Summary: Mr X complained the Council failed to provide him with suitable care for four months. He also said the Council did not provide him with satisfactory care when his care visits resumed. He said this negatively affected his health. There was fault in the Council’s actions but this did not lead to an injustice for Mr X.

The complaint

1. Mr X complained the Council failed to find a suitable care provider for approximately four months, which left him without the care and support he needed. He said when his care visits resumed, they were not sufficient to address his needs and the carers who attended his home wore perfume which irritated his allergies.
2. He said this caused him distress and poor health.

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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. 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

5. I contacted Mr X and discussed his view of the complaint.
6. I considered the Council’s submission to the Ombudsman which included Mr X’s letter of complaint, a copy of his needs’ assessment, care and support plan, case notes and internal emails.
7. I wrote to Mr X and the Council with my draft decision and gave them an opportunity to comment before I made a final decision.

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What I found

Law and Statutory Guidance

8. 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.
9. In this case, the Council arranged and commissioned the care provided by the Care Provider for Mr X.
10. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan for people who the Council have identified as having ‘eligible needs’. The plan should clearly include the services and support to be provided and when they will be provided.
11. The Act also states councils should conduct a review of the plan if the carer or the person receiving care asks for one.

Council’s complaints policy

12. The Council’s complaints policy states a service user can raise a complaint by talking to the employee at the Council with whom they have most contact.
13. If they are unable to resolve the issue informally, a member of the Council’s customer care and complaints team can investigate.
14. The Council will then contact the person and let them know what they have done about the complaint. If the person is still unhappy, they may refer their complaint to the Ombudsman.

Background

15. Mr X suffered a stroke several years ago which left him paralysed in one arm and partially paralysed in the other. He has poor mobility and needs help to carry out most daily tasks including cooking, eating, taking his medication, and cleaning himself.
16. Mr X’s care and support plan states care workers should not wear scented deodorants, perfume, and/or strong-smelling fabric conditioner because this aggravates Mr X’s breathing.
17. Mr X’s care and support plan states he needs 19 and a half hours of care per week spread out over 4 daily visits in the morning, lunchtime, teatime and evening.
18. Mr X’s care and support plan also states he requires help with administration of medication as he cannot open bottles or blister packs on his own.

What happened

19. In June 2019, Mr X complained to the Council. He said he had been left without care since April 2019 following a disagreement with his carers about the perfume they were wearing.
20. The Council said Mr X’s previous care provider terminated his contract in early April 2019 because of Mr X’s aggressive behaviour. The Council said in March 2019 it began sending daily emails to care providers in the area to replace Mr X’s care package.
21. The Council offered Mr X temporary respite care, but he declined this. The Council offered to provide Mr X with direct payments so he could find his own carer, but he did not want to do this. The Council said most agencies it approached declined to work with Mr X due to past issues with his behaviour. One care provider agreed to provide Mr X’s care, but he rejected this because he said it had previously supplied carers who wore perfume.
22. As a temporary measure, the Council arranged care visits for Mr X with a specialised care provider starting from mid July 2019. The visits were for 27 hours a week, spread out over 3 days. The Council said Mr X’s family could support him on the other days of the week whilst it was looking for a care provider who could satisfy the care set out in Mr X’s care plan.
23. Four days after the care visits began, Mr X contacted the Council and asked to speak to his case worker. He said he could not take his medication every day because he could not open bottles on his own.
24. The Council agreed carers should make sure Mr X could access his medication when they were not there but told Mr X to contact his family or GP for help as his case worker was not available.
25. In the following weeks, Mr X continued to complain to the Council. In mid-August, Mr X told the Council he suffered a mini seizure because he could not take his medication. He also said a carer had worn perfume near him. He was unhappy the Council did not return his calls and he could not reach his case worker.
26. The Council told Mr X it had approached all care providers in the area, and he would not accept the care provider who agreed to work with him. Mr X asked whether his current care provider could visit more frequently. The Council contacted Mr X’s care provider, but it said it could not do this. The Council also confirmed with the care provider that Mr X’s health had not declined.
27. Mr X continued to complain to the Council after it confirmed his current care provider would not increase his visits. The Council again offered the care provider he had previously rejected and again Mr X declined. He then told the Council he was unhappy with the details set out in his care and support plan and wanted to change them. The Council agreed to contact his care provider about this.
28. The Council contacted Mr X’s care provider to discuss his care and support plan. The care provider said it visited Mr X on several occasions to discuss the plan and he had agreed with its contents. The Care Provider said it would visit Mr X again to discuss the plan.
29. In early September 2019, Mr X complained again about his care. The Council repeated what it had previously told him and offered him an assessment with the care provider he had already refused. Mr X again declined.
30. Mr X contacted the Council in mid-September 2019 to ask for an update. The Council confirmed it was still looking for a suitable care provider and again offered him the services of the care provider Mr X had refused. It also offered to discuss Mr X’s allergies with the carers. Mr X again declined. Mr X told the Council he could not eat or drink on the days he did not have care visits, but he was able to take his medication with great difficulty. Mr X advised he was still unable to reach his case worker and she did not return his calls.
31. Mr X referred his complaint to the Ombudsman in late September 2019, as he remained unhappy with the situation.
32. During the investigation, the Council confirmed it has continued to approach care providers, but they have either declined, or Mr X has declined to work with the agency.

