Summary: The Council failed to ensure domiciliary care services provided to Mrs Y were of a satisfactory standard. It also failed to properly address complaints about this.

The complaint

1. Mrs X complains about the poor standard of domiciliary care provided to her mother, Mrs Y. She says despite many complaints there has been no improvement. Mrs X believes her mother should not have to pay for an inadequate service.

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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. 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

4. I have:

• considered the complaint and discussed it with Mrs X;
• considered the correspondence between Mrs X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council, and considered the responses;
• taken account of relevant legislation;
• offered Mrs X and the Council the opportunity to comment on a draft of this statement, and considered the comments made.

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What I found

Relevant legislation

5. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 apply to care providers. The Care Quality Commission (CQC) monitors, inspects and regulates adult care services providers to ensure they meet fundamental standards of quality and safety.
6. The CQC has provided guidance on the regulations. This says that:

• The care and treatment of service users must be appropriate, meet their needs and reflect their preferences (regulation 9).
• The care and treatment must be provided in a safe way for service users (regulation 12). The intention of this regulation is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Providers must assess the risks to people's health and safety during any care or treatment and make sure that staff have the qualifications, competence, skills and experience to keep people safe.

What happened

7. Mrs Y is a centenarian. She lives in her own home. She is registered blind and is hearing impaired. Mrs X and her sister provide emotional and practical support.
8. The Council commissioned home care services from Comfort Call Care Agency (the care agency) in January 2019. Mrs X says the care planning was done without her or her sister present. She says Mrs Y would not have been comfortable partaking in any sort of meeting without the support of her family, and says Mrs Y would not have been able to articulate all her needs properly, neither would she be able to identify the level of support Mrs X and her sister provide.
9. Mrs X became concerned about the quality of the care soon after it started. She complained to the Council and the care agency about:

• poor hygiene in kitchen and bathroom
• an open tin can in the fridge with the lid up
• dirty fridge – out of date food in the fridge
• bins not emptied, and a carer leaving a bag of rubbish in the hallway
• carers not washing hands prior to food preparation and medication administration
• a carer recording inaccurate visit times

10. Mrs X says when the carers arrive they ask Mrs Y what tasks need doing. Mrs Y does not like giving instruction and is not always aware of household tasks because of her impaired eyesight. She says Mrs Y is reluctant to shower and she needs much encouragement, but carers do not make any real attempt to encourage her.
11. Mrs X complained to the Council in January and February 2019. The Council offered Mrs X the option of changing to a different care provider or moving to direct payments so Mrs X could employ her own carers. Mrs X declined both options saying there were three or four carers who provided good care, and Mrs Y had a good relationship with these individuals. The Council offered to review Mrs Y’s care. The officer asked Mrs X to contact the Council if she wanted to go ahead.
12. Following Mrs X’s complaint, she, and her sister met with the care agency on 6 March 2019 to discuss the problems. An officer from social services was also present. Mrs X was unhappy with the attitude of the council officer. She says the officer said “…if it isn’t in the care package it would not be done… you have received the services therefore you will have to pay.” And, as the officer was leaving she said she sometimes left knives in the sink in her own house. Mrs X says the officer did not seem to realise the implications for someone who is blind.
13. As a result of this meeting the care agency completed a new care plan on 11 March 2019. It included a risk assessment and information about Mrs Y’s capacity to make decisions about her care. I have seen a copy of this document. It records Mrs Y’s comments, that her family help her a lot and that she would like family present for important decision making. The assessor recorded Mrs Y has intermittent confusion, a visual impairment and that she wears a hearing aid and needs people to speak loudly and slowly in front of her.
14. Information about Mrs Y’s day to day needs is detailed. It gives specific instructions about keeping Mrs Y’s environment safe from clutter and that spills should be mopped up immediately. Storage facilities should be kept tidy and sharp objects/breakables removed. Kitchen sides should be clean, and bins emptied. Mrs Y’s bathroom and toilet should be kept clean and tidy. Carers should ensure Mrs Y’s kettle is refilled after use. Other domestic tasks include washing pots and ensuring they are put back in the same place, ensuring food in the fridge is in date, assistance with laundry and making/changing the bed, and that Mrs Y needs encouragement and support to have a shower, and some assistance with dressing.
15. On 14 March 2019 Mrs Y submitted a formal complaint to the Council, in addition to her complaint about the quality of care provided, she also complained about the attitude of the council officer present at the meeting on 6 March 2019. An officer from the Council’s complaints team contacted Mrs X on 26 & 27 March 2019. She apologised for the delay in acknowledging the complaint. She said she would contact the care agency to ask it to respond to the complaint and said she “presumed that your desired outcome is for the charges in the sum of £324.29 to be waived”.
16. The care agency responded to Mrs X’s complaint on 3 April 2019. It acknowledged a carer wrongly documented her exit time from Mrs Y’s home and apologised for this. It said it had already apologised to Mrs X for a carer leaving an open tin can in the fridge, and that it had addressed this with the carer. It apologised for bins not being emptied and said this would be added to the care plan. It addressed matters of kitchen and bathroom hygiene and said this would be addressed in the care plan and with carers.
17. Mrs X complained repeatedly to the care agency about the same issues. In addition to the complaints Mrs X praised one of the carers, saying she was dedicated, went the extra mile, and was an asset to the company.
18. Mrs X also continued to complain to the Council saying the standard of care was not adequate and despite assurances from the care agency the problems continued. She said Mrs Y should not have to pay for a service she was not receiving. She asked the Council to waive Mrs Y’s contribution towards her care, at that time, a total of £604.80.
19. The Council responded to Mrs X’s complaint on 9 April 2019. The author said she had spoken to the council officer who attended the meeting on 6 March 2019, and the officer accepted she had made a comment about knives being left in the sink. She said she was trying to explain how this could happen if carers were distracted talking to Mrs Y. The officer could not recall making any other comments. The officer who undertook the initial care planning with Mrs Y acknowledged it may have been better if Mrs X or her sister had been present meeting. The author of the letter apologised that this had not happened. She went on to say, “[council officer] has regularly engaged and listened to your concerns and has promptly responded by liaising with Comfort Call and Adult Care Financial Services, ACFS, to support you to resolve the issues regarding your mother’s care package”. The Council says the knife left in Mrs Y’s sink was a butter knife.
20. Mrs X continued to have concerns about a lack of cleanliness by carers and discussed this with the care agency on 20 May 2019. The officer from the care agency asked Mrs X for dates and times when this happened and said she would read the care logbook in Mrs Y’s home. The officer completed a task checklist for carers which she said would be put on Mrs Y’s fridge door. She asked Mrs X to approve the list.
21. Mrs X asked that the duties list be placed on Mrs Y’s fridge as soon as possible. She also asked that carers refill Mrs Y’s sugar and teabag bowls. She said she should not have to keep sending emails to remind carers to complete basic tasks and that the situation was getting her down.
22. Mrs X says the task list was not put in place.
23. As a result of Mrs X’s continued complaints, the care agency sent a manager to Mrs Y’s house on weekly basis to check cleanliness. It contacted social services on 29 May 2019 to ‘confirm that everything was in order’.
24. I have seen a log of the managers visits to Mrs Y’s home. On one occasion, 30 May 2019, the manager sent Mrs X an email to says she had recently visited Mrs Y and “was happy with the standard of cleanliness of the property”. She then went onto explain she had completed some domestic tasks herself, including wiping the fridge, and cleaning a utensil pot on the draining board. She told Mrs X “as long as we work together and continue to communicate with each other im hopeful we can overcome these issues”.
25. On 4 June 2019 the Council wrote to Mrs X responding to her complaint. The author of the letter said she was responding to Mrs X’s complaint about the quality of care, and Mrs X’s request for the Council to waive Mrs Y’s contributions towards her care. The officer said, “I understand that you recently confirmed to [council officer] that there were still problems with the care package and as result of this you would like the care charges, as stated above, to be waived. You reported to [council officer] that there were problems with the care package on a daily basis”. The officer went to say “If you are dissatisfied with the quality of care provided by Comfort Call, which you clearly are, the remedy would be to consider a change of care provider or for your mother to have a Direct Payment so you could employ your own care agency or Personal Assistant”.
26. Mrs X responded to the Council in writing on 5 June 2019 saying although she was “…disputing the invoices she had paid them even though the complaints were continuing. She said she wanted “to keep the financial side of matters in hand”. Mrs X said she was willing to pay but expected decent quality care. She reiterated her complaint about her absence from the initial care planning meeting.
27. On 25 June 2019 Mrs X sent an email to the care agency again to say a carer had not given Mrs Y the correct medication, Mrs Y had realised and told the carer, and the carer had said she had got the wrong day. Mrs X expressed concern about this. The manager responded and said the carer had given a different version of events, that she realised she had taken the wrong medication out of the packet and rectified it straight away. The manager said she had told the carer to be more conscientious when dealing with medication.
28. Mrs X gave an example of poor care that occurred during this investigation. On the weekend of 14/15 September 2019, Mrs Y was unwell, and an ambulance service was called. Paramedics attended and after undertaking checks, they advised Mrs X to contact Mrs Y’s GP. Mrs X contacted the GP early on Monday 16 September 2019. She then went to Mrs Y’s home around 8.30am to await the GP’s visit. When she arrived, she found Mrs Y in a soiled nightdress and tissues soiled with faeces strewn around the bedroom floor and in the bathroom. The carer had left shortly before Mrs X arrived.
29. Mrs X contacted the care agency to complain and was told the carer did not see the tissues and did not notice Mrs Y was in a soiled nightdress because she did not mobilise whilst the carer was present. Mrs X says she does not understand how the carer could not notice.
30. Mrs X says she is exhausted with complaining to the care agency and the Council about the same issues. She says the care agency manager no longer responds.
31. In a recent discussion with Mrs X she confirmed there to be ongoing issues of poor care. She says she was reluctant to change providers or accept direct payments because there are three carers who provide an excellent service, and Mrs Y has a good relationship with these individuals. However constantly having to deal with issues that arise is having a detrimental effect on her wellbeing. She expressed a wish to explore direct payments but said she did not understand how it works

Analysis

32. The Council had a duty under section 8 of the Care Act 2014 to meet Mrs Y’s eligible needs. It did so by an arrangement with the care agency. Any failings in the care agency’s service to Mrs Y is fault by the Council because the care agency provided services on the Council’s behalf under section 8.
33. It is clear the standard of care provided to Mrs Y did not meet Mrs X’s expectations. The issue to be considered is whether the standard of care was good enough, and whether the Council did enough to address the issues Mrs X raised.
34. There is also the matter of Mrs X having been excluded from the initial care planning meeting. Mrs X and her sister provide significant support to Mrs X. They should have been involved in the care planning from the outset. The Care and Support statutory guidance says, (10.21) “In considering the person’s needs and how they may be met, the local authority must take into consideration any needs that are being met by a carer. The person may have assessed eligible needs which are being met by a carer at the time of the plan – in these cases the carer should be involved in the planning process”.
35. The care plan completed by the care agency contained key information, but it is not easily readable. It is not a document that could be read quickly by carers visiting Mrs Y. The tasks are lost in the narrative. However, carers are aware Mrs Y is blind and it is difficult to understand why a carer would place a tin can with the lid open in a fridge. The raises questions about carers competency, training and indicates a basic lack of common sense. This should have caused the Council concern. It did not, instead the Council told Mrs X if tasks were not in the care plan they would not get done. The care plan did record that sharp objects and breakables should be removed, but even if had not, it is a reasonable expectation that carers have awareness of health and safety.
36. During a meeting Mrs X had with the Council and the care agency, a council officer made a comment about leaving knives in the sink. Even allowing for differing interpretation. The comment was inappropriate and insensitive. There are no circumstances which excuse carers leaving any type of knife in a bowl in the home of a blind service user. The same can be said for any other obvious hazard, such as an overflowing bin.
37. In response to Mrs X’s repeated complaints, a manager from the care agency made several inspection visits to Mrs Y’s home. On one occasion, the manager said she was satisfied with the standard of cleanliness then went on to describe some domestic tasks she had completed during the inspection. This is contradictory, if the standard of cleanliness was satisfactory then there would have been no tasks to complete. Mrs X’s lack of confidence in the care agency is understandable.
38. Mrs X repeatedly complained to the Council about the care and said Mrs Y should not have to pay for a service she was not receiving. In its response the Council said officers had regularly engaged with Mrs X, listened to her concerns, and promptly engaged with the care agency. This was not good enough. I have not seen any evidence which shows the Council properly addressed the issues with the agency, some of which presented a real risk to Mrs Y’s safety. It appeared to accept the care agency’s assurances and gave little weight to the information provided by Mrs X. Consequently, unacceptable practice continued. Other service users may also have been affected.
39. The Council said if Mrs X was dissatisfied with the care provided then the remedy would be to change care providers or change to a direct payment. This is not an acceptable response. Service users are entitled to expect good quality care and should not be expected to change providers or accept direct payments because they complain about poor care. The Council should have taken robust action to address the issues and monitor the ongoing quality of care provided to Mrs Y and any other service users it commissions care for.
40. Mrs X says Mrs Y should not have to pay for poor quality care. I note Mrs X has not withheld payment of Mrs Y’s contributions. She has paid in full. Mrs X would like the Council to waive Mrs Y’s contributions in full. She acknowledges that not all the care was poor and praised three or four carers. On that basis I cannot recommend the Council refund all the contributions Mrs Y paid. However, Mrs Y has experienced ongoing instances of poor care. The Council missed several opportunities to address this. Because of this it should refund Mrs Y 50% of the contributions she paid towards her care.
41. Mrs X is in her seventies. She has been put to significant time and trouble pursuing her concerns with the care agency and the Council. She has been caused worry and uncertainty about the care Mrs Y is receiving. This has caused her anxiety and low mood. The Council should apologise for this. It should also offer a carers assessment.
42. The Council should provide Mrs X with information about direct payments and provide support should she wish to proceed.

Agreed action

43. The Council will within four weeks:

• apologise to Mrs Y for the poor care highlighted above
• refund her 50% of all contributions paid towards her care from January 2019 to the date of the final decision
• complete a review of Mrs Y’s needs and update her care and support plan as necessary
• apologise to Mrs X for the worry and uncertainty she has suffered and apologise for the time and trouble she has been put to pursuing the complaint with the Council, care agency and the Ombudsman, and pay her £500 in acknowledgement
• offer Mrs X a carers assessment
• provide Mrs X with information about direct payments and provide guidance and support should she wish to proceed.
• monitor the care agency’s performance including records, care plans, call time adherence and client satisfaction as part of its regular contract monitoring and take appropriate action to address any concerns in service

44. Under the terms of our Memorandum of Understanding and Information Sharing Protocol, I will send CQC a copy of the final decision statement.

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Final decision

45. The Council failed to ensure Mrs Y received a satisfactory standard of care. It also failed to properly address the concerns raised about this.
46. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman