Summary: Miss C complained about the domiciliary care package provided to her late mother. Miss C said her mother paid for care she did not receive and her family had to provide personal care. We have found fault as some care outcomes were not consistently achieved but consider the agreed actions of an apology, partial refund of fees and procedural improvements provide a suitable remedy.

The complaint

1. The complainant, whom I shall refer to as Miss C, complains about the domiciliary care package provided to her late mother. In particular, Miss C says the care provider:

• failed to always offer personal care to her mother;
• failed to inform the family when her mother refused personal care;
• left her mother soiled and not changed;
• failed to keep proper records in the daily logs; and
• did not treat the family fairly about the notice period when her mother moved to a care home

2. Miss C says because of the provider’s fault, her mother paid for care she did not receive and her family had to provide personal care.

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The Ombudsman’s role and powers

3. 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)
4. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. 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)
6. 
   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)

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How I considered this complaint

7. I read the papers provided by Miss C and discussed the complaint with her. I have considered some information from the Care Provider and provided a copy of this to Miss C. I have explained my draft decision to Miss C and the Care Provider and considered the comments received before reaching my final decision.

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What I found

Background and legislation

8. Domiciliary care (home care) is support to people at home and may include: personal care, medication, access to the community, shopping or household tasks such as laundry, cleaning and meal preparation. These can be provided in daily visits or by a live-in carer, either through an agency or a personal assistant paid for by a direct payment.
9. The service can be commissioned privately in which case the contract will be between the care provider and the person requiring support or their representative, this includes agencies commissioned via a direct payment.
10. The care provider must assess the person and develop its own care plan(s) which are also known as support plans and risk assessments to ensure that the service it provides achieves what is being commissioned. These should provide step by step instructions to its staff so that they can provide the correct support without any previous knowledge of the person. Staff should make sufficient records to evidence the support it provides is in line with the care plan. These should be person centred – including information about how the person is feeling and any wishes they express. Daily notes usually give the details of this and care plans should be amended to reflect any changes.
11. Agencies are regulated by the Care Quality Commission. The CQC’s Fundamental Standards gives guidance to home care providers (among others) on complying with the requirements of the Health and Social Care Act 2008 in carrying out regulated activities.
12. NICE guideline NG21 Home care: delivering personal care and practical support to older people living in their own homes, was published in September 2015 and gives further guidance.

Key events

13. Miss C’s mother was elderly and paid for her own domiciliary care with a home care agency. The care plan dated 14 August 2019 for Miss C’s mother set out the following outcomes and detail:

• to provide company
• encouragement to go to the toilet
• to enable to remain at home
• help with getting up and ready for the day including a shower and getting dressed in the mornings
• help with pull up continence pads on all visits
• prepare breakfast, an early lunch and afternoon snack with drinks and encouragement to eat and drink

14. The above care plan also set out that if a shower had not been taken this should be logged in the journal so Miss C was aware. The care plan also referred to food preparation, laundry, bed making and light cleaning tasks as needed.
15. Care staff were scheduled to visit three times a day (an early morning visit, lunch and afternoon).
16. The signed service level agreement dated 14 August 2019 confirmed the start date for the services as 14 August 2019. This also set out that 28 days notice in writing or email was required to end the services once the statutory 14 day cooling off period had ended.
17. Miss C’s mother moved into residential care on 28 January 2020 and the contract ended after the expiry of the notice period on 6 February.

My consideration

18. The provider’s complaint correspondence with Miss C accepted that personal care was not always provided as this was often refused but stated that care workers would notify the office so they could let the family know. It was also noted that the daily logs would be removed at regular intervals for review to see if any changes were needed to the agreed care plan. I would have expected such a review to have identified that the agreed outcomes of the care plan were not all being consistently achieved.
19. I have considered the available daily care notes and the call-logging data which shows the times when care workers entered and left the property. The call logging data covers the total period 14 August 2019 to 6 February 2020. For the period of care between 14 August 2019 and 27 January 2020, I have been provided with daily logs between 22 August and 17 December 2019 with several logs missing during this period. Therefore, it is not possible for me to review the whole period in terms of the detail of the care provided. There is no suggestion that calls were missed or not of the required length.
20. From the notes I have reviewed, it appears the care provided was not always in line with the care plan. In particular, there is little evidence of a morning shower being encouraged or achieved or that a note was made in the journal when a shower had not been taken to alert Miss C as required in the care plan.
21. The daily notes show personal care was regularly refused or not fully completed at a significant number of the calls from the start of the contract. These include a note from Miss C’s brother on 4 September that it was important for the office to be told so they could let him or Miss C know. There are only a small number of occasions when there is a record in the logs of contact with either the office or the family directly about the refusal of care.
22. I have also reviewed the system notes provided which date from 30 September 2019 to 24 January 2020 which include telephone contact with the office by care workers to say personal care had been refused or not completed fully and that the office had informed the family. These include an email dated 14 October to the relevant team to say that if a clean pad could not be provided despite encouragement to inform the office so the family could be made aware.
23. However, when the system notes are cross referenced with the record of personal care being refused contained in the daily logs, the evidence is that only a small proportion of occasions were reported to the office and/or the family. The care provider has noted that the family were able to see the care calls and times that personal care was being refused via cameras in the property. The care provider also removed the charge for three calls during September.
24. I have found no fault in the way the provider acted in relation to the notice period which was in line with the signed contract.
25. Based on the information provided, I am satisfied the outcomes of the care plan were not all being consistently achieved with particular reference to personal care and communication as agreed with the family. This fault will have caused distress both to Miss C’s mother and the family.

Agreed action

26. The Care Provider will:
1. apologise to Miss C for the failure to ensure her late mother’s care outcomes were consistently achieved and the failure to communicate with the family as agreed within one month of my final decision;
2. refund 30% of the fees charged for the period of the contract within two months of my final decision;
3. pay Miss C £50 for her time and trouble in making the complaint within two months of my final decision; and
4. provide evidence to the Ombudsman that it has internal procedures in place to ensure it securely maintains an accurate, complete and contemporaneous record in respect of each service user, including a record of the care provided to the service user to show the support it provides is in line with the care plan within three months of my final decision.

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Final decision

27. I have completed my investigation as I have found fault but consider the agreed actions above are enough to provide a suitable remedy.

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Investigator's decision on behalf of the Ombudsman