Summary: The Council was not at fault for its response to Mr Y’s complaint about the care his late brother received from a private care provider. It properly considered his concerns and ensured the provider changed its practice.

The complaint

1. The complainant, whom I refer to as Mr Y, complains on behalf of his late brother, whom I refer to as Mr X.
2. Mr X received home care from 2017 until his death in early 2019. This care was arranged by the Council but delivered by Assist Home Care Limited (which I refer to as ‘the Care Provider’).
3. Mr Y complained to the Council about the standard of care Mr X received. He said carers did not turn up when they were supposed to (or did not stay as long as they should have), and did not administer or record medication properly.
4. The Council investigated Mr Y’s complaint and found that the Care Provider had failed to meet acceptable standards in several ways. However, Mr Y complains that the Council said it would take action to improve matters, but did not do so.
   Mr Y says he wants staff to be disciplined, and for the Ombudsman to find that the Council was negligent.

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What I have investigated

5. I have investigated Mr Y’s complaint about the Council’s response to his complaint about the Care Provider. The final two paragraphs of this decision statement set out why I did not investigate other matters.

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The Ombudsman’s role and powers

6. 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)
7. 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

8. I considered information from Mr Y and the Council. I wrote to Mr Y and the Council with my draft decision and considered their comments.

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What I found

What happened?

9. In early 2019 Mr Y complained to the Council about the care Mr X received before his death. The Council agreed to investigate the complaint, and inspected the Care Provider’s files in May. It issued its investigation report in June, and conducted a follow-up monitoring visit in July.

The Council’s findings and follow-up

Complaints handling

10. The Council’s investigator found that some of the Care Provider’s complaint responses to Mr Y were slightly ‘defensive’. She also found that wider complaint responses were not of a high standard in 2018, but they improved in 2019.
11. The investigator raised the ‘defensive responses’ issue with the Care Provider. She recommended that each complaint’s front sheet be amended to include timescales. She also recommended that a front sheet be put on the overall complaints file with outlines of complaints, including subjects and conclusions.
12. The Care Provider agreed that it could have dealt with some of Mr Y’s complaints better. When the investigator visited again, it had amended the complaints files in line with her recommendations.

Staff training

13. The Council’s investigator selected six staff files and noted that three carers had been fired because of practice issues (including medication and record-keeping). The other three had received medication training in the past shortly after errors in administering medication. All three were up-to-date with medication training.
14. The investigator found there was evidence of regular checks of carers’ practice. However, she noted that the Care Provider had carried out no medication competency assessments.
15. The investigator provided a template for medication competency assessments. When she visited the Care Provider again it had assessed 15 members of staff and was assessing the others. It had also hired a new supervisor to be in charge of checking carers’ practice.

Medication administration and record-keeping

16. The Council’s investigator looked at six months’ worth of records – including medication administration records (MARs) – for Mr X and ten others.
17. The investigator found that some of the Care Provider’s records were illegible, and there were various errors and omissions.
18. The investigator found that, when daily records were wrong – such as when they said a visit was longer than it had been – this was raised with staff members. However, she noted that, despite this, issues with record-keeping re-occurred regularly and for prolonged periods.
19. The investigator recommended that the Care Provider’s staff should attend training in transcribing (for MARs) and record-keeping. She also recommended that staff who had been warned about medication administration and record-keeping but had shown no improvement should face disciplinary action.
20. When the investigator visited the Care Provider again it had told its staff that disciplinary action would be taken if their practice in record-keeping and medication administration did not improve.
21. At that point the Care Provider was arranging record-keeping training for its staff. It had been unable to identify any specific ‘transcribing training’ but it had put a ‘prompt list’ in place for carers to work to. The investigator found that this had led to significantly improved MARs, and noted a 99.9% accuracy in transcribing.

Inspection by the Care Quality Commission (CQC)

22. The Council’s investigator noted that the CQC had inspected the Care Provider in April 2019. The CQC found problems with how it administered medication.
23. The CQC report said the Care Provider had recently introduced a monthly audit of MARs. The Care Provider also told the Council’s investigator that issues identified by this monthly audit would be raised in staff briefings.
24. The Care Provider said it had a new ‘key worker’ system which meant service users had a named member of staff to whom they could report issues (such as with medication). It said issues would be dealt with quicker under this system.

After the Council’s investigation

25. The Council issued a new policy in July 2019 which sets out how it will deal with concerns about care providers – including when and how it will involve its contracts monitoring team.
26. The Care Provider will be subject to yearly contract monitoring visits which will consider issues reported to the monitoring team under this policy.

My findings

27. Mr Y’s complaint is that the Council failed to take action to improve the Care Provider’s practice when he raised concerns (and refused to cancel the Care Provider’s contract).
28. I cannot tell a council whether to use (or stop using) the services of a care provider. However, when it has arranged care for someone, I would expect it to consider taking action in response to concerns reported by a family member.
29. In this case, Mr Y raised several issues about the care Mr X had received. He had particular concerns about how the Care Provider administered and recorded medication and visits.
30. The Council investigated his complaint and agreed with him on several points. It found a series of failures in medication administration and recording, and general record-keeping. It noted that some of its findings mirrored those of the CQC in its most recent inspection.
31. The Council made a number of recommendations to improve the Care Provider’s practice. It then conducted a monitoring visit, and found that the Care Provider had either carried out the recommendations or was in the process of doing so. It also found that this had led to a noticeable improvement in practice.
32. I am satisfied that the Council properly considered Mr Y’s complaint and ensured the Care Provider made improvements in the areas Mr Y had highlighted. Because of this, I see little reason to criticise the Council, and have found no fault with its actions.
33. The Council will continue to check the Care Provider’s performance as part of its contract monitoring process, and this will include consideration of serious concerns raised by service users and their families (when the Council decides the concerns are relevant to the contract monitoring).
34. The Council can also report the Care Provider to the CQC if it has reason to believe there has been a breach of the CQC’s fundamental standards.
35. Although I do not consider the issues raised in Mr Y’s complaint to warrant a recommendation that the Council report the Care Provider to the CQC, if Mr Y still has serious concerns he is free to contact the CQC himself.

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Final decision

36. The Council was not at fault for its investigation into Mr Y’s complaint about the care Mr X received from the Care Provider.

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Parts of the complaint that I did not investigate

37. I did not consider whether the Council was ‘negligent’. Only a court can consider such matters.
38. I did not consider whether the Council’s officers should be disciplined. The Ombudsman does not criticise individual members of staff, and does not become involved in disciplinary procedures.

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Investigator's decision on behalf of the Ombudsman