Summary: Mrs X complained the Care Provider commissioned by the Council, Sesnha Care, did not properly care for her mother, Mrs Y and failed to address the complaint she raised about this. She said this caused her and her family distress and inconvenience. There was fault in the Care Provider’s actions when it failed to lock Mrs Y’s door, missed several care visits, and did not administer her medication correctly. The Council was at fault when it did not review Mrs Y’s care package in line with statutory guidance. The Council has agreed to pay Mrs X £150 to recognise the distress and time and trouble she was put to by these faults.

The complaint

1. Mrs X complained about the care her mother, Mrs Y, received from the Care Provider. She said:
• carers failed to lock the door or set the alarm after visiting Mrs Y;
• carers did not activate Mrs Y’s wanderer alarm before leaving her unattended;
• carers regularly missed scheduled visits, leaving Mrs Y without meals or medication; and
• the Care Provider repeatedly failed to notify Mrs X before cancelling or attending visits late.
2. She said this caused Mrs Y distress and put her to time and trouble raising complaints about these issues.

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The Ombudsman’s role and powers

3. 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)
4. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
5. 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)
6. 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)
7. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
8. 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

9. I contacted Mrs X and discussed her and Mrs Y’s view of the complaint.
10. I considered the Council’s submission which included Mrs X’s complaint letter, Mrs Y’s needs assessment and email correspondence between Mrs X and the Care Provider.
11. I wrote to Mrs X and the Council and considered their comments before I made the final decision.

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What I found

Statutory Guidance

12. Part 3 of the Local Government Act 1974 covers complaints where councils provide services themselves or arrange or commission care services from social care providers, even if the council charges the person receiving care for the services. The Act says we can treat the actions of the Care Provider as if they were the actions of the council in those cases.
13. In this case, the Council commissioned the Care Provider to care for Mrs Y.
14. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan. A care and support plan is for someone who needs or provides care. The plan should clearly set out the services and support to be provided, when they will be provided and who will provide them.
15. Section 27 of the Care Act 2014 states councils should conduct a review of the care and support plan at least every 12 months. The Council should carry out the review within a reasonable timeframe and in proportion to the needs to be met. The Act also states councils should conduct a review if the carer or the person receiving care asks for one.

Mrs Y’s medical needs and background

16. Mrs Y is elderly and suffers with dementia and poor mobility.
17. Mrs Y’s needs assessment states she requires four daily visits from a carer to provide her with assistance:
• maintaining her personal and oral hygiene;
• eating regular meals and drinks;
• using the toilet; and
• using her home safely.

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What happened

18. The Care Provider began caring for Mrs Y in early 2018. In July 2019, Mrs X raised a complaint about the care her mother was receiving.
19. Mrs X also emailed the Care Provider with a list of incidents that had occurred over the previous 12 months. It showed carers:
• had regularly failed to address her mother’s personal care needs;
• did not notify Mrs X before cancelling visits or turning up late on six occasions;
• failed to supply her mother’s medication and food on three occasions; and
• did not lock her mother’s door or put her wanderer alarm on before leaving her home on seven occasions.
20. The Care Provider and Mrs X met in late August 2019 to discuss her complaint. The Care Provider then carried out an investigation into Mrs X’s concerns and found carers were late or missed scheduled visits without notifying Mrs X on several occasions.
21. The Care Provider also interviewed the carer who attended Mrs Y’s home on the day Mrs X found her mother’s alarm turned off, but the carer could not remember if she had activated the alarm before leaving.
22. The Care Provider apologised for the shortfalls in service Mrs Y had experienced and confirmed it would take the following action:
• phone calls to the carer on each visit;
• phone call to Mrs Y if a visit was due to be late or cancelled;
• carers to complete and sign a checklist before leaving the house confirming all appropriate duties had been carried out;
• a senior carer assigned to monitor the carers and ensure they were completing paperwork correctly;
• training for carers around medication; and
• disciplinary sanctions as needed.
23. The Care Provider also implemented a new checklist system for carers to complete and sign, confirming they had carried out their duties. Finally, the Care Provider confirmed it would prioritise Mrs Y if her visits were cancelled due to an emergency.
24. Mrs X was not happy with the Care Provider’s response. She said the investigation did not explain who left her mother’s door unlocked or who cancelled visits without notifying her. She remained upset that carers forgot to administer her mother’s medication.
25. Mrs X complained the Care Provider agreed to call her when visits were cancelled or late but failed to do this on the last two occasions, she had cancelled visits.
    Mrs X also said carers were not completing the new checklist.
26. The Care Provider responded later that month, confirming it removed a carer from Mrs Y’s rotation because they admitted to leaving the door unlocked after visiting her. The Care Provider told Mrs X it had recorded the recent occasions she had cancelled visits and reconfirmed it would call her in the event of late or cancelled visits in future.
27. The Care Provider then called Mrs X in October 2019 to discuss the service improvements. Mrs X reported that on her most recent visit to her mother the door had been left unlocked.
28. She raised a further complaint in early November 2019. She said carers were still not completing the checklists or locking her mother’s door and had missed giving Mrs Y her medication on one occasion.
29. The Care Provider investigated Mrs X’s complaint and said carers had completed the checklist on the back of the paper and apologised for confusing Mrs X.
    The Care Provider said it would sanction and retrain the carer for failing to administer medication and would ask carers to call to confirm they had locked Mrs Y’s door.
30. Mrs X referred her complaint to the Ombudsman as she was not satisfied with the Care Provider’s response.
31. To aid the investigation the Care Provider provided a selection of the checklists completed by its carers between September 2019 and December 2019.
32. The Council confirmed the Care Provider did not review Mrs Y’s care package until January 2020 nor contact it regarding the concerns Mrs X had raised and conceded this was not best practice.
33. The Council also confirmed the Care Provider served notice to terminate the contract to provide Mrs Y’s care in January 2020, because the relationship between it and Mrs X had broken down. The Council further explained that two carers had resigned, which magnified the issues as several carers were not willing to visit Mrs Y due to the communication breakdown.
34. The Council has since sourced a new Care Provider for Mrs Y and confirmed the new arrangements are going well.

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My findings

35. When Mrs X first complained about the care her mother was receiving, the Care Provider accepted fault. Mrs X complained carers put Mrs Y at risk by failing to lock her door or activate her wanderer alarm. The Care Provider implemented a daily checklist requiring carers to confirm they had followed safety precautions.
    It also took action when a carer admitted to leaving Mrs Y’s door unlocked and stopped this carer from visiting her again. After Mrs X complained that her mother’s door had been left unlocked and medication had not been administered, the Care Provider asked carers to confirm they had taken the necessary safety precautions by phone after each visit.
36. The Care Provider took action to address Mrs X’s concerns. However, Mrs X complained the door was left unlocked several times and Mrs Y’s medication was not administered correctly on at least one occasion even after the Care Provider took this action. This is fault. There is no evidence Mrs Y was in danger due to the unlocked door and there is no evidence the missed medication caused Mrs Y harm. However, Mrs X likely experienced frustration and worry because of this.
37. After Mrs X’s initial complaint, the Care Provider asked carers to confirm they administered medication on the daily checklist. After Mrs X’s second complaint, the Care Provider implemented sanctions and retraining for carers to ensure this did not happen again. I am satisfied the Care Provider understood the seriousness of this complaint point and acted proportionately to address it.
38. Carers were required to visit Mrs Y four times a day. The Care Provider has confirmed carers were late or cancelled visits without notifying Mrs X prior to implementing the checklist/rota system. This is fault. Mrs Y is dependent on her carers for her physical and mental health and likely suffered an injustice because of this. Mrs X also suffered an injustice because she had to spend time complaining and arranging alternative care for her mother. The Care Provider apologised and implemented a new system to keep carers accountable. I have a reviewed a selection of the daily logs provided, and I am satisfied the Care Provider responded appropriately.
39. During the investigation, the Council acknowledged it failed to review Mrs Y’s care package for more than 12 months. This is not in line with statutory guidance. This is fault. Mrs X remained consistently unhappy with the service provided by the Care Provider. It is possible the Council could have addressed Mrs X’s concerns earlier if it had reviewed Mrs Y’s care package or if the Care Provider had referred Mrs X’s complaints to it. However, I cannot say what impact this would have made. The Council has said it is willing to engage with the Care Provider to ensure it is made aware earlier if there are ongoing issues with a Council commissioned care package. This is an appropriate action for the Council to take.
40. The Care Provider confirmed that over the course of the investigation several staff members left its employ and communication and trust broke down between it and Mrs X. The Care Provider considered it could no longer meet Mrs Y’s needs and opted to serve notice on the care package. There was no evidence of fault in the way the Care Provider made this decision.
41. 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. So, although I found fault with the actions of the care provider, I have made recommendations to the Council.

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Agreed Actions

42. Within one month of the date of my final decision the Council has agreed to contact the Care Provider to advise that in future where the Council has commissioned a care package, the Care Provider should alert the Council to any problems with a care package.
43. Within one month of the date of my final decision the Council has agreed to apologise to Mrs X and pay her £150 to acknowledge the distress and time and trouble caused when the Care Provider failed to address issues with Mrs Y’s care.

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Final decision

44. There was fault by the Care Provider causing injustice. The Council has accepted my recommendations. I have therefore completed my investigation.

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Investigator's decision on behalf of the Ombudsman