The Ombudsman's final decision:
Summary: There is evidence of some failings in the care provided to Mr Y. I do not consider any significant injustice was caused to Mr Y or Mr X. I am also satisfied the Care Provider and the Council responded adequately to the concerns Mr X raised. There is no evidence of fault in the way the Council monitored the care provided to Mr Y. There is no outstanding injustice that requires a remedy.
- Mr X complains about the quality of domiciliary care Step Ahead Care Agency provided to his father, Mr Y on behalf of the Council.
What I have investigated
- I have investigated matters between 6 September 2019 and 12 January 2020. I have not addressed any matter dealt with in previous complaints, (19017395 & 19014796)
The Ombudsman’s role and powers
- 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)
- 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)
- 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)
How I considered this complaint
- I have:
- considered the complaint and discussed it with Mr X;
- considered the correspondence between Mr X and the Council, including the Council’s response to the complaint;
- made enquiries of the Council and the Care Provider and considered the responses;
- considered relevant legislation
- offered Mr X and the Council an opportunity to comment on a draft of this document, and considered the comments made.
What I found
- The Care Act 2014 is the legislation that sets out local authorities’ powers and duties in respect of adult social care. The Care Act places a duty on local authorities to promote the wellbeing of people in their area.
- Sections 9 and 10 of the Care Act require local authorities to carry out an assessment of any adult who appears to need care and support. Where a local authority has determined that a person has eligible needs, it must meet those needs.
- In some circumstances, a local authority may commission another organisation to provide care services on its behalf. However, it remains responsible for those services and for the actions of the organisation providing them.
- The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 applies to care providers. The Care Quality Commission (CQC) monitors, inspects and regulates adult care services providers to ensure they meet fundamental standards of quality and safety.
- Mr Y lives in his own home and receives domiciliary care services commissioned by the Council. Mr X was dissatisfied with a previous Care Provider commissioned by the Council so the Council attempted to find another contracted care provider, but none could arrive at the times Mr Y required. Consequently, it was not able to secure a provider with which it held a ‘framework contract’. Because of this the Council commissioned Step-Ahead Care Agency, (the Care Provider), and a ‘spot-contract’ was drawn up. The Council says the Care Provider had undergone a recent inspection by the Care Quality Commission (CQC), which concluded the service was ‘good’. The Council says it made this information available to Mr X and he accepted the offer of care.
- The Care Provider began providing care to Mr Y on 6 September 2019.
- Mr X first raised concerns with the social worker on 19 September 2019, saying the Care Provider had not completed a care plan and a carer had not known what to do. The social worker contacted the Care Provider, who said it usually completes a care plan after the first visit because it enables carers to inform it if anything else needs to be added. A social worker asked the Care Provider to complete a care plan for the following day.
- Following further concerns from Mr X, the social worker arranged to meet the director of the Care Provider at Mr Y’s home on 26 September 2019. At the meeting Mr X raised several issues, which were discussed with Mr Y, Mr X, the director of the Care Provider and the social worker. The Care Provider provided a copy of Mr Y’s care plan. Mr X was unhappy that the service had commenced with no care plan in place, and the evening carer appeared not to know what to do and had sought instruction from him. Mr X asked to read the completed care plan following which he said it was not clear.
- Mr X says he had observed a carer putting in too much sugar and juice in Mr Y’s drinks; Mr Y is diabetic. Mr X said carers should know how much juice they need to put in a glass, and that carers working with diabetic clients should have enough knowledge of this. Mr X asked if the carers were trained. The Care Provider explained the morning carer had been given explicit instructions on how to care for Mr Y but the evening carer had not. Mr X was also concerned that carers appeared not to ‘log in’. The Care Provider said some service users “…did not like carers writing”. The social worker told the Care Provider that the carers should log in and out otherwise there was no record of the carer attending, and this should be part of the Care Provider’s protocol. The social worker also asked the Care Provider to ensure the carers follow the care plan. At Mr X’s request, the social worker added additional personal care tasks to Mr Y’s care plan. After the director left the meeting Mr X asked the social worker to find a different provider. The social worker told Mr X that frequent changes of Care Providers were not in Mr Y’s best interest and noted Mr Y’s comments “…are we having another agency.Can we not wait and give it a try”. The social worker agreed to visit again after one week to monitor the service.
- Mr X submitted a formal complaint to the Council on 26 September 2019.The Council contacted the Care Provider to ask for comments on the complaint.
- On 30 September 2019, the social worker received a call from Mr Y and Mr X to say carers were not following the care plan and expressed concern that a carer had left Mr Y to walk downstairs alone. He said the carer should not be allowed to return and he wanted the Council to source a new care provider. The social worker contacted the Council’s care brokerage team to request a change of provider. She also offered to arrange another meeting with the director of the Care Provider, but Mr X declined and asked that the care worker concerned should not be allowed to return. The social worker contacted the Care Provider to inform it.
- Mr X contacted the social worker again in October 2019 expressing further concerns about the care provided to Mr Y. The social worker visited Mr Y. The records show a conversation between the social worker and Mr Y. Mr Y said he used the stairs sometimes and wanted to remain independent. He did not understand why he could not use the stairs. Mr X believed he was unsafe. Mr Y confirmed he had a good relationship with the carers and did not wish to change providers. The social worker told Mr Y that Mr X was not happy with the care being provided and he wanted to change providers, “[Mr Y] asked [Mr X] why they couldn’t work together. [Mr X] replied to his father that they are being paid and need to do their job properly”. The social worker told Mr Y she thought he should have an advocate.
- The Council responded to Mr X’s complaint in writing on 24 October 2019. It included the Care Providers comments on the complaint. In response to Mr X’s complaint about a lack of a care plan, the Care Provider said “It is standard procedure for us spend time developing a care plan during the initial period of a service users care. Whilst the amount of time it takes Step Ahead to implement a ﬁnalised care plan can change depending on individual circumstances, we generally aim to have a ﬁnalised copy prepared by the time of our ﬁrst review with a service user”. In response to carers rushing the evening visit, the Care Provider said in the first few week’s carers were ‘getting to know’ Mr Y and had not rushed him. Mr Y changed his own clothes at his own pace, and he may have done this more quickly because he was unfamiliar with the carer, and the carer had reported Mr Y going at a steadier pace as he became more familiar with the carer.
- In response to a carer not knowing what to do and seeking instruction from Mr X the Care Provider said a carer reported a tense situation between Mr X & Mr Y. Mr Y appeared not to be receptive to the carer, so the carer had asked Mr X’s advice about how best to deal with the situation. Responding to the allegation about carers not shaving Mr Y, the Care Provider said on occasions Mr Y refused a shave.
- The Care Provider acknowledged a carer had not logged their time of arrival and departure and said it had addressed this with the carer involved. Regarding the complaint that carers had put too much sugar in Mr Y’s tea and not diluting his squash enough, it said carers had not prepared these drinks for Mr Y, Mr X did. It also said Mr Y could prepare drinks for himself. The carer reported his only involvement with beverages was carrying a tray with beverages to Mr Y’s bedroom.
- The Care Provider acknowledged a carer had left a tray of drinks in Mr Y’s bedroom and said the carer had left the tray because he planned to use it later to carry all cups/glasses back downstairs. The carer did not consider the tray to be unsafe or pose any risk to Mr Y.
- In response to Mr X’s allegation that a carer had not interacted well with Mr Y whilst supporting him to use the lift, the Care Provider said “...the only times when our carer has indicated any problems communicating with [Mr Y] are during visits when there is an indication of tension in the household or when [Mr Y] does not appear to be in a good mood as this has made him resistant to carers suggestions”.
- The Care Provider had noted Mr X’s wish that Mr Y should wear slippers when upstairs, it said carers had expressed concern to Mr X about the type of slippers Mr Y was wearing and the slippers posed a falls risk. It said Mr X had expressed concern about exposed nails in the floor, and carers had asked Mr X to provide suitable slippers and to arrange for the exposed nails to be repaired.
- In response to Mr X’s allegation that a carer left Mr Y’s walking stick in the bathroom, The Care Provider said the stick was often not where it was left and said the carer sometimes had to search for it on arrival.
- The Care Provider went onto say “We believe the concerns raised above to be, in part, be to miscommunication and/or a misunderstanding of the exact type of care we are providing… We are already in the process of developing more robust audits for communication and visit logs and have established a system which means they will be checked more regularly…”
- The Council said the Care Provider had acknowledged faults in some areas and apologised as did the Council.
- Mr X remained unhappy with the quality of the care and continued to raise issues with the Care Provider and the Council.
