Summary: Ms X complained about the care provided to her father, Mr Y, and the way the Council dealt with her complaints about that. She said this caused significant distress. We find the Council at fault. It has agreed to reimburse Mr Y 50% of his contribution to his care and pay Ms X £600. It has also agreed to take action to avoid similar problems in future.

The complaint

1. The complainant, whom I shall refer to as Ms X, complained on behalf of her father, Mr Y about the care provided to Mr Y by the Council. She also complained about the way it dealt with her complaints about that. She said she and her family have had to provide care when the care should have been in place and the Council has ignored their safeguarding concerns. She said she had been caused significant distress because of the Council’s failings; she said family had been “worn down” juggling their lives to care for Mr Y.

Back to top

The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), 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 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), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended). We are satisfied Ms X is a suitable person to complain on Mr Y’s behalf.

Back to top

How I considered this complaint

5. I considered information from the Complainant and from the Council.
6. I sent both parties a copy of my draft decision for comment and took account of the comments I received in response.

Back to top

What I found

Background

Extra care housing

7. Extra Care Housing has varying levels of care and support available on site. People who live in Extra Care Housing have their own self-contained homes, their own front doors and a legal right to occupy the property.
8. Support to people at home might 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 (PA) paid for by a direct payment.

What happened

9. Mr Y needed support to live at home. In April 2019 he moved to Beechwood Court, the Council’s extra care sheltered housing scheme for people with dementia. He received support from Westminster Homecare Limited (North London/Herts), (the Care Provider) in his own flat. He received two hourly, 15 minute checks overnight, and four visits a day:
• 45 mins to give breakfast and support with personal care, dressing, catheter care and medication.
• 30 minutes to give lunch and support with catheter care if needed.
• 30 minutes to give dinner and support with catheter care and medication.
• 30 minutes to support with getting ready for bed.
10. The Care Provider took on the contract to provide care services for all the Council’s Extra Care sheltered sites, from September 2018. Mr Y had previously received support from the same Care Provider before he moved to Beechwood Court. This had been the subject of a previous complaint which resulted in a change of care providers. His family, particularly Ms X, were concerned about using the Care Provider but this was the service which had the contract for Beechwood Court. The Council and the Care Provider reassured them that the service would not be the same as before. Mr Y’s family had provided extra support to Mr Y for some time in his previous home and continued to do so.
11. Ms X says when she met the service manager from the Care Provider early in 2019, they said the Care Provider would work with the family to support Mr Y. He would be able to have some independence and the option of social activities including games, music, reminiscence, and outings. However, soon after Mr Y moved in, the family had “grave concerns” about the lack of care and attention given to Mr Y by the Care Provider. Ms X says there was no routine. Previously he had received three planned, timed visits for care but at Beechwood Court, he received only “sporadic and unannounced” visits by various care workers.
12. Mr Y was prone to infections and Ms X says the hygiene standards of the care workers were poor. Mr Y would leave soiled continence pads around the flat which the family would clear up on their visits as care workers did not. Wash cloths and other items were left with urine or faeces residue and not cleaned for further use, so family also did this. They also found spillages, urine and faeces smears around the flat, and washing up not done. Mr Y’s flat was cleaned weekly which he paid for in the service charge for his flat, but family had to do the cleaning between visits. Soon after he moved to Beechwood Court, Mr Y was admitted to hospital for a urine infection.
13. Ms X also said staff did not have a consistent “dementia-friendly” approach and took no action when Mr Y lost a lot of weight. Ms X also said the Care Provider did not record visits, or the care provided, and did not complete the fluid chart. Care workers didn’t speak to Mr Y when giving him medication and left food in front of him without prompting or assisting. She said family had no means of communicating effectively with the Care Provider and there were no records for them to see, or comment on, in the flat. Mr Y’s family had to take the lead on supporting his nutritional intake by involving the nutrition and dietetics service. The Care Provider was not recording Mr Y’s nutritional and fluid intake. The Care Provider did focus on getting Mr Y out of his flat to be with the other residents, but Ms X said this was for the Care Provider’s convenience rather than to undertake activities. She said staff were not professional and family got shrugging shoulders, eye rolling, doorstepping and bombarding with private information in public. The family believed Mr Y’s dignity, respect, care and liberty were being compromised and were concerned that the Council had not taken the concerns seriously.
14. Ms X first complained in May 2019. The social worker escalated her concerns and Ms X spoke directly with the commissioning team. They who agreed to complete an unannounced monitoring visit to Beechwood Court in June but this did not happen.
15. In October 2019, following an approach from the family, a councillor forwarded their complaint to the Council’s complaints team.
16. The Council responded to the complaint one month later. The Council said it would expect the Care Provider to agree timing for Mr Y’s four calls each day with Mr Y and his family and adhered to as far as possible. Also, to leave the area where personal care was delivered in a satisfactory state and to dispose of continence pads and cleaning products appropriately. It asked Ms X to identify specific times when care workers did not clean up properly. It also said it would ask the social worker to complete a review, carry out an unscheduled visit and consider the issue of clearing plates, worktops and maintaining the home environment. The social worker would also review arrangements around monitoring Mr Y’s nutrition and hydration, also how the Care Provider recorded the care provided. It said it expected those working in a professional capacity to show sensitivity to discussing personal information. It mentioned that it would be helpful to explore some of these issues further in the meeting. It offered Ms X a meeting with the Head of Complex Care, the Care Provider’s Operational Director and managers from commissioning, and contracts.
17. In early January 2020, the Head of Complex Care and Head of Commissioning met with the family. The Council says Ms X said it was too late to consider complaints about the early part of Mr Y’s stay at Beechwood Court. The family said Mr Y should have his own care workers as they believed the current arrangement was putting him at risk. She said the care plan was out of date and referred to issues from 2017 and 2018. The Council said it was not possible for Mr Y to have his own care workers. Ms X understood the Council had not reviewed the service since April 2019 and it did not provide confirmation of any monitoring visits since then.
18. In March 2020, the first COVID-19 related national lockdown began and this significantly restricted access to care establishments. The family complained to the Council that care workers were not cleaning Mr Y’s catheter.
19. In May 2020, the social worker noted concerns by the scheme manager about the family’s expectations around personal care. The Council also says the Care Provider asked the family to complete a record of Mr Y’s food intake when giving him food.
20. Ms X says she arranged a case conference with various professionals and the family to discuss Mr Y’s needs as the family felt they were not being met. The dietician felt that staff were not coming back to feed Mr Y when necessary or recording his food intake. The Council increased Mr Y’s care package. It also offered a direct payment so that family could organise care workers to provide care during the day. The Care Provider had care workers on site, so would have still provided the overnight care. Mr Y’s GP felt Mr Y’s dementia was worsening and he needed specialist care in a care home for people with dementia. The social worker agreed with this. However, the family did not agree to this because of the situation with COVID-19.
21. The Council had no further contact with the family until December 2020.
22. The Council normally undertakes annual monitoring visits to Beechwood Court. The 2019 visit took place just before Mr Y moved there, but the visit planned for 2020 could not take place because of COVID-19. The next monitoring visit took place in May 2021. The Council says this was because it had to prioritise monitoring of other services due to risk. Officers visited to complete individual reviews during this time, but they reported no concerns to its commissioning team. The Council also held regular contract meetings with the Care provider which included discussions about the service at Beechwood Court. The Council says it has no specific concerns across the overall contract that would trigger any clauses which might result in terminating the contract. At the May 2021 visit, the Council noted that Mr Y had a folder in his flat containing his care plan and other documents. It noted there were no concerns and no evidence to support the family’s complaints. The Council concluded the Care Provider was delivering care in line with Mr Y’s care plan. However, it apologised and acknowledged it should have dealt with the complaint and dealt with the communication difficulties sooner. It offered a 50% reduction in Mr Y’s contribution to 12 May 2021, which amounts to £1,350. It also offered Ms X £300 for the delay and £300 for her time and trouble in making the complaint.
23. Ms X’s view is that the family’s concerns raised many safeguarding issues which had potential to result in Mr Y being neglected and injured. Rather than providing a more supportive environment than Mr Y was in previously, Ms X says the opposite happened. I understand Mr Y’s needs have settled now and the service has improved.

Was there fault which caused injustice?

24. I am satisfied that, on the balance of probability, Mr Y’s care was less than adequate when Ms X first complained. The Council should have looked into this more effectively when Ms X first complained. Given the seriousness of the allegations and the potential risk to residents, an unannounced visit in June 2019 would have been appropriate, but this did not happen. These issues were potentially safeguarding issues but the Council delayed in addressing them. Mr Y was in his flat for almost one year before COVID-19 affected the Council’s ability to monitor the service effectively. The Council did apologise and offered a reduction in Mr Y’s contribution of 50%, which I consider an appropriate remedy for the service he did not receive.
25. I am satisfied that Ms X experienced significant and undue stress and frustration because the Council did not properly deal with her concerns. She was also caused much avoidable time and trouble. The Council’s offer of £600 was also appropriate to remedy this injustice.

Back to top

Agreed action

26. To remedy the injustice identified above, I recommended the Council:
• Apologise again to Ms X for the injustice caused.
• Reimburse Mr Y with 50% of his contribution (a value of £1,350) as previously proposed.
• Pay Ms X £600 in recognition of the stress, frustration, time and trouble it caused, also as previously proposed.
• Review the quality monitoring policies and procedures to ensure that the Council responds more promptly to concerns about the care provided.
• Review the communication between operational teams, care providers and the commissioning team to ensure collaborative and effective responses to concerns.
• Complete these actions within two months of my final decision and submit evidence of this. Suitable evidence would include:
1. A copy of the apology letter
2. Confirmation of the payments
3. An action plan showing progress on the remaining recommendations.

The Council has agreed to complete these actions.

Back to top

Final decision

27. I have completed my investigation and uphold Ms X’s complaints about the care provided by the Council to Mr Y and the way it dealt her complaints about that.

Back to top

Investigator's decision on behalf of the Ombudsman