Summary: Mr B complained about the standard of care provided to his father in law, failure to take prompt action to identify a new care provider which led to Mr C missing out on care provision, failure to take action when he raised concerns about a new call time, Council officers speaking inappropriately to his wife and failure to offer a satisfactory remedy. There were failings in the care provided to Mr C and there is no evidence the Council followed that up with the care provider. There is no fault in the remainder of the complaint investigated by the Ombudsman. A financial remedy, apology and ensuring the care provider carries out the training promised is satisfactory remedy to reflect the distress caused to Mr B and his wife and the time and trouble they had to go to pursuing their complaint.

The complaint

1. The complainant, whom I shall refer to as Mr B, complained about how the Council dealt with his concerns about his father in law’s care. I will refer to Mr B’s father in law as Mr C. Mr B complained:
• about the standard of care provided by company X to Mr C and the Council’s failure to take action on that;
• the Council failed to take prompt action to identify a new care provider which meant Mr C did not receive any care provision between 22 February 2019 and 5 March 2019;
• the Council failed to take action when he raised concerns about the new call time and actions of a carer provided by company Y;
• Council officers spoke inappropriately to his wife; and
• the Council failed to offer a satisfactory remedy to reflect the impact on his family.

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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)
4. 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

5. As part of the investigation, I have:
• considered the complaint and Mr B's comments;
• made enquiries of the Council and considered the comments and documents the Council provided;
• considered Mr B’s comments on my draft decision; and
• gave the Council an opportunity to comment on my draft decision.

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What I found

Background

6. On 18 February 2019 company X took over the care package for Mr C.
7. On 20 February Mr B’s wife contacted the Council with concerns about the care agency. Mr B’s wife reported carers had not documented what care they had provided Mr C with over the previous three days, had given him the wrong medication on Tuesday and Wednesday and had not ensured Mr C had taken his night-time medication all week. The Council contacted company X who explained there was an issue about the medication pack. The care provider said it was happy to meet with Mr B’s wife. Mr B’s wife agreed to the meeting, which was to take place on 22 February.
8. On 22 February the family cancelled the care by company X after experiencing more problems including a missed call on that day. Mr B’s wife reported company X had not attended the arranged meeting. The Council referred the case to brokerage to look for a new agency.
9. On 25 February the Council told Mr B’s wife it could take time to source another care agency. When Mr B’s wife raised concerns the Council explained she had not given it the opportunity of speaking to the care agency to iron out the issues.
10. The Council spoke to company X. Company X confirmed the missing visit, although it said a carer had visited later in the day. Company X accepted it had failed to attend the meeting on 22 February. The Council passed that information onto Mr B’s wife. Mr B’s wife said company X had lied about the visit on 22 February as the family had been there at the time the carer allegedly visited. The Council discussed the option of allowing company X to continue with the care until the Council could source a new agency. Mr B’s wife said she would discuss it with her family. Mr B’s wife explained her sister might be able to provide care in the interim as she worked nights at a care agency. The Council discussed the option of private care but explained because it was only for a short time the agency may not take the calls but the Council could provide some agency names. Mr B’s wife advised she would get back to the Council. Company X subsequently said it could not provide the care package, although Mr B’s wife said she did not want that anyway. Mr B’s wife later told the Council her sister would provide the care in the mornings for the next few days.
11. On 28 February the Council contacted providers to source a care package. Mr B’s wife asked for a new care package from the following day but the Council explained it had not identified a provider. The Council suggested respite which Mr B’s wife was not happy with.
12. The Council chased various care providers on 1 March. That included company Y which explained it might have capacity. Company Y then offered a 6am call from 5 March 2019. When the Council told Mr B’s wife about that she raised concerns about the call being too early. Mr B’s wife later said they would take the 6am call for now and see how things went. Company Y began providing care from 5 March which involved a 6am call.
13. Mr B put in a complaint on 5 March.
14. On 18 March Mr B reported problems with the care package from company Y. Mr B reported the carer often arriving at 6am banging on the door to wake Mr C rather than using the key safe. Mr B reported a deterioration in Mr C’s state of mind and body. Mr B asked the Council to do something to deal with that.
15. The Council received an offer for a 7am call from a new care provider, company Z, on 26 March. Company Z took over the care package from 2 April.
16. The Council wrote to Mr B in response to his complaint about company X on 9 April. The Council upheld the complaint about incomplete care records, poor quality care recordings, lack of evidence of carers completing the tasks required, a missed visit on 22 February and failure of company X to attend an arranged meeting on 22 February. The Council accepted company X had not reached the desired standard and apologised. The Council said it would take the concerns raised into account to ensure improvements across the service. The Council agreed to pay £250 as a goodwill gesture. The Council also apologised for any distress as a result of Mr B’s wife talking to Council officers.
17. On 31 May Mr C sadly died.

