Summary: There was some fault in the way the care agency provided care to Mrs C, its timekeeping and its communication. The Council has agreed to apologise in writing and pay £150 in recognition of the fault.

The complaint

1. Mr B complains about the care provided by Prime Care Support Ltd agency to his mother, Mrs C. I will refer to Prime Care as the Agency in this document. The Agency took over from another agency in December 2018.
2. Mr B says the Agency’s carers were often unfamiliar with Mrs C’s care plan which meant the care was not provided properly or the carers would take longer than required. There were frequent changes in carers which added to the problem. He says there was a problem with time keeping and missed appointments.
3. Mr B says that the Agency ended the contract because of his use of CCTV and that other agencies refused to provide care for the same reason.

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The Ombudsman’s role and powers

4. 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)
5. 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)

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How I considered this complaint

6. I have discussed the complaint with Mr B and I have considered the documents that he and the Council have sent.
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I found

Law, guidance and policies

Care act 2014

8. The Care Act 2014, the Care and Support Statutory Guidance 2014 (updated 2017) and the Care and Support (Charging and Assessment of Resources) Regulations 2014 set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.
9. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs and a personal budget which calculates the costs of those services.
10. If a person’s income is too high to be eligible for Council funding for their care and a person self-funds their care, they can still ask the Council to meet their needs and organise the care package. If the needs are met in the community (not a care home), then the Council must meet those needs although the care package will not be paid for by the Council.

