Summary: The Council did not provide a proper response to complaints about the service the complainant received from a home care agency. The Council has implemented several service improvements, both with respect to the commissioning of care, and also its investigation of complaints and safeguarding concerns. The Council also offered a financial remedy for the complainant’s distress, and her representative’s time and trouble, but has agreed to increase this offer upon recommendation from the Ombudsman.

The complaint

1. The complainant, to whom I will refer as Mrs L, is represented in her complaint by her son, to whom I will refer as Mr M.
2. Mr M complains about the Council’s handling of his complaints about the service Mrs L received from a home care agency. In particular, he says the agency’s carers frequently arrived late, or in some cases failed to arrive at all, which represented a significant health risk to Mrs L. However, while the Council accepted his complaints for investigation, it did not provide a meaningful and satisfactory response.
3. Mr M also complains about delay by the Council in referring Mrs L for Continuing Healthcare (CHC) funding.

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What I have investigated

4. I have investigated the matters described in paragraph 2. I have not investigated the matters described in paragraph 3, for reasons I will explain at the end of this decision statement.
5. I also shared a draft copy of this decision with each party for their comments.

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The Ombudsman’s role and powers

6. 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)

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How I considered this complaint

7. I reviewed Mr M’s correspondence with the Council, the Council’s investigation report, and information the Council provided to me about steps it has taken to improve its processes.

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What I found

8. Mrs L has a number of health conditions. These include diabetes, which she controls through the use of insulin injections. However, neither she, nor her husband, have the capacity to safely manage the injections, nor to ensure Mrs L’s eats at the appropriate time after her injections to prevent dangerous episodes of hypoglycaemia.
9. After a period of reablement care, a domiciliary care package was arranged for Mrs L. This involved three calls a day at home (later increased to four). Mrs L was also receiving two visits from a district nurse each day to inject her insulin, and two of the care calls were timed to ensure Mrs L was provided with food after her injections. The care package began on 4 January 2019.
10. Over the following weeks, Mr M raised a number of complaints with the agency and the Council. He said carers would sometimes arrive late, or not at all, which represented a serious risk to Mrs L because of the time-critical nature of her care needs. He also complained about carers not having the correct information about his mother’s health needs, and on one occasion, that money had gone missing from his parents’ house.
11. The Council held a review meeting on 23 January, and a re-assessment of Mrs L on 25 January, in an attempt to improve the service she was receiving. However, this was unsuccessful, and Mr M made a further series of complaints in April and May.
12. On 7 May, Mr M met a social worker, who agreed to investigate his complaints and provide a report by 24 May. Mr M says he considered this was an unrealistic deadline, and did not immediately pursue the matter when it came and went without a response. However, he contacted the social worker for an update at the end of June.
13. In July, the social worker informed Mr M her report would be issued to him shortly, as it was awaiting sign-off by her manager. However, having still not received a copy of the report, Mr M submitted a formal Stage 1 complaint to the Council on 20 August. The Council replied to say it would respond by 19 September.
14. In the meantime, Mr M referred his complaint to the Ombudsman on 11 September.
15. On 18 September, the Council wrote to Mr M, saying its response would be delayed until 4 October. The Council then issued its formal response, having escalated the complaint to Stage 2, on 14 October. It also provided the social worker’s report at this time.
16. The Council noted Mr M had raised a series of complaints about the service Mrs L had been receiving, and that a number of meetings had been held with the care agency, and Council, to address these issues. However, the Council recognised that this had not led to sustained improvements in the service. The Council also noted it had offered to investigate switching Mrs L to a different care provider, but Mr M had declined this because he felt consistency was important for her.
17. The Council explained the social worker’s report had been delayed because her manager had delayed signing it off. It apologised for this and said it had raised the matter with the manager in question.
18. The Council also explained it always sought to address complaints informally at first, and the social worker had approached Mr M’s complaints in accordance with this policy. However, it recognised it had failed to explain this to Mr M at the time. This caused him frustration when he had originally attempted to register a Stage 2 complaint about the delay in providing the report, only to be told the complaint was only informal at that stage and so he would need to register a Stage 1 complaint.
19. The Council said “recommendations and learning” had been identified through the investigation process, including matters related to the quality of care and communications from the care agency, as well as practice issues with Mrs L’s own social worker. The Council also said it had initiated a review into the safeguarding issues which had arisen in Mrs L’s case.
20. The Council explained the investigating social worker, while very experienced in social work, was new to her managerial post. The Council said it considered she had not been provided adequate support or direction in investigating a complaint, or adhering to the Council’s complaint procedure. It again assured Mr M it would take appropriate steps to improve this element of its service.
21. The Council also provided a copy of its response to the Ombudsman. The Ombudsman decided on 25 October to accept Mr M’s complaint for investigation.