Analysis

18. Mr B says company X, which provided care to Mr C on behalf of the Council failed to provide adequate care. The Council has already accepted the care records completed by company X do not show the care provider carried out the tasks on Mr C’s care plan. The Council has also accepted the care provider failed to provide a call on 22 February. I agree with those conclusions. Failure to keep proper care records and attend calls is fault. The inadequate care records also leave Mr B uncertain about whether company X provided Mr C with adequate care.
19. I welcome the Council’s acceptance company X did not provide suitable care to Mr C. I also note the care provider has accepted fault in this case and is intending to carry out training for care staff in writing care notes. I also welcome that. However, given company X provides care on behalf of the Council I would expect the Council to have in place a mechanism to monitor the care provided by company X. I therefore recommended the Council follow up with company X to ensure appropriate training is carried out with care workers so that similar problems do not occur for other service users. The Council has agreed to that recommendation.
20. Mr B says the Council failed to take prompt action to identify a new care provider. As I understand it, the family cancelled company X’s provision of care following the failure to visit on 22 February. I understand why the family would not have wanted company X to continue to provide care given the issues that arose during the first week. However, it seems to me Mr B might have expected the Council to put in place an alternative provider almost immediately. I understand why the family would have wanted that to happen. However, to put in place alternative provision the Council first had to identify a care provider with capacity. I am satisfied the Council began the process of trying to find a new care provider as soon as it knew of the cancelled care package. I have seen no evidence the Council identified a new provider until 1 March when it sourced a 6am care call from company Y. So, while Mr C was without a care package between 22 February 2019 and 5 March 2019 I do not consider this due to fault by the Council. Rather, I am satisfied the delay occurred because the package ended with little notice and the Council could not identify a care provider with capacity to take on the care.
21. Mr B says the Council failed to take action when he raised concerns about a new call time for Mr C’s care. Mr B says the Council changed the call time to 6am from 5 March which was too early for Mr C. Mr B also says the carer that visited at 6am did not use the key safe and instead banged on the door to wake Mr C if he was not up already. Mr B says the new call time led to a deterioration in Mr C’s health and he believes it contributed to his death.
22. The evidence I have seen satisfies me the Council put in place a 6am call time after liaising with Mr B’s wife as this was the only care provider that could take over the package. So, the choices available to the Council at the time were a 6am call time or to continue to provide no care package until a new provider could be identified with an appropriate time slot. The evidence I have seen satisfies me Mr B’s wife accepted that proposal on a temporary basis to see how her father managed with it. I have seen no evidence Mr B or his wife raised any concerns with the Council until 18 March. At that point Mr B reported Mr C struggling to manage the 6am start time which was impacting on his health. Mr B also raised concerns about the carer banging on the door to wake Mr C rather than using the key safe.
23. Although Mr B says the Council did not take any action I am satisfied it did as it identified an alternative care provider within 10 days of Mr B reporting difficulties. I am also satisfied that care provider, company Z, then took over the care package shortly after that. So, I could not say the Council failed to take action when Mr B raised concerns. I appreciate the action the Council took may not have been as quickly as Mr B would have liked. However, it takes time to identify an alternative care provider. As I am satisfied the Council took prompt action to find a new provider in response to Mr B’s concerns I have no grounds to criticise it.
24. Mr B says Council officers spoke inappropriately to his wife. Mr B says Council officers made his wife feel as if she was a troublemaker and that she should have pursued private care for her father. I believe Mr B is referring here to telephone conversations which took place between his wife and Council officers on 25 and 28 February 2019. It is clear from the Council’s notes from those telephone calls that Mr B’s wife was understandably upset by the care company X had provided to Mr C and the Council’s inability to swap to a new provider straightaway. I have already referred to the fact there will inevitably be a gap in provision when care provision is ended suddenly without an alternative ready to take over. I understand in those circumstances why Mr B’s wife might have felt officers were being critical of her. In the absence of any telephone recordings though I cannot reach a safe conclusion about whether officers dealt with Mr B’s wife inappropriately.
25. Mr B says the Council’s offer of £250 is not a satisfactory remedy to reflect the impact the failures in this case had on his family. It is no longer possible to remedy the injustice to Mr C as he has sadly died. However, Mr B and his wife have suffered an injustice as a result of the failures identified in paragraph 18. Those failures mean Mr B and his wife are justifiably concerned Mr C did not receive the care he should have done during the week Company X provided carers. Mr B and his wife have also had to go to time and trouble to pursue their complaint. Taking into account the time period involved, which is five days, and the fact I do not criticise the Council for the period for which no care was provided or in relation to its actions to move the package to a care provider with a later start time, I consider £350, plus an apology, a more appropriate remedy for the complaint. As I said earlier though, I would expect the Council to follow up with the care provider to ensure it has completed the training on writing care notes. I also recommended the Council carry out checks with any service users for whom it had arranged company X to provide care to ensure medication charts are properly used. The Council has agreed to my recommendations.

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Agreed action

26. Within one month of my decision the Council should send a further apology to Mr B and pay him £350;
27. Within two months of my decision the Council should provide evidence it has liaised with company X to ensure training for carers on writing care notes and maintaining medication charts has been carried out.

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Final decision

28. I have completed my investigation and found fault by the Council in part of the complaint which caused Mr B an injustice. I am satisfied the action the Council will take is sufficient to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman