Summary: Ms B complains Quality Care Services Bedford changed the times of her calls when she came out of hospital in February 2019 and then cancelled calls with little notice, leaving her without care. Quality Care Services Bedford should not have been providing personal care to Ms B, as it is not registered to do so with the Care Quality Commission. However, there is not enough evidence of injustice arising from its actions to justify recommending a remedy.

The complaint

1. The complainant, whom I shall refer to as Ms B, complains Quality Care Services Bedford (QCSB) changed the times of her calls when she came out of hospital in February 2019 and then cancelled calls with little notice, leaving her without care.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(4), as amended)

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How I considered this complaint

3. I have:
• considered the complaint and the documents provided by Ms B;
• discussed the complaint with Ms B;
• considered the comments and documents QCSB has provided in response to my enquiries; and
• shared a draft of this statement with Ms B and QCSB, and taken account of the comments received.

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What I found

Key facts

4. Ms B is quadriplegic and relies on carers to meet all her care needs. She has a live-in carer and uses agencies to provide extra support in the mornings and evenings.
5. She arranged for QCSB to provide some of that extra support from November 2018.
6. Ms B’s contract with QCSB says: “The work of the personal assistant may involve personal care requiring hand-on contact, and assistance with household tasks such as cooking, cleaning, washing, ironing and pet care”. It identifies these hours:
• Monday 21.15-22.15
• Wednesday 21.15-22.15
• Friday 09.00-10.30 / 21.15-22.15
7. According to QCSB’s care and support plan a carer would visit for 1 ½ hours in the mornings and 1 hour in the evenings on Mondays, Wednesdays and Fridays. It says the carer will:
• Mornings
• help the live-in carer get Ms B ready for her morning shower;
• make the bed, tidy the bedroom and fill a bottle with hot water;
• help the live-in carer get Ms B ready for the day;
• clean the bathroom;
• take the bin out;
• Evenings
• prepare the bed and night clothes;
• help the live-in carer with hoisting Ms B into bed;
• make Ms B comfortable and ready for the night;
• tidy the bedroom;
• take the bin out.
8. Ms B went into hospital in January 2019. While in hospital she discussed with QCSB the possibility of it providing a live-in carer. She says QCSB agreed to change one her calls from Friday to Thursday morning. On 25 February she sent QCSB an e-mail setting out the calls she would need:
• Monday 21.00-22.00
• Wednesday 21.00-22.00
• Thursday 08.00-09.30
• Friday 21.00-22.00
• Saturday 08.30-10.00
• Saturday 21.00-22.00
• Sunday 07.00-08.30
• Sunday 21.00-22.00
9. Ms B told QCSB she could not afford its charge for a live-in carer (£7,000 a month). She says it then told her all her morning calls would be at 09.00 “so no one will be confused about times”. But this was not convenient for her as she has physiotherapy on Thursdays and goes to church on Sundays.
10. At 16.14 on 7 June QCSB texted Ms B saying it had to cancel the call for the next morning. Ms B said this was not good enough as she would have no one else. QCSB said “Sorry but we don’t have a choice. It is enough notice. Sorry again and wish you good day”. Ms B says she had other examples of QCSB cancelling calls by text, but she no longer has the same mobile so cannot access them.
11. QCSB stopped sending carers to Ms B in June and sent her its final invoice on 13 June.
12. QCSB’s invoices show it charged Ms B for:
• 41.5 hours in February
• 39 hours in March (44 scheduled)
• 38.6 hours in April (39 scheduled)
• 39.2 hours in May (41.5 scheduled)
• 18.5 hours in June
13. Ms B has provided copies of the timesheets completed by QCSB’s carers during March and June:
• 4-10 March: all calls delivered
• 11-17 March: all calls delivered plus extra call on Tuesday am
• 18-24 March: no calls Friday pm, Saturday am/pm or Sunday am/pm
• 25-31 March: no calls Wednesday am or Thursday pm
• 1-7 June: no calls Monday am or Wednesday pm
• 8-15 June: no calls Saturday am, Monday am, Wednesday pm, Saturday pm or Sunday pm
14. The time sheets identify:
• Thursday calls starting at: 08.00; 08.30 x 2, and 09.15 x 2;
• Sunday calls starting at: 07.00 x 2, 07.15 and 08.40.
15. On 5 July Ms B complained to QCSB about:
• changing the time of her morning calls to 09.00 without her agreement;
• often not coming on Saturdays and other times;
• giving her less than 24 hours’ notice when cancelling calls;
• often telling her the carer’s car had broken down, which she did not believe.
16. QCSB emailed Ms B on 7 July. It said it must have been very frustrating when her expectations were not met. It said it had tried contacting her many times to try and resolve any possible complaints. It said she had never sent a formal complaint, although it had stopped providing a service for her a month ago. It said it had always been there when she needed it. It apologised for any trouble and inconvenience it had caused and offered to meet her to discuss any concerns she may have. Ms B did not take up the offer.
17. QCSB is not registered with the Care Quality Commission (CQC) to provide personal care. It says:
• CQC turned down its application for registration because the proposed manager did not have enough experience;
• it has put the application on hold;
• it would never provide personal care without being fully approved by CQC.
18. QCSB says:
• after she came out of hospital, Ms B often changed her calls with little notice because her other care agencies let her down;
• it organised someone to stay with Ms B as there was no one to help with her basic needs while she was in hospital;
• Ms B had been pleased with its services and wanted it to take over her full care package;
• before CQC turned down its application for registration, Ms B started reducing her hours to four every other week.
19. Ms B says:
• she always gave enough notice when changing her calls;
• QCSB adapted to her needs well at the beginning;
• QCSB never sent anyone to stay with her;
• on one occasion QCSB provided a carer when another care agency let her down;
• if she complained too much QCSB would not provide care the next day, so she stopped complaining;
• QCSB did not give enough time to make alternative arrangements when it cancelled calls;
• she reduced the hours because she was unhappy with the service and wanted to move to another care agency.

Did QCSB’s actions cause injustice?

20. Both the contract and the care and support plan show QCSB knew its carers would be providing personal care to Ms B in addition to other services. It should not have entered into such an arrangement when it is not registered with CQC to provide personal care.
21. With regard to Ms B’s specific complaint, there is a lack of hard evidence. It is clear QCSB did not always provide calls at the times Ms B wanted them. But it also appears she accepted that. There is evidence of one occasion when QCSB did not provide Ms B with enough notice of cancelling a call. Its texts did not take account of the fact Ms B relied on its calls to get up and dressed in the morning. There is also evidence of QCSB providing an additional call when another care agency let Ms B down. It is clear QCSB did not provide all the calls Ms B had asked for. What is not clear is the extent to which this was due to QCSB’s failures, Ms B making changes to her schedule or her decision to source care elsewhere.
22. On balance, there is not enough evidence for me to see QCSB’s actions caused injustice to justify recommending a remedy. Although QCSB’s records do not meet the standard I would have expected from a company providing personal care, there is no point in my making recommendations over this as it says it is not providing personal care to other clients.
23. Under the terms of our Memorandum of Understanding and information sharing agreement with CQC, I will send it a copy of my final decision statement.

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Final decision

24. I have completed my investigation as there is not enough evidence of injustice for me to propose a remedy.

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Investigator's decision on behalf of the Ombudsman