Summary: Mr X complains about the actions of a care provider in providing domiciliary care to his mother, Mrs Y. The Ombudsman has not found evidence the actions of the care provider caused an injustice to Mr X or Mrs Y so has completed his investigation.

The complaint

1. Mr X complains for his mother Mrs Y about the domiciliary care provided by Three Sister Community Care LLP (the care provider). In particular Mr X says
• There were problems with the care calls to Mrs Y. Mr X says they were not given a fixed time for a call so had to rely on a prior notification call to know when carers would arrive. Mr X says he did not always receive a call, carers did not arrive on time, or together. Mr X says the carers did not stay the full length of the call and did not achieve the aim of the call.
• On some visits the carers gave Mrs Y a strip wash rather than bathe her. Mr X considers the time taken to complete the strip wash was too short.
• The quality and accuracy of the care notes made by carers were questionable and did not reflect the call. Mr X alleges the carers worded notes of calls to seem more successful than they were.
• The carers wrongly raised a safeguarding concern against him. Mr X questions the quality, experience, professionalism, and rigorousness of the care provider in making the allegation. Mr X says the carers did not speak to him about their concerns first.
• The care provider did not directly address his issues of complaints such as the time taken to carry out a strip wash and what it should entail.
• Mr X questions the qualifications and training of staff to handle Mrs Y who had dementia. Mr X considers the carers lack training to deal with Mrs Y as they spoke loudly over her, repeated instructions, and contradicted her.
• He considers that he and his brother, have been discriminated against as males caring for a female.
• Staff at the care provider fraudulently signed both his and Mrs Y’s signature on the initial assessment form.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
3. We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• the action has not caused injustice to the person who complained, or
• the injustice is not significant enough to justify our involvement, or
• it is unlikely we could add to any previous investigation by the care provider, or
• it is unlikely further investigation will lead to a different outcome, or
• we cannot achieve the outcome someone wants, or
• there is another body better placed to consider this complaint.

(Local Government Act 1974, sections 34B(8) and (9))

4. If we are satisfied with a care provider’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 have read the paper submitted by Mr X and we have spoken to him about the complaint. I considered the care provider’s comments on the complaint and the supporting documents it provided.
6. Mr X and the care provider 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

Guidance

7. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 apply 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.
8. The CQC has provided guidance on the regulations which says that:
• The care and treatment of service users must be appropriate, meet their needs and reflect their preferences (regulation 9).
• Providers should ensure they safeguard people who use services from suffering and form of abuse or improper treatment while receiving care and treatment. (regulation 13)
• Any complaint must be investigated, and necessary and proportionate action must be taken in response to any failure identified (regulation 16).
• Providers only employ ‘fit and proper’ staff who are able to provide care and treatment appropriate to their role and to enable them to provide the regulated activity. (regulation19)

Background information

9. Mrs Y suffered from vascular dementia. She lived at home with two sons one of which is Mr X. Mr X acted as Mrs Y’s main carer.
10. In August 2018, the care provider carried out an initial assessment of Mrs Y’s needs. It agreed a care package of one hour a day to help with bathing, washing her hair, drying her, and helping into clean clothes. The calls were due between 10.30 am to 12 noon. The form shows a signature for Mr X signing for Mrs Y.
11. Mrs Y had one carer to help her at first. This was increased to two carers as she responded better so there were always two carers at each visit.
12. Two carers were bathing Mrs Y on a call in September 2018. They later raised safeguarding concerns about alleged actions by Mr X to Mrs Y while they were bathing her. The care provider raised a safeguarding concern to the local council to consider in October 2018 and told the CQC. The Council investigated but considered the allegation unsubstantiated and took no further action.
13. The care provider reviewed the care package in October 2018 after the safeguarding allegation. The care provider’s notes record Mr X was ‘really happy’ with the two carers. The notes also say the ‘brothers are happy for the care provider to remain involved in providing supporting care’.
14. In commenting on the draft decision Mr X says that at this time he spoke to the OT and ‘voiced reservations about it (the care package) being effective’. Mr X says it was due to the OT and council social worker persuading him that he continued with the care package.
15. Mrs Y’s health declined, and she received end of life care, so Mr X cancelled the care package from the care provider in January 2019. Mrs Y sadly passed away later that month.
16. Mr X submitted a complaint to the care provider in September 2019. The care provider says Mrs Y had challenging behaviour and the carers did as much personal care as they could up to a high standard. It responded to Mr X’s complaints and apologised to Mr X if he felt the care provided for Mrs Y was lacking in some areas and for any delays or confusion over call times.

