Summary: The care provider failed to keep records as is required. It also failed to properly investigate the complaint into this matter and to implement the recommendations made in its response. In recognition of the injustice caused by these failings we recommended the care provider refunds Mr Y’s care costs for the month prior to his death, apologises to his family, amends its procedures and reminds its staff of the conduct it expects from them. The care provider agreed.

The complaint

1. Mrs X, who is complaining on behalf of her deceased father Mr Y, who had been receiving care at his home. She says the care provider failed to:

• put a logbook in place for a month and record what care was provided;
• escalate concerns about Mr Y’s health or notify his family, as requested;
• provide a copy of its contract with Mr Y;
• prevent Mr Y’s carer storing personal items at his home; and
• investigate the complaint about these matters properly as there were discrepancies in the response.

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The Ombudsman’s role and powers

2. We may investigate complaints from a person affected by the matter in the complaint, or from someone the person has authorised in writing to act for him or her. If the person has died or cannot authorise someone to act, we may investigate a complaint from a personal representative or from someone we consider suitable to represent the person affected. (section 26A or 34C, Local Government Act 1974)
3. The Ombudsman investigates complaints about adult social care providers and decides 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)
4. If there has been fault by a care provide, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34H(3) and (4), as amended)
5. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
6. If we are satisfied with the 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

7. As part of my investigation I discussed the complaint with Mrs X and considered information she provided. I made enquiries of the care provider and considered its response and information it provided. I set out my initial thoughts on the complaint and I considered Mrs X’s comments in response.

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What I found

8. Mr Y received care at his home from the care provider for several years. The care was funded by the Council. However following a review, the Council decided Mr Y no longer required care.
9. Mr Y and his family disagreed and asked the care provider to continue providing care which they would pay for.
10. On 22 November 2019, the care provider carried out a welfare assessment for Mr Y. The assessment said Mr Y should be visited each morning to provide personal care, help changing clothes and to change and make his bed. It also said the carer should log in and out, fill in any relevant charts or logs and notify the office of any concerns.
11. Mr Y’s self-funded care began on 24 November. I understand a contract was signed setting out the terms of the care provided.
12. Around the 14 December Mr Y began suffering from an upset stomach. Mr Y’s carer did not call a doctor, alert the office or contact his family, as they had requested if he was unwell.
13. On 20 December Mr Y received a scheduled visit from the district nurse. I understand that following this visit Mr Y was admitted to hospital where he died from pneumonia and septic shock.
14. Concerned about the care provider’s actions, Mrs X and her sister made a complaint. They asked why Mr Y’s carer had not contacted them or a medical professional earlier, why there was no logbook at his home detailing the care that had been provided and why no copy of the contract had been sent. They also asked why the carer had been storing a suitcase at Mr Y’s home and changing there for some time (correspondence says that Mr Y did not want to raise the matter with the care provider at the time).
15. The care provider responded that:

• while it followed its procedures when caring for Mr Y, its staff are not trained medical professionals. It could be difficult to assess the severity of an illness especially one such as vomiting;
• it acknowledged its carer could have responded differently and it has updated its internal procedures so staff are supported in making decisions in the future; and
• it had reported the incident to the Care Quality Commission (CQC) who had closed the case.

16. Unhappy with the response Mrs X wrote to the care provider again. It replied saying Mr Y’s care had changed to self-funding the week prior to his death and the paperwork was still being completed. This was why there was no logbook at his home and it had changed its procedures so this did not happen again. It did not address the other issues complained about or provide a copy of the contract.
17. Mrs X remained unhappy, especially as the final response from the care provider was inaccurate and approached the Ombudsman for assistance.
18. As part of my investigation I made enquiries of the Council. It provided the following response:

