Summary: Ms X complains about the care services provided to her. She says the Council’s actions left her with inadequate care. From the evidence provided, the Ombudsman finds fault with the Council as there were periods Ms X did not receive care and inconsistencies in the care provider’s records. There were also delays in assessing Ms X and in carrying out a safeguarding enquiry. The Ombudsman has made recommendations to remedy the injustice caused to Ms X which the Council has agreed to.

The complaint

1. The complainant, whom I refer to as Ms X, complains about the care services provided to her. She says the Council is at fault for:
• Delaying in providing a care service.
• Delaying in carrying out a care assessment.
• The level of care received from the care provider the Council commissioned and how the Council investigated this.
• Leaving her without care from 9 August 2018 until 19 September 2018.

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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. As part of this investigation:
• I considered the complaint raised by Ms X and the response from the Council.
• I made enquiries to the Council and considered its response.
• I considered the information provided by Ms X’s representative.
• I sent a draft of this decision to Ms X and the Council and considered the comments I received in response.

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What I found

Law and guidance

5. The Care Act 2014 requires local authorities to carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve.
6. Where an assessment decides that a person has any eligible needs, councils must meet these needs. The Regulations set out the eligibility threshold for adults with care and support needs and their carers.
7. Councils must provide a care and support plan which sets out the person’s needs, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area.
8. 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.
9. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
10. Guidance on Regulation 13 (safeguarding from harm and abuse) says ‘providers and staff must take all reasonable steps to make sure that people who use services are not subjected to any form of degradation or treated in a manner that may reasonably be viewed as degrading.’
11. The Care Act 2014 requires councils to make necessary enquiries if it has reason to think a person may be at risk of abuse or neglect and has needs for care and support which mean he or she cannot protect himself or herself. It must also decide whether it or another person or agency should take any action to protect the person from abuse or risk.

What happened

12. Ms X suffers from a medical condition which causes pain all over her body. She has reduced mobility and needs help managing daily activities.
13. The Council transferred Ms X into temporary accommodation within its area. Ms X previously had her care needs met in a different local authority area.
14. The Council received a referral for a Care Act Assessment for Ms X on 6 February 2018. The referring local authority also told the Council Ms X’s current support stops on 20 February 2018. The Council used the previous care assessment provided by the referring local authority to commission a service for Ms X for one month. This stated Ms X needs help with the following care needs:
• Accessing and engaging in work, training, education or volunteering.
• Being able to make use of the home safely.
• Being appropriately clothed.
• Maintaining personal hygiene.
• Managing and maintaining nutrition.
• Managing toilet needs.
15. The care plan commissioned 15 hours of care for Ms X per week, two hours daily and one hour a week for shopping. In the mornings a carer visited Ms X for one hour to help with getting dressed and washing. At lunchtime and in the evening a carer visited Ms X for 30 minutes.
16. The care assessment also said Ms X could not communicate in English and speaks Spanish. She relied on her sons to help her communicate and in their absence would need an interpreter.
17. The Council identified a care provider to provide care for Ms X. This service started on 5 March 2018. Between 20 February 2018 and 5 March 2018 Ms X did not receive care. The Council said this was partially due to Ms X asking the service she received from the referring local authority to end on 20 February 2018.
18. On 13 March 2018 the care provider carried out an assessment of Ms X’s needs.
19. In early March 2018 the Council assigned Ms X a social worker to complete a care assessment. From the Council’s records the social worker started the care assessment on 19 March 2018 and visited Ms X on 23 March 2018.
20. On 19 April 2018 the care provider tried to visit Ms X as there had been reports Ms X was refusing some carers. The notes say the care provider could not gain access and the doorbell was unplugged. On 30 May 2018 the care provider carried out a further visit to Ms X to talk about Ms X refusing carers. The notes say the care provider could not gain access.
21. On 14 June 2018 Ms X’s solicitors wrote to the Council saying Ms X was unhappy with the care received from the care provider. The letter listed several allegations made against the care workers.
22. On 19 June 2018 Ms X’s social worker completed her care assessment.
23. In late July 2018 the care provider gave notice to the Council it would be ending its service with Ms X due to the number of carers she had refused. The care provider told the Council it would continue to provide care until 9 August 2018. The Council contacted the care provider to negotiate it continuing to provide care until it arranged direct payments for Ms X.
24. On 9 August 2018 the care provider confirmed it would end its service to Ms X as the 14 days’ notice had elapsed. The Council tried to contact Ms X by telephone over one week later but could not get through. Ms X’s solicitors emailed the Council in early September 2018 saying she is reliant on her children to support her and cannot properly wash.
25. The Council approved Ms X’s application for direct payments on 19 September 2018.

