Summary: Ms C complained to us about the homecare she received, the way in which the care provider investigated an incident, and the way in which it terminated her support package. We found fault with the way in which the care provider recorded some information.

The complaint

1. The complainant, whom I shall call Ms C, complains that:
• Even though she should have received four visits a day after the assessment in November 2019, she regularly only got three or two visits a day from March 2020 onwards.
• The care provider did not have a sufficiently strong and valid reason to give notice to her to quit.
• The care provider failed to inform her that it had given her notice to quit. It only told the Council, even though the contract was with her, and the terms and conditions said it should tell her.
• The care provider would tell care workers to stay 15 or 30 minutes longer, out of the blue and while the visit was taking place, without involving / asking her if that was ok. There was no need for it and, as a result, carer workers would just hang around in her property for 15-30 minutes, because there was nothing left to do. This was not in her best interests and should not have happened.
• The care provider failed to properly investigate and deal with an incident she had raised about one of its care workers.

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The Ombudsman’s role and powers

2. 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)
3. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. 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)

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How I considered this complaint

5. I considered the information I received from Ms C and the care provider. I shared a copy of my draft decision with Ms C and the care provider and considered any comments I received, before I made my final decision.

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What I found

The number of visits

6. Ms C lives in extra care accommodation where she received homecare support from the care provider. She arranged this via a Direct Payment that she received from the Council. This meant that any agreement about her care should be between Ms C and the care provider. The financial assessment from the Council concluded Ms C would have to pay around one third of the total cost of her care, with the Council paying the rest.
7. Ms C’s needs assessment of November 2019 says:
• She needs hoisting for all transfers.
• She is wheelchair dependent and cannot self-propel around her property.
• Her support package was 28 hours a week, consisting of 3 visits a day by two care workers who would visit together. Following a care review, the Council changed Ms C’s care package by five hours to 22.75 / hours week, consisting of four visits per day by one care worker. This was after an Occupational Therapist had assessed that Ms C’s care could be provided by only one care worker:
1. Morning visit (90 min): Full support with personal care, toileting, transfers, breakfast and morning routine.
2. Lunch visit (45 min): Support with preparation of lunch / snack and ensure to leave Ms C with a drink and items she needs for the afternoon. Support with toileting and personal care when required.
3. Afternoon visit (30 min): Support with personal care and toileting. Support with snacks/evening meal. Ensure property is left tidy on leaving, such as empty bins, wash up dishes from dinner, hang / put away clothing from the day.
4. Evening visit (30 min): Support with personal care, toileting and preparing for bed as needed.
• Ms C has a friend who supports her every day.
• Ms C can prepare snacks, light meals and drinks. Her friend tends to support her with preparing the main meal. Alternatively, care workers will do this.
• Ms C manages her medication with no issues.
• There can be occasions when Ms C may have to call the care agency to return to her if she has been incontinent, or her care calls may go over if she needed some additional support around her personal care. She can use her Direct Payments flexibly to cover these occasions and the care provider is able to accommodate that.
8. Ms C says that, even though she should have received four visits a day after her care review in November 2019, she regularly only got three or two visits per day after March 2020.
9. The care provider says that, because she did not want several care workers coming to her anymore, it explained to Ms C that it did not have enough workers left to guarantee it could provide her with four calls a day. There was therefore a verbal agreement in place with Ms C to work flexibly, delivering four calls based on the availability of the carer workers on her team. The provider advised Ms C that on the days she would not have a mid-afternoon visit, she could call the office if she needed support between her mid-afternoon and bedtime call. It discussed with Ms C that if Ms C was not happy with this arrangement, she was free to terminate the support and find another provider that could guarantee four visits per day. However, Ms C chose to remain.
10. The care provider’s records from April and May 2020 show that Ms C did not have four visits a day on 34 out of 61 days.
11. Ms C told me that:
• There were only three care workers she did no longer want to see, which were after incidents that happened and which she reported to the care provider.
• There was no such verbal agreement in place. She never agreed for her support to be flexible, she had no choice but to accept it.
• She would have been able to better manage the situation if the care provider had regularly provided her with a copy of the week’s rota. This would have shown in advance when there would be a gap in her support. However, she hardly received these; only about three times in almost two years.
• As such, she had to constantly call the office to find out if care workers would come and when. In those situations, she was just waiting without knowing what was happening, which was very distressing. She also soiled herself several times.
12. In response, the care provider said that:
• It never stopped sending a rota to Ms C. This only did not happen on a few occasions. Between January 2020 - June 2020 there were approximately four occasions on which rotas were not sent. Ms C received printed rotas via a care worker or via e-mail and text.
• Ms C did not have to wait without knowing what was happening as the care provider was in regular contact with her. Ms C communicated with the care provider every day about her care, so she was always aware what was happening.
• Ms C never soiled herself because care workers did not show up. Ms C was working flexibly with the care provider. On the occasions when it could not provide four calls, Ms C knew she could always call the office for immediate assistance if and when needed. In between her care calls there have been occasions when Mrs C had to call us out to attend to emergencies and we have always attended to her.
13. The care provider said it sent a copy of the weekly rotas to Ms C. However, Ms C told me she never actually received them. There is insufficient evidence to conclude whether or not the rota’s that I have seen, were actually sent and/or received by Ms C.

