Summary: Mr D complained about the domiciliary care his mother, Ms E, received from the Care Provider. We find that Mr D and Ms E suffered an injustice when the Care Provider failed to provide suitable care to Ms E. The Care Provider has agreed to our recommendations to address this injustice.

The complaint

1. Mr D complained about the domiciliary care his mother, Ms E, received from the Care Provider. He says Ms E was left cold, hungry, and confused. He says the carer failed to administer medication for a couple of days, the house was left unhygienic and dirty, he found the carer asleep in Ms E’s office and he found rotting food in Ms E’s kitchen.
2. Mr D adds the Care Provider’s responses to his complaint were inaccurate, inadequate, and incomplete.
3. Mr D says Ms E was distressed by the neglect she suffered. He also says he was upset to find Ms E in a state of distress.

Back to top

The Ombudsman’s role and powers

4. 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)
5. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
6. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
7. 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)
8. Under our information sharing agreement, we will share this decision with the Care Quality Commission.

Back to top

How I considered this complaint

9. I considered information Mr D submitted with his complaint. I made written enquiries of the Care Provider and considered information it provided in response.
10. Mr D and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

Relevant law and guidance

11. The Care Quality Commission (CQC) is the statutory regulator of health and social services in England. It keeps a register of care providers, inspects care services to assess if they meet the fundamental standards of care and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
12. 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.
13. Regulation 10 says service users must be treated with dignity and respect.
14. Regulation 12 says care and treatment must be provide in a safe way for service users.
15. Regulation 17 says care providers should maintain an accurate, complete, and contemporaneous record in respect of each service user.

Lasting power of Attorney (LPA)

16. This is a legal document that lets a person appoint one of more people to help make decisions or make decisions on their behalf if they have lost mental capacity. There are two types of LPA: ‘health and welfare’ and ‘property and financial affairs’.

What happened

17. In July 2020, Ms E started a package of domiciliary care with the Care Provider, Bluebird Care, which is run by Rampion Limited. Ms E has Alzheimers. Mr D holds a joint LPA for Ms E for both health and welfare and property and financial affairs.
18. The plan was for Ms E to have a live-in carer for four weeks, and then Mr D would look after Ms E for a week, and then the cycle would repeat itself.
19. Ms E’s care and support plan said she wanted the live-in carer to keep her house clean and tidy, administer all her medication and prepare her meals and drinks throughout the day. It also said she wanted to choose her own clothing, but she might need prompting from the live-in carer to change her clothing if she was not clean.
20. The carer in relation to this complaint started providing care to Ms E on 1 September.
21. Ms E regularly refused to take her inhaler. The carer referred Ms E’s refusal to take her inhaler to her GP on 4 September. He said it was not dangerous for her to occasionally refuse her inhaler, but the carer should make sure she did not stop altogether.
22. The care notes show that on 20 September, Ms E was coughing and short of breath. The carer gave Ms E her inhaler and she quickly recovered.
23. Later that same day, the carer called 111 and the out of hours doctor. She could not get through to the out of hours doctor, so she reported the matter to Ms E’s GP surgery.
24. The care notes from 21 September show that Ms E was still recovering from her asthma attack. The carer discovered there had been rats in the conservatory. She cleaned the area with bleach and soap. Mr D says there was a mouse in the conservatory rather than rats.
25. Ms E started to suffer from a sickness bug on 23 September. The carer gave her honey to keep her blood sugar levels up. Later that same day, the carer called 111 for advice. The operator told her she was doing everything right and she had to continue giving Ms E honey. Mr D says the carer called him four hours later to tell him about Ms E’s sickness bug and her asthma attack.
26. A paramedic visited Ms E on 24 September to assess her after her asthma attack and sickness bug.
27. Mr D emailed the carer on the same day and told her to remove all foodstuffs from the conservatory and buy some rat poison.
28. The notes show Ms E refused to take her medication on 27 and 28 September. Mr D disputes this and says Ms E would not refuse to take her medication.
29. The notes from 28 September also show that the carer became unwell in the morning and moved into Ms E’s office. She told Ms E that she was unwell. She heard Ms E prepare own lunch. Ms E’s neighbour came round for the afternoon.
30. Mr D arrived at Ms E’s house at around 6:30pm. He said the carer could stay until the following morning. He gave Ms E her medication and prepared her supper.
31. Mr D says Ms E’s house was unhygienic and untidy. He says he spent two hours cleaning out the kitchen and the garage.
32. Mr D complained to the Care Provider about several issues, namely:

• When he arrived at Ms E’s house, he found her cold and hungry.
• He found the carer asleep on the bed in Ms E’s office.
• Ms E had not had her medication for the past two days.
• There was mouldy food in the fridge and on the kitchen worksurface.
• The garage was untidy.
• Ms E was not wearing her alarm pendant.
• The carer delayed telling him about Ms E’s asthma attack and sickness bug.

