Summary: the complainant says the Council’s care contractor failed to provide the care for her parents set out in their care plans. This resulted in carers leaving the couple soiled, in soiled clothes and lacking dignity. The Council says its contractor did fail to provide care to the standard expected and it followed up the faults with the contractor. The Council offered the family advice on how to engage care direct. The Ombudsman finds the Council at fault for the failings in the care provided and lack of significant improvement.

The complaint

1. The complainant, whom I shall refer to as Mrs X, says when delivering adult social care to her parents, Mr and Mrs Y the Council failed to:
• Provide the care set out in Mr and Mrs Y’s care plans leading to neglect of their personal care and hygiene
• Properly supervise the delivery of the care service and fully investigate concerns raised about the care received.
2. Mrs X says this led to a lack of care causing Mr and Mrs Y distress sitting in soiled clothes resulting in a lack of dignity, delays to meals and medication. Mrs X wants the Council to recognise the poor service received and to ensure Mr and Mrs Y receive the service they need and deserve.

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The Ombudsman’s role and powers

3. 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)
4. If 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)
5. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

6. In considering the complaint I have:
• Contacted Mrs X and read the information presented with the complaint;
• Put enquiries to the Council and studied its response;
• Researched the relevant law, policy and guidance;
• Shared with Mrs X and the Council my draft decision.

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What I found

7. Mr and Mrs Y live in their own home supported by their son, Z. The Council assessed Mr and Mrs Y as each having social care needs and arranged for carers to visit each day to help both Mr and Mrs Y to:
• Get up in the morning, wash, dress and have breakfast;
• Settle them into their chair downstairs;
• Prepare lunch, use the toilet and settle again in their chairs;
• Prepare supper, use the toilet, wash, undress and get into bed;
• Take medication.
8. The Council engaged a contractor who provided carers to support Mr and Mrs Y. The contractor gave the Council notice ending the care services it provided for the Council’s residents. It said it could not provide the services needed. The Council engaged a new contractor who delivered the service from May 2019.
9. Soon after the contract began the Council received complaints about the care services three residents, including Mr and Mrs Y, received from the care service. Mrs X says carers arrived late delaying meals and medication Mr and Mrs Y needed to take. Carers would use their mobile phones when they should be delivering the care. Mrs X reported to the contractor the following examples of faults:
• Late arrivals to deliver care, and at least one care session missed;
• The contractor had nobody available to take calls when Mrs X or Z tried to call them to find out what had happened with the carer;
• Beds not changed when wet. The care plan says carers should check the beds because Mr and Mrs Y suffer incontinence and if wet, put the bedding in the washing machine;
• The carers on occasion failed to shower Mr and Mrs Y, or shave Mr Y as set out in the care plan;
• Failure to help Mr and Mrs Y use equipment;
• Failure to dress Mr and Mrs Y suitably;
• Failure to help with personal hygiene and put teeth in;
• Putting eye drops in the wrong eye;
• Failure to apply skin creams at the right time.
10. Mrs X says the problems began as soon as the contractor took over. The family became very concerned and asked the Council to restore the previous contractor. As an example of the poor time keeping, on one occasion the carers arrived at 11.00am to deliver the 8.20am care service with a return visit planned for 1.00pm.
11. Under the contract the Council expects the contractor to resolve any problems or complaints. The family’s social worker has oversight of the care and is available should the family need to raise any issues.
12. On 7 June 2019 Mr and Mrs Y’s social worker raised concerns with the contractor. The social worker also raised concerns raised by other clients. The social worker raised further concerns on 19 June 2019. The social worker spoke with the Adult Social Care Complaints Team. They suggested she meet with the clients and the contractor and if that did not produce a satisfactory result, they would treat the issues as a formal complaint. The family met with the contractor and the social worker on 26 June 2019. The contractor agreed action to improve punctuality and personal care. Some improvement followed. The Council said it expected the contractor’s branch manager to oversee the carers. The social worker contacted the family in July 2019 to ask if they had seen an improvement and felt happier with the service. The family told the social worker there had been some improvement, but they remained unhappy with the contractor.
13. The service did not improve enough. The family ended the Council’s service on 25 August 2019 and with help from the social worker hired a different contractor.
14. The Council accepts it could have responded more quickly and undertaken more detailed supervision of the care service. However, it expects care contractors to meet the times set for calls in 75% of cases and to deal swiftly with any complaints. The contractor’s service agreements with Mr and Mrs Y do not say any complaint can referred to the Council. Instead it advises clients they may contact the Ombudsman. Therefore, Mrs X did not complain to the Council again but direct to the Ombudsman. The Council has changed the complaints procedure to encourage families to complain first to the Council.
15. In recognising the Council could have done more it says its social workers carry a large caseload. Therefore, they cannot always follow up on clients’ concerns as quickly or as in depth as they may wish. In this case the contractor failed to resolve the issues with its carers.
16. Mrs X says the carers appeared inexperienced and poorly trained. Carers could not follow the instructions in the care plan. They used their mobile phones when delivering the care. They left Mr and Mrs Y soiled, in soiled clothes, wet bedding and failed to treat them with dignity. They applied eye drops to the wrong eye and Mrs X felt unable to trust them with the medication. Mrs X and Z witnessed some of the faults which left them troubled about what happened when they could not be there. This caused Mrs X and Z distress and anxiety and Z had to take time off work to restore structure and ensure Mr and Mrs Y received the care they needed.

Analysis – was there fault leading to injustice?

17. My role is to examine how the Council delivered the care it assessed Mr and Mrs Y needed and how it dealt with complaints about that care. Where I find fault, I must decide if it has caused an injustice and if so, what remedy I should recommend.
18. The Council has a duty to provide care to support those who need it. While it may engage contractors to deliver the care it remains responsible for the standard of care. We expect councils to carefully oversee the care delivered and to swiftly take up any concerns raised by clients.
19. The care contractor failed to provide the standard of care Mr and Mrs Y and Mrs X and Z may reasonably expect. Nobody should be left soiled, wearing soiled clothes or in wet or soiled bedding. That is not preserving their dignity. The times set for care calls reflect the needs of the client to be woken up, washed, fed and given their medication. I find the contractor failed significantly to provide the care at the right times and to the right standard. As the Council’s contractor, the Council is responsible for that poor care.
20. The social worker raised concerns with the contractor and met with the family and contractor within a month of the start of the contract. The social worker followed up the actions agreed at the meeting about two weeks later. The family confirmed the contractor had improved but not enough for them to feel Mr and Mrs Y received the standard of care they had previously enjoyed with the former contractor. The social worker offered information and advice on engaging a care contractor which the family would fund. The family chose to self- fund.
21. The social worker did follow up the concerns and the improvements promised at the June meeting. However, I find the Council did not do enough to ensure significant improvement leading to a service equal to the service previously enjoyed by Mr and Mrs Y.
22. Mr and Mrs Y need significant care and Mrs X may expect there to be the occasional problem and therefore she may need to spend time resolving those problems. However, Mr and Mrs Y experienced significant faults in the care received and I find the Council at fault in the service delivered to them. I find this led to Mrs X and Z spending avoidable time and experiencing avoidable distress and inconvenience in dealing with the faults.
23. The contract lasted three months. Although the standard improved, in Mrs X’s view, the service never met the standard of the previous care service. It should. In changing provider clients may expect to experience some disruption. However, experienced care staff should find it easy to follow the care plan and to raise with their employer any difficulties. These should not still be occurring three months later. It is difficult to find and keep good experienced care staff. However, that is not Mr and Mrs Y’s problem. They relied on the Council engaging a contractor to deliver care to the standard expected by the Council and Mr and Mrs Y.
24. The failings in care resulted in significant distress for Mr and Mrs Y, Mrs X and Z.
25. Since this complaint the Council has reviewed its liaison with contractors and recognised where it may improve how it follows up on complaints.

Recommended and agreed action

26. In recognition of the injustice arising from the faults identified in this investigation I recommend; and the Council agrees to within four weeks of my final decision:
• Apologise in writing to Mrs X;
• Pay Mrs X £750 in recognition of the distress caused to her, Mr and Mrs Y and Z by the failings in the care provided by its contractor and the time taken to resolve it.

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Final decision

27. In completing my investigation, I find the Council at fault in the care provided.

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Investigator's decision on behalf of the Ombudsman