My Assessment

Care Calls

17. The care provider said it did not collect the case folder containing information on Mrs Y’s care package and calls from Mr X when the package ended. This meant it could not comment on every detail of the calls. It said it worked hard to meet clients’ call times, but this could vary due to unexpected circumstances at earlier calls and traffic when moving to the next call. The care provider said Mr X asked specific carers for Mrs Y, so this reduced its flexibility to adjust to any changing circumstances.
18. The care provider noted Mr X settled any invoices without dispute and he did not raise any issues about the care calls in the courtesy calls to him while Mrs Y received the care package.
19. The care provider interviewed the carers involved who could not recall details of individual calls. But confirmed Mr X had not raised any concerns and they considered he was happy with what was achieved in each call. The carers said there were occasions they did not arrive together, but Mr X and his brother had not appeared concerned at the time.
20. The carers said they did not leave early or cut the time of the call short. They always worked towards achieving all personal care tasks. But on some visits, it was not always possible if Mrs Y was displaying challenging behaviour.
21. It is unfortunate there were occasions when the care provider did not make the prior notification calls, or the carers did not arrive at the same time. But I consider it is difficult to establish with any certainty what did happen after the time that has now passed. There is no evidence to show Mr X raised these concerns while Mrs Y was receiving the care or query the invoices received. This would have enabled the care provider to investigate Mr X’s concerns and deal with any issues at the time.
22. The documents show Mr X had opportunities to raise any concerns in the courtesy calls but did not do so. The carers say they did not leave the calls early or cut them short. I do not consider I can come to a robust conclusion about this issue now after so much time has passed. Mr X says he voiced concerns about the effectiveness of the care package in washing Mrs Y to the OT, however he did not raise any issues about the actions of the care provider. Mr X’s comments about the care provider during the care package remain positive which contradicts the complaint he is now making.
23. The care provider accepted there was one missed call in September 2018 when Mr X arranged for an occupational therapist to be present during a call. Mr X said no carers had been. The care provider apologised for an error in not allocating the call to a carer. The care provider rearranged the appointment and did not charge Mrs Y.
24. While it is unfortunate that one recorded call was missed, the care provider has accepted and apologised for this. Mrs Y was not charged for the call. I consider it was suitable action for the care provider to take. So, I do not consider I can achieve anything further for Mr X over this one recorded missed call.

Quality of care notes

25. The care provider explained the care notes are a summary of the visit and try to reflect the call in a short and concise way. This is so carers can focus on providing care rather than writing detailed notes. The care provider said it regularly reviews carers notes and provides guidance if it feels important details are missing.
26. Mr X has provided me with a copy of the care records. I consider they provide a clear summary of the calls and action taken to carry out the care package agreed. This is what we would expect of the care notes. I cannot comment on whether they are an accurate reflection or ‘too positive’ as I was not present at the calls.
27. The care provider left the care notes each day with Mr X and Mrs Y. So, I consider Mr X could have raised concerns about the quality of notes while Mrs Y was receiving care if he considered they did not reflect the visits. I do not consider I can achieve anything more for Mr X through further investigation because of the time that has now passed since the calls were made.

Strip wash

28. The care provider said the needs of each client vary so it could not define and say how long a wash should take. The care provider said one carer can wash a mentally capable client in a shorter time than someone with no mobility and limited capacity who may need two carers. It said the aim was to leave a client well washed without affecting their dignity.
29. The care provider confirmed it is difficult to say with any certainty how long it should take to carry out a strip wash on a client. This is because it varies according to each client’s needs. There is no evidence Mr X raised this as an issue during Mrs Y’s care with the care provider. This would have enabled a more detailed look at the strip washes and what was being achieved. I do not consider it is possible for me to reach a view on this issue. In addition, there is no injustice caused to Mr X on this issue so no grounds for me to pursue the matter further. Any possible injustice would be to Mrs Y and this has now ended.

Staff training

30. The care provider says it provides continuing training for its staff including specific dementia training. It says dementia affects people differently and no training could hope to equip staff to deal with the detailed knowledge and awareness Mr X and his brother had developed for Mrs Y.
31. The care provider explained it left care plans at a client’s home to reflect the information needed by the client and their families. The carers read the plans, and these can be updated by family members if they feel they do not represent matters enough. The care provider also briefed carers before visits to give an overview of a client’s case.
32. The care provider has provided a copy of the training records for the carers involved with Mrs Y. These show they have received training on dealing with clients with dementia which is according to the fundamental standards. It is for the care provider ensure its staff are properly trained and qualified.

Safeguarding allegation against Mr X

33. The care provider recognises raising a safeguarding can be contentious, but its main concern is for a client. It says it has a duty of care to respond to any concerns. The care provider has a safeguarding policy which says it will report any incidents where abuse is suspected to a vulnerable person. The policy outlines the steps to be taken to report such a concern and raise an alert to the local authority.
34. The carers did not raise the incident with Mr X on the call as they felt uncomfortable about doing so and lacked confidence to say anything. The carers returned to the main office afterwards to report it according to the safeguarding policy.
35. The care provider says it was not saying it was unacceptable for Mr X to be providing personal care to Mrs Y, but it was his actions in providing the care that caused the concerns. The care provider reported the concerns about Mr X’s actions through the appropriate channels to the local authority to consider. While the safeguarding concern was not upheld by the local authority. The care provider says it would not take action against staff members for raising a concern as it would not want to discourage them from doing so in the future to the detriment of clients.
36. The care provider is under a duty of care to report any safeguarding concerns to the local authority to consider. The documents show the care provider followed its policy and reported it as required. The Council considered the concerns but decide they were unsubstantiated so would not pursue it further. While I appreciate the upset caused to Mr X, the fact the local authority did not pursue the concern does not mean the care provider should not have raised it. The care provider’s first duty of care was to Mrs Y. It followed the fundamental standards of quality and safety to ensure it safeguards people.

Failure to address the issues of his complaints

37. The care provider responded to Mr X’s complaints but explained it was difficult to address all his concerns due to the time that had passed. The care provider offered to meet with him to discuss the issues he did not consider had been addressed. I consider this was suitable action for the care provider to take to try and address Mr X’s concerns. It is unfortunate Mr X declined the offer.
38. In commenting on the draft decision Mr X says he declined the offer as he had no reason to consider the meeting would address, examined, or clarify his concerns and complaints.

Allegation of Discrimination against Mr X and his brother

39. Mr X alleges he and his brother have been discriminated against as males caring for a female. This is a matter more properly dealt with by the courts and so I consider Mr X should seek legal advice about taking such action should he wish to continue with this allegation of discrimination.

Fraudulent signature on initial assessment document

40. The member of care staff involved in the initial assessment says she cannot remember when the forms were signed but under no circumstances would she ever sign someone’s signature. The staff member confirmed it does look like she added the date to the form afterwards.
41. The care provider has denied it fraudulently signed the form in Mr X’s name. I do not consider I can resolve this with any certainty because of the lack of independent witnesses and the time that has passed since the alleged event occurred.

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Final decision

42. I am completing my investigation. I have not found evidence that the care provider’s actions have caused an injustice to Mr X or Mrs Y.

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Investigator's decision on behalf of the Ombudsman