The Ombudsman's final decision:
Summary: Ms X complained about the care and support provided to her father Mr Y by a Council commissioned care provider and that the Council failed to notify her when the care provider gave notice to terminate the contract. There was no fault in the care provided or in the way the care provider responded to Ms X’s concerns. The care provider was at fault when staff failed to complete daily records on four occasions and when a member of staff made an inappropriate comment to Mr Y. It has already taken action to prevent this recurring. The Council was at fault for not informing Ms X the care provider had terminated the contract. The faults caused Ms X and Mr Y distress and meant Ms X had to care for Mr Y when there was a gap in care provision. The Council has agreed to apologise and make payments to Ms X and Mr Y to acknowledge the impact of the faults.
- Ms X complains the Council commissioned care provider, Manorcourt Homecare, failed to provide adequate care and support to her father Mr Y. It missed some visits, failed to meet all his personal care needs and a carer was rude to Mr Y. In addition, the Council and care provider failed to notify her when the care provider gave notice to terminate the care package. This caused Ms X and Mr Y distress and meant Ms X had to meet Mr Y’s needs until emergency care was arranged.
The Ombudsman’s role and powers
- 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)
- 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)
How I considered this complaint
- I have considered the information provided by Ms X and have discussed the complaint with her on the telephone. I have considered the Council’s response to my enquiries, including records from the care provider.
- I gave Ms X and the Council the opportunity to comment on a draft of this decision and I considered any comments I received in reaching 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
Relevant Law and Guidance
- 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.
- 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 CQC has issued guidance on how to meet the fundamental standards below which care must never fall.
- The care and treatment of service users must be appropriate, meet their needs and reflect their preferences (regulation 9).
- The nutritional and hydration needs of the service user must be met. (regulation 14).
- The care provider must securely maintain accurate, complete and detailed records in respect of each person using the service. (regulation 17)
- Mr Y received a care package from the care provider, arranged through the Council. In 2020 Mr Y received three visits a day, with a one hour morning, 30 minute lunchtime and 45 minute tea time call.
- Mr Y needed support with personal care and application of creams, particularly to an infected area of skin. He could transfer independently and was mobile round the home with crutches but needed support with meal and drink preparation and prompting with medication.
- The daily care records show periods when Mr Y often refused personal care and declined having the infected skin cleaned and creamed. At the morning call Mr Y regularly wanted to continue sleeping and did not want assistance or breakfast. On some other visits Mr Y declined food as he had already eaten or was due to be visited by family who were providing a meal.
- There are no notes relating to a morning visit on 5 and 6 June 2020 or on 26 and 29 June 2020 and no notes of a lunchtime visit on 17 July 2020.
- Ms X emailed the care provider in early July 2020. She was concerned the carers were not meeting Mr Y’s needs. She reported they were not making his bed and were not creaming his infected area of skin.
- Ms X sent the care provider a further email later that day. She said the care coordinator from the care provider had visited Mr Y that day and she was unsure why. She said Mr Y raised some issues about a carer which the care coordinator would not listen to and they raised their voice. She also referred to a previous phone call made by the care coordinator to Mr Y when they asked for Mr Y to put the carer on the phone. Ms X says the care coordinator told the carer ‘to get that man off my back’ without realising the telephone was on speakerphone. Ms X said she had also contacted the Council to request a review of Mr Y’s care needs and call times. She also raised concerns that carers were not making Mr Y’s bed or doing washing, some carers were not able to cook and carers were not cleaning and dressing the infected skin area.
- The care provider arranged to meet with Ms X the following week. The notes of the meeting record Ms X raised her concern about the comment made by the care coordinator on the phone. The care provider said the comment was denied and they asked for details of the carer who was present. They also discussed the issues Ms X had raised in her email.
- Ms X said Mr Y did not like some of the carers’ cooking and that Mr Y may say he was not hungry but he would eat if food was put out for him. She was concerned some food was getting out of date. The care provider agreed to offer the food to Mr Y in date order. Ms X also reported Mr Y suffered with depression and there was an issue with him washing. He needed supervision in the shower as he had falls. The care provider noted this was not in the care plan which it said needed reviewing. It noted the daily records showed Mr Y seemed to eat well but did not want his skin checked. It agreed to add to the care plan about offering personal care in the evening if Mr Y refused support in the morning.
- Ms X also raised concerns about the bins not being emptied and Mr Y’s sheets not being changed. The care provider agreed to add these to the care plan. In addition, she said Mr Y did not want the care coordinator to visit again and raised concerns that other carers were off loading personal problems onto him. The care provider agreed to send a message to staff that this was not appropriate and to ensure the care coordinator did not visit. Ms X identified particular carers Mr Y preferred and the care provider agreed to try and accommodate this. Ms X also said she wanted to request extra time from the Council. The care provider asked Ms X to contact it when she had spoken to the Council so it could work on plans and ideas for Mr Y’s care.
- Following the meeting Ms X emailed the care provider. She said she had agreed with the Council that Mr Y would have a one hour visit in the morning, 45 minutes at lunchtime and a shorter tea time call. She stated Mr Y missed his late wife and required motivating. Ms X said she had also requested an increase from the Council of two hours for Mr Y’s well -being. She requested that all calls, appointments and time changes should be arranged through her.
- The care provider agreed to look to see if this could be accommodated. It later asked whether the meeting could be written up as a review of Mr Y’s care plan. It explained it would need to look at whether it could accommodate the longer lunchtime visit and it would let her know when this could start. Ms X responded that the Council had agreed to the changes and she requested a start date. She said she did not want to speak with the care coordinator and wanted communication by email. She also sought assurance that the care coordinator was spoken to about the previous interaction with Mr Y. The care provider offered to meet with Ms X again.