What happened

11. Mrs C suffers from dementia and lives on her own. She lacks the mental capacity to make decisions about her care, but Mr B holds a Power of Attorney.
12. Mrs C requires support in all aspects of care. She received care from agencies and her family. The agency care was organised by the Council, but funded by Mrs C.
13. Mrs C received care from agency 1 from September to May 2018, agency 2 from May to June 2018, agency 3 from June to December 2018 and then Prime Care, the agency that is the subject of the investigation from early December 2018 to April 2019.
14. The care plan was for a carer to attend twice a day.
15. The morning visit at 8:00 am was for 60 minutes. During the morning call the carer had to:
• Assist Mrs C with toileting.
• Provide Mrs C with personal care and get her dressed.
• Give Mrs C her breakfast which was cereal and a hot drink.
• Give Mrs C her medication.
16. On Wednesday the morning call was for 90 minutes to enable Mrs C to have a shower.
17. During the lunch time call (30 minutes) the carer had to:
• Assist Mrs C with toileting.
• Check the menu board for instructions for the lunchtime meal.
• Heat the meal and a pudding and serve it to Mrs C. The meals and lunches were pre-prepared. The menu board said what lunch Mrs C was having and what the heating instructions were.
• Ensure Mrs C drank a glass of water.
18. The carers had to put the dirty dishes in the dishwasher and make sure the doors were locked and no hot drinks were left out. There was an outside bin for the continence pads.
19. Agency 3 contacted the Council in October 2018 and said the lunchtime call was taking 45 minutes, not 30 minutes. The Council raised this with Mr B who disagreed.
20. In December 2018 the Council was informed that agency 3 was closing down and the Council told Mr B that it would transfer the care package to a different agency. Mr B said he did not want agencies 1 or 2 to be involved again.
21. The Council transferred Mrs C’s package to the Agency (Prime Care) in December 2018.
22. The manager of the Agency rang the Council on 7 January 2018 and asked for an unscheduled review of the care package. She said the lunch call was taking longer than 30 minutes and she wanted to increase the call to 45 minutes or an hour. The manager said Mr B had installed CCTV cameras in Mrs C’s house and that he was talking to the carers through the cameras to tell them what they were doing wrong. The carers ‘felt like they were walking on eggshells.’ Mr B had rung the Agency because carers were late or did not stay the full time. The manager wanted a meeting with Mr B and the social worker to discuss all the issues.
23. The Council contacted Mr B who agreed that a meeting was a good idea. He said he had already contacted the Agency asking for a meeting.
24. Mr B contacted the Council on 16 January 2019 to say that he was not satisfied with the agency’s services. He had noticed a bruise on Mrs C’s hip and wanted an unscheduled review.
25. The review meeting took place on 23 January 2019. The family raised concerns about the care and the manager informed the family that the carers felt uncomfortable as they were being watched all the time. Mr B says that the Agency agreed at the meeting to continue for another two weeks to see how things progressed.
26. On 25 January 2019 the Agency said it was giving notice for the following reasons:
• The carers felt uncomfortable and refused to go into the house because of the cameras and the fact that Mr B talked through the cameras at them. The Agency had tried a variety of carers and none of them wanted to go in.
• The 30-minute lunch call took 45 minutes to an hour. The Agency did not have the capacity for a longer call and the family did not want to pay for the extra care.
27. The Agency said its last visit would be on 10 February 2019. The Council had difficulty finding an agency so the Agency continued to provide a service to Mrs C after 10 February. The Agency stopped providing care on 5 April 2019 citing ‘relationship breakdown’ as the reason.
28. The social worker sent an email to Mr B on 29 April 2019 because she had been unable to find an agency that wanted to provide care to Mrs C. She said this was due to historical concerns related to cameras in the house and carers had reported that they were watched while they were doing their job. She said this information has been shared with other providers and this seemed to be the reason why other care providers were unwilling to pick up the care package.
29. Mr B complained to the Council on 23 May 2019. He said:
• The care plan had not been discussed with the Agency when it took over and some of the new carers did not know the care plan.
• The carers did not always comply with the care plan and the care was poor.
• The carers missed some calls and were sometimes late.
• There were a lot of different carers who did not know Mrs C.
• The problems occurred because the Agency was overstretched.
• The Agency stopped the care because of the CCTV cameras and this was not a valid reason to refuse care.
• The Council told him it could not find an alternative agency because of the CCTV. He questioned why the issue of CCTV was shared to other providers.
30. Mr B gave examples of the poor care the Agency provided:
• The carer did not turn up on 14, 26 and 29 December 2018.
• The carer did not turn up for the morning call on 2 February 2019. The family rang at 08.45 when they were told the carer would come in later and at 09.30 am when they were told the carer was dealing with an emergency and could not come over. Mr B said the Agency should have contacted them and informed them.
• On 28 December, the carer did not read the menu board and went to give Mrs C cold food.
• On several occasions, the carers took longer than the 30 minutes at lunchtime because they did not know what to do.
• The carer did not change Mrs C’s continence pad on one occasion leaving her sitting soaked in urine.
• Mrs C had a bruise on her hip on 15 January 2019, but the carer did not note this in the care notes and the family was not informed. Mr B says he noticed the bruise on the evening of 15 January 2019 and he rang the Agency to let them know. The Agency then said they were aware and they were trying to get the district nurse to come and see Mrs C. They apologised for failing to inform the family.
• The carers sometimes stayed for an hour instead of the allocated 90 minutes during the shower call on Wednesdays.
• The carers left the dirty pads in the kitchen bin twice, despite instructions to leave them outside.
• There was an incident where the carer repeatedly did not give Mrs C the full meal that the family had left her. The family complained to the Agency and the carer then rang the family at 06.55 am shouting that she always fed Mrs C.
31. The Council replied and said:
• The Council took a number of measures to ensure a smooth transition when agency 3 stopped trading. This included informing service users by letter and offering a telephone conversation.
• A lot of the carers who worked for agency 3 transferred to the Agency.
• The Council shared Mrs C’s care plan which it held on its database with the Agency on 5 December 2018.
• The Agency based itself at agency 3’s offices before the transfer so that agency 3 could share the relevant care plans that the Agency was taking over.
• An immediate review of the care plan was not possible as a lot of service users were transferred to the agency. The Council asked for a review within 6 weeks.
• The carer did not turn up on 14 December 2018, but a different carer was offered at 09.20 am which was declined by the family.
• The carer was late on 26 December 2018. The family were informed and cancelled.
• There was a missed call on 29 December 2018.
• It agreed that the carer did not read the instructions for lunch on the board on 28 December.
• The bruise was noticed on 16 January 2019 (not 15 January) and the carer left a note for the family and informed the office. The office tried to ring the family, but was unable to get through.
• The Agency had confirmed that CCTV was not an issue for them and they had other service users who had CCTV. It said the main reason was the way they were treated by the family, mainly due to instructions being given over the camera.
• The Agency had never discussed Mrs C or the use of the CCTV with other agencies.
• The Agency said it was not overstretched when it took over, but acknowledged there was an issue over the Christmas period as the carers who had transferred from agency 3 had already given their availability (I presume this meant regarding annual leave). This set the Agency back a little, but it said it coped well.
• The Agency was following agency 3’s care plan.
• Mrs C received care from carers who were previously employed by agency 3 and from 7 new carers who were not previously employed by agency 3.
• The carer calling at 06.55 am was ‘unacceptable behaviour’.
• The Agency gave notice in January but continued to provide care until April because the Council could not find another agency.
• The Council put the details of the care package on its portal on 6 different dates and no agency came forward. The information put on the portal is the basic information about the support package.
• There was only one other agency (agency 5) operating in the area in addition to agencies 1, 2 (agencies Mr B did not want to employ), agency 3 (now out of business) and Prime Care. Agency 5 did not have the capacity to take on the support package.
• The Council considered offering direct payments but Mrs C’s contribution was higher than the cost of the package so this was not an option. The Council therefore advised the family to find their own carers.
32. The Council took the following actions as a result of the complaint:
• It apologised to Mr B for issues he had experienced in regard to care delivery and poor communications.
33. It said it would make the following service improvements as a result of the complaint:
• It would brief social work professionals at team meetings regarding clear communication.
• Its Quality Assurance Team would ensure that commissioned agencies had a policy in place around camera usage.
• It would formalise the discussions it had with the Agency to ensure that lessons were fully learned and implemented. This would include developing guidance for carers.
• It would make sure there was clear point of contact for complaints when complaints related to a commissioned provider and social work practice.

