Summary: The Council acknowledges the Care Provider failed to clarify timings of home care visits and that there were occasions when Mr Y’s care was not delivered in accordance with his care plan.

The complaint

1. Mr X complains that the Council-commissioned domiciliary care provided to his father, Mr Y, was inadequate.

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The Ombudsman’s role and powers

2. 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)
3. 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)
4. 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)

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How I considered this complaint

5. 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 statement, and considered the comments made.

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What I found

Relevant legislation

6. 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.
7. 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.
8. 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.
9. 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.

What happened

10. The Care Provider was commissioned by the Council to provide a home care package to Mr Y starting in July 2019. The Council sent a service request to the Care Provider at the end of May 2019. This stated Mr Y required 30 minutes in the morning to support with washing, dressing and preparing breakfast, 30 minutes at night to help get Mr Y ready for bed, make sure appliances were switched off and offer a drink, and two hours weekly to support Mr Y to maintain his home and do the laundry.
11. The Care Provider visited Mr Y on 11 July 2019 and completed an initial assessment. Mr X was present. The Care Provider says during this visit the worker confirmed the service would begin on 17 July 2019 and that timings of visits were discussed. Mr X expressed concern about the timings, saying the evening visit was too early for Mr Y. The worker said she would clarify if any changes to the times agreed with the Council could be made once she was back in the office and update Mr X. Mr X says this did not happen.
12. Mr X spoke to the worker again on 16 July 2019 and expressed his concern about the timings of the visits. He followed this up with numerous emails. The Care Provider shared Mr X’s concerns with the Council and said it could not accommodate later visits.
13. Mr X continued to raised concerns about this and other issues, including that he believed a carer had attempted to dispose of a glove down the toilet. The Care Provider met with Mr X, Mr Y, and the Council to discuss these concerns. The Care Provider also discussed the issues with its carers. It said it had not found any specific evidence to evidence the carer had attempted to dispose of the glove down the toilet, and the carer denied having done so, but it removed the carer from Mr Y’s rota. It says it clearly stated to Mr X and the Council it could accommodate the evening visits at 8:00pm only.
14. At the end of July 2019, Mr X emailed the Care Provider to report several concerns about the care package. This included Mr Y’s clothes and biscuits not being put in the correct place, Mr Y’s shirt sleeves not having been buttoned on several occasions, and some cleaning tasks not having been completed. He reiterated the evening visits were too early compared to Mr Y’s bedtime. Mr X told the Care Provider the morning visits also needed to be timed more consistently. Mr X said he frequently had to explain to carers where things were during evening visits. He said the care package was not achieving the aim of reducing stress for the family, who needed to help Mr Y just before bedtime due to the care visits being too early. Mr X said as Mr Y had not received the expected service, he should not have to pay for it.
15. The Care Provider spoke to Mr X the following day and followed this up with an email the day after that. The email reiterated the Care Provider could only offer an evening visit at 8 to 8:30pm due to existing commitments. It said it recognised this may not be wholly appropriate for Mr Y, but the care package was aimed to support him to get ready for bed, rather than put him to bed. The Care Provider suggested Mr X could discuss this with the Council to consider whether an alternative care provider should be commissioned.
16. The Care Provider said it would discuss the issues with care staff and make changes to Mr Y’s support plan to reflect Mr Y’s needs for assistance with his clothing and the placement of biscuits. It said any queries about paying should be raised with the Council. It explained its staff should only iron Mr Y’s clothes and not other family members’, but one of its care staff had reported Mr X’s clothes were in the pile of ironing. The Care Provider explained its service was a basic clean, not a deep clean, and carers could not move heavy furniture, clean windows if they could not reach them from floor height, nor could they clean walls and ceilings.
17. The Care Provider said the issues Mr X kept raising were detrimental to Mr Y’s care, and carers had reported feeling uncomfortable in the property. It explained due to Mr X excluding one carer, and two others asking to be removed from the rota, there were limited carers available to complete Mr Y’s care calls.
18. In August 2019, the Care Provider completed an updated support plan and discussed this with care workers. It identified a core team of care workers to provide some continuity and ensure carers had a clear understanding of Mr Y’s needs. The Care Provider reiterated to Mr X it was satisfied it was fulfilling the requirements of the Council’s service request, despite the timing of evening visits not being fully in line with Mr X’s request. The Care Provider said it spot-checked its carers in the community. It had stopped providing a cleaning service at Mr X’s request, and the Council’s social care department had confirmed they would be looking for a new provider, but the Care Provider would continue until then.
19. In mid-August, Mr X called the Care Provider to return to pick up a glove from the floor on one occasion, and to do up Mr Y’s shirt cuff buttons on another.
20. Mr X emailed the Care Provider explaining there was significant variation in how Mr Y’s support plan was being followed, and some items were still being returned to the wrong locations. He said he was surprised he had needed to tell the Care Provider that having familiar carers would be beneficial for Mr Y. Mr X said as the Council was not paying for Mr Y’s care, and Mr Y was, the Care Provider should be taking instruction from Mr Y and not the Council. He explained on several occasions, carers had been significantly late and had not notified the family. He said he had not seen evidence of spot checks. Mr X reiterated reducing his stress was part of the reason the care package was in place as he was a cardiac patient.
21. At the end of September, the Care Provider wrote to Mr X. It accepted its Care Supervisor had not telephoned Mr X as promised after the initial visit, to clarify whether timings of evening visits could be changed. It said Mr X had agreed timings of the evening visit were acceptable on one occasion but had then raised concerns again. It explained it had sent carers back on the occasions when Mr X requested this, and it had stressed to carers the importance of making sure Mr Y had access to his walking stick and telecare wrist band at the end of each visit. It explained some carers had accidentally opened the curtains and made the bed in a different bedroom rather than Mr Y’s bedroom, because they had got him ready in the other bedroom which was where his lift was situated. The Care Provider apologised that issues had arisen and told Mr X it had done everything within its control to address his concerns.
22. The care package was ended in September 2019 by the family due to their dissatisfaction. The Care Provider continued to provide a service to Mr Y until a different provider was commissioned for Mr Y.
23. At the beginning of October, Mr X wrote back to the Care Provider. He explained he believed his concerns had been trivialised and facts evaded. He said the Care Provider had not monitored carers until the end of August, and a spot check was only completed then because he had complained. He said the person who visited to monitor had said there had not been any monitoring in the area for a long time. He explained the Care Provider had failed to deal effectively with his concerns, and that communication had not been effective – for example, the family was not told when domestic work would start. He said the Care Provider had failed to appreciate the seriousness of a carer not having put Mr Y’s telecare wrist band back on after he had showered.
24. At the beginning of October 2019, Mr X contacted the Council to discuss the complaint after having exhausted the Care Provider’s complaint procedures. Mr X told the Council the Care Provider’s response did not address the facts and included insulting and condescending statements. The Council placed the invoices on hold.
25. The Care Provider offered a 10% discount on the invoices. Mr X says this is inadequate and he says the complaint response did not deal with all issues he raised. Mr X says the whole situation caused him unnecessary stress and extra work and affected his confidence in the Care Provider’s ability to deliver adequate care.

The Council’s response

26. The Council acknowledges there were occasions when aspects of Mr Y’s care plan were not delivered, for example his telecare alarm was not put on (although he did not suffer any adverse effects as a result of this); his walking stick was not left where he could reach it; and he was not offered a shave, but these were not regular or ongoing problems and they were addressed by the Care Provider and the social worker as and when they occurred. It also acknowledges there were issues with some of the finer detail of the tasks that care workers were performing. It says this is not unusual for issues of this nature to arise in the early stages of a care and support package, and the Council would expect the social worker and the provider to resolve these as the package settled in.
27. It says the domestic element of the care plan was cancelled at Mr X’s request. It says the Care Provider made suggestions as to how it may be possible to reconfigure the domestic tasks but as it was not possible to provide this in a way which met Mr X’s requirements he asked this to be removed.
28. It says the substantive issue related to the timings of visits. It accepts Mr X’s claim that there was a lack of clarity about the timing of visits and says it would have been helpful for the timings to have been clarified sooner. It “…proposes that the financial remedy that has been offered should be increased in recognition of the confusion about timings. [The Care Provider] has already offered to waive 10% of its invoice, which amounts to a little under £100. The Council therefore offers to double this to £200”.

Analysis

29. 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.
30. People have a right to good quality care. A person’s care and support needs should be clearly set out in a written support plan that describes what carers need to do to make sure a person receives personalised care. Carers should have sufficient knowledge about a person’s health needs and personal preferences. These are reasonable expectations.
31. Sometimes people’s expectations are not met, as is the case here. 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.
32. The Council acknowledges there were occasions when some aspects of Mr Y’s care and support plan were not met. This related to his telecare alarm, walking stick and shaving. I can understand Mr X’s frustration and concern about this, and that it may have affected his confidence on the Care Provider.
33. Ideally such incidents should not occur, but in reality they do. In such circumstances the Ombudsman considers the impact, and crucially how the Care Provider and Council responded. In this situation, no harm came to Mr Y, albeit Mr X was put to time and trouble reporting the matters. When he did, the Council, and the Care Provider responded appropriately. It discussed each reported incident with the carers involved, and updated Mr Y’s support plan with more detailed instructions.
34. I cannot come to a finding about Mr X’s allegation a carer dropped a glove down Mr Y’s toilet. However, I am satisfied the Care Provider took the allegation seriously and investigated the matter. The carer involved denied the allegation. The carer and Mr X have their own interpretation of events, and it is simply not possible for the Care Provider to come to a finding.
35. Some of the issues Mr X raised relate to matters than I would not consider a failing, but human error which had no adverse impact on Mr Y, issues about the placement of biscuits, a shower head and a dropped glove. I am satisfied the Care provider took steps to adequately rectify the situation.
36. In relation to domestic tasks. It is clear Mr X’s expectations were not met, but I am unable to come to a finding of any fault. It is not possible to determine the standard of any tasks completed by carers. I can say the Care Provider was correct, in that any cleaning was not a deep clean and carers should not be expected to move furniture. Neither should carers be expected to undertake cleaning, laundry, or ironing for anyone other than Mr Y.
37. Some carers requested not to visit Mr Y because of Mr X’s manner towards them. Again, this is open to differing interpretations and difficult to determine.
38. The Council acknowledges there was a lack of clarity about timings of visits. Mr X raised this before the care package started and thereafter. The Care Provider’s failure to clarify this at the outset led to frustration for Mr X and an element of mistrust. The timings may not have been convenient or desirable for Mr Y, but I am not persuaded any significant injustice was caused to him. The Council began looking for an alternative provider that was able to meet the times Mr Y requested.
39. Mr X believes the Care Provider failed to deal properly with his complaints and alleges it used insulting and condescending statements. I have seen no evidence which confirms the Care Provider used inappropriate language or condescending statements. However, it did fail to acknowledge its failure to clarify the timings of visits, and that Mr X had been to put to time and trouble chasing this matter.

Agreed action

40. The Council should, within one month of the final decision:

• apologise to Mr X and Mr Y for the faults identified above
• follow through on its offer to waive £200 from the outstanding care invoice
• pay Mr X £100 to acknowledge his time and trouble caused by the lack of clarity in timings of visits.

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Final decision

41. The Council acknowledges the Care Provider failed to clarify timings of home care visits and that there were occasions when elements of Mr Y’s support plan were not delivered. I do not consider any significant injustice was caused to Mr Y.
42. I do find Mr X was put to time and trouble pursuing the matter.
43. I consider proposed remedy, along with a written apology to be satisfactory way to settle the complaint. It is on this basis; the complaint will be closed

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Investigator's decision on behalf of the Ombudsman