My findings

33. Mr X’s care and support plan states carers should not wear perfume or deodorant during visits. Mr X complained that carers were still wearing perfume. It is clear from the evidence that Mr X had raised this issue previously. There is no evidence the Council investigated this complaint or contacted Mr X’s care provider to check carers were observing this. This is fault. As of September 2019, the care provider confirmed Mr X’s health had not declined. It is unlikely further investigation into this aspect of the complaint would achieve anything useful as the care provider went on to terminate its contract with Mr X following this complaint.
34. The Council is required to ensure Mr X receives four care visits each day, four times a week. In between April 2019 and July 2019, the evidence indicates Mr X did not receive care visits. The Council has provided evidence showing it began searching for a suitable care provider for Mr X the month before his previous care provider terminated his contract. The Council confirmed it offered Mr X respite care or a direct payment he could use to look for his own care. It also identified a care provider who would work with Mr X. Mr X refused all offers. The Council acted appropriately to ensure Mr X was not left without care whilst it searched for a permanent care provider. Mr X was entitled to refuse those offers, but I cannot hold the Council responsible for his decision. There was no fault in the Council’s actions.
35. Mr X has repeatedly stated that the care arranged by the Council in July 2019 did not adequately address his needs when it moved from 19½ hours a week over four days to 27 hours a week over three days. The Council has provided evidence showing it contacted numerous care providers in Mr X’s area and many of them declined to work with him due to lack of availability or past issues with Mr X’s behaviour. The evidence also shows the Council offered to discuss Mr X’s needs with a care provider willing to work with him, but he repeatedly rejected this.
    It also increased the hours of support he received over the week for the three days it was able to find him a care provider. The Council took appropriate action to address this complaint. There was no fault with the Council’s actions.
36. Mr X’s care and support plan states he cannot open bottles on his own and needs help to take his medication. Mr X contacted the Council soon after his interim care began in July, to advise carers were not leaving his medication in an accessible condition on days he was on his own. There is no evidence the Council took action to address this with his care provider. This is fault. Mr X advised he suffered a mini seizure because he was not taking his medication every day however, he also advised he was eventually able to take his medication without help albeit with great difficulty. It is unclear to what extent Mr X missed his medication and the impact this made. However, Mr X was offered alternative support to meet his needs by the Council as described at paragraph 34 and this was refused. I therefore do not hold the Council responsible for the impact of this.
37. Mr X repeatedly contacted the Council to discuss his concerns with his case worker but was unable to talk to her. He also said the Council failed to return his calls. Based on the number of times Mr X raises this issue in the case notes, I consider it likely the Council failed to respond to Mr X’s calls several times. The Council has not provided a reason for this. It would have been best practice for the Council to get back to Mr X. However, because of the specific circumstances of the case, I stop short of finding fault. Mr X and the Council went on to have several conversations about his concerns following each missed call. Therefore, even if I were to identify fault, there is no evidence Mr X experienced an injustice or was disadvantaged by this part of his complaint.
38. The Council’s complaints policy states a service user can complain by talking to the person at the Council they have most contact with. Mr X clearly voiced his unhappiness with his care package on numerous occasions between July 2019 and September 2019. The Council responded by repeating information it had given him previously and offering him a care provider he had previously declined. The evidence indicates the Council did not recognise Mr X was making a complaint or follow its complaints process. This is fault. However, this did not cause Mr X to suffer an injustice. This is because it is unlikely following the complaints process would have led to a different outcome for Mr X.

Final decision

39. There was fault in the Council’s actions, but this did not cause Mr X an injustice.
    I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman