Summary: Miss Y complained the care provider failed to provide adequate care and support to her grandmother, behaved in an intimidating way towards the family and then ended the contract without notice, leaving her grandmother without the support she needed. We have found fault with the care provider’s record keeping and for not providing all the care required by the care plan. It has already remedied the injustice caused.

The complaint

1. Miss Y complained on behalf of her grandmother, Ms X, that her care provider failed to provide adequate care and support to her, behaved in an intimidating way towards the family and then ended the contract without notice, leaving Ms X without the support she needed.
2. Miss Y said this led to a loss of support for her grandmother as well as upset and inconvenience for her family who struggled to find care for Ms X.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
4. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
6. If we are satisfied with the care provider’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

7. I spoke to Miss Y and made enquiries to the care provider. I considered the evidence from the care provider and Miss Y before making a draft decision.
8. I gave the care provider and Miss Y the opportunity to comment on my draft decision and have considered the comments received before making this final decision.

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What I found

9. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards. The Ombudsman considers the 2014 Regulations and guidance when looking at complaints about standards of care.
10. Ms X signed a contract with the care provider in March 2018. The care provider agreed to make three visits per day on weekdays and four at weekends to provide her with care, in accordance with her care plan. By signing this contract Ms X agreed to the care provider’s terms of business.
11. Ms X’s agreed care plan detailed the care and support the care provider would give to help her wash, eat regularly and carry out housekeeping duties in a routine. The care plan also said the care provider would keep daily care records and for carers to administer medication while Ms X was “sat on the bed”.
12. Miss Y complained the care provider failed to give adequate care to Ms X. This included giving medication without helping Ms X to sit up, despite her condition increasing her risk of choking. She also complained carers were not attending at the required times and not staying long enough. She said carers failed to toilet Ms X and that the toilet seat was broken.
13. The care provider said carers did not give medication while Ms X was lying down. It said where she could not sit up herself, carers used pillows to support her so she would be sat up when taking her medication. Its care records do not record how she was supported to take medication. They do record her difficulty sitting up unaided. There are also regular references in the care records to medication being given to Ms X with drinks by carers. They do not record any problems with Ms X taking her medication.
14. As the medication was taken without apparent incident, it seems more likely than not that some support was provided to enable Ms X to sit up enough to do this safely. I have therefore not found fault in the care provider’s actions when providing medication to Ms X.
15. The available daily care notes state staff were attending Ms X’s property in accordance with the care plan. However, the care provider’s response explains it found in its own investigation a carer had left an appointment early and falsified records of the time they left.
16. The care provider was at fault when it left the appointment with Ms X early and incorrectly recorded the time it left Ms X. This fault caused Ms X an injustice, as she had paid for the full visit and did not receive the service agreed. The care provider said when it realised the fault had happened, it took appropriate action concerning the carer, reduced the invoice to the family and apologised. This is a suitable remedy for the injustice the care provider’s fault caused.
17. Miss Y has also complained about Ms X having fallen while the care provider was in her home. The daily care notes state Ms X fell when her legs gave way. It then records Ms X was made comfortable with pillows before her family were contacted. It states relevant records of the fall were made, including a body map recording the bruising the fall caused. Ms X’s family came to the property and helped the carer to lift Ms X into a chair. These were appropriate steps for the care provider to take when Ms X fell. The care provider acted appropriately and without fault.
18. Miss Y complained the care provider broke a toilet seat in Ms X’s property. The care provider said it had no knowledge of this, or the cause. There are no records of this allegation. I cannot, even on the balance of probabilities, reach a finding on Miss Y’s allegation.
19. Miss Y also said the care provider had failed to toilet Ms X. Miss Y said Ms X had used a care helpline to ask for help as she was wet and in distress. The care provider said it could not control what happened after its staff leave, but its daily care records stated Ms X was taken to the toilet regularly as required by the care plan. It said it was not aware of a specific date for the complaint made, but said it seemed unlikely it would have missed this task. It said where the daily records did not specifically say if Ms X had been to the toilet this was because its staff had recorded other tasks in the notes.
20. I cannot say whether Ms X was taken to the toilet as outlined in the care plan. As the daily care notes state carers helped in this task regularly, it is more likely than not the carer gave Ms X the opportunity to go to the toilet in accordance with the care plan. Therefore, I have not found the care provider at fault.
21. Miss Y has also complained the care provider behaved in an intimidating way towards the family and then ended the contract without notice, leaving her grandmother without the support she needed.
22. The care provider has provided copies of messages sent to its staff from Miss Y’s telephone number. Care staff felt threatened by the content of the messages. Because of this they were not willing to continue caring for Ms X.
23. The care provider terminated the contract because of its concerns for its staff. It says it terminated the contract with immediate effect, but this was while Ms X was being cared for by the NHS. This gave the family an opportunity to arrange alternative care provision. I cannot, even on the balance of probabilities, reach a finding on Miss Y’s allegation of intimidating behaviour by the care provider towards her.
24. Ms X’s contract with the care provider allowed it to terminate the care package without notice in circumstances which it believed made the continuation of the service unsustainable. It was for the care provider to make a judgement based on its assessment of the concerns reported by the carers.
25. It decided, based on those concerns, to terminate the contract. That was a decision it was entitled to make. The care provider was not at fault in its termination of the contract. It was also not at fault for terminating the contract without giving the notice period as this was allowed under the terms of business agreed by Ms X.

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Final decision

26. I have completed my investigation to find the care provider was at fault for its record keeping and this caused an injustice to Ms X. I found fault with the care provider for failing to provide all the care required in the care plan. No further remedy is needed as the care provider has already given a suitable remedy to the injustice caused.

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Investigator's decision on behalf of the Ombudsman