- On 4 November 2019 Mr X sent an email to the social worker with further concerns. He was concerned a carer had chatted to Mr Y whilst Mr Y was showering, and that another carer had dropped a glove on the driveway. This led to discussions between the social worker, an officer from the Council’s commissioning team, the director of the Care Provider, Mr Y and Mr X. Mr X asked that certain carers did not provide care to Mr Y, consequently, there was a shortage of carers and the director of the Care Provider was providing the care herself, which she said could only be sustained for a short period. The Care Provider reported that Mr X would not greet carers and did not like them chatting to Mr Y. The director of the Care Provider had discussed this directly with Mr Y, who said he would speak with Mr X. The Council was concerned that Mr X’s expectations and behaviour were the cause of some difficulty, and if not addressed would result in the breakdown of the care package.
- The records show that numerous telephone calls took place on 4 & 5 November 2019 between social workers, commissioning managers, the Care Provider and Mr X. The outcome of these calls was that Mr X agreed to allow carers whom he had previously asked to stay away to return.
- On 8 November 2019, the Council met with Mr X, his MP, two Councillors, and two senior officers from the Council’s commissioning team. The meeting had intended to deal with Mr X’s complaints about a previous care provider, but it was decided to address his complaints about the current Provider. I have seen a copy of the notes of this meeting. Mr X discussed his concerns about the previous and current Care Provider, and the actions of the Council. The Council’s Commissioning Manager agreed to discuss Mr X’s concerns about the current Care Provider with its director.
- The Social Worker arranged an Occupational Therapist (OT) to carry out a moving and handling assessment on 4 December 2019., and to provide advice to carers about the use of the through-floor lift.
- Following the meeting Mr X continued to raise concerns with the Care Provider, Councillors, and the CQC. He complained about the position a shower head had been left, the timing of visits and the use of the key-safe by carers to gain access to Mr Y’s home.
- The Care Provider reported Mr X made carers feel uncomfortable, and because of this it deemed it necessary to send two carers. It sent an email to the Council asking if Mr X had been offered a carers assessment “or any other support” and asked if Council officers could speak to Mr X about his behaviour towards the carers. It said on one occasion Mr X shouted at a carer, Mr Y asked the carer if they were ok. On another occasion Mr X refused to allow a carer to leave because of ‘reckless’ use of the shower head.
- On 20 December 2019 Mr X noticed a cut on Mr Y’s nose. Mr X supplied me with a photograph of the cut. Mr X asked a carer how it had happened. The carer said she did not know but thought it may have been accidently done whilst shaving Mr Y. Mr X contacted the Council to report the matter as a safeguarding concern. He said the carer should have noticed the cut and noted it in Mr Y’s daily care records and reported it to him. The social worker contacted the Care Provider to ensure it had followed the correct safeguarding process. The Care Provider confirmed the action it had taken and provided the Council with a copy of its safeguarding policy.
- The Council says the working relationship between Mr X and the Care Provider was tense. The social worker and an officer from its commissioning team liaised with Mr X and the Care Provider to ensure continuity of care for Mr Y until a new provider could be found.
- Mr X believes the Council failed to properly monitor the quality of care provided by the Care Provider. The Council says that although the Care Provider was not on its framework contract it was still subject to its quality standards, which includes an annual assessment of quality. As Mr X began raising concerns within a short period of the service commencing, the Council was actively involved in monitoring the care. The social worker and commissioning managers were in frequent contact with Mr X and the Care Provider throughout the period it provided care to Mr Y. The Council provided evidence to show it confirmed the carers were appropriately trained.
- The Council provided Mr X with a final written response to his complaint on 11 December 2019. The author of the letter, a senior officer in the Council’s commissioning team, confirmed the issues had been discussed during his weekly telephone discussions with Mr X. The officer responded to each point raised and acknowledged Mr X’s continued dissatisfaction with the Care Provider and assured him the Council was actively looking for another care provider.
- The Council says it sourced other care providers to take over the care package, but they were declined by Mr X because the visit times were not suitable for Mr Y.
- The Council commissioned a different domiciliary care provider for Mr Y on 10 January 2020. The Care provider ceased providing care to Mr Y on 12 January 2020.
- The Council had a duty under section 8 of the Care Act 2014 to meet Mr Y’s eligible needs. It did so by an arrangement with the Care Provider. Any failings in the Care Provider’s service to Mr Y were fault by the Council because the Care Provider provided services on the Council’s behalf under section 8.
