Summary: Mr X complained the Care Provider, Comfort Call, commissioned by the Council did not properly care for his mother and would not respond to his queries. He also disagreed with an investigation carried out by an independent investigator into his complaint. He said this caused his mother distress and put him to significant time and trouble. There was no fault in the Council’s actions.

The complaint

1. Mr X complained about the care his mother, Mrs Y, received in sheltered accommodation commissioned by the Council. Mr X says the Council did not ensure his mother received appropriate care.
2. He says the Council:
• failed to ensure the Care Provider prepared his mother’s food and drink correctly;
• did not set his mother’s thermostat to the required temperature; and
• did not respond to his emails enquiring about his mother’s care.
3. Mr X also complained that the independent investigation commissioned by the Council in August 2018 was not carried out properly.
4. He said his mother has been distressed by these events and he has been put to unnecessary time and trouble raising complaints about these issues.

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What I have investigated

5. I have investigated Mr X’s complaint points regarding events that took place between August 2018 and March 2019.

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The Ombudsman’s role and powers

6. 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)
7. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
8. 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

9. I have reviewed a copy of Mrs Y’s support plan and the service user agreement.
10. I considered the information provided by Mr X and the Council, which includes email correspondence between the Council and Mr X and the Council’s final response.
11. I have written to Mr X and the Council and considered their comments before I made a final decision.

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What I found

Council Policy and Law

12. Part 3 of the Local Government Act 1974 covers complaints where local councils provide services themselves or arrange or commission care services from social care providers, even if the council charges the person receiving care for the services. The Act says we can treat the actions of the care provider as if they were the actions of the council in those cases.
13. In this case, the Council commissioned the Care Provider to care for Mrs Y.

Mrs Y’s medical and social needs

14. Mrs Y’s support plan states that amongst other things:
• care staff must administer Mrs Y’s medication 3 times a day and eye drops 4 times a day.
• all food she receives should be prepared for her in fork-mashable, bite-sized pieces and all drink she receives should be a syrup consistency.
• Mrs Y’s food should be labelled with the opened and expiry date.
• Mrs Y’s hearing aid batteries should be changed twice a week and cleaned once a week.
• Mrs Y’s flat should be cleaned once per week and left clean and tidy after each visit.
15. The support plan says the care staff should record these tasks in Mrs Y’s daily care records.
16. The support plan states that Mrs Y requires, “full support,” to maintain her home environment but does not explicitly specify what the room temperature of Mrs Y’s room should be.

Background

17. Mrs Y moved into the Care Provider’s extra care sheltered housing scheme in May 2014.
18. Mr X brought a complaint to the Ombudsman in 2017, stating the Council had failed to provide Mrs Y with the care stipulated in her support plan. Specifically, he said that:
• Mrs Y’s food was not properly labelled with opened and use by dates;
• carers were not giving Mrs Y the correct medication dosage; and
• carers were not changing Mrs Y’s batteries when required.
19. Mr X also said the Care Provider did not respond to his correspondence in a timely manner.
20. The Ombudsman found fault with the care Mrs Y had received. The Council therefore agreed to review and revise the way it administered the care and support Mrs Y required.
21. The Council also confirmed it made extra payments to the Care Provider for weekly audit reports to monitor the issues Mr X had raised.

Mr X’s recent complaint

22. Following the Ombudsman’s investigation, Mr X again became unhappy with his mother’s care and complained to the Care Provider on 8 August 2018. He said there were problems relating to Mrs Y’s hearing aid care, food labelling and general care, which had persisted since the Ombudsman had investigated these issues.
23. The Council commissioned an independent investigator to look into these complaints. The investigation took place between August and October 2018.
24. On the matter of Mrs Y’s thermostat, the investigator wrote, “The Care Provider stated that they were unable to say who had turned the thermostats down but that carers are advised not to change them unless asked to do so by the resident” and “… I was informed by [the Care Provider] that carers do not normally alter the thermostats and that the Care Provider had also looked into the matter but could find no evidence whatsoever that staff had turned down the heating or of Mrs Y living in a cold flat.”
25. The investigator did not uncover evidence of Mr X previously raising a complaint about the heating in Mrs Y’s flat. However, after speaking to staff at the care home, he confirmed a maintenance man visited Mrs Y’s flat several times to check the heating was working correctly. The investigator was also advised that it was common for Mrs Y to complain of being cold despite the room being warm.
26. The investigator responded to Mr X’s complaint about Mrs Y’s food care saying, “It is clear to me that extensive efforts well over and above the normal checking of food has been made by the provider… the additional auditing put in place appears to me to be very thorough, relevant and reliably carried out. It does document from time to time issues I would regard as minor but relevant…issues that have previously been flagged up such as dates on food and maintenance of hearing aids are being very carefully checked and re-checked… it should be added that the care staff themselves have been very fully briefed on numerous occasions about Mr X’s repeated assertions about dates on food... I am informed… that Mr X is the only relative of a person receiving care on the scheme who reports out of date food as an issue.”
27. After reviewing the audits conducted by the care home, the investigator found that there were some issues with how the Care Provider recorded how often Mrs Y’s hearing aid batteries were changed, “…there are a number of references to hearing aids which do indicate to me that the Care Provider was picking up on the issue and trying their best to resolve it.”
28. However, the investigator ultimately concluded, after consulting with an audiologist, that the Care Provider had taken appropriate steps to resolve it:
    “The audit notes clearly demonstrate to me that far from being negligent in this aspect of Mrs Y’s care, the staff were proactively trying to address it…I understand Mrs Y’s batteries are now being changed twice weekly… I asked audiology myself if twice weekly was normal and they confirmed this… I am left in no doubt that the Care Provider is rigorously checking and changing the batteries.”
29. The investigator’s report concluded, “Mrs Y’s current care provision is at the limit of what can reasonably be provided by an onsite domiciliary service. She has a minimum of 7 visits daily to provide/care/monitor her well-being which is already somewhat beyond what can normally be provided. I have found Mrs Y to be receiving a very high level of care and support and is described by all who see her apart from Mr X as very happy in her flat with the high level of support she receives.”
30. Of the 31 complaints Mr X raised, the investigator upheld 1 of them.

Mr X’s current complaint

31. In December 2018, Mr X complained to the Council about the care Mrs Y was receiving. He said:
• the thermostat in her flat was not working and was regularly set lower than 23 degrees, which was too cold for her;
• her food was labelled incorrectly; and
• carers were giving her expired food and her carers were not visiting her at the correct times.
32. The Council referred Mr X to the previous investigation it had carried out into his previous complaints. The Council told Mr X to contact the Care Provider directly about his concerns with the thermostat. The Council also invited Mr X to attend a meeting. However, Mr X declined this offer.
33. The Council also began conducting a monthly audit, checking that Mrs Y was receiving the appropriate care. The audits required carers to record the condition of Mrs Y’s food, hearing aids and thermostat and provide feedback if anything had been done incorrectly.
34. The Council contacted Mr X again on 7 January 2019 to confirm it had spoken with a staff member who had delayed giving Mrs Y her evening meal on one occasion to make sure this did not happen again. The Council also clarified it could not provide Mrs Y with supervision whilst she ate, and her support plan did not say she needed this.
35. Mr X replied to the Council on 21 January 2019, explaining he did not know what his mother’s latest support plan outlined. He went on to ask several questions relating to Mrs Y’s hearing aid batteries, the fork-mashable diet she required,
    the thermostat in her room and several other concerns he had about her care.
36. The Council replied on 24 January 2019 addressing his concerns, confirming that Mrs Y’s hearing aids were cleaned on a weekly basis and updating Mr X about the process the Care Provider was using to label her food. The Council also sent Mr X a follow up letter on 28 January 2019 asking him to name his preferred venue and time for a meeting to discuss Mrs Y’s care. Mr X declined to meet the Council.
37. Mr X continued to contact the Council and the Care Provider throughout January, February and March 2019, reiterating his concerns about the care his mother was receiving. He remained unhappy about the setting of the thermostat in his mother’s room, her food storage and her general healthcare needs. He was also unhappy about an occasion where Mrs Y had been unwell, and the Care Provider had not phoned a doctor or informed him about it.
38. Additionally, he said the Care Provider was not keeping his mother’s flat tidy, had administered laxatives to his mother whilst she was suffering with diarrhoea and sent her a recorded letter despite knowing his mother was registered blind and would be unable to read or sign for it. He said the Care Provider was being vague about his mother’s health issues and was not caring for her properly.
39. The Council responded in late March 2019, confirming it had contacted the landlord, who went on to replace the thermometer at the flat. The Council also advised Mr X to discuss the cleanliness and heating in the flat with the Care Provider. The Council said it had sent a letter to Mrs Y via recorded delivery as Mr X had complained previously that he had not received letters from the Council. The Care Provider had previously explained Mrs Y had suffered with diarrhoea for a day before being quarantined for two days to avoid infection. The Care Provider stated that a carer had administered a laxative a few days after Mrs Y had been ill and this staff member had been advised of the correct procedure should such an event occur again.
40. Following this, a GP had visited Mrs Y three days later and decided she should not receive laxatives and so she did not receive further medication. The Council advised it was satisfied with the Care Provider’s response to this situation and referred Mr X to the Ombudsman.
41. Mr X was not satisfied by the Council’s response and brought his complaint to the Ombudsman.

My findings

42. Mr X has repeatedly disagreed with the 2018 investigation, stating that the investigator ignored important emails and misunderstood or overlooked his complaint points. The investigator conducted interviews with relevant staff members, reviewed a proportionate amount of correspondence between the staff and Mr X and gave detailed, well thought out reasons for why he did not uphold the majority of Mr X’s complaint. Mr X is entitled to his view that the investigation was flawed; however, based on the evidence seen, the investigator carried out a thorough and robust investigation.
43. After the 2018 investigation, the Council began conducting a monthly audit to monitor the care Mrs Y was receiving. I have reviewed a selection of these audits. These generally show Mrs Y received satisfactory care. On the occasions when there have been issues with Mrs Y’s food not being labelled correctly or her hearing aids not being cleaned, the Care Provider has taken prompt and appropriate action to resolve these matters.
44. When the Council noted that Mrs Y was ill, it consulted with a GP and gave feedback to members of staff to ensure Mrs Y was not given unnecessary medication. The Council took pre-emptive and decisive action to ensure Mrs Y was properly cared for in line with her care plan.
45. Mr X has sent regular emails over several months querying all elements of
    Mrs Y’s care. The evidence indicates the Council has responded to these by either consulting with the Care Provider or advising Mr X to speak with the Care Provider directly. Mr X has expressed upset that the Council does not respond to his emails in a timely manner. The Council has explained that this is often due to the number and length of the emails Mr X sends.
46. Having reviewed several email exchanges between Mr X and the Council, I see Mr X often sends the Council multiple emails containing numerous questions.
    The Council has endeavoured to respond to these emails but on occasion has taken time to do so. The Council responded to Mr X appropriately and any injustice he has experienced as a result of occasionally longer wait times is minimal.
47. On several occasions the Council has attempted to arrange a face to face meeting with Mr X to discuss his issues with the care Mrs Y is receiving.
    The evidence indicates Mr X has not responded positively to these attempts.
    I do not find fault with the Council.

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Final decision

48. I have not found fault in the Council’s actions. I have, therefore, completed my investigation.

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Parts of the complaint I did not investigate

49. I have limited the scope of my investigation to events which took place between August 2018 and March 2019.

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Investigator's decision on behalf of the Ombudsman