Summary: The Council (which commissioned the care provider) investigated Mr Z’s complaint about poor care for his elderly mother Mrs B properly. There is no evidence that fault caused injustice to Mrs B.

The complaint

1. Mr Z (as I shall call the complainant) complains that the care agency (Immaculate) commissioned by the Council to provide domiciliary care for Mrs B failed to arrive on time, did not complete all the tasks required and care workers were rude to Mrs B.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word ‘fault’ to refer to these. 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)
3. We have powers to investigate adult social care complaints in both Part 3 and Part 3A of the Local Government Act 1974. Part 3 covers complaints where local 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. We can by law treat the actions of the care provider as if they were the actions of the council in those cases. Part 3A covers complaints about care bought directly from a care provider by the person who needs it or by a representative, and includes care funded privately or with direct payments under a personal budget. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act)

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How I considered this complaint

4. I considered the information provided by Mr Z and by the Council and care agency. The Council has also provided the community nursing record. Both the Council and Mr Z had an opportunity to comment on an earlier draft of this statement before I reached a final decision.

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What I found

Relevant law and guidance

5. 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.
6. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
7. Regulation 10 of the regulations says that people must be treated with dignity and respect. They should not be neglected or left in undignified situations, and their lifestyle and care choices should be respected.
8. Regulation 12 says people should receive safe care and treatment.
9. Regulation 14 says people’s nutritional and hydration needs should be met.

What happened

10. Mrs B is a very elderly lady who lived at home on her own at the time of these events. The Council commissioned a package of domiciliary care for her. In December 2018, after complaints by Mr Z about the previous care provider, the Council commissioned Immaculate care to provide 4 calls a day to Mrs B, to help with meal preparation, personal care and hygiene, washing and dressing, and toilet needs.
11. The Council’s records do not show any further significant contact from Mr Z until 23 August 2019 when he requested a nursing placement for Mrs B. He said Mrs B was now doubly incontinent, her mobility had been significantly reduced and she was vulnerable to falls as she tried to get up in the night.
12. The following week Mr Z contacted the Council again to ask for a placement as a matter of urgency. He said he had had to arrange for the gas supplier to turn off the supply as there was a strong smell of gas in Mrs B’s property. He told the duty social worker the care workers were not arriving at the allotted times. He said a care worker had arrived at 1.15 to make his mother’s lunch and said she would be back at 3.00 to make her dinner – Mrs B would then not have another meal that day. The Council’s files show a telephone call was made to Immaculate care to ask why no care workers had reported a smell of gas if they were attending four times a day.
13. Two days later Mr Z contacted the Council again for urgent assistance. He said Mrs B was now permanently bedridden, doubly incontinent and unable to carry out any tasks of daily living. He said the care home where his mother wanted to live had a place vacant, but he wanted the Council to arrange the contract.
14. A social worker was allocated on 4 September to assess Mrs B: she carried out the assessment on 12 September. She also contacted the chosen care home about vacancies. She telephoned Mr Z on 23 September to explain that Mrs B was not eligible for a nursing placement as she did not have nursing needs but could be admitted in a residential placement. Mr Z considered his mother had nursing needs as she required the administration of morphine, but the social worker explained the District Nurse would administer any necessary drugs.
15. The Council’s records show the social worker explained about the possibility of a deferred payment agreement if Mrs B could not sell her property quickly, and also explained the Council could disregard the value of Mrs B’s property for the first twelve weeks of her stay, but Mr B said the Council was taking too long and he would place his mother privately.
16. The social worker also contacted Immaculate care about the complaints Mr Z had made. The agency manager was recorded as being aware of concerns about late calls but said it was not possible to predict exact times because of the traffic. She said she tried to ensure the same care workers were sent as much as possible. She expressed surprise at some of the complaints (that care workers refused to pick up papers from the floor) but agreed to check with the care workers.
17. Mrs B moved into the care home on 24 September as a privately funded resident.
18. The Council investigated Mr Z’s concerns about the care provided by Immaculate as a safeguarding concern. After speaking to the care agency manager, the investigating social worker wrote to the referring social worker, ‘I realised that this is more of a complaint than safeguarding, in my opinion, and on the basis of the information provided, I do agree with your decision to progress to case management. The risk has also been minimised by placing her in a care home.’
19. Mr Z also complained direct to the care agency and the manager responded in October 2019. She denied that care workers had failed to change Mrs B’s incontinence pads, or failed to supervise her meals (although care workers acknowledged that Mrs B ate very slowly and had not always finished by the time they left). Mr Z complained to the care agency that Mrs B had developed pressure sores during their care of her. The agency manager said the care worker had in fact reported the sores to Mr Z, had advised him to contact the District Nurse (which he had done) and had reported it to the office. Mr Z also complained about the late arrival of care workers but the agency manager said he always called the agency during the 30 minute ‘shoulder’ time and frequently the care workers had arrived by the time the agency checked.
20. Mr Z responded that her letter was a distortion of the facts. He complained to the Ombudsman. He said the care workers had left Mrs B in wet and soiled incontinence pads all day, had failed to ensure she ate properly leading to a loss of weight, and had provided inconsistent care.
21. Mrs B sadly died in May 2020.
22. The Council says Mrs B was already being seen by community nurses about her pressure sores when Mr Z made the complaint. The community nurses considered the pressure sores were attributable to a long period lying down after a fall before she was referred to their service. The Council says as a result of the community nurses’ involvement Mrs B was also taking supplement drinks to boost her calorie intake and had the proper pressure-relieving equipment.
23. The Council says it has not been possible to check the daily care logs from the period of time covered by Immaculate care as the logs remained in the house and were not returned.
24. The Council offers to complete the process explained by its social worker, to backdate a 12-week property disregard and set up a third party top-up agreement with Mr Z for the care home charges, although it points out this offer was made at the time of the complaint and related to the previous financial year.

Analysis

25. The Council remains responsible for the care provided by the agency as it commissioned the care package.
26. The care agency recognised there had been problems with time-keeping but said these were nearly always within the allowed period of grace.
27. Although Mr Z was understandably distressed by the deterioration in Mrs B’s condition, in the absence of the daily care logs there is insufficient evidence to conclude she suffered that deterioration as a result of poor care on the part of the agency workers.
28. The Council offered to review the funding for Mrs B’s placement if Mr Z wished.

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Final decision

29. There is no evidence that fault on the part of the Council’s commissioned agency caused injustice to Mrs B.

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Investigator's decision on behalf of the Ombudsman