Summary: Ms X complained about the quality of reablement care provided to Mrs Y on behalf of the Council. The Council was at fault for failing to ensure CRG Homecare kept proper records and provided a female carer for Mrs Y. This caused Ms X unnecessary distress and frustration. The Council has agreed to make a symbolic payment and ensure CRG Homecare reminds staff to record their visits properly.

The complaint

1. Ms X complained about the reablement care provided to her mother by CRG Homecare (CRG) on behalf of the Council. Ms X is unhappy:
• CRG sent a male carer to help her mother, Mrs Y, contrary to Mrs Y’s wishes;
• visits were often too short; and
• CRG failed to respond to her communication and complaints in a timely and comprehensive way.

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The Ombudsman’s role and powers

2. 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)
3. 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)
4. 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)
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

6. I have considered:
• all the information Ms X provided and discussed the complaint with her;
• the Council’s comments about the complaint and the supporting documents it provided; and
• relevant law and guidance and the Ombudsman's guidance on remedies.
7. Ms X and the Council 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

Relevant law and guidance

The Care Act 2014

8. The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan to a person with eligible needs. The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. The Council is responsible for ensuring the support set out in the care and support plan is delivered.

CQC Regulations

9. The Care Quality Commission (CQC) is the statutory regulator of care services. Its Regulations set out the fundamental standards those registered to provide care services must achieve. The CQC has issued guidance on how to meet these standards. The standards include:
• Regulation 10: Dignity and respect. When providing personal care, the provider must try to respect the person’s preference about who delivers their care. This includes providing staff of a specific gender;
• Regulation 16: Receiving and acting on complaints. This Regulation requires care providers to have suitable processes in place so that it can investigate and act on any complaint without delay; and
• Regulation 17: Good governance. Providers should keep an accurate and contemporary record of the care and treatment provided to the person receiving support. Guidance also says records should be stored and destroyed in line with current legislation and guidance.

NICE quality statements

10. The National Institute for Health and Care Excellence have issued guidance on home care for older people. The guidance says home visits should be at least 30 minutes. Exceptions to this rule include where the visits are for specific tasks or checks or where they have been agreed as part of a wider support plan.

Reablement care

11. The Care Act 2014 guidance says reablement services are those usually provided to older people after they have left hospital. They are provided for a limited period of time to help a person to maintain or regain the ability to live independently.

CRG Homecare’s complaint policy

12. The complaint policy has four stages. Stage one involves local resolution. In stage 2, a complaints coordinator will acknowledge the complaint in three working days and a regional manager will respond in a further 15 working days. Stage 3 is escalation to a director who will review the decision within 15 working days. Finally, the complainant can ask for an appeal. The managing director considers the appeal and should send the outcome within 28 working days.

What happened

13. Mrs Y has a medical condition which affects her memory and ability to care for herself. At the time of the issues complained about, Mrs Y lived with Ms X. The Council produced a care and support plan which detailed the help she needed. This included carers coming into Ms X’s home to help Mrs Y to feed, wash and dress herself.
14. In 2019, Mrs Y was admitted to hospital. In preparation for her discharge, the Council assessed her needs and decided she should receive reablement support at home. The Council arranged a package of support which included one hour of mobility help in the afternoon and half an hour in the evening. The Council's reablement plan noted the evening call should only be carried out by a female carer. The evening visit was to help Mrs Y use the toilet and change her incontinence pad.
15. The hospital discharged Mrs Y in mid-August 2019. CRG provided the reablement support for one week before Mrs Y was admitted to hospital for a different health concern.

Male carer

16. On the first three nights of the reablement, CRG sent a male reablement assistant (RA). Ms X says she told the RA on the first day that Mrs Y had asked for female carers. She refused the RA entry on every occasion. The Council says CRG contacted its Reablement Team on the first day to say Mrs Y had refused to allow the RA to provide care. The Council did not take any action until later in the week.
17. After the male RA visited on the third evening, Ms X says she contacted CRG again to ask them to send a female carer. She says CRG directed her to contact the hospital, and she eventually spoke to social services at the Council. The Council said it could not send a carer until 3am. Ms X says this was distressing for her and Mrs Y and meant Mrs Y soiled herself. CRG said that when Ms X called, it should not have directed her to the hospital. However, it does not hold a record of the phone call so cannot confirm what advice it gave that night.
18. On the final three nights, CRG sent a female carer to Mrs Y in the evening.
19. In its response to my enquiries, CRG said it has now introduced a new process. It calls the person it will be supporting before reablement begins and is preparing an information leaflet with details of its service. It also has a section on its staff rota to record a person’s requirements, including the gender of their carers.

Short visits

20. Ms X says the week CRG provided reablement, the visits were often short. CRG uses a system which allows carers to log in and out of a visit to record its length. Carers did not use the system for the first four days of the reablement. CRG says this could be because the male RA could not log in or out if Ms X refused him entry. It said other appointments may have been cancelled. However, I note there were no cancellations and carers visited every afternoon but failed to log in or out.
21. On the final three days, all the visits were at least ten minutes shorter than the reablement plan stated. On one occasion, a carer visited for thirteen minutes instead of an hour. CRG has been unable to provide me with records of the carer visits. It said a member of staff who has now left the business collected the care records from Ms X’s home and it cannot find them.

Complaints handling

22. Ms X was dissatisfied with the quality of care and contacted a manager to complain. She did not receive a response so contacted a regional director. Ms X says she did not hear anything in response. CRG says both the manager and regional director left the company before responding to Ms X’s complaint. They did not record the complaint on CRG’s complaint handling system or tell anyone else about it.
23. Ms X then took no further action for some time. In mid-2020, she complained to another senior member of staff. Ms X says the response was unsatisfactory and incomplete. As a result, in June 2020, CRG offered to investigate more fully.
24. A branch manager responded later that month. CRG said:
• the male carer visited because of an oversight by the care coordinator at the hospital and once it became aware of the issue, it ensured only female carers would visit; and
• it was sorry for the length of time it took to respond to Ms X’s complaint. In future it would respond to complaints in ‘the agreed time frame’, and ensure it communicates effectively with clients and family.
25. Ms X continued to express her concerns to CRG. The same branch manager responded. Ms X remained dissatisfied and complained to the Ombudsman.
26. In its response to my enquiries, CRG said it now ensures only certain members of staff are involved in responding to complaints.

Findings

Male carer

27. Regulation 10 says care providers should ensure care respects a person’s preferences, including the gender of the caregiver. CRG accepts it should not have sent a male carer to Mrs Y’s home. It says this was due to a miscommunication from a hospital coordinator. However, Mrs Y’s reablement plan clearly states she should only have female carers in the evening. CRG failed to comply with Regulation 10 this was fault. We hold the Council responsible for acts and omissions of organisations acting on its behalf.
28. Ms X says Mrs Y would have been extremely distressed by the presence of male carers. On every occasion the male RA visited, Ms X was present and prevented the carer from entering the home. I am therefore satisfied Mrs Y did not experience significant personal injustice from the male carer visiting.
29. The fault by CRG meant that for three nights, Mrs Y did not have the support the Council assessed her as needing. However, the support was to encourage Mrs Y to use the toilet and help change her pad. Ms X was present throughout the night to provide emergency support so I do not consider Mrs Y was put at risk of harm. The fault caused Ms X uncertainty and distress.
30. CRG have been unable to provide me with the record of Ms X’s telephone call to ask for a female carer. I therefore cannot make a judgement on what advice it gave Ms X.

Short visits

31. CRG’s time logs show carers visited for less than Mrs Y’s allocated time. This may have been appropriate, if Mrs Y did not need or want support when the carers arrived. CRG says it cannot find Mrs Y’s daily records as a former member of staff took them from Ms X’s home. This was fault. CRG had a responsibility to ensure records were kept securely.
32. CRG’s time log shows carers did not log visits in the first four days it provided support. I accept this may not have been feasible for the male reablement carer when Ms X refused him entry. However, CRG is at fault for failing to ensure the carers who visited in the afternoon properly recorded their visit.
33. I do not consider the failure of CRG to make and keep proper records caused Mrs Y or Ms X significant personal injustice. Ms X was aware of the carers arrival and departure. There is no evidence that Mrs Y missed out on care she should have received in the afternoon calls or that Ms X complained about that at the time.

Complaints handling

34. At the time of Mrs Y’s reablement, Ms X complained to two managers about the care Mrs Y received from CRG. Neither manager responded to her complaint. This was fault. This caused Ms X frustration and meant she had to spend unnecessary time pursuing the complaint.
35. CRG says the managers left the organisation before answering Ms X’s complaint. It said it now responds within the relevant time frames and has restricted the staff who can respond to complaints to make sure it answers them. I am satisfied with the action CRG has taken to prevent the issues recurring.
36. Once Ms X resubmitted her complaint in June 2020, CRG responded within 15 working days. However, it did not follow its own escalation procedure. This was fault but did not cause Ms X significant personal injustice because she was still able to complain to the Ombudsman.

Agreed action

37. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the service of CRG Homecare, I have made recommendations to the Council.
38. Within one month of the date of my final decision, the Council will:
• apologise for the faults identified in this decision; and
• pay Ms X £100 in recognition of the uncertainty and distress caused to her by CRG’s fault.
39. Within three months of the date of my final decision, the Council will ensure CRG Homecare reminds staff:
• they must properly record their arrival and departure from visits;
• all records should be kept securely in line with its policy and relevant legislation and guidance; and
• they should consider complaints according to its policy.

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Final decision

40. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice and prevent reoccurrence of the fault.

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Investigator's decision on behalf of the Ombudsman