Analysis

14. Although Ms C received three instead of four visits on half of the days, this was mainly because she had indicated she did not want several care workers anymore. As such, there was a shortage in the number of care workers the provider could still allocate to her.
15. The care provider says that, as such, it explained to Ms C what it would be able to offer her going forward. It says the new arrangement was based on a verbal agreement with Ms C. This is fault, as there should have been recorded evidence that this change, which in affect was a change in the care plan and the agreement between both parties, was discussed and agreed by both parties.
16. Nevertheless, Ms C does not deny that the new arrangement (and the reasons for it) were explained to her. It was also Ms C’s choice to subsequently decide whether this would be acceptable to her, or if she wanted to try and move to another provider that could guarantee her four visits a day. There is no evidence she tried to see if there would be another provider.
17. As such, due to the unique circumstances explained above, I did not find there was fault with the care provider’s actions, as it told Ms C in advance what the limitations would be of what it could offer, which Ms C accepted.

The care provider’s notice to terminate the service:

18. Ms C says the care provider:
• Did not have a sufficiently strong and valid reason to give notice to her on 9 June 2020.
• Only told the Council that it decided to quit. It failed to inform her that it had given her notice to quit, even though it had the contract with her. She only found out when she called the Council.
• Should have been especially careful with making the decision to stop a client’s package, because all homecare agencies had stopped taking on new clients due to the Covid-19 Pandemic. This made it impossible for her to find another provider.
19. In response, the care provider says:
• It is the care provider’s policy to give two-week notice to the client and the Council. The care provider is entitled to give notice if it believes it can no longer work with a client. On the other hand, all service users are entitled to stop their care at any point.
• It told Ms C on 9 June 2020 that it would give notice to her because she continued to find the support unsatisfactory. This was before the care provider spoke to the Council on 10 June. As such, the support was to end two weeks later on 24 June.
• None of the care providers refused to take on new clients during the pandemic. Ms C had a lot of opportunity to find a new provider because there are a lot of providers within the area. However, some providers have refused to work with Ms C due to her behaviour with staff and her multiple complaints.
20. The care provider gave me:
• A copy of a hand-written note that said what was discussed during the meeting between the care provider and Ms C, before the package started. It mentioned there would be a 2-3 week notice period.
• A copy of its Service User Guide which it says it gives to all service users before the support package starts. However, Ms C says she did not receive a copy of this. The care provider did not make a record at the time that showed it had given this important document to Ms C. Furthermore, the document does not say anything with regards to notice periods, which is an important aspect of service delivery agreements.

Analysis

21. There was no fault in the care provider’s decision to give notice to Ms C. It tried to continue with her package, despite having a limited amount of care workers available for Ms C. However, it realised this solution was not working to Ms C’s satisfaction. In the end, a care provider is entitled to make such decisions.
22. Based on the balance of probabilities, I found the care provider did tell Ms C on 9 June 2020 that it would stop her support. However, it should have made a record of this important conversation at the time, which it failed to do. This is fault.
23. Furthermore, the care provider did tell Ms C verbally, at the start of the service, that there is a 2 to 3 week notice period.
24. However, the Service User Guide does not include any information about notice periods, when and how notice can be given and what the notice period is (if any). This is fault as this is important information that should be included.

The complaint about care staff hanging around after a visit

25. Ms C says:
• The care provider would tell care workers to stay 15 or 30 minutes longer, out of the blue and while the visit was taking place.
• This was done without involving / asking her if that was ok.
• There was no need for care workers to stay longer and, as a result, carer workers would just hang around in her property for 15-30 minutes, because there was nothing left to do.
• This was not in her best interests and should not have happened.
26. When asked, the care provider told me that:
• It never asked care workers to stay 15 or 30 minutes longer on calls.
• If care workers ever had to stay longer on a visit to Ms C, it was only with her approval.
• It would not allow care workers to ‘hang around’ in any service user’s home, as there is plenty of work to do. As such, its care workers always need to be on the go at all times.

Analysis

27. There is insufficient evidence to conclude, on the balance of probabilities, what happened.

The incident with a care worker

28. The incident happened early 2020. Ms C says:
• A care worker entered her flat and was constantly ‘sucking her teeth’.
• Ms C greeted the worker, but she totally ignored her.
• The care worker sat down and did not want to do anything, instead using her phone.
• She asked the worker to make a cup of tea and tidy the airing cupboard, but the worker ignored her.
• The worker also made a threat about gagging her to shut her up.
29. Ms C says the care provider failed to properly investigate and deal with this incident. Ms C raised the incident and chased this up. However, Ms C felt the care provider did not give any importance to it.
30. The care provider gave me a statement it obtained in February 2020 from the care worker. The version of events provided by the care worker at the time, was different to the one provided by Ms C and said:
• The care worker greeted Ms C.
• She cleaned the dishes, the desk and the sink.
• There was a disagreement about arranging towels in a certain manner, with the care worker saying she had already arranged the towels the day before.
• Ms C became upset and called the office to say the worker was insulting her and refusing to do what she told her.
31. There is no evidence if/how the care provider subsequently fed back the findings of its investigation to Ms C.

Analysis

32. There is insufficient evidence to conclude, on the balance of probabilities, what happened.
33. However, there is no evidence the care provider fed the outcome of its investigation back to Ms C, which is fault.

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Agreed action

34. Within four weeks of my decision, the care provider should:
• Ensure it has a system in place through which it will provide service users with written information about notice periods before the service starts.

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Final decision

35. For reasons explained above, I found some fault with regards to the care provider’s actions. However, these did not result in significant injustice to the complainant.
36. Under the terms of our Memorandum of Understanding with the Care Quality Commission (CQC), I have shared a copy of my final decision statement with the CQC.

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Investigator's decision on behalf of the Ombudsman