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Analysis

22. In response to the series of complaints raised by Mr M, the Council agreed to draw up a report on Mrs L’s experience with the homecare agency. When Mr M brought his complaint to the Ombudsman, his main issue was the Council’s failure to disclose the report.
23. After the Council disclosed the report, Mr M wrote back to the Council. He criticised the format and presentation of the report, and said it did not adequately address the complaints he had made.
24. I have read the report. It is, in fairness, detailed, and provides a lot of information about the care Mrs L was receiving and the problems she had experienced. There is no suggestion the investigating social worker believed Mr M’s complaints lacked merit, and the report contains a significant volume of evidence to support them.
25. However, I agree with Mr M the report is not really a proper response to his complaint. It appears, rather, to be more a series of notes and observations (albeit very detailed ones). It does not present any clear findings, and while it lists a series of conclusions, there is no obvious plan of action or any recommendations for improving the service to Mrs L.
26. In contrast, the Council’s formal complaint response, to which the report was attached, does provide a clear set of findings. It explains the investigating social worker was new to her role, and accepts she was not given directions on how to handle a complaint, for which it apologises. It also explains the Council has spoken to the social worker’s manager about the delays in signing off the report, which was a significant source of frustration to Mr M.
27. The complaint response also says the Council had taken steps to improve various aspects of its service, including its complaint handling and the management of commissioned care services.
28. I asked the Council to give me more details about the improvements it had made, and what efforts it had made to monitor their effectiveness.
29. In response, the Council provided a very detailed list of changes which had been made. These include, but are not limited to, the care agency implementing a system to notify Mrs L’s family if carers were running late, to ensure alternative arrangements can be made in time, and gaining an agreement from the district nurses to leave food out for Mrs L during their own visits, to ensure she has something to eat if there is a problem with the care call. The care agency had also implemented a new system for quality assurance checks, and the Council had taken steps to improve the supervision of new managers because of the problems with its investigation of Mr M’s complaints.
30. The Council also recognised several of the issues raised during Mr M’s complaints were potential safeguarding matters. It said it had issued a note for all relevant staff, to clarify when issues should be raised as a safeguarding matter.
31. I am satisfied with this evidence. The Council’s approach to improving its service appears to have been comprehensive, and it has also explained the monitoring it has undertaken to ensure the improvements take effect, which appears to have been successful.
32. Further to this, at the beginning of my investigation, I spoke to Mr M. He explained the service Mrs L is receiving is now essentially satisfactory, and he also referred to the notification system implemented between the family and care agency, to ensure alternative arrangements can be made when necessary.
33. Taking this together, I do not consider there is anything further the Ombudsman can add in this respect.
34. However, while I am reassured by the way the Council has now investigated this matter, it remains a concern this situation was allowed to arise in the first place. The Council has confirmed, for example, when it initially contacted the care agency with a view to commissioning Mrs L’s package, the agency stated it did not, at the time, have the capacity to attend her morning call.
35. I appreciate it may not always be possible to coordinate a person’s care needs with the service which is available at any one time, and some compromise may need to be reached. However, Mrs L’s call times were not simply a matter of convenience, but critical to her health; and so it is difficult to understand why a contingency plan, such as those which have now been established, was not put in place from the beginning.
36. In its response to my enquiries, the Council has offered to pay Mrs L £250, to reflect the distress caused by the poor service she received. It has also offered £100 to Mr M, in recognition of the time and trouble he was put to pursuing his complaint.
37. It is positive the Council has offered this without prompting. However, and while the amounts generally recommended by the Ombudsman to reflect distress, time and trouble are typically modest, I do not consider the Council’s offer adequately reflects the circumstances here.
38. I note, in particular, Mrs L suffered at least two hypoglycaemic episodes because of the inconsistency in the service she received. These are serious incidents, which the Council’s report recognises put her at risk of harm. I also consider the lengthy and confused complaint handling represents a greater degree of time and trouble for Mr M than the Council’s proposed remedy recognises.

Summary

39. The Council was at fault because it did not take adequate steps to ensure a consistent and reliable service for Mrs L. This is an injustice, because it placed her at risk of harm.
40. The Council was also at fault because its investigation of Mr M’s complaints was delayed, and the process it followed was confused and not clearly explained to Mr M. This is an injustice, because of the time and trouble he was put to in pursuing it.
41. I am encouraged by the positive steps the Council has taken to improve its service in both respects. It has not sought to excuse its faults, and it has implemented a very comprehensive list of service improvements, which it has monitored to ensure effectiveness. I am satisfied with this and have no further recommendations to make here.
42. However, and while it is also encouraging the Council has offered a financial remedy without prompting, I consider it should offer a higher amount. Based on the Ombudsman’s Guidance on Remedies, I recommend the Council offer £500 to reflect Mrs L’s distress, and £250 to reflect Mr M’s time and trouble.

Agreed action

43. Within one month of the date of my final decision, the Council has agreed to pay £500 to Mrs L, and £250 to Mr M, in recognition of their distress and time and trouble arising from the faults identified here.

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Final decision

44. I have completed my investigation with a finding of fault causing injustice.

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Parts of the complaint that I did not investigate

45. I have not investigated Mr M’s complaint the Council delayed referring Mrs L for CHC funding. This is because it did not form part of his original complaint to the Council, and he only raised it after receiving the Council’s formal response. It is therefore a premature matter for the Ombudsman.
46. In any case, councils’ role in CHC is limited, as it is the NHS which decides eligibility. It is also possible to make a backdated claim for CHC funding, if there is evidence a person became eligible for it earlier than they received it.
47. Even if the Ombudsman were to find fault with the Council here, therefore, he would not be able to say there had been an injustice, unless the NHS agreed Mrs L should have been eligible earlier. And, if the NHS did agree this, the provision of back-dated funding would then remedy the financial injustice to Mrs L. So it is unlikely the Ombudsman would investigate this complaint, even if it were not premature.

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Investigator's decision on behalf of the Ombudsman