Summary: Mr B complains on behalf of his late father, Mr C, that the care provider commissioned by the Council to provide domiciliary care for him failed to provide the agreed care. The Ombudsman finds there is insufficient evidence that the standard of care provided was inadequate but the daily visit logs completed by the carers were insufficiently detailed causing uncertainty as to whether the agreed support was provided. The Council has agreed to apologise to Mr B and pay him £250 in recognition of this uncertainty.

The complaint

1. Mr B complains on behalf of his late father, Mr C, that, the care provider commissioned by the Council to provide domiciliary care for Mr C, failed to provide the agreed care. He says the care provider’s refusal to waive the charges is causing stress to the family.

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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 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)

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How I considered this complaint

4. I have considered all the information provided by Mr B, made enquiries of the Council and considered its comments and the documents it provided. I have also considered documents provided by the care provider.
5. Mr B and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Key facts

6. Mr C was elderly and living at home. In August 2019 his daughter, Ms D, asked the Council to arrange a package of care as she was struggling to meet his needs. She explained that Mr C was able to care for himself but needed prompting with personal hygiene tasks. She requested a morning call from carers each day to assist Mr C with personal hygiene and said she would continue to support him with other tasks such as shopping and cleaning. Mr C had a history of declining assistance and Ms D sought assurance from the social worker, Officer X, that the carers would encourage him to complete personal hygiene tasks.
7. Officer X completed a care needs assessment. She found Mr C was physically able to complete personal care tasks but his memory impairment was having an impact on him doing so and he needed support and prompting.
8. Officer X completed a support plan which stated there would be a 30 minute call each morning and once a week there would be a one hour visit when carers would encourage Mr C to sit on his shower board in the bath and have a wash.
9. The support plan stated that carers should encourage Mr C to maintain his hygiene needs and keep a clear log of evidence confirming whether this had been completed or not. It stated that carers should encourage Mr C to shave and clean his nails. They should put clean clothes out for him and put used clothes into the laundry basket. They should also encourage him to flush the toilet and check that this had been done. Carers should check the bedding and encourage Mr C to engage with them when changing it. The plan stated this should be done “on a regular basis”.
10. The Council commissioned a care provider (“Company Y”) to provide the package of care which started on 12 August 2019.
11. On 19 August 2019 Ms D telephoned Officer X stating that Company Y had not provided the agreed support. She said she had visited during the week and found the kitchen worktops had not been wiped down, the toilet had not been flushed and Mr C’s bed had not been changed. She said she had spoken to the care manager but nothing had improved.
12. Officer X explained that the support plan detailed the support required but the carers needed to build a rapport with Mr C first. Ms D wanted to cancel the care package because it was causing more stress having to repeatedly telephone the care provider than complete the tasks herself. She wanted the service to end with immediate effect and said she and other family members would provide support for Mr C. She requested a refund of the charges paid. Officer X explained she could not agree to this.
13. The same day the care manager contacted the Council. She told Officer X she had explained to Ms D that the carers needed to build a rapport with Mr C. She also said the bed was due to be changed on a two weekly basis and so had not yet been done. She agreed to end the support package with immediate effect even though a notice period would normally be required. Officer X contacted Ms D to confirm this.

Analysis

14. Mr B says Company Y failed to meet Mr C’s care needs as set out in his support plan. He wants the care charges cancelled because the carers did nothing to help Mr C.
15. Company Y has declined to cancel the charges. It says care staff visited Mr C’s home, made sure he was safe and well and completed those tasks he would do with them. They tried to encourage Mr C to wash and change his clothes but, whenever they visited he was already dressed and refused to do so saying he had already done it. They varied the call times slightly to try to catch him at a better time but this made no difference. It says Mr C would let carers help with making cups of tea and washing-up and they kept the kitchen and bathroom clean. Company Y says staff will encourage the service user as much as possible, which is what was requested, but will not force anyone to do anything against their will.
16. With regard to changing Mr C’s bed, the care manager says Ms D told her the bed had not been changed so she agreed that staff would do it the following day. However Ms D said she had already done it so she agreed care staff would do it the following week but would check daily for any accidents and change it if necessary.
17. Council paperwork to start the package of care stated that carers were to change the bed “on a regular basis” but did not specify when or how often.
18. The support plan completed by Company Y stated there would be six 30 minute calls “to encourage personal care, clean nails, shave”. It stated on Fridays there would be a one hour call when the carer was to encourage Mr C to sit on the shower board and wash. The carer was also to change the bed on this call and put washing on. However, Company Y says the one hour call was not due to start until the second week of the care package.
19. Daily visit logs were completed by the carer at each visit. On 12 August 2019 the carer referred to tidying up and completing a risk assessment. Between 13 and 15 August 2019 the carer referred to tidying up and Mr C having a shave.
20. On 16 August the carer recorded that they cleaned the bathroom sink, toilet, kitchen table, worktops and sink. She stated that Mr C declined to have a bath three times.
21. On 17 August 2019 the carer recorded that she wiped down the kitchen surfaces, did the washing up and cleaned the toilet. Mr C declined to have a bath.
22. On 18 August 2019 the carer recorded that Mr C cleaned the kitchen worktops, washed up and cleaned the toilet and sink. She stated he would not have a bath.
23. On 19 August 2019 the carer again recorded that Mr C refused to have a bath and would not let her give him clean clothes to wear. She recorded that they washed up and cleaned the kitchen worktops and bathroom sink and toilet.
24. There is a conflict of evidence between the family’s version of events and that of Company Y. Mr B says the agreed support was not provided. Company Y says carers did the best they could given that Mr C would not engage.
25. Where there is a clear difference between two versions of events, the Ombudsman could not reach a safe conclusion about precisely what happened in the absence of tangible evidence.
26. The only written evidence I have seen is the daily visit logs completed by care staff. These support Company Y’s argument that care staff did complete some of the agreed tasks but were unable to encourage Mr B to have a bath.
27. It is noticeable that during the first two visits less tasks were completed and I do not criticise the care provider’s view that it would take some time for carers to establish a rapport with Mr C before he would fully engage with them.
28. However, the support plan states that carers should encourage Mr C to maintain his personal hygiene needs on each visit and, if he said he had already completed a task, they should “keep a clear log of evidence if this task has been completed or not”. It stated carers should encourage him to shave, clean his nails and flush the toilet and that they should encourage him to change his clothes regularly, put out clean clothes for him and check the bedding.
29. The daily care logs do not state whether carers checked Mr C’s nails and found them to be clean or, if not, encouraged him to clean them. They do not state whether carers checked if Mr C was wearing clean clothes or the same clothes as the previous day. On only one occasion do they state that clean clothes were offered and refused. The notes also do not state whether the carers had to encourage Mr C to flush the toilet. As they were supposed to be keeping a clear log of evidence confirming whether or not these tasks had been completed, they should have recorded these things.
30. The notes do not always make it clear whether the carer completed cleaning tasks themselves or whether they encouraged Mr C to do these tasks. The whole point of the support package was that the family wanted Mr C to be encouraged to complete tasks himself. The support plan specifically states that carers were to encourage Mr C “to engage with them when completing tasks”.
31. Overall, I find there is insufficient evidence for me to reach a clear finding that the standard of care provided to Mr C was inadequate. Because of the lack of detail in the notes it is not clear whether carers failed to carry out the required tasks or whether they simply failed to record everything. This lack of detail was fault and creates uncertainty about what was or was not done.

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Agreed action

32. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of the care provider, I made recommendations to the Council.
33. The Council has agreed that, within one month, it will apologise to Mr B and pay him £250 in recognition of the uncertainty caused by the inadequate recording in the daily visit logs.

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Final decision

34. I find the Council was at fault because the daily visit logs completed by care staff were insufficiently detailed.
35. I have completed my investigation on the basis that the Council has agreed to implement the recommended remedy.

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Investigator's decision on behalf of the Ombudsman