Safeguarding

26. On the 16 June 2018 the Council raised a safeguarding enquiry in light of the letter from Mrs X’s solicitors.
27. On 27 July 2018 the Council discussed the concerns with Ms X’s son. He said the care workers can be rude and sometimes the care provider will not send any care workers.
28. The Council visited Ms X on 31 July 2018 with an interpreter present to discuss her concerns about each allegation Ms X raised. Ms X confirmed the allegations and said the care workers would often argue with her children when the pointed out the care Ms X received was not in line with her care plan. Ms X confirmed she would like to receive a direct payment so she can employ a person of her choice to meet her care needs.
29. The safeguarding investigation considered the following allegations raised by Ms X:
• Carers failed to prepare food stating they were only able to heat food. Carers prepared juices for Ms X with ingredients she did not like (such as onions and peppers) and they recorded food they did not prepare for her.
• Carers left early and turned up late.
• Carers were aggressive and shouted at Ms X. Carers suggested she can do things for herself.
• The care provider contacted a friend of Ms X to question whether she needed care.
• A carer left Ms X unattended in the middle of a shower. She fainted and fell to the floor. Her son who was at home tried to help and took Ms X into bed. Ms X woke up the following day on a damp bed, naked with a towel over her, feeling undignified.
• Between 16-17 June 2018 Ms X stayed on her bed as no carers attended and there was no notice from the care provider.
• On 21 June 2018 the carer refused to wash Ms X saying she can only wash her in the mornings.
• On 28 June 2018 a carer failed to wash the conditioner out of Ms X’s hair and did not wash up the juicer.
• On 5 July 2018 a carer failed to help properly in washing Ms X’s hair.
30. The care provider provided its response to the Council and raised the following points:
• Care workers had observed that Ms X was on some days able to wash herself and eat and drink independently and use the toilet independently. The care provider said it encouraged Ms X to do things within her means to retain independence.
• The care provider disagreed carers had shouted at Ms X. However, in July 2018 Ms X’s son was verbally abusive to a carer when she attended and did not let her into the property. Ms X has turned away many care workers and the care provider is ending its service with Ms X as it has exhausted all its care workers assigned to Ms X’s area.
• The care provider said care worker were not allowed to use the cooker for health and safety reasons. However, carers did prepare juices for breakfast lunch and dinner as well as salads.
• The care provider spoke with the carer who is alleged to have left Ms X undressed on her bed. The carer says she wanted to call an ambulance as Ms X felt dizzy after helping her out of the shower. Ms X’s son would not allow her to call an ambulance. The carer also says she dressed Ms X and denied the allegations made.
• The care provide also said Ms X refused carers on 21 June 2018 in the morning and at lunchtime.
31. On 20 December 2018 the Council finished its safeguarding enquiry report. The Council found on the balance of probabilities there had been no neglect or emotional or psychological abuse of Ms X. The Council considered Ms X had different expectations about the support the care workers could provide. There were also communication issues which led to misunderstandings which in turn frustrated Ms X. The Council agreed to arrange direct payments for Ms X so she can employ a carer of her choice.
32. The Council only told Ms X the result of the safeguarding enquiry via telephone in February 2019.