- There is no question that the care provided to Mr Y did not meet Mr X’s expectations. In such circumstances the Ombudsman considers if a person’s care and support plan has been adhered to, and if not, what if any, injustice arose from it. In this case Mr X raised many issues, some of which were easier to come to a finding on than others.
- At the outset, the Care Provider did not complete a care plan, it said it usually waited until after the first visit to complete a care plan so it could establish any additional tasks that may be needed. This was not good practice, except for an emergency, which this was not, a care plan should be completed before care commences. A care plan is very important, it identifies the needs, what is to be done about these needs, by whom and when, without this a carer has no clear instructions on how to care for a person. This is what happened here, a carer arrived not knowing what to do. This must have been frustrating for Mr Y and Mr X and undermined Mr X’s confidence. However, I do not consider any significant injustice arose. After Mr X reported the matter to the Council, it contacted the Care Provider immediately and a care plan was produced the following day.
- Mr X raised some valid issues, for example, carers not logging in and out, a cut to Mr Y’s nose not being recorded, and Mr Y walking downstairs unsupervised. The Care Provider acknowledged some issues arose and apologised. Although this must have been frustrating for Mr X no significant injustice was caused to either Mr Y or Mr X. The Care Provider and the Council addressed each issue as it arose and attempted to resolve the issues to Mr X’s satisfaction. I consider the actions of the Council and the Care Provider to be proportionate and satisfactory.
- Not all the concerns Mr X raised could be considered a failing, some were human error, and some cannot be explained. For example, a carer dropped a glove on Mr Y’s driveway. Mr X alleged carers put too much sugar in Mr Y’s tea, the Care Provider says its carers did not make such drinks for Mr Y, Mr X did. Its carers only carried the prepared drinks to Mr Y.
- Mr X opted not to resolve the issues informally with carers. It would have been reasonable for him to politely address minor issues with carers as they arose, for example, Mr X believed a carer was rushing Mr Y when he was dressing/undressing. The Care Provider says it was Mr Y’s unfamiliarity with the carer that caused him to rush, and this settled down as he became more familiar. Mr X could have discussed this with Mr Y and the carer at the time and the carer could have provided reassurance to both Mr X and Mr Y.
- On some occasions Mr Y appeared uncooperative and a carer asked Mr X for advice about how best to deal with Mr Y. Mr X perceived this as a failing by the carer, that he/she should have known what to do. I cannot find fault here. Seeking advice from a relative about how best to approach an older person who appears be non-compliant is not a failing but a commonsense approach to a difficult situation.
- Shortly after the care commenced Mr X asked the social worker to find a new care provider. I note Mr Y did not share his view. He wanted to “…give it a try”, and asked Mr X why they could not work together with the carers. It is clear there was tension at times between Mr Y and Mr X. On one occasion Mr Y expressed concern about the way in which Mr X spoke to a carer. It is fair to say Mr X’s behaviour towards the carers did at times cause difficulty. On one occasion, after a carer wrongly replaced a shower head, Mr X refused to a allow a carer to leave Mr Y’s home.
- Prior to providing care to Mr Y, the Care Provider was not included in the Council’s ‘framework contract’ and subject to the associated monitoring. Before commissioning the service, the Council checked the CQC inspection report, which rated the service as ‘good’, and provided this information to Mr X. After the service commenced it responded to Mr X’s concerns as he raised them. It considered his complaints properly and where necessary it ensured the Care Provider made improvements/ amended its practice. The Council clearly set out its expectations in the administrative aspects of care provision, in this case the timely completion of care plans and that carers should always login/out of service user’s homes. The Council had an almost ongoing dialogue with the director of the Care Provider. Because of this, I cannot criticise the Council, and have found no fault with the way it monitored the Care Provider.
- To summarise, there is evidence of some failings in the care provided to Mr Y. I do not consider any significant injustice was caused to Mr Y or Mr X. The Care Provider and the Council responded quickly and adequately to the concerns raised and apologised where appropriate. I consider the action to be adequate and proportionate to the circumstances.
- There is no outstanding injustice that requires a remedy.
- There is evidence of some failings in the care provided to Mr Y. I do not consider any significant injustice was caused to Mr Y or Mr X. I am also satisfied the Care Provider and the Council responded adequately to the concerns Mr X raised. There is no evidence of fault in the way the Council monitored the care provided to Mr Y. There is no outstanding injustice that requires a remedy from the Ombudsman.
- It on this basis; the complaint will be closed.
Investigator's decision on behalf of the Ombudsman