Summary: The Council failed to ensure the commissioned care provider (Lodge Care) adhered to the care and support plan for Mrs X. As a result meals and medication were missed and her family was caused considerable anxiety. The Council could not respond fully to the family’s complaint because the care provider’s records were in a process of change. The Council agrees a payment to recognise the anxiety caused by poor care as well as the additional time, trouble and expense caused.

The complaint

1. Mrs A (as I shall call the complainant) complains about the poor care provided for her mother by an emergency care provider commissioned by the Council. She also complains that the Council’s response acknowledged there were problems but did not recognise the distress caused by the care provider’s failures.

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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. 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

3. I considered the information provided by the Council and by Mrs A. Both had an opportunity to comment on an earlier draft of this statement.

Relevant law and guidance

4. We have powers to investigate adult social care complaints in both Part 3 and Part 3A of the Local Government Act 1974. Part 3 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. We can by law treat the actions of the care provider as if they were the actions of the council in those cases. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act)
5. 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.
6. Regulation 12 says medication should be administered accurately and at suitable times to make sure people who use the service are not placed at risk.
7. Regulation 14 says the nutritional and hydration needs of service users must be met. The guidance says snacks or other food must be available between mealtimes for people to like to eat little and often.

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What I found

8. Mrs X is an elderly lady with dementia. She is unable to walk without a walker or to climb stairs without assistance. She is reliant on carers to provide meals, medication and personal care. Her needs were assessed by the Council and her care plan was for 4 care calls a day.
9. In November 2018 the care provider which had been caring for Mrs X gave short notice that it would cease provision. The Council held a review meeting with Mrs X’s family and it was agreed that Lodge Care would take over Mrs X’s care package on a temporary basis until the Council could commission a permanent provider.
10. The Council says Lodge Care was to arrange regular carers to attend with calls “being embedded into the carers round to enable regular call times as near as possible to those previously being provided by (the previous provider). However due to the emergency nature of the service, this would vary but the agency made every effort to settle calls into their rounds as soon as they could”. There is no record that the Council explained to Mrs X’s family at that stage that call times would vary.
11. The Council’s records show it emailed Lodge Care on 4 December with a request for it to start provision from the teatime call that day.
12. On 5 December Mrs A telephoned Lodge Care. She says no-one there could tell her when a carer would be going to Mrs X. No-one from the care provider returned her call as requested. Mrs A telephoned the Council. She said her mother had not had a hot meal for three days and carers had not arrived on either 4 or 5 December. The duty social worker contacted Lodge Care who said a carer had been unable to get to Mrs X for the first call until 11.30 am so the other calls would also be provided at a later time. The social worker told Mrs A that care times might vary because of the emergency nature of the provision. Mrs A said she understood but her mother was not being supported to get out of bed.
13. Lodge Care’s manual record entries for 4 and 5 December show carers attended at 19.54 on 4 December, then at 12.00, 14.55 and 18.45 on 5 December. An electronic record (at this time the care provider was transitioning to an electronic system) recorded a bedtime call at 20.00.
14. The Council’s records show it emailed a copy of Mrs X’s care plan (from the previous provider) to Lodge Care late on 6 December. The care plan was for visits scheduled at 09.30 – 10.15; 13.30- 14.00; 16.30 – 17.00; and 21.30 – 22.00.
15. Mrs A says there was a pattern of missed or late calls over the next few weeks. She says prepared meals were left in the fridge or uneaten on the table. The medication blister packs showed that medication had been missed (Mrs A has provided photo evidence). When she telephoned the care provider to ask what was happening, she rarely received a return call. She says on one occasion (when she discovered her mother had not had a hot meal in three days despite the meals being ready labelled in the fridge) she drove to the care provider’s office to complain. She says the manager told her the carer had been in and given her mother breakfast, but Mrs A says her brother was at Mrs X’s house that morning and no carer had arrived – he had got his mother up and given her breakfast.
16. The records show the Council notified the family that a new care provider would take over the permanent contract from 7 January.
17. On 21 December Mrs A complained to the Council about the missed calls from Lodge Care and said she would complain formally. The Council’s safeguarding department requested an urgent review.
18. Mrs A complained formally on 29 December.
19. On 22 January the Council issued a notice to Lodge Care to say it was temporarily ceasing to offer care packages to it because it had not delivered services to the standard required by the Council.
20. The Council replied to Mrs A’s complaint on 1 March. It said the arrangement with Lodge Care was a temporary arrangement when the previous care provider had suddenly withdrawn services, and an officer had explained to the family on 7 December that times could not be guaranteed. It said there were no nutritional concerns raised about Mrs X by the carers, and they reported she often said she was not very hungry but was left with a selection of foods available, and she “enjoyed snacks of chocolate and crisps”. It said medication could be prompted but not administered.
21. The Council said the care provider was in the middle of changing to an electronic record system so its entries were not always consistent. It acknowledged there were some late calls when carers had been attending other emergency calls.
22. Mrs A responded to the Council. She said its reply had given reasons why the carers had not attended as they should have done but did not acknowledge the anxiety caused by the care provider’s shortcomings. She said she had given photo evidence of the missed medication but the Council had simply responded the carer had entered “give me my tablets” (the care plan instruction) on the record. She said despite her knowledge (because her brother was present) that no carer had arrived one morning, the Council had replied that the carer’s visit was late but was evidenced by the entry “give me my tablets’ morning personal care’ breakfast’ (the instructions from the care plan) on the records. She said there had been continuing failures on a daily basis which in the end had prompted her to collect her mother and care for her herself.
23. The Council responded again to Mrs A in April. It said Lodge Care acknowledged the failings in its service and communication with the family. It said Lodge Care apologised to the family and accepted its standards had been poor because of “winter pressures, flus, care sickness, and carer departures”. The Council also apologised. It offered £100 to Mrs X for the distress caused and £100 to Mrs A for the time and trouble of pursuing the complaint.
24. Mrs A complained to the Ombudsman.
25. The Council says it was difficult to investigate the complaint because of the combination of manual and electronic records held for the relevant time period by the care provider. It says it met the care provider to discuss the shortcomings. It temporarily ceased contracting with it to allow it a period to recover from the pressures caused by taking on too many care packages. It lifted the suspension in February 2019 after the care provider had complied with an action plan.
26. The Council says Lodge Care acknowledged that (Mrs X) “had experienced some disruption, however was never at risk of any harm”.
27. Mrs A says her sister had to travel on the bus across town often twice daily to check carers had been, as the care provider did not return calls and sometimes said carers had been when they had not. She says her brother, a firefighter, would finish a long shift then visit Mrs X to make sure she had been fed and given her medication. In the end she collected her mother and brought her back to her own home for the last week of Lodge Care’s emergency contract before the new permanent care agency began on 7 January.

Analysis

28. The care provider failed to ensure that medication was administered “accurately and at suitable times” as the regulations required.
29. The care provider failed to ensure that carers were present to give Mrs X meals at appropriate times. Although they said she “enjoyed snacks of chocolate and crisps”, that was a poor substitute for the hot meals which her family had provided.
30. The care provider failed to return calls or give proper information to the family: on one occasion at least there was an untruth about the attendance of a carer.
31. The Council failed to act on Mrs A’s complaints at the right time, when care was missed or late but instead signposted her back to Lodge Care who often did not return her calls.
32. The failures on the part of the Council and the care provider caused considerable anxiety and frustration to Mrs X’s family and meant Mrs X received a lower standard of care than she should have done. It is disingenuous of the care provider to say she was not at risk of harm, when for example a missed care call in the morning meant she was at risk of trying to get out of bed alone; missed meals were substituted by unhealthy snacks, and medication was also missed or given late.

Agreed action

33. The Council has already taken action to investigate and monitor the actions of the care provider as a result of this and other complaints, so I do not make a specific recommendation in the respect;
34. The Council will review how it acts on verbal complaints about care provision and consider how it liaises with the care provider at that stage;
35. Within one month of my final decision the Council will offer a payment of £500 to Mrs X for the poor care and anxiety she suffered during the time Lodge Care was providing her care;
36. Within one month of my final decision, the Council will also offer £250 to Mrs A and her siblings for the anxiety and distress caused and their time and trouble in pursuing the complaint; in addition it should also offer £200 as recognition of their expenses in extra travel.

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Final decision

37. There was fault on the part of the Council’s commissioned care provider which caused injustice to Mrs X and her family.

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Investigator's decision on behalf of the Ombudsman