Ms X’s complaint

33. On 4 March 2019 Ms X complained to the Council with the help of her solicitors about the care services she received between March and September 2018. This included how the Council assessed Ms X and the level of care she received from the care provider commissioned by the Council.
34. On 1 May 2019 the Council provided its response to Ms X’s complaint. In relation to its assessment of Ms X the Council said:
• It did not provide care between 20 February 2018 and 5 March 2018 but this was due to Ms X ending the care services with the previous local authority. The Council apologised for Ms X not having care for this period.
• The care provider carried out its own assessment of Ms X to fully understand her needs and this resulted in no changes to the support plan she received as commissioned by the Council.
• Council accepted it took too long to complete Mrs X’s care assessment.
35. In relation to the standard of care from the care provider it commissioned the Council said:
• After it received concerns about the standard of care it raised a safeguarding alert.
• Ms X’s social worker arranged a meeting between the parties involved however, Ms X did not want to attend. The social worker then asked the care provider to write a report outlining its position on the allegations raised.
• The safeguarding enquiry concluded on 12 November 2018 and found on the balance of probability Ms X suffered no abuse from the care provider. The Council decided it was the care providers word against Ms X’s.
• The Council acknowledged it delayed in completing the enquiry and did not tell Ms X in writing of the result of the enquiry. The Council said it reviewed its processes and will write to Ms X to tell her the result of the enquiry.
• The Council said the care provider acknowledged it could do some things differently and has decided to send a supervisor to conduct a joint visit with future service users so any issues can be dealt with early.
36. Ms X remained dissatisfied so complained to the Ombudsman.

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Findings

Care services provided to Ms X

37. The Council was responsible for Ms X’s care. It received a referral on 6 February 2018 from another local authority which notified it Ms X’s current provider would end on 20 February 2018.
38. The Council did not arrange for a new care provider to support Ms X until 5 March 2018. Ms X was without care between 20 February 2018 and 5 March 2018. This is fault.
39. I accept the Council wanted to provide a Spanish speaking care provider for Ms X and therefore it took longer to source. However, it should have put something in place for Ms X temporarily while it sourced a Spanish speaking care provider as she had eligible needs which the Council must meet. The obvious injustice to Ms X is she did not receive the care she needed to help her meet her eligible needs from 20 February 2018 until 5 March 2018.
40. I consider a payment for the distress caused to Ms X is appropriate. When coming to a figure I have considered the time Ms X was without care, her family support and the timeframe the Council had to arrange care when it became aware her support would stop.
41. There is also fault as the Council delayed in carrying out Ms X’s care assessment. The Council at first put in place the assessment from the referring local authority while it carried out its own assessment, which was appropriate. However, it took Ms X’s social worker from early March 2018 until mid-June 2018 to complete the care assessment.
42. The Council has rightly recognised this and apologised to Ms X. Meanwhile, the Council also asked the care provider to carry out an assessment of Mrs X to see if the care package met her needs. From the evidence seen Ms X appeared to receive the same care package before the Council completed a care assessment and after it completed one. Therefore, I do not think Ms X suffered injustice because of this delay.
43. When the care provider ended the service provided to Ms X’s the Council did not put anything else in place. Ms X did not receive care from 9 August 2018 until the Council approved her application for direct payments on 19 September 2018. This is also fault.
44. While I accept Ms X refused care from several carers which caused the care provider to end its service the Council still had a duty to meet Ms X’s eligible needs. From the evidence available, after the care provider cancelled its service the Council did not try to contact Ms X for a week. Nor did the Council try to arrange any other provision for Ms X while it awaited approval of her direct payment application.
45. The Council said in response to my enquiries Ms X’s son told the Council she privately commissioned a carer to look after her and received support from family and a friend. However, Ms X’s solicitor contacted the Council in early September 2018 saying Ms X’s sons had been preparing her food but this was not adequate for her diet. They also said Ms X could only wash at the weekend with help from her friend. On balance I do not think Ms X received appropriate care during this period and has suffered injustice. I do not dispute family and friends may have helped her however, it is clear from the email by Ms X’s solicitor she could not regularly wash or have her normal food.
46. I consider a payment for the distress caused to Ms X to be an appropriate remedy for the injustice. In coming to a figure, I have considered Ms X’s behaviour towards the care provider, the level of support she may have received when she was without a care service and the actions of the Council following it becoming aware Ms X’s care would end.

