Summary: There was a delay of three weeks in the Council arranging for an agency to provide Mrs B’s home care. This caused Mrs B and her family avoidable inconvenience and meant the family are likely to have provided care that should have been provided or arranged by the Council. To remedy the injustice, the Council will apologise and pay Mr A and Mrs B £100 each to reflect the avoidable inconvenience.

The complaint

1. Mr A complains for his mother Mrs B about home care arranged by Bournemouth, Christchurch and Poole Council (the Council). A1 Care (the Agency) provided Mrs B’s home care. Mr A says:
1. The Agency failed to empty Mrs B’s catheter bag and the Council’s response to this was inadequate
2. Call times were not as agreed and the Agency did not provide continuity of carers
3. The Council did not arrange another agency to provide the care package after the Agency’s service stopped.

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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. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
5. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. The Council commissioned the Agency to provide Mrs B’s care under duties in section 18 of the Care Act 2014. Any fault by the Agency is therefore fault by the Council.

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How I considered this complaint

6. I considered Mr A’s complaint to us, the Council’s response to his complaint and documents described later in this statement. The parties received a draft of this statement and I took comments into account.

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What I found

Relevant law and guidance

7. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the person’s social care assessment, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. (Care Act 2014, sections 24 and 25)
8. The Care Act spells out the duty to meet eligible needs (needs which meet the eligibility criteria). (Care Act 2014, section 18)

Key facts

9. Mrs B lived at home and had a package of home care arranged and funded by the Council. One of her sons (Mr A’s brother) often stayed with her. Mrs B was receiving a visit in the morning from one of the Agency’s carers to support her with washing and dressing and preparing breakfast. Mrs B’s care and support plan noted she became anxious when there were new carers. Her preferred call time was 10 am.
10. At the end of October 2018, Mr A phoned the social care team saying a carer had not turned up for the second time that week. The social worker tried called Mr A but could not get hold of him. The Council’s records indicate Mr A did not call back. The social worker spoke to the Agency which told her there had been some issues with call times, but carers were now visiting Mrs B at 8.15.
11. In December, Mrs B asked for an extra care call in the evening. The social worker emailed Mr A to say the Agency would add an extra call as soon as they had space. The social worker said Mrs B would need to be flexible as the Agency was fitting her in around other clients. The records I have seen indicate the evening call was in place by December 2018.
12. There was a review of Mrs B’s care and support plan in January 2019. This was due to a change in circumstances: Mrs B needed care in the evenings to support her to go to bed and with washing and undressing. She also needed someone to prepare her tea-time meal Monday to Friday. Mrs B was noted to be happy with most of her carers.
13. There was an incident in February 2019 where a carer left the call without connecting Mrs B’s catheter bag. The social worker visited Mrs B to discuss the incident. Mr A was present. Mrs B said the carer had refused to do tasks on the care plan, the carer left her house to call the office and then did not return. Mr A said he was at work and had to make several calls and had phoned the Agency to send a different carer but they had no other carers; and so he arranged for the district nurse to empty and connect the catheter bag.
14. The social worker noted she contacted the Agency about the incident with the carer and it provided a written statement from the carer. I have summarised the carer’s statement below:
• On arrival, Mrs B’s urine bag was disconnected and in the middle of the room. There was a small amount of urine in the bag. Mrs B was sitting on the bed wearing a long t-shirt and covered with a sheet.
• She (the same carer) had connected the bag the previous night, her son witnessed this (Mr A’s brother) as he was in the house and helped change the bedding.
• She (the carer) was confident in connecting the bag and had done this many times before
• Mrs B often disconnected the bag to help her walk around
• Mrs B became angry and asked her to leave, saying she did not need care. Mrs B would not let her write anything in the records, she was holding the record book in her hand and refused.

Mr A disputes the Agency’s account of events and told me:

• The bag was not disconnected and was full and backed up by the time the district nurses attended
• It was a different carer who had attended the previous night
• His mother never disconnected the bag herself
• The carer had refused to clear his mother’s table and went to her car to call the office to confirm what was in the care plan. His brother was in the house but left for an appointment at the time the carer went to her car to call the office.
• The carer never came back and Mrs B was left cold and began feeling unwell.
6. The social worker wrote to Mrs B to say she wanted to discuss the care package and had asked Mr B to give her some dates for a review.
7. The social worker noted she had arranged a meeting with one of the Agency’s managers and Mr A, but Mr A cancelled the meeting.
8. Mr A emailed the Agency in the middle of April to say he was concerned about the current rota as most of the carers on it were unknown to Mrs B. And the carer that day had not been introduced to Mrs B. Mr A also told me one of the rotas in April had the majority of slots with no carer named. The social worker contacted the Agency by email about this and it said staff turnover was high and it was recruiting more staff and one of Mrs B’s regular carers was out of the country.
9. The Agency gave four weeks’ notice in the middle of May saying it could not provide continuity of care due to staff changes. A few days later, Mr A emailed the Agency asking it not to visit again. He said the Agency’s treatment was detrimental to Mrs B’s mental health. In response to a draft of this statement, Mr said the Agency backdated notice and he was the one who gave notice first.
10. A manager contacted Mr A a few days later to ask if Mrs B wanted the Council to arrange another agency. Mr A emailed saying he had shared the email with his mum and after the experience with the Agency they needed a little time to consider Mrs B’s needs and would get back soon. Mr A told me he had asked the Council to find another agency and was told this could take some time. The Council’s records do not reflect this and indicate there was no firm request for a replacement agency for Mrs B until July (see paragraph 21).
11. The social worker emailed Mr A in the middle of June as she had not heard from either Mr A or Mrs B. Mr A said he would get back to her. The social worker left two phone messages for Mrs B over the next few days. Mr A told me he left messages for the social worker who was often not at work when he called. He also told me his mother had problems accessing her phone messages.
12. Mr A emailed the social worker at the start of July to ask her to look for another agency to provide Mrs B’s care.
13. Mrs B went into hospital for a few days in July. She was discharged at the end of July. The social worker arranged a meeting at the beginning of August which Mr A cancelled. Mrs B went back into hospital in the first week of August. She was discharged home with a care package from a different agency.
14. The Council told me one of its managers offered two dates to meet with Mr B to discuss his concerns about the Agency (in June and July 2019,) but Mr B declined both dates.
15. I have looked at some of the Agency’s staff rotas for Mrs B and these show she had one carer for two thirds of visits, another carer for about a quarter and the remaining visits were by four staff.
16. The Council’s response to Mr A’s complaint said:
• The carer reported Mrs B had been abusive and she left the property and phoned the office. The Agency removed the carer from the rota.
• The Council was satisfied with the Agency’s action in response to his concerns.
• Agencies could not guarantee certain carers would be available
• It was unfortunate there was no meeting to discuss the concerns
• The Agency gave notice in the middle of May because relations had deteriorated and it could not provide continuity of care due to staff changes
• The Agency did not work the notice period because he asked for care to stop immediately
• The brokerage team was looking for another agency and the social worker and new agency, when identified, would meet with Mrs A to discuss her care.
17. The Council told me:
• A call was late when it was more than 15 minutes after the preferred time. Its contract with A1 said that the Council may adjust the payment due if there were frequent failures to arrive at the agreed time and the Agency should tell people when its staff are running late
• The call logs which listed the start and finish times of each call were in Mrs B’s house and Mrs B would not let the Agency take the file out of her house when the service ended.

Was there fault?

Complaint a: The Agency failed to empty Mrs B’s catheter bag and the Council’s response to this was inadequate

27. I do not uphold this complaint. There is a dispute about what happened on the day in question. Relying on the carer’s contemporaneous statement; I am satisfied she did not have consent to change the catheter bag or to be in Mrs B’s property as Mrs B had asked the carer to leave. The carer’s response was appropriate to Mrs B’s request to end the call. The district nurse changed the bag and so Mrs B was not left without care. I accept Mr A arranged the district nurses and this caused him some inconvenience, but as I do not uphold his complaint, I am not recommending a remedy.
28. The social worker met with Mrs B and Mr A to discuss the incident. The Agency removed the carer from Mrs B’s rota. These were appropriate actions.
29. I am satisfied the Council’s complaints response addressed this point appropriately.

Complaint b: Call times were not as agreed and the Agency did not provide continuity of carers

30. The Agency’s rotas indicate it allocated two regular carers to Mrs B’s care. I do not uphold this complaint as agencies cannot guarantee absolute continuity of carers because this is not within their control. I am satisfied the Agency provided regular staff where this was possible.
31. There is only one record in October 2018 suggesting any issue with call timings and Mrs B has retained the records of calls and times. There is not enough evidence of fault.

Complaint c: The Council did not arrange another agency to provide the care package after the Agency’s service stopped.

32. The records indicate Mr A and Mrs B did not ask the Council to arrange a different agency until July and before then officers kept in touch with Mr A to ask if the family wanted a new agency and he said not.
33. The Council failed to find a new agency when Mr A asked it to in July. This was fault and meant that Mrs A’s eligible needs may not have been met and Mr A and his brother may have had to provide the care that the agency would have provided had one been sourced. Mr said his mother went into hospital after two falls and these falls happened because she was without a care package. There is not enough evidence to link the failure to arrange a care agency with the falls: Mrs A was not assessed as requiring round the clock supervision and so could have fallen any time whether a carer was in attendance or not.
34. Mrs B had short two hospital admissions in July and August. The Council arranged for intermediate care when she left hospital and then found a different agency to provide care once intermediate care stopped. There was no period when Mrs B was without care after leaving hospital.

Agreed action

35. The Council should, within one month of my final decision:
• Apologise to Mr A and Mrs B for the delay in finding a new agency
• Pay them £100 each to reflect the avoidable inconvenience of being without care for about three weeks.

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Final decision

36. There was a delay of three weeks in the Council arranging for an agency to provide home care. This caused Mrs B and her family avoidable inconvenience and meant the family are likely to have provided care that should have been provided or arranged by the Council. To remedy the injustice, the Council will, within one month, apologise and pay Mr A and Mrs B £100 each to reflect the avoidable inconvenience.
37. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman