The Ombudsman's final decision:
Summary: Mrs X complains about the standard of live-in care the care provider gave to her mother Mrs Y and its decision to charge a cancellation fee when she ended the care agreement. There is no evidence the actions of the care provider caused injustice to Mrs X or Mrs Y so we have completed our investigation.
- Mrs X complains for her mother, Mrs Y, about the standard of care Helping Hands Live in National (“the care provider”) gave to Mrs Y through live in carers which caused distress. In addition, Mrs X complains the care provider is unreasonably pursuing her to pay a cancellation fee when she ended the agreement to provide care. Mrs X considers the care provider should waived the fee because of the poor care Mrs Y received.
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. (Local Government Act 1974, sections 34B and 34C)
- We provide a free service but must use public money carefully. We may decide not to start or continue with an investigation if we believe:
- it is unlikely we could add to any previous investigation by the care provider, or
- it is unlikely further investigation will lead to a different outcome.
(Local Government Act 1974, sections 34B(8) and (9))
- We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:
- their personal representative if they have one, (Local Government Act 1974, section 26A(2), as amended)
- 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)
How I considered this complaint
- I have read the papers submitted by Mrs X and spoken to her and Mr X about the complaint. I considered the care provider’s comments on the complaint and the supporting documents it provided.
- Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
What I found
Relevant law and guidance
- 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.
- Regulation 19 says the care provider must give people information about the terms and conditions of their care, treatment, or support, including the expected costs and the requirement to pay for their care, treatment, and support.
- The care agency (which is registered with the CQC to provide domiciliary care services) provides live-in care at a person’s home. The live-in carers provide support with personal care, prompting or giving medication, using mobility aids and mobilising around the home safely. It says in the care agreement it asks clients to sign, “ Cancellation Fee – we require 14 days’ notice to cancel care either on an hourly or Live-In basis. We are committed to paying our carers for calls cancelled at short notice, so if care is cancelled without the required notice being given the first 14 days of care will still be invoiced. ” and “ if you wish to cancel the Services permanently, you must give us at least 14 Days’ notice.”
- Under a section on Refunds and Disputes it says “we want you to be happy with the service we provide to you and your loved one. In the event something goes wrong or is not to your liking, please contact your Care Manager at the earliest opportunity.”
Events leading to the complaint
- In December 2019 Mrs Y signed a care agreement with the care provider to provide her with live in care from one carer. The agreement included the terms and conditions. Mrs Y had capacity to decide on such an agreement.
- Mrs X told a care manager in January 2020 she was pleased with the care provided to Mrs Y. But wanted continuity of care so asked for a carer who could stay for a longer time. In February 2020 Mr X contacted the care provider to say Mrs Y was doing well and he served notice to end the care in two weeks. Mr X contacted the care provider a week later to retract the notice as Mrs Y‘s health had declined, and she wished to continue with the live-in care. Unfortunately, Mrs Y was admitted to hospital until April 2020 because of a fall.
- Mrs Y returned home in April 2020 with one carer and Mr and Mrs X stayed at the property for a week to help. A care manager updated Mrs Y’s care plan as Mrs Y needed two carers to tend her as the fall affected her mobility. The care manager sent the care plan to Mrs X and advised this doubled the weekly charge. Mrs Y told the care manager how happy she was with the carer who tended to Mrs Y on her own.
- The care manager reviewed the care plan and carried out a manager’s visit virtually because of COVID-19 restrictions. In the following weeks Mrs X questioned whether Mrs Y needed the two carers but agreed with the care provider to remain with two. The logbooks note that one carer reported to Mr and Mrs X about a change in Mrs Y’s behaviour and mental alertness. Mr and Mrs X were staying at Mrs Y’s property, so Mrs Y wanted them to provide her with support. The carer noted Mrs Y becoming unreasonable and demanding with them all and would not engage with her. The carer reported the matter to the care manager who arranged a different carer for Mrs Y.
- The care provider carried out two supervision sessions with the carers. An Occupational Therapist (OT) assessed Mrs Y’s mobility on 30 April 2020 to enable the carers to use a hoist to lift Mrs Y. The care provider says the hoist was delivered without a manual and handling plan. The logbooks record the carers tried to use the hoist to lift Mrs Y, but she complained of knee pain. On reporting this to the care manager they were told not to use the hoist until the OT drew up an action plan.
- The OT’s action plan specified 2 carers needed to use the hoist and to follow a Moving and Handling Plan. Mrs X says the OT sent the plan on 2 May, but the care provider says the OT did not provide it until 4 May 2020. The carers did not open the plan as they had not been trained to use the equipment then. The care provider says they could not use the equipment until they had received the appropriate training.
- On 1 May 2020 Mrs X emailed the care manager saying Mrs Y would be using a carer from a new care provider to support her from 4 May 2020. The new care provider would also be supplying a second carer. The care manager checked with Mrs X whether she was serving notice and advised of the two-week cancellation fee. Mrs X responded they were impressed with the service from the care provider, and they may well revisit it in the future. Mrs X asked for a reduction in the termination fee. The care provider declined the request and reminded Mrs X its terms and conditions were set out in the care agreement. The care provider invoiced Mrs X for £2831.
- Mrs X emailed the care provider saying she was only willing to pay the notice period at the daily rate of the new care provider who charged a lesser amount. The care provider refused the request. It says Mrs X did not raise any issues about the care provided to Mrs Y at this point and she had not previously raised concerns or made complaints.
- Mrs X thanked the care provider and considered one carer could not meet Mrs Y’s needs so was going with the new care provider who would use the hoist. The care provider reduced Mrs Y’s package of care to one carer on 4 May 2020 due to the new care provider supplying a carer. The care provider emailed Mrs X to confirm the remaining carer was trained in manual handling and happy to use the hoist for Mrs Y. It advised Mrs X if they decided not to keep using the carer, they will still receive an invoice to cover the two-week notice period.
- Mrs X submitted a complaint to the care provider about Mrs Y’s care. She provided a list of notes she kept about issues during the care package. Mrs X complained:
- The care provided fell short of that promised in the care provider’s publicity brochure in the care, duties and emotional support offered.
- There was poor communication between one carer and Mrs Y.
- The carers rang Mrs X on many occasions.
- One carer was reluctant to carry out night duties, leaving it to Mr and Mrs X when they stayed at the property for a short time.
- The carers did not keep Mrs Y’s bedroom and house tidy and change dirty bedlinen.
- The carers did not offer to go out and buy Mrs X a daily newspaper.
- A carer went out on long walks.
- The care manager would not visit due to COVID-19 restrictions.
- The carers regularly gave Mrs Y a PRN medication (provided on request) without her asking or with her knowledge as they did not use a syringe to administer it orally to her but used a spoon.
- The carers lacked confidence and were reluctant to hoist Mrs Y so she could get up and have essential exercise. Mrs X said the OT had left operating instructions which the carers opened but did not action them.
- During the care package Mrs X commented how pleased she was with the carers and said she was impressed by the service when she ended the agreement. This is at odds with the complaints Mrs X then raised when the care provider refused her request to waive the two-week notice fee. The terms and conditions of the agreement state Mrs X should raise any unhappiness with the service at the earliest opportunity. There is no evidence Mrs X raised any issues of concern about the care given to Mrs Y while the contract was in place. I would have expected her to do if she were unhappy with the care being provided. It was also a requirement of the terms and conditions to raise any issues at the earliest opportunity. If Mrs X raised concerns during the care package it would have allowed the care provider to investigate straight away and resolve matters if needed.
- In commenting on the draft decision Mrs X says she verbally raised concerns with the carers during the care package. But I have found not found any evidence to support this.
- The care provider looked into Mrs X’s concerns after the agreement ended. Its response shows it investigated and considered the concerns she raised about the standard of care, but expressed difficulty as she had not raised these issues while it was providing care to Mrs Y. The care provider referred to the carers’ logbooks which did not support the issues raised by Mrs X. The care provider did not uphold most Mrs X’s complaints because of lack of evidence to support her concerns.
- I have reviewed the logbooks provided by the care provider which are a detailed account of the care given to Mrs Y by the carers. The logbooks record carers carried out personal care and cooked meals for Mrs Y. They show the carers tidied the house, washed bed linen, and regularly went to get Mrs Y a newspaper. The logbooks note the carers helped Mrs Y exercise and the medication records show carers gave PRN medicine to Mrs Y at her request. These support the care provider‘s findings in response to Mrs X’s complaint. I do not consider I can add anything to the investigation it has already carried out or that any further investigation will lead to a different outcome.
- Mrs Y signed an agreement with care provider accepting the terms and conditions. These included agreeing to give 14 days’ notice to end the contract. Mrs X was aware of the requirement having done so in February 2020. Mrs X did not provide the necessary notice in May 2020, so the care provider was entitled to charge the cancellation fee in line with the agreement Mrs Y made. Because of this I do not consider the care provider’s actions have caused an injustice to Mrs X or Mrs Y.
- My finding is that no injustice has been caused to Mrs X or Mrs Y by the actions of the care provider.
Investigator's decision on behalf of the Ombudsman