Standard of care Ms X received

47. Ms X says she suffered neglect and abuse from some carers who attended her home. Once Ms X raised these allegations with the Council it took steps to investigate by raising a safeguarding alert.
48. The Council decided it did not have evidence of abuse or neglect after considering the evidence and accounts from Ms X and the care provider. From the evidence seen I cannot say whether the all the allegations Ms X complained about occurred however, I have found fault in aspects of Ms X’s care.
49. The care logs show times where carers attended late, particularly in the mornings. In response to Ms X’s complaint the Council says the care provider uses an electric call monitoring system to keep a record of when carers arrive. This is linked to a client’s landline or a green box. The records provided by the care provider do not match up with the written care logs completed by the carers. I note the care provider’s records also mention it could not use Ms X’s landline.
50. Ms X expected carers to attend within a certain timeslot and arriving later would have caused her uncertainty. The logs also show carers did stay for the required time even when arriving later.
51. Ms X also alleges a carer refused help wash her hair on 21 June 2018. From the evidence seen, this occurred during an afternoon call. Ms X’s care plan says carers are to help her to wash in the morning call. On 21 June 2018 there is not a record, in the care logs, of a carer attending Ms X’s property in the morning. Therefore, Ms X would not have received assistance to wash in the morning of 21 June 2018. I note the care provider’s records show a carer attended Ms X’s property three times on 21 June 2018 however, the lunchtime call does not match up to the written care logs completed by the carer. The care provider also alleged Ms X refused care in the morning and at lunchtime on 21 June 2018. In response to my draft decision I gave the care provider the opportunity to provide evidence carers were turned away on 21 June 2018 however, no documentary evidence was provided to support this claim.
52. On balance I am satisfied carers did not turn up for the morning and evening appointments on 21 June 2018 meaning Ms X could not be washed.

Safeguarding investigation

53. The Council opened the safeguarding enquiry in mid-June 2018 but did not conclude the enquiry until December 2018. The Council accepted in its complaint response it should have concluded the enquiry sooner.
54. From the evidence seen, the Council tried to arrange a meeting with Ms X and the care provider but Ms X did not wish to attend. The Council then asked the care provider to investigate Ms X’s allegations and provide a response. I cannot see evidence the Council considered the care logs completed by Ms X’s carers as part of this investigation or requested these. It would have been helpful for the Council to see this evidence as it supported Ms X’s concerns that carers arrived late.
55. The Council also did not tell Ms X of the result of the enquiry until February 2019 and only did so by telephone. This is fault as the Council should have provided Ms X with a written copy at the time. The Council has since provided a written copy to Mrs X following her complaint and apologised. By delaying in completing the enquiry and not communicating the result in writing Ms X would have been uncertain about the result and how her allegations had been investigated.

Agreed action

56. Within one month of my final decision the Council has agreed to carry out the following and provide evidence to the Ombudsman it has done so:
• Pay Ms X £200 for the distress caused by not initially providing care services when she was referred to the Council in February 2018.
• Pay Ms X £300 for the distress caused for not providing care services after the care provider cancelled its service.
• Pay Ms X £100 for the uncertainty caused from the faults in the safeguarding enquiry.
• Remind Council staff about the need to ensure the outcome of a safeguarding enquiry is provided in writing.
• Apologise to Ms X for the late arrival of carers on occasions and for the missed appointments on 21 June 2018.
• Considering the differences between the written care logs and care providers call monitoring system, write to the Ombudsman explaining what procedures are in place or the Council intends to put in place to ensure current service providers keep adequate care records.

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Final decision

57. I have completed my investigation and found fault by the Council which caused injustice to Ms X. The Council has agreed to carry out the above actions to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman