Summary: Some areas of the domiciliary care provided to Ms X were below an acceptable standard. The care provider failed to adhere to a care plan in offering Ms X showers, and wrongly charged her for visits cancelled. The care was commissioned by the Council, so it is responsible for the failings. The Council failed to investigate Ms X’s complaints. This added to her frustration and denied her full and fair investigation into her complaint.

The complaint

1. Ms X complains about the standard of care provided by Radiant Life care agency, on behalf of the Council. Specifically, she complains about:

• male carers attending when female carers had been requested from the outset
• carers turning up at wrong times, for example Ms X requested a 9.30am visit, carers turned up at 7am
• carers not turning up and on occasions only staying 5/10 minutes of a 30-minute visit
• carers being verbally abusive
• carers not assisting Ms X to change from nightwear into day clothes
• carers using visits for lunch breaks and watching TV for the duration of the visit
• being offered two baths in 12 weeks
• being overcharged for care visits when visits had been cancelled
• a social worker was verbally abusive. Ms X says the incident was witnessed by two others
• a financial assessment took five months to complete
• delay in the complaints handling. Ms X says she waited 14 weeks for a response to her complaint, and when she received it, it did not address all the points she raised.

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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. 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)
3. 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)
4. 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. We can treat the actions of the care provider as if they were the actions of the council. (Local Government Act 1974, section 25(7), as amended)

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How I considered this complaint

5. I have:

• considered the complaint and discussed it with Ms X’s representative:
• considered the correspondence between Ms X and the Council, including the Council’s response to the complaint:
• made enquiries of the Council and considered the responses:
• considered the care records completed by the Care Provider:
• taken account of relevant legislation:
• offered Ms X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

6. 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.
7. 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.
8. The care provider must have a system in place so they can handle and respond to complaints. They must investigate it thoroughly and take action if problems are identified.

What happened

9. Ms X is in her forties. She lives with her partner, Mr Y. Mr Y works during the day and supports Ms X during evenings and weekends.
10. In January 2019 Ms X had a stroke. She has short-term memory issues and depression. Consequently, she needs support with daily living tasks. The Council assessed Ms X’s care needs and completed a risk assessment. This concluded Ms X to be at risk of self-neglect, malnutrition and becoming unkempt in appearance.
11. On discharge from hospital Ms X received reablement care between March 2019 and May 2019. The care was non chargeable. This care was not provided by Radiant Life care agency.
12. Prior to the cessation of the reablement care a social worker visited Ms X with the intention of reviewing her care needs. Ms X says the social worker was rude and aggressive and this was witnessed by two people present, one a friend, the other a care worker from the reablement care agency. Ms X says the social worker expected Mr Y would be present at the meeting, but he was unable to attend because he was at work. The social worker appeared cross about this and shouted at Ms X. One of the witness’s present has provided me with a witness statement confirming Ms X’s claims. The witness goes onto say “It all ended with [social worker] saying this meeting is abandoned and storming out, after I had interjected with my feelings”.
13. The Council completed a review of Ms X’s needs in May 2019 which concluded she had longer term care needs. The Council commissioned Radiant Life (Care Provider) to provide home care services. Three visits a day were arranged and included:

• 30 minutes am to prompt medication, assist with cleansing routine and getting dressed, prompt to eat breakfast, ensure kitchen & bathroom left tidy
• 30 minutes lunchtime to provide hot meal or snack and ensure kitchen and bathroom is clean and tidy
• 30 minutes pm call to prompt with showering and assist with getting ready for bed.

14. In June 2019, Mr Y contacted the Council to complain care workers were “not really supporting [Ms X] with her needs”. He also complained about a male care worker attending Ms X. The Council informed the Care Provider about the complaint. The Council did not investigate further.
15. The Care Provider says, at its initial assessment Ms X said she did not mind having male care workers. It says it was Mr Y who did not want Ms X having male care workers. The records show contact between the Care Provider, Ms X, and her sister about this issue. There is no evidence to show Ms X complained about having male care workers. On 4 July 2019, the Care Provider contacted Ms X to inform her the regular care worker was unavailable, and a male care worker would be attending instead. Ms X did not object. She was aware of Mr Y’s objections but told the Care Provider to disregard Mr Y’s views as it was she who was in receipt of the care, not Mr Y. Ms X’s sister also told the Care Provider Ms X had no issue with male care workers and to disregard Mr Y’s views about this.
16. I have had sight of the care plan completed by the Care Provider. Is makes no reference to a discussion about male care workers. The care plan is not signed by Ms X.
17. On 12 July 2019, Ms X contacted the Care Provider to complain the care worker had not offered her a wash. The Care Provider contacted the care worker, who said she had offered Ms X a wash, but she had declined saying she had headache. The daily care records for this day show a care worker arrived at Ms X’s home at 7am. Ms X said she was still sleeping so the care worker left and returned at 11.40am. The care worker recorded Ms X had complained of headache. There is no record that Ms X was offered or refused a wash.
18. The records show that on some occasions Ms X was already dressed when care workers arrived in a morning. On nearly all occasions Ms X was offered support to wash or observed to wash. On one occasion, 11 June 2019 a care worker arrived at 8.50am and offered Ms X a bath, Ms X declined. The Care Provider says the care plan sets out that Mrs X be offered showers not baths and on occasions she did not shower it because she declined. The records do not record occasions Ms X was offered/declined a shower.
19. Ms X says care workers did not assist her to change from day clothes into nightwear. The records show care workers offered to/or supported Ms X to change into nightclothes. There were occasions this did not happen because Ms X was going out for the evening and returned home after the last visit of the day. Care workers recorded these occasions.
20. Ms X says on some occasion’s care workers arrived too early in the morning. She had requested visits around 9am. The Care Provider says on some occasions care workers did arrive earlier than 9am because Ms X needed to attend appointments. The records show care workers arrived at 8.50am, on 7 July 2019, and 11 July 2019 because Ms X had a medical appointment. On 12 July 2019, a care worker arrived at 7am. Ms X had no appointment to attend this day.
21. Ms X complains some care workers only stayed 5/10 minutes of a 30-minute visit, but inaccurately recorded they stayed longer. I have had sight of the daily care records. Care workers recorded the time they arrived and left, and the tasks undertaken. The records do not show any visits shorter than 30 minutes.
22. Ms X says some care workers used the visits for their lunch breaks and to watch TV. All but a few visits were recorded to be around 30 minutes. On a few occasions care workers did stay longer, for example, on 25 May 2019 a care worker arrived at 2.15pm and found Ms X distressed about matters relating to her relationship with Mr Y, and that she required emotional support. The care worker stayed until 3.20pm. The care worker reported this to Care Provider. On 30 May 2019, a care worker arrived at Ms X’s home at 9.35am and found Ms X distressed and threatening self-harm. The care worker stayed until 10.30am to offer support. On another occasion a care arrived at 11.03am and left at 12.15pm. She recorded she “had chat to keep [Ms X] company”. There is no evidence to show Ms X was charged for the extra time.

On 15 July 2019 Ms X sent an email to the Care Provider to say a care worker had not arrived for the morning and lunchtime visit. The Care Provider contacted the care worker, who said that when she had arrived for the morning and lunchtime visit, there was no key in the key safe. When she called again for the tea-time visit, she knocked and waited at the door, Mr Y opened the door. Ms X reported low mood and that Mr Y had taken the key out of the key safe because he did not feel safe with key in the key safe. The care worker recorded staying 20 minutes chatting to Ms X.

23. Ms X says she has been charged for care visits which she cancelled. The records show a log of telephone calls made by Mr Y, and emails sent to cancel visits. On some occasions he cancelled in advance on others he cancelled the same day.
24. The Care Provider says there was lot of confusion between Ms X and Mr Y which did not help. It says “The very last week prior to her call ending, [Mr Y] had called about 4 times during the week to cancel calls which were honoured however he had sent an email on a Saturday to cancel a Monday call which I could not access hence I informed that as carer was sent out they would be charged for it especially as they both have the out of hours number to call in case of any emergency”.
25. Ms X says some care workers were rude to her. The Care Provider refutes this.
26. Ms X says it was five months before the Council completed a financial assessment. The Council says its financial assessment team received a referral in May 2019 and officers contacted Ms X in June 2019 to complete a financial assessment over the telephone. The Council says the delay was due to organisational change. When an officer contacted Ms X in June 2019 she declined a telephone assessment and said she wanted to “self-complete…complete com 361”. The Council received the completed assessment on 22 July 2019, as Ms X had not included bank statements it could not complete the assessment. The Council received the bank statements on 6 August 2019 and completed the assessment on 29 August 2019.
27. Ms X says an officer from the Council visited her at home around September 2019. Mr Y was present. Ms X says the officer assured her she would undertake a full investigation into her complaint. Ms X says she had confidence in the officer. Ms X never heard from the officer again. Mr Y says he telephoned the Council numerous times asking to speak to the officer but was put through to a different officer. Ms X says the complaint was then passed to a social worker. Ms X does not believe the social worker properly investigated all the issues she raised.
28. Ms X says the Council has not properly investigated her complaints. There were delays and she waited 14 weeks for a response to her complaint. When she received a response, it did not address all the issues she raised.
29. The Council says it fully investigated Ms X’s complaints “and extensive intervention was completed with face to face visits and email communication, in order find a resolution to [Ms X] verbal expression of dissatisfactions. This was communicated within an email to [Ms X], she commented that she felt better after the visit. The issues between [Ms X] and the provider was mostly resolved regarding times and missed visit, she expressed she felt reassured…”.
30. I have seen no evidence to show the Council formally investigated Ms X’s complaint, neither have I had sight of a formal complaint response letter. The Council has provided a copy of an email a social worker sent to Ms X dated 12 February 2019, I understand the date should be 2020. The social worker says she asked the Care Provider to provide Ms X with a written apology “for the emotional distress and upset they have caused due to the level of service they had provided you. I have made the following suggestions to the care agency for future notice

1. In future if care calls are being missed or declined due to the hours, please try to work this out with the adult, if it cannot be resolved please let social care know as soon as possible.
2. In future should there be a dispute regarding care calls please notify social care if they are commissioning the care”.