- Ms X contacted the care provider four days later. She declined the offer of a meeting. She said Mr Y remained upset about his interaction with the care coordinator and was concerned he was not believed. He had decided to find another care provider and so she had spoken to the Council. The care provider responded that they would complete their investigation into Ms X and Mr Y's concerns.
- The care provider wrote to Ms X in late July 2020 with its findings of the investigation into Ms X’s concerns. It explained the care coordinator had visited to carry out Mr Y’s care. It said the care coordinator had attempted to explain to Mr Y why they could not address the issues he raised as they related to a person who no longer worked for the care provider. It accepted the care coordinator made an inappropriate comment during a phone call and apologised for this. It advised the care coordinator would no longer visit Mr Y.
- It found the carers had offered and provided food and drink. Mr Y was spending long periods in bed. It agreed to try and use a particular carer Mr Y liked to encourage him to get out of bed and said that it would look to amend the call times but this would take time to arrange. It apologised for any distress caused by the situation.
- In late July 2020, the care provider gave the Council 28 days’ notice. The Council contacted the care provider seven days before the end of the notice period to request an extension as it had yet to source an alternative provider. The care provider agreed to extend the notice period by a further seven days.
- On 17 August 2020 Ms X contacted the Council as the carers had not turned up to support Mr Y. When she contacted the care provider, she told the Council, it had told her 16 August was their last day and the Council was aware of this. Ms X spoke to the Council which told her it had not been able to find a replacement provider yet. Ms X asked about the option of direct payments. The Council agreed to send her information about this. As Ms X was on annual leave from her job that week, she agreed to support Mr Y.
- The Council arranged an emergency care package for Mr Y which commenced on 24 August. Ms X met Mr Y’s care needs between 17 and 23 August. Following this Ms X sourced a personal assistant for Mr Y using direct payments.
- In late August 2020, Ms X complained to the Council about the gap in care provision. It responded in early September 2020. The Council noted the allocated council officer involved was ‘sincerely apologetic’. They had failed to contact Ms X to advise the care provider had given notice on the care package and had failed to keep her updated about their efforts to source an alternative care package. It said the officer should also have discussed the option of direct payments with the family at an earlier date. The Council said it had spoken to the officer about best practice and the actions they should have taken.
- The care provider’s records show it assessed Mr Y’s needs appropriately when it started supporting him. At the majority of visits, it competed daily care records which noted the support provided at each visit.
- There were five visits in the notes for which there is no entry. Of these five the care provider says one was a cancelled call. The care provider says the four other calls were attended but the carers did not complete the daily records. This is fault and leaves Ms X with a sense of uncertainty over whether the visits occurred or what happened at the visits.
- The care provider says it audits care records but accepts it had not identified these gaps sooner. It says where errors are identified it normally raises these with staff to establish if this was an error or they were asked to leave before they could complete the records. It says it is currently investing in call monitoring technology whereby staff would log in and out using mobile phones and would complete electronic records of visits. It aims to have this in place by late spring 2021. I am satisfied this action will prevent the same fault happening again.
- The daily care records show Mr Y regularly refused personal care in the mornings. Mr Y had capacity to make his own choices about the care he would accept. Ms X may feel the carers should have been more persuasive but that does not amount to fault by the care provider. When Ms X met with the care provider in July 2020 the notes record she accepted Mr Y was embarrassed about carers providing personal care. The care provider agreed that in future if Mr Y had not received personal care in the morning it would offer it again at the later visits. This was appropriate.
- The records show carers provided Mr Y with a variety of meals, based on his preferences. Mr Y had concerns about certain carers but based on the records available there is no evidence of fault. Ms X raised concerns about food going out of date. The care provider agreed that in future it would offer food to Mr Y in date order. Mr Y had capacity to make his own choices about what he wanted to eat and when and about whether or not to receive personal care. Mr Y had the right to make decisions which were not necessarily in his best interest and the carers had a duty to respect his wishes.
- When Ms X raised concerns the care provider acted appropriately by meeting with Ms X. At the meeting Ms X identified issues around Mr Y’s mood and mobility which were not reflected in the care plan. She also raised issues around his bed not being changed and bins not being emptied.
- Some of Ms X’s complaints of poor care relate to incidents for which there is no real objective record. That means I cannot draw conclusions about whether the care was satisfactory. However, the care provider acted appropriately by agreeing to update his care plan to address these issues. This was appropriate considering Ms X’s dissatisfaction with the care provided.
- The care provider investigated and responded to Ms X’s complaint. Following the investigation, it accepted the care coordinator made an inappropriate comment about Mr Y and it has already apologised for this. However, this affected Mr Y’s confidence in continuing to use the care provider.
- The Council was at fault when it failed to advise Ms X the care provider had given notice, it failed to keep her updated and failed to discuss the alternative options for care, including the use of direct payments, until after the notice period had ended. This is fault and meant Ms X had to fill the gap in care provision between 17 and 24 August 2020.
- Within one month of the final decision, the Council has agreed to apologise to Mr Y and pay him £100 to acknowledge the distress the staff member’s behaviour had on his confidence in the care provider. The Council has also agreed to apologise to Ms X and pay her £300 to acknowledge the uncertainty caused by the gap in the care provider’s records and the distress and additional strain she was placed under by having to meet Mr Y’s care needs when there was a gap in provision.
- I have completed my investigation. There was evidence of fault causing an injustice which the Council has agreed to remedy.
Investigator's decision on behalf of the Ombudsman