33. Mr D also sent the Care Provider some photographs to support his complaint.
34. The Care Provider responded to Mr D’s complaint. It said:

• The carer was suspended from work until it carried out a full investigation.
• The carer was on her break and feeling unwell when he arrived at Ms E’s house. This was unacceptable and the carer should have followed its policy by calling the office and arranging cover.
• The carer apologised for Ms E’s house not being clean and tidy for his arrival. This was because she was unwell.
• The carer received a verbal warning.
• It was not acceptable that food in the fridge and on the side in the kitchen had gone mouldy and was out of date.
• It placed the carer on food hygiene training.
• Ms E chose her own clothes. It must work to the guidelines of the Mental Capacity Act and therefore it cannot force a customer to change their clothing.

35. Mr D remained dissatisfied with the Care Provider’s response to his complaint. He said it had failed to answer his complaints, particularly that the carer had failed to administer medication for two days, failed to advise him straightaway of Ms E’s asthma attack and sickness bug and failed to ensure Ms E was wearing her alarm pendant.
36. Mr D also said the Care Provider’s response to the other parts of his complaint were inadequate. He said he believed Ms E’s house had been unclean for some time and it is likely that the carer had been in Ms E’s office for a while. He also said it was absurd to suggest that it was appropriate for Ms E to have been wearing shorts on a cold day.
37. The Care Provider issued its final response to Mr D’s complaint. It reiterated that it was unacceptable for the carer not to have taken appropriate action when she became unwell and apologised for this. It confirmed it had taken the matter seriously by implementing additional training regarding food hygiene. It also said:

• Ms E refused her medication on 27 and 28 September.
• The carer followed the correct procedure by contacting 111 and taking advice after Ms E’s asthma attack and sickness bug. The carer was in contact with Mr D when she was able to.
• The carer apologised for Ms E not wearing her alarm pendant. Ms E was with the neighbour during the afternoon and therefore was not alone.
• The carer moved into Ms E’s office because she was readying the bedroom for Mr D’s arrival.

38. Mr D remained dissatisfied with the Care Provider’s response and referred his complaint to the Ombudsman.

Back to top

Analysis

39. The Care Provider’s absence management policy says if an employee is taken ill while on customer premises or between assignments, they should contact their manager immediately so that appropriate alternative arrangements can be made. In this case, the carer failed to follow this policy. As a result, Ms E did not receive the care that she should have done. She was left to care for herself while the carer was unwell. Mr D was also distressed when he arrived at Ms E’s house and saw that she had not received the care that she was entitled to.
40. I have looked at the photographs of Ms E’s house and agree it was not as tidy as it should have been. There was also mouldy food in the fridge and on the worksurface.
41. Mr D says there was an accumulation of dirt in the house that would have taken at least 10 days to build up. While I note Mr D’s concerns, I have no way of independently verifying whether this was the case.
42. I note Mr D’s concern about the clothes Ms E was wearing when he arrived at her house. He also says he does not believe she would have chosen to wear those clothes. The carer has a different view and says Ms E chose her own clothes as per her care and support plan. As I was not there, it is difficult for me to reach a safe conclusion on whether Ms E chose her own clothes or not. However, I have seen a photograph of the clothes Ms E was wearing and I do not consider they were inappropriate in the circumstances.
43. The Care Provider’s medication policy says if a customer refuses medication, all incidents should be referred to the prescriber, the customer’s GP and/or nurse, key worker, or community pharmacist. The carer referred Ms E’s refusal to take her inhaler to the GP on 4 September and he advised that it was not dangerous for her to occasionally refuse her inhaler. However, Ms E did not have any of her medication on 27 September, and only received her evening medication on 28 September when Mr D arrived. Mr D disagrees that Ms E would refuse her medication, and has provided testimony from previous carers that she always accepted medication. Mr D says the Care Provider has falsified records to indicate Ms E refused medication, when the carer had failed to provide it.
44. Without further detailed investigation, I do not consider it is possible to reach a balanced conclusion on whether or not Ms E refused medication, or whether the carer failed to provide it. As I go on to explain, the care records are unreliable, and we have conflicting accounts from the Care Provider and Mr D about what happened.
45. But in either event, the carer failed to abide by the policy and refer Ms E’s missed medication on 27 and 28 September to the medical professionals. While there is no evidence of any adverse effects on Ms E’s wellbeing due to missed medication, this was clearly a cause for concern for Mr D. The unreliable records have compounded this concern.
46. Mr D says the carer told him about Ms E’s asthma attack three days after it happened. He also says she told him about Ms E’s sickness bug four hours later. The Care Provider says the carer contacted Mr D when she could. While I do not consider four hours is an unreasonable amount of time to tell Mr D about Ms E’s sickness bug, I agree with Mr D that the carer should have told him sooner about her asthma attack.
47. Mr D believes the Care Provider amended the care notes from 27 and 28 September after he made his complaint. He disputes that Ms E could have made her own lunch. He also says the neighbour did not spend the whole afternoon with Ms E and she would not have agreed for the carer to use her office. Finally, he says he found the carer at 7pm, and not 6:30pm as the care notes suggest. The Care Provider disputes this and says Mr D confirmed he arrived at Ms E’s house at 6:30pm, and so it is unlikely