Analysis

31. The Council had a duty under section 8 of the Care Act 2014 to meet Ms X’s eligible needs. It did so by an arrangement with the Care Provider. Any failings in the Care Provider’s service to Ms X were fault by the Council because the care agency provided services on the Council’s behalf under section 8.
32. There are numerous issues to consider here, firstly the actions of a social worker, how the Council dealt with a financial assessment, the quality of care provided by the Care Provider, and how the Council responded to complaints about this.
33. In relation to the allegation a social worker was rude to Ms X at a meeting in May 2019, this is difficult to determine. A witness statement does suggest the social worker was frustrated by Mr Y’s absence at the meeting, and this caused upset to Ms X. Whilst the social worker may not have intended to cause Ms X distress, she did, and it would be appropriate for the Council to apologise to Ms X for any distress caused.
34. Complaints about rudeness can be difficult to determine. Each person has their own interpretation of events and it is simply not possible to know what happened. I am unable to come to a finding on Ms X’s allegations that some care workers were rude.
35. The relationship between Ms X and Mr Y, and Ms X’s sister appeared to be complex at times. There is evidence to show a difference of opinion between all three on the issue of male care workers.. I have seen no evidence which supports the Care Provider’s claim that at its initial assessment Ms X expressed any opinion about male care workers. However, the evidence shows Ms X did later inform the Care Provider she had no issue with male care workers, as did her sister. For the avoidance of doubt, the Care Provider should have recorded Ms X’s views about this matter on its initial assessment. When Mr Y raised this matter with the Council in June 2019, it should have contacted Ms X directly to clarify the matter.
36. Ms X complains about the timings of care visits and the that some visits were shorter than the allocated 30 minutes. Overall, I find no fault in the timings of visits. The Ombudsman considers it acceptable for care visits to vary by 30 minutes either side of the allocated time. There was only one occasion a care worker arrived well before this (7am) with no good reason. Whilst this must have caused Ms X inconvenience, I cannot find it caused her a significant injustice. It happened once, and when Ms X told the care worker she wanted to sleep, the care worker left and returned later in the morning.
37. I have found no evidence to show care workers cut visits short. Ms X says some care workers inaccurately recorded the length of the visit. It is not possible to come to a finding on this aspect of the complaint.
38. All the care records I have seen show Ms X was offered support to wash. The records do not show if she was offered or declined a shower. Ms X should have been offered shower in accordance with the care plan. I find it more probable than not, that care workers would have recorded if Ms X had showered or had declined a shower. On that basis I find fault with the Care Provider for not adhering to the Care Plan.
39. On the issue of bathing, I find no fault by the Care Provider. Baths were not set out in the care plan and, on the one occasion a care worker did offer Ms X a bath she declined.
40. I find no evidence which shows care workers failed to assist Ms X from daywear into nightwear. The records show this assistance was offered. The only occasions it was not was because Ms X was going out for the evening. I find no fault by the Care Provider here.
41. Overall, I find no evidence to support Ms X’s claims that care workers regularly used the care visits for their lunch breaks and to watch TV. On all but one occasion that care workers stayed longer than the allocated time, it was to provide emotional support to Ms X. On the one occasion, a care worker did stay longer than the located time without good reason, the length of the visit was accurately recorded as was the activity, that the care worker had chatted to Ms X. It is possible the care worker was using this time to have her lunch. If so, it was inappropriate. However, I do find it caused Ms X any significant injustice.
42. On the issue of the two missed visits on 15 July 2019. A care worker did attend Ms X’s home and could not gain access because the key had been removed from the key safe. This is not the fault of the Care Provider; however, I would have expected the care worker to report the matter to the Care Provider immediately. The Care Provider should then have at the very least telephoned Ms Y to establish the situation.
43. Regarding the visits cancelled by Ms and Mr Y, for which they were charged. It is clear Ms X was charged for visits cancelled in good time. On one occasion Mr Y sent an email to the Care Provider on a weekend to cancel a visit, but the Care Provider said it had no access to emails on a weekend. It said Mr Y should have contacted its emergency line. It is not acceptable to expect service users to call an emergency line to cancel care visits. The fact that the Care Provider could not access emails on a weekend should not impact on service users. The Care Provider is at fault here.
44. Ms X says the Council took too long to complete a financial assessment. The evidence shows a delay in the Council’s initial contact with Ms X about the financial assessment. Its financial assessment team received a referral in May 2019, but it did not contact Ms X until June 2019. This is fault. However, I do not consider it caused Ms X any injustice. When the Council telephoned Ms X in June 2019 to complete the assessment, she declined saying she wanted to complete the assessment independently. She was entitled to do so. Ms X did not provide the Council with all the necessary information until 6 August 2019, which contributed to the delay in completion of the assessment. The Council completed the assessment three weeks later, on 29 August 2019. It acknowledges this was not within an expected timeframe and apologises to Ms X. It says it now aims to complete all financial assessments within five working days.
45. I have seen no evidence the Council properly investigated any of the concerns or complaints Mr Y and Ms X raised. The Council was aware as early as June 2019 of dissatisfaction with some aspects of the service provided by the Care Provider. It failed to act. When an officer did visit Ms X and Mr Y in September 2019, they were hopeful of a thorough and fair investigation. This did not happen. Consequently, Mr Y was put to significant time and trouble chasing the investigating officer, he was not able to speak the officer and neither Ms X nor Mr Y heard from the officer again. This is poor practice.
46. When Ms X did receive a response to her complaint, it was in the form of an informal email from a social worker to say she had asked the Care Provider to apologise for the emotional upset caused. It did not address the issues Ms X raised and was wholly inadequate. When I asked the Council why it had asked the Care Provider to apologise, it said “it is important that appropriate reassurance is given, this remains the most appropriate response to how [Ms X] expressed she felt”. Ms X was not asking for an apology for her feelings, she was asking for an investigation into her complaint. The Council failed to do so. This is fault. Not only did this add to Ms X’s frustration it denied her a full investigation into her complaint.
47. To summarise, there is some evidence of fault by the Care Provider. It failed to adhere to Ms X’s care plan in offering showers and wrongly charged Ms X for visits cancelled in good time. The Council failed to undertake a proper investigation into the complaint.

Agreed action

48. To remedy the injustice caused the Council will within three months:

• provide Ms X and Mr Y with a written apology for the failings set out above
• make a payment of £250, split between Ms X and Mr Y, to acknowledge the time and trouble caused pursing this complaint with the Council, and the Ombudsman
• undertake a full audit of the cancelled calls and establish if any reimbursement of care contributions should be made to Ms X
• ensure effective monitoring of commissioned domiciliary services and ensure complaints about the same are properly investigated.

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Final decision

49. There is evidence of fault in this complaint. The above recommendations are a suitable way to address the injustice caused.
50. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman