Summary: The care provider did not ensure care workers with the right skills and experience were employed to support Mr X. As a result he became distressed and Mrs X had to terminate her contract with the agency.

The complaint

1. Mrs X (as I shall call the complainant) complains the care provider consistently put forward inexperienced careworkers as suitable to care for her husband who has dementia.

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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. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))

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How I considered this complaint

4. I considered the information provided by the care provider and by Mrs X. I spoke to Mrs X. Both the care provider and Mrs X had the opportunity to comment on an earlier draft of this statement and I considered their comments before I reached this final decision.

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What I found

Relevant law and guidance

5. 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.
6. Regulation 9 says care and treatment must be person-centred and meet service-users’ needs. It says the care provider should design care and treatment with a view to achieving service-users’ preferences an ensuring their needs are met.
7. Regulation 19 says staff should have the qualifications, competence, skills and experience necessary for the work to be performed by them.

What happened

8. Mr X has dementia and sometimes displays challenging behaviour. Mrs X approached the care provider for a live-in careworker who would be able to look after him and allow her some time off from her full-time role of caring for him.
9. Mrs X says the agency undertook a detailed assessment of Mr X’s needs. The agency has provided a copy of the care and support plan which it drew up to enable careworkers to support Mr X properly. The care plan says specifically that Mr X becomes anxious when separated from Mrs X; should not be asked too many questions; and becomes agitated when unable to express himself.
10. Mrs X says the agency assured her that its careworkers were highly experienced with dementia sufferers and well trained to manage Mr X’s behaviour. She says however that none of the careworkers the agency sent were able to cope with Mr X.
11. Mrs X says the first careworker was clearly anxious from the moment he arrived. She says on the first full day he was living with them, he took Mr X out for a walk and Mr X returned in an angry and frustrated state because the careworker had asked him lots of questions about his life. Mrs X points out that due to his dementia Mr X is no longer able to understand or respond to such questions. She says she spoke in more detail to the careworker about the nature of Mr X’s dementia and his responses made her question the extent of his training and experience.
12. Mrs X says she telephoned the agency with her concerns but was persuaded to give the careworker more time to settle in. She says she had an appointment the following day when she was away from the house for several hours and on her return Mr X was more agitated than she had previously seen him. She asked the careworker more directly about his experience and he said he had only cared for three elderly people with dementia, who were all compliant.
13. When Mrs X asked for a change of careworker, she asked the agency for a careworker with “significant experience” of caring for someone with dementia. The care provider replied that although there were no guarantees, the new careworker had experience and “had expressed his confidence” about looking after Mr X.
14. Mrs X says the second careworker was older and she thought would cope better with Mr X. She said however it was apparent from the outset that he struggled to communicate with Mr X. On the fourth day of his time with them the careworker took Mr X out for a walk. She says after 15 minutes the careworker called her to say Mr X had refused to go any further, tried to attack the careworker and then tried to run away. She says the careworker was so shaken by the experience he asked to be taken off the contract but to comply with the agency’s procedures, she had to terminate his contract. The careworker told her he had limited experience of caring for people with dementia.
15. Mrs X says the third careworker who the agency sent had only cared for her grandmother with dementia. Mrs X says she felt the third careworker was more willing to try and establish a relationship with Mr X. She says unfortunately she was frightened of Mr X and could not be left alone with him. Again Mrs X says she asked to be taken off the contract. The agency’s profile for this careworker said “For a half year (this careworker) has been taken (sic) care of a person who was living with Dementia and she understands the needs of people living with Dementia/Alzheimer’s.”
16. Mrs X complained to the care provider. She said the care provider had told her the careworkers had the necessary experience, but they did not. She said it had put the careworkers themselves in a difficult situation and caused herself and Mr X considerable stress and anxiety. She said it appeared that careworkers were simply asked if they had experience of caring for someone with dementia and not asked any more searching questions.
17. The care provider replied the careworkers had “successfully supported” other clients. The care provider said “Careworkers have a basic awareness of Dementia / Alzheimer’s as part of their training and may also have worked previously with clients with these conditions, but as we are sure that you are aware, all people living with dementia have different needs ….” and that the careworkers needed “time and support” to care for clients with dementia.

18. Mrs X said the agency had not provided the service it had invoiced for and she would only pay part of the invoice. She complained to the Ombudsman.
19. The care provider has sent us statements from the careworkers. One careworker said he asked to be removed from the contract ‘after the patient tried to beat me up’. Another of the careworkers denied he had asked to be removed from the contract but said he had only stayed three days.
20. The care provider has also provided details of the dementia awareness training which its careworkers received. It says “our care workers have training in line with the Skills for Care Care Certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. This is the training all care providers use as part of their induction process”.
21. One of the care provider’s team leaders who was responsible for sourcing carers comments, “I think that we need to be more careful when selecting a carer for Clients who live with their family and have a very strong relationship with them, and when we already know that there might be issues with Clients behaviours.” Another manager says he thought the fault possibly lay with the franchise partner who may have ‘oversold’ the service to Mrs X, “thus raising her expectations in regards to care worker training and experience, which was something that sadly and ultimately we could not deliver.”
22. The care provider has offered to waive the outstanding amount it said Mrs X owed. It agrees it did not meet the expectations or requirements of Mrs X but says the same care workers have worked previously and continue to work successfully with other people who are living with dementia.
23. Mr X went into residential care for a period of respite and has remained there.

Analysis

24. There was a mismatch between the experience of the careworkers, the needs of Mr X and the expectations of Mrs X which were to some extent raised by the care provider’s franchise partner with whom she liaised. Despite the detailed assessment and support plan, none of the three careworkers which the agency sent to look after him was able to cope, although Mrs X recognised they may have managed very well with other clients.
25. Two of the careworkers did not follow the care plan which the agency drew up. The plan was specific about the need not to ask detailed questions, so it was not surprising that Mr X became agitated when a careworker did precisely that.
26. The care provider has offered to waive the outstanding fees.

Agreed action

27. Within one month of my final decision the care provider will confirm to Mrs X that it has waived the outstanding fees.
28. Within one month of my final decision the care provider agrees it will review the way it matches client with careworkers to ensure where particular experience is requested, it is confirmed, and specifically how to manage clients’ expectations : it should provide details to me of how it intends to take this forward.

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Final decision

29. The actions of the care provider caused injustice to Mr and Mrs X. Completion of the recommendations at paragraphs 20 and 21 will remedy that injustice.

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Investigator's decision on behalf of the Ombudsman