• Mr Y was a self-funding client from the 24 November to 21 December.
• In March 2020 the care provider sent records from the branch that cared for Mr Y to a storage facility as the branch had closed. For this reason, it has been unable to find a copy of the contract signed by Mr Y. It says that as Mr Y had capacity it would not normally send the information to a third party as it contained financial information.
• The logbook has also likely been archived as care records are removed from clients every month. So far a copy of the logbook has not been found. It said the logbook was likely removed to reflect changes to Mr Y’s care package.
• It could not find any record of Mr Y’s family’s request they be contacted if his health deteriorated.
• The officer who replied to Mrs X’s initial complaint has left the care provider and so they cannot clarify the changes referred to in his response.
• Disciplinary action has been taken against the carer regarding the storage of a suitcase at Mr Y’s home and the carer entering the property after Mr Y’s death to recover it. It said the carer suggested Mr Y said he could keep the suitcase there but acknowledged this cannot be collaborated. Nevertheless, the carer’s actions were a breach of its practices.

Analysis

The care provider failed for a month to put a logbook in place and record what care was provided

19. The care provider cannot provide a copy of the logbook and was unable to do so before the closure of the branch that cared for Mr Y. The final response from the care provider in February 2020 suggests the logbook was not in place at the time of his death because of the change to the funding of Mr Y’s care. I therefore, on the balance of probabilities, conclude the logbook was not provided. Without a logbook in place there would be no record of what care was provided to Mr Y during the month he was self-funding. This is fault as care providers should keep accurate records of the care provided.

The care provider failed to provide a copy of its contract with Mr Y

20. As with the logbook, the care provider cannot find a copy of the contract and says this is because it has been archived. However, Mrs X asked for a copy shortly after Mr Y died and well before the branch that cared for him was closed. I do not see why the contract could not have been provided when Mrs X first asked for it.

The care provider failed to escalate concerns about Mr Y’s health or notify his family, as requested

21. The care provider says it can find no record of this request and the documents given to me by the care provider do not refer to it. However as these are a welfare assessment and risk assessment, they would not necessarily record the request.
22. In its response to Mrs X’s complaint, the care provider says Mr Y’s carer followed its procedure but also he could have acted differently. It also said it had revised its procedures to ensure staff feel supported in making decisions. There is therefore some ambiguity about whether the carer acted as would be expected and if the care providers procedures were clear in this regard.

The care provider failed to prevent Mr Y’s carer storing personal items at his home

23. The carer should not have been doing this and the care provider took disciplinary action once it became aware. This was following Mr Y’s death as I understand he had not wanted to notify the care provider himself. I cannot find the care provider at fault for not taking action earlier.

The care provider failed to investigate the complaint about these matters properly as there were discrepancies in the response

24. I agree. The care provider’s final response to Mrs X wrongly stated Mr Y had only been receiving care as a self-funder for one week. He had been receiving care for nearly one month before he died. This mistake caused confusion to Mrs X and understandable concerns that her complaint was not investigated properly. Responses to complaints should be accurate.
25. Furthermore, the responses received by Mrs X refer to changes in procedures by the care provider. However, the care provider could not supply the details I requested because the responding officer had left. This suggests the changes have not been made as there would be a record of them. For this reason, it would not appear that the recommendations of the investigation were implemented. This is fault.

Agreed action

26. I have found fault by the care provider because it has not been able to provide copies of the logbook or contract. This has caused Mrs X concern about the care provided to Mr Y and in part necessitated her complaint.
27. I also found fault with the care provider’s handling of Mrs X’s complaint and its implementation of the recommendations it made in its response to her.
28. In recognition of these matters I recommend the care provider:

• apologises to Mrs X for the failings I have identified;
• makes a payment equal to Mr Y’s care costs for the month from 24 November 2019 in recognition of the uncertainty caused by the failure to provide a logbook or contract;
• reviews its procedures and notifies us of the changes made to ensure staff are supported in making decisions about the welfare of clients and that logbooks and contracts are provide to clients in a timely manner; and
• reminds carers of the standards it expects from them and that they should not store personal items, wash or change clothes at clients’ homes.

The above actions should be completed within six weeks of my decision.

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Final decision

29. I have ended my investigation of this complaint as the care provider accepted my recommendations which address the fault I found and the resulting injustice.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman