider B review its procedures to ensure this happened in future.
• Two of the seven different staff from care provider B who supported Mrs M had not received dementia training. These two staff were not working to the high standard expected and had since left care provider B. Care provider B had since made dementia training a mandatory training module for all staff. It also agreed to refund to Mrs X the cost of the 20 x 30 minute calls carried out by two staff which were below the care provider’s expected standard.
• Care staff should have completed light household tasks if they had any time left on the care visit, including emptying bins and disposed of out of date food. Once care provider B was made aware of the concerns it updated the care plan to include emptying the bins, checking the bathroom and checking for out of date food. It found if more time was needed during the calls, carers should have reported this to the office staff. Care provider B had reminded all staff of the importance of taking note of a person’s living environment, even if this was not stated on the care plan, and reporting concerns to the office.
• The contact details for making complaints to care provider B were out of date which was why care provider B did not receive Mrs X’s complaint in March 2019. Care provider B had now updated its policy to prevent this recurring in future.
• Care provider B produced an amended care plan in response to the complaint Mrs X submitted in February 2019 but said it did not provide a formal complaint response because Mrs M had stopped receiving its care. It had amended its policy to ensure, in future, complaints would be investigated regardless of whether or not the service user was still in receipt of services.

Findings

27. The Council has completed a detailed investigation of Mrs X’s complaint. As part of this, care provider B undertook its own internal investigation. They identified a number of faults as set out at paragraph 24 and have recommended action to address these faults. This is appropriate.
28. There was a significant delay in responding to Mrs X’s complaint. She complained to care provider B and the Council in March 2019 but did not receive a response until a year later. This delay is fault and caused Mrs X distress and frustration.
29. In response to my enquiries the Council said it would update the complaint action plan produced following the investigation to ensure learning from the complaint is established as good practice.
30. In addition to the faults already identified by the Council I have found the following additional faults:
31. The care records were not sufficiently detailed to show how often Mrs M was eating the food left for her. The records do show two consecutive days in December 2018 when Mrs M did not eat the food left at teatime and two occasions when carers threw out the contents of the cool bag as they were mouldy. When Mrs X visited she also found a stale sandwich in the cool bag. There were also seven occasions when carers noted there was food already in the cool bag. The failure to prepare a fresh teatime meal, for Mrs M, as required by her care plan is fault. This suggests Mrs M was not regularly eating the food left for teatime. The failure to report this to the office so it could alert Mrs X is fault. The opportunity to review the care plan was therefore missed, for example, to consider whether extra visits were required.
32. There were nine visits when Mrs M was not in when carers arrived. There were other occasions when Mrs M arrived home after the carers had arrived. Mrs M was mobile and able to go into town or out locally and this is supported by the daily records where it is noted she had been out locally or to the hairdressers. However, the missed visits included three out of the four Friday visits in January 2019. On the fourth she was late arriving home. The care provider did not raise this with Mrs X to alert her that Mrs M had missed visits, nor did it consider whether to alter the visit time given the frequency and pattern of missed visits. This is fault. Although Mrs M was able to go out alone, the purpose of the care package was to ensure Mrs M ate enough due to the risk of weight loss. The missed visits left Mrs X with a sense of uncertainty over whether Mrs M ate on those days.
33. Mrs M’s condition deteriorated but I cannot say that was directly as a result of the faults identified. Mrs M only received one 30-minute call once a day. Although care provider B prepared lunch and tea, it could not force Mrs M to eat and drink and it was not responsible for ensuring she drank sufficiently throughout the rest of the day. However, the faults did cause Mrs X distress and a sense of uncertainty.
34. As part of the complaint investigation, care provider B agreed to refund the cost of 20 x 30-minute calls. This equates to £156.40. It has not done so. This is fault causing additional distress and frustration. The Council has apologised for this in response to my enquiries and has offered to pay £150 to Mrs X to remedy the additional time and trouble caused. I consider this is not sufficient to remedy the distress caused by the faults identified including the delay in responding to her complaint. In line with our guidance on remedies I consider a payment of £250 more appropriate, as well as the care provider’s offer to refund some costs.

Agreed action

35. The Council has agreed, within two months of the final decision, to apologise to Mrs X for the distress and uncertainty caused to her by the faults identified. In addition, it has agreed to refund Mrs X £156.40 as previously agreed and to pay Mrs X £250 to acknowledge the distress and uncertainty caused by the faults
36. The Council has agreed, within two months of the final decision on this complaint, to provide the Ombudsman with evidence that care provider B has completed the actions identified as a result of its complaint investigation. It should also provide the Ombudsman with a copy of the updated complaint action plan.
37. Within two months of the final decision the Council has agreed to ensure care provider B reviews its procedures to ensure where calls are missed it considers whether further action should be taken to either alert a representative or amend the care package.

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Final decision

38. I have completed my investigation. There was evidence of fault causing injustice. The Council has agreed to take action to remedy the injustice and to prevent a recurrence of the fault.

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Investigator's decision on behalf of the Ombudsman