Further information

34. I asked the Council for the agency’s policy on what action a carer should take if they were going to be late. The Council said carers had to notify the office if they were 15 minutes late so that the office could inform the client.
35. The agency’s notes say the carer left a note for the family on 16 January 2019 about Mrs C’s bruise. The Agency tried to ring Mr B and left a message on his phone. Mr B then rang back and said he had already spoken to the Agency on 15 January 2019 and had been told that the Agency knew from the previous day that Mrs C had a bruise, but had not informed the family.
36. Mr B has provided evidence that the carers did not stay for the allocated 90 minutes for a shower call on two Wednesdays.
37. In its response to the Ombudsman the Council said there were no missed calls, but admitted that some of the calls were late. It said that 70% of the calls were on time.

Analysis

38. I find no fault in the transfer of the care plan from agency 3 to the Agency. Agency 3 ensured the Agency was given Mrs C’s care plan. The Agency based itself at agency’s 3 premises and employed a lot agency 3’s carers so the Agency had all the information to enable it to put in Mrs C’s support package. The care plan had not changed.
39. However, I cannot say whether every individual carer at the Agency was fully familiar with the care plan when they went to provide care. The Council has already upheld Mr B’s complaint that the carer did not read the board on two occasions which suggests that some carers were not fully aware of the care plan.
40. The Council has also upheld Mr B’s complaint about the carer ringing Mr B at 06.55 am after a complaint that she did not follow the care plan. The agency agreed that this was unacceptable behaviour.
41. The issue was probably made worse by the fact that there were a lot of different carers and this was not ideal for a person who suffered dementia. I appreciate that a change in carers is not something that is necessarily under the Agency’s control so I cannot say that this was fault. However, Mr B says that the Agency would often not tell him in advance who would be attending and I agree it would be good practice to at least inform the family if there is a change in carer.
42. I have further considered the complaint about the missed calls and the timing of the calls.
43. I agree with Mr B that, if a carer was meant to turn up at 8:00 am, then the family could consider this a missed call if the Agency offered a different carer at 09:20 am. Therefore, the call on 14 December 2018 could be classed as a missed call as was the call on 28 December 2018. The Council has already upheld the complaint that the call was missed on 29 December. And the call on 2 February 2019 was also essentially a missed call because of the poor communication.
44. It is my understanding that Mrs C was not charged for the 4 visits when the carers did not attend.
45. Mr B has also provided evidence that the carers only stayed for an hour on a couple of occasions where they were meant to stay for 1 and a half hours so I uphold that complaint. The Council says the carers attended on time 70% of the time, but it does not say how late they were on other occasions. I would expect there to be some flexibility in the timing of the calls, but the agency should have informed the family of any lateness beyond 15 minutes in line with its policy and this did not always happen.
46. I agree with Mr B that the Agency should have rung him about the bruise, as soon as it was discovered and not wait until the following day and it failed to do so.
47. I have also considered Mr B’s complaint that his use of CCTV was the reason why the Agency stopped providing care and the reason why it was difficult to find a different agency. It is difficult for the Ombudsman to comment on this issue as most agencies will have their own policy on the use of CCTV.
48. The Agency has said it has no problem with the use of CCTV. The email correspondence showed the reasons why the Agency ended and the Council informed Mr B of the reasons. The use of CCTV was not the only or main reason.
49. In terms of the other agencies, the social worker said in her email that the use of the CCTV and carers being watched while they worked was the reason why it was difficult to find an agency. However, in later emails the Council then further explained the reasons and said the problem was that there were only 5 agencies commissioned by the Council in Mrs C’s area and 4 of those had already worked with Mrs C and were considered not suitable by Mr B. Therefore, that only left 1 agency and this agency did not have the capacity.
50. I note that the Council has asked care providers to have a policy on CCTV and the Agency now has a policy. I think that is an appropriate response to the issues raised by the use of CCTV.

Agreed action

51. I note the Council has already made a number of service improvements as a result of the complaint so I have not made any further recommendations in that respect.
52. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise to Mrs C and Mr B in writing for the fault.
• Pay Mrs C £150 to reflect the fault in relation to the care, the fault in the timekeeping and the lack of communication.
53. If Mrs C has been charged for the four occasions where the carers did not attend, then these charges should be waived

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Final decision

54. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

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Investigator's decision on behalf of the Ombudsman