The Ombudsman's final decision:
Summary: Mrs D complained about the unsatisfactory standard of domiciliary care provided to her mother, Mrs E, by Austen Allen Healthcare Ltd. Mrs D also complained that care calls were inconsistent and too short. We find that Mrs E and Mrs D suffered an injustice. To remedy this, the care provider has agreed to apologise to Mrs E and Mrs D, and pay Mrs E and Mrs D a financial remedy.
- Mrs D complains the standard of care provided by Austen Allen Healthcare Ltd to her mother, Mrs E has not been satisfactory. She complains that Mrs E received inconsistent call times with carers staying for shorter durations than were scheduled.
- Mrs D also complained about;
- Mrs E receiving poor and unhygienic care;
- Receiving poor query response times and a poor service from the accounts department;
- The Care Provider not following its own action plan.
- Mrs D says this has caused distress to both Mrs E and herself and has put her to the time and trouble of complaining.
- This is a joint complaint. Mrs D also represents her mother, Mrs E, in making this complaint.
The Ombudsman’s role and powers
- 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. If they have caused an injustice we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
- We may investigate a complaint on behalf of someone who cannot authorise someone to act for them. The complaint may be made by:
- their personal representative (if they have one), or
- someone we consider to be suitable.
(Local Government Act 1974, section 26A(2), as amended)
- We normally name care homes and other providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
- We normally expect someone to complain to the Care Quality Commission about possible breaches of standards. However, we may decide to investigate if we think there are good reasons to do so. (Local Government Act 1974, section 34B(8), as amended)
How I considered this complaint
- I have spoken to Mrs D and considered the correspondence in support of her complaint.
- I have made enquiries with the Care Provider and considered the responses provided.
- I have sent a draft to Mrs D and the Care Provider and have considered the comments before making a final decision.
- Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.
What I found
Law and policy
- 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.
- The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
- I have also considered the National Institute for Health and Care Excellence “NICE” guidance NG21 Home care: delivering personal care and practical support to older people living in their own homes. Namely the following sections:
- 1.4.11 – Risks associated with missed or late visits and take prompt remedial action. Recognise that people living alone or those who lack capacity may be particularly vulnerable if visits are missed or late.
- Ensure monitoring of missed and late visits is embedded in quality assurance systems and discussed at contract monitoring meetings.
- 1.4.15 – Ensure home care workers contact the person who uses services (or their carer) if they will be late or unable to visit, as well as informing their manager, if appropriate.
- In 2016, Mrs E started a package of domiciliary care with the Care Provider, Austen Allen Healthcare Ltd trading as Austen Allen Homecare. This continues to the present day. Mrs E suffers with dementia and is now bedbound. Mrs E does not have capacity to decide about her care, so Mrs D acts as her representative and has power of attorney. Mrs D privately commissioned the Care Provider for Mrs E, agreed to the care package and signed a contract which set out its terms and conditions.
- Mrs E received three domiciliary care calls a day, each scheduled for 30 minutes. The carers attended in the morning, at lunchtime and in the evening to get Mrs E ready for bed.
- The Care Provider completed a care plan and a care assessment for Mrs E. These documents detailed Mrs E’s needs and specified she needed a high degree of support with her personal care, hygiene and the application of medicated cream. The care provider says that care plans and tasks were created with the input and cooperation of Mrs D. It says it reviews the care plan each year which can be altered or amended if circumstances change.
- Mrs D said Mrs E’s care needs changed in August 2019. She said two carers were required to attend at each care call to help due to her becoming bedbound. This also incurred an extra cost to Mrs E.
- Mrs D said she would often be present when the carers attended her home to attend to Mrs E. She said she became concerned about the time keeping of the carers and the short length of time it took them to complete tasks set out in Mrs E’s care plan. Mrs D said the carers were not staying for the full allocated 30 minute duration but still charging Mrs E for the full amount of time. She questioned whether the standard of service and care Mrs E was receiving had been affected as tasks were being completed in a short amount of time.
- In December 2019, Mrs D began a log detailing the time keeping and duration of calls provided by the Care Provider to Mrs E.
- Mrs D said that the standard of care provided by the Care Provider had been inadequate. She complained about an incident where she said the carers while assisting Mrs E with personal hygiene had failed to remove a cleaning wipe from Mrs E’s thighs. Mrs D said this had caused her distress and was unacceptable.
- Around the same time a member of staff from the Care Provider visited Mrs D to conduct a review of Mrs E’s care package. This review acknowledged that Mrs D had previously raised concerns regarding short calls and standard of service during a previous telephone review in November 2019. It was recorded that this was the first time Mrs D had made the Care Provider officially aware of her concerns.
- Mrs D complained about a number of issues, namely;
- Inconsistent and short call times;
- Poor query response times;
- Poor service from the accounts department;
- Mrs E receiving a poor standard of care due to unhygienic practices.
- The Care Provider responded in February 2020 and set itself an action plan to improve the service it offered. It accepted there were occasions care workers did not arrive within the agreed time frames or stay for the full duration. The Care Provider said it would address this with staff. It also accepted it had not always communicated with Mrs D as well as it could. It listed and responded to each individual complaint.
Poor and Inconsistent Time Keeping and Short Calls
- The Care Provider acknowledged:
- Call times “varied massively in times and duration”. It said this was not an acceptable standard of service and did not reflect [its] intentions;
- Mrs E was not provided with consistent or similar times;
- Care staff had at times deviated from the allocated rota;
- Call allocations can be affected due to high sickness levels or holiday periods.
- On occasions prior to November 2019, care documentation had been minimal regarding details of the care provided to Mrs E.
- Call durations (to Mrs E) were below expected times between October, November and December 2019
Poor Query Response Times
- The Care Provider apologised to Mrs D from the delay in contact and also apologised for a missed care visit.
Poor Service by the Accounts Department
- In response to Mrs D’s complaints about poor service from the accounts department the Care Provider said;
- All tasks were completed during visits;
- There had been low call duration times;
- There had been a noticeable reduction in time with the service delivered to Mrs E;
- It had apologised for Mrs D receiving an incorrect invoice;
- Invoices for care were taken from the time care were set on the system not the time the carers attended.
- It had changed its invoicing software to avoid further issues.
- It said that all care calls were commissioned at a minimum of 30 minutes regardless of the care needed. It also said carers who regularly and consistently visited a client’s home would often be able to complete the tasks in a shorter time. The Care Provider also said if all duties had been completed the carer(s) are able to leave early with the permission of the client or family member.
- The Care Provider said;
- It had reviewed documentation from the day in question with tasks logged and completed;
- Record keeping and documentation not completed to a satisfactory standard (possibly due to the short call times); and
- It had spoken to two members of staff about the unhygienic practices. Neither carer could remember the incident and said the cleaning wipe had not been left on Mrs E’s person intentionally. It said both carers were alarmed to hear they potentially provided an unsatisfactory standard of care to Mrs E;
- The Care Provider concluded it took these matters very seriously and said Mrs E had not received an acceptable standard of care. The Care Provider said it had formally spoken to both carers involved in the complaint and that it would actively supervise them.
- The Care Provider agreed to undertake an action plan to resolve Mrs D’s concerns and said it would:
- Endeavour to attend call allocations within advised hourly slots.
- Provide care between 8:00-9:00am, 13:00-13:30pm and 18:00-19:00pm.
- Run weekly audits to monitor call durations.
- Conduct quality assurance telephone calls to verify tasks were completed to a satisfactory standard.
- Provide extra supervision for staff found to be significantly cutting the timing of visits.
- Electronically lock Mrs E’s care calls so the call time could not be manually adjusted and only changed by a manager or with Mrs D’s approval.
- Conduct two staff meetings to discuss concerns regarding Mrs E’s care.
- Carry out regular quality assurance calls with Mrs D to ensure all concerns are identified and to prevent Mrs E from receiving an inadequate service.
Further complaint regarding hygiene
- Mrs D emailed the Care Provider in mid-February 2020 with further complaints and concerns regarding the quality of care Mrs E had received throughout January and February.
- Mrs D said Mrs E’s standard of care was still not adequate and complained that further unhygienic practices were still occurring. She said there were:
- Occasions where only wipes were used when attending to Mrs E’s personal hygiene, rather than soap and water.
- Incidents where Carers had not disposed of soiled or unhygienic wipes and flannels and on an occasion had left them on a table in reach of Mrs E and near to confectionary;
- Concerns for Mrs E’s safety after she was left slumped in bed with the bed bar left down and;
- Concerns for Mrs E’s privacy and dignity as on one occasion blinds were left open when attending to her personal needs.
- Mrs D said she continued to monitor the care calls with the majority of calls being less than 15 minutes. Mrs D told the Care Provider she felt her mother did not need 30 minute care call times and requested these be reduced to 15 minute call times in line with the contract signed in 2016.
- The Care Provider said it conducted several telephone reviews with Mrs D between May 2020 and August 2020. It also had a follow up meeting with Mrs D to check on the quality of care. The Care Provider noted Mrs D had said she was unhappy her mother was being charged for 30 minutes of care when she felt she only needed 15 minutes.
- The Care Provider also completed two staff meetings discussing the standard of care to Mrs E. It noted that it was unacceptable for staff to be spending less than 50% of the allocated call times with clients. It said staff could leave early but this had to be at the client’s discretion and should only be 5-10 minutes. It explained that staff should now only be using the electronic monitoring system when visiting Mrs E and that it would be carrying out an audit.
- The Care Provider also did a care call audit from 14 February 2020 to 26 June 2020. This noted that all tasks had been performed but that the call durations were still falling short.
Further complaint regarding short calls
- In August 2020, Mrs D complained that despite the Care Provider’s action plan Mrs E was still receiving short calls and was charged for the allocated 30 minutes which she was not receiving.
- Mrs D again told the Care Provider she believed Mrs E did not need 30 minute care calls as all tasks were complete sufficiently within 15 minutes. Mrs D asked that Mrs E’s care calls be reduced to 15 minutes.
- The Care Provider acknowledged Mrs E’s needs were being met in less than the allocated 30 minutes. However, it also said that it did not offer care visits for 15 minutes and gave Mrs D four weeks notice to end the contract.
- Mrs D replied and said that Mrs E’s original contract signed in 2016 had offered 15 minute care calls and asked the care provider why this was no longer available.
- The Care Provider said 15 minute care calls had ended in 2017 and it said it sent letters containing the new terms and chargeable rates to all self-funded clients in January 2019. It said it assumed Mrs D and Mrs E had received the letter as they continued to pay for care
- Mrs D raised her complaint with the Ombudsman. She said that although the Care Provider had corrected most of the consistency and standard of care, she felt her mother was still being charged for 30 minutes of care when she was receiving significantly less.
- Although it gave Mrs D the notice to quit, the following day the Care Provider responded to Mrs D’s request and said it would reduce Mrs E’s care call duration to 15 minutes three times a day and offered her a custom-made service. It also asked Mrs D to tell it immediately if she felt Mrs E’s care needs were not being met.
- Mrs D accepted the offer and Mrs E continues to receive care from the Care Provider.
Time frames and duration of care calls
- The Care Provider has recognised it did not provide an adequate or consistent service to Mrs E and acknowledges there were low call duration times. It has gone some way to remedying the injustice by offering a custom-made service, reducing her care call times to 15 minutes and implementing closed and audited electronic monitoring of consistency and duration. It also set up a quality assurance telephone review to ensure Mrs D was satisfied.
- In August 2020 and despite the Care Provider saying it was monitoring care call times, Mrs D felt the need to complain about it making short and inconsistent calls. I have seen evidence the Care Provider did conduct a call duration audit and noted it said that all tasks were being performed. An overview of the time and duration of care visits between October 2019 to mid-August 2020 showed that call durations were below the expected times with the majority of care calls to Mrs E being either late, early or short calls. This was fault, causing Mrs E uncertainty and distress.
- While I accept the Care Provider did set up an action plan and audited Mrs E’s care call durations from February 2020, it would have been reasonable to expect it to have acted on the data from the audit relating to care calls up to August 2020 which showed care call durations and consistency were still short and below the 30 minutes Mrs D expected. This was fault as it put Mrs D to the time and trouble of complaining about the same issue on several occasions.
- Since implementing the reduced call times to Mrs E, the Care Provider has said there have been no further issues with the care call durations.
Standard of service from the accounts department and poor query response times
- On the evidence I have seen, the Care Provider acted appropriately and looked into Mrs D’s concerns. It apologised for poor response times and poor service from the accounts department. It also accepted Mrs D had been issued with an incorrect invoice. The Care Provider said it corrected the mistake with the invoice as soon as it was aware and that it had changed the invoicing software to ensure further mistakes do not happen. I am satisfied with the Care Provider’s response and have not seen that this has caused a significant injustice to either Mrs E or Mrs D.
- The Care Provider’s response in February 2020 acknowledged that while tasks were being completed the record keeping and documentation was not to a satisfactory standard. When Mrs D raised her first complaint regarding unhygienic practices, the Care Provider acted appropriately and investigated her concerns. It took steps to try to prevent this happening again. It said it had checked its records and spoke to both carers regarding the incident. It also said it would actively supervise the carers involved. It conducted a comprehensive investigation into the complaint and produced an action plan to address Mrs D’s concerns.
- In its response to my enquiries in January 2021 the Care Provider said, “there was no evidence bought forward by other multi-disciplinary teams to support any detrimental effect on Mrs E’s personal care or wellbeing.”
- However, Mrs D made a further complaint about poor standards of care and unhygienic practices between January and February 2020. The Care Provider said on the first occasion unhygienic practices were bought to its attention it held a meeting with the carers involved. It said they had been unaware of the soiled wipe being left on Mrs E’s person.
- I am satisfied on the balance of probabilities that the lack of satisfactory evidence on how tasks were delivered means I must consider Mrs D’s recollections as showing some care was not delivered to an acceptable standard. The Care Provider should have been actively monitoring Mrs E’s care and it should have properly documented this.
- The CQC fundamental standards are clear. The Care Provider should have made sure Mrs E received safe care and prevented avoidable harm or risk of harm. It should have also made sure it provided care that always respected Mrs E’s dignity and privacy. Any unhygienic practice and poor care touches on the dignity of Mrs E. Mrs D was also distressed by the poor standard of care. This was fault affecting both Mrs E and Mrs D. The action taken by the Care Provider does not remedy the injustice entirely and therefore I feel on the evidence I have seen that a greater remedy is required.
- We aim to put someone back in the place they would have been but for fault. Our Guidance on Remedies suggests that where this is not possible, we will recommend the Care Provider make a symbolic payment for the lost hours and in recognition of the distress caused to Mrs E and Mrs D and for putting Mrs D to the time, trouble and inconvenience of complaining.
- The action taken by the Care Provider and the offer of an apology to Mrs D and Mrs E is what we would have recommended. However, it does not address all the fault that affected Mrs E and Mrs D.
- To remedy the injustice caused, the Care Provider has agreed to take the following action by 11 June 2021:
- Apologise in writing to Mrs D and Mrs E for the poor standard of service received and for putting Mrs D to the time and trouble of complaining.
- Pay Mrs E the sum of £500 for the distress caused by some incidents of poor care and the uncertainty of short visits.
- Pay Mrs D the sum of £200 for distress and putting her to avoidable time and trouble of making a complaint.
- The Care Provider is to notify the Ombudsman when it has completed the agreed actions.
- I find fault with the standard of service and care provided which has caused an injustice to Mrs E and Mrs D. The care provider has accepted my recommendations and I have completed my investigation.
Investigator's decision on behalf of the Ombudsman