Summary: The care provider took the right action to investigate the allegations about two separate carers. It liaised with the local safeguarding teams. It refunded money in goodwill where there was little evidence of inappropriate use. There is no worthwhile outcome to be achieved by further investigation.

The complaint

1. Ms A (as I shall call the complainant) complains about the way in which the care provider investigated her allegations about two live-in carers for her mother Mrs X, who has dementia. She complains their actions put Mrs X at risk.

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What I have investigated

2. I have investigated the complaint as set out above. I explain at the end of this statement why I have not investigated one aspect of this complaint.

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The Ombudsman’s role and powers

3. 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 34H(3) and (4), as amended)
4. We may decide not to start or continue with an investigation if we believe:

• it is unlikely further investigation will lead to a different outcome, or
• we cannot achieve the outcome someone wants, or
• there is another body better placed to consider this complaint.

(Local Government Act 1974, section 24A(6), as amended)

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How I considered this complaint

5. I considered the information provided by Ms A and the care provider. That includes details of the safeguarding investigation. I spoke to Ms A. Both Ms A and the care provider had the opportunity to comment on an earlier draft of this statement, and I took their comments into account before I reached a final decision.

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What I found

Relevant law and guidance

6. 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.
7. Regulation 19 says that people who are employed to carry out caring tasks must be able by reason of their health, once reasonable adjustments are made, to perform tasks which are intrinsic to their work;
8. Regulation 13 says service users must be protected from abuse, including “misuse or misappropriation” of money belonging to a service user.

What happened – the first carer

9. Mrs X is an elderly lady with dementia. Her daughter, Ms A, arranged for a live-in carer from the Good Care Group to move in with her mother after some poor previous experience of care. Mrs X’s care plan specified that she could not be left alone in the house. The company policy was for carers not to drink alcohol while they were on duty.
10. Carer J moved into Mrs X’s home on 24 July 2018. (There were relief carers engaged to cover periods of absence and breaks.)
11. Ms A expressed concerns from the start about Carer J. She said she spent long breaks in her own room, leaving Mrs X unsupervised. She asked for cleaning products then didn’t use them, or carry out the light cleaning tasks (replacing bin liners, for example) she was asked to do. She made unprofessional remarks about the relief carers. Although Mrs X liked to stay up in the evenings until late, neighbours reported the house was now often dark from 10pm. At the end of July, Ms A asked the care provider to replace her.
12. On 7 August Mrs X left the house while Carer J was in her room, taking a break. Mrs X went next door to the neighbour’s house and told her that Carer J had spent most of the afternoon in her room with the door shut. An hour after Mrs X had left the house, the care provider telephoned Ms A to say she had been found.
13. Ms A complained immediately to the care provider. She said Carer J had not even checked at the neighbour’s house to see if Mrs X had gone there. She said Carer J should not have spent so long in her room on a break without making sure there was a relief carer (for whom she had the telephone numbers) available. She said no-one had notified her Mrs X was missing until the call to say she had been found. She asked for a replacement carer. The care provider removed Carer J from post and replaced her immediately.
14. The care provider says, “Ms A had not requested that the carer organise her own breaks using the numbers for the relief carers provided; rather she had asked the carer to take her breaks indoors as there was no one to cover on this day. We would not normally ask a carer to take their break in the client’s home, as they cannot be expected to supervise their client during their rest time; their breaks should be a time in which the carer is not responsible for the client and this naturally increases the level of risk to the client. This is made clear to the client who still asked carer J to take her break indoors with no cover in advance of this event”.
15. In August Ms A made a written complaint to the care provider about the way the carer had been employed, her shortcomings while in post and the incident which resulted in Mrs X leaving the house on her own, unnoticed.
16. The care provider replied in full in October. The manager who replied said she had wanted to meet Ms A before finalising the response but had been unable to do so. She said Carer J’s references, employment checks and DBS (Disclosure and Barring Service) checks had all been satisfactory. She apologised for Ms A’s poor experience of the carer and said Carer J had asked to apologise if any of her remarks had caused offence. She said Ms A had asked Carer J to remain in the house during her break in case Mrs X needed anything which was not something the agency would have expected as the carer needed a proper break from work. She apologised that Ms A had not been notified immediately of her mother’s absence.
17. The care provider also responded to Ms A’s general complaints about the management of her mother’s care plan and in particular the need to put in more than one carer on a regular basis. She said because Ms A had requested the service at short notice, it had been difficult to find carers to replace the one whom Ms A found unsatisfactory, although she added that Carer J had not been on duty when Mrs X left the house. She waived some outstanding fees.

What happened – the second carer

18. The care provider arranged for new carers to take on the placement. Carer Q began work in the placement in September 2018.
19. Ms A says the relief carer found Carer Q drinking alcohol at Mrs X’s house on 9 December. He had returned from a break and tried to let himself into the neighbour’s house. Ms A went to her mother’s house and confronted him about it. She says he promised it would not happen again and so she did not report the matter to the care provider.
20. On 12 December Mrs X rang Ms A to say Carer Q had been in his room all afternoon and she had to make her own dinner. Ms A called the care provider’s out-of-hours team to raise her concerns that he was drunk. The care provider offered to replace the carer immediately. As a replacement carer would not arrive until the early hours of the morning, Ms A agreed to wait until the following day. The care provider notified the local council safeguarding team and the CQC.
21. Ms A visited Mrs X the following day and found 3 empty port bottles in the recycling box, which had been empty four days previously. She spoke to Mrs X who was very concerned for Carer Q. Mrs X said Carer Q would often join her for a drink if she offered one.
22. The care provider’s manager visited the house on the morning after the incident and interviewed carer Q. She recorded that he was still in bed when she arrived at 9.15am. He acknowledged he had a long-standing drink problem. Empty wine bottles were found in his room.
23. Following the incident Ms A also alleged that Carer Q had used Mrs A’s money to purchase alcohol for himself. She provided receipts which showed purchases which had not been logged onto the company system.

The investigation

24. The care provider’s regional manager wrote to Ms A in January 2019 about the incident and the outcome of the investigation into what had happened. She said she knew Carer Q had been a trusted member of the care team and apologised for the breakdown in trust. She said the company had a ‘zero tolerance’ approach to consumption of alcohol on duty which was considered to be gross misconduct. She said the carer denied spending Mrs X’s money on alcohol for himself but agreed he had accepted her offer of alcohol regularly. She said Carer Q had now been dismissed and a referral made to the DBS. She offered a credit note for £95 which was the amount of petty cash spent over the previous fortnight, to offset the cost of alcohol which Carer Q had accepted from Mrs X.
25. Ms A was dissatisfied and replied to the care provider. She said no enquiries had been made about the 10 bottles of alcohol which another carer had reported as missing; Carer Q was known to be a regular drinker at the local pub; her brother had seen him drinking at Mrs X’s house before December 2019; an amount of money had gone missing from her mother’s purse.
26. The regional manager responded again. She said the other carer had raised concerns that it was difficult to keep track of Mrs X’s drinking because bottles were in different places around the house. She said Carer Q said he drank soft drinks at the pub but in any event, he had acknowledged his alcohol consumption on duty. She said there was no evidence that Carer Q had taken money from Mrs X’s purse but she raised a credit note for the amount alleged to have gone missing. In response to Ms A’s concern about the amount of money Carer Q had spent on alcohol allegedly for Mrs X during his employment, she said it was not possible to say what proportion of that had been consumed by Carer Q so she arranged to credit Ms A for the whole amount spent. She also raised a credit note for all petty cash given to Carer Q by Ms A as she could not evidence how it was spent.
27. Ms A continued to raise concerns, both about the investigation itself and about other matters, such as the disappearance of family silver which she said she had raised in May but the care provider had not properly investigated.
28. The regional manager responded on 19 July that she had paused the investigation while she contacted the police to see if they were happy for the care provider to investigate a potential theft itself. She said the police had only confirmed on 15 July that it was content for her to do so. She also gave notice on the contract as she said it was clear trust had broken down but said she would continue to investigate the concerns about the silver.
29. In October the care provider wrote again to Ms A. She said she had interviewed all carers but none was able to identify any of the silverware in the house (Ms A says this was because they did not eat in the dining room where the silver was kept). She said she had also asked the police about their investigations but the police were unable to update the care provider. She said she was unable to uphold the allegation. She also responded to another concern that another carer had consumed alcohol with her mother while on duty. The care provider said she had now raised a credit note for the total sum of £3743 to be deducted against the outstanding balance of fees, which was reduced to £10,000.
30. Ms A complained to the Ombudsman. She said Carer Q had not appeared at his disciplinary hearing, the care provider had withheld information from the local safeguarding investigation and she had personally spent many hours investigating matters which she felt the care provider should have investigated.

Analysis

31. The care provider investigated promptly the complaint made about the first carer. It acknowledged there had been some delay in finding a replacement for her once Ms A expressed her dissatisfaction. It explained however it was not its policy to expect carers to take their break in the house in case something happened, and the carer had been on a break when Mrs X left the house.
32. The care provider waived some outstanding fees in acknowledgement there had been shortcomings.
33. The care provider offered a replacement for Carer Q as soon as it was alerted to his intoxication.
34. The care provider investigated the incident as soon as it was alerted to what happened. It noted earlier incidents had not been reported to it by Ms A.
35. The care provider took effective action by organising a disciplinary hearing, making the relevant referrals to the DBS and also by involving the local council safeguarding team.
36. The care provider refunded moneys to Ms A even where there was doubt over whether Carer Q had spent Mrs X’s money on alcohol for his own consumption.
37. Beyond the distress of the incident on 12 December, no harm came to Mrs X.

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Final decision

38. The care provider took all appropriate action to remedy the complaint. Further investigation would not achieve a different outcome for Ms A.

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Investigator's decision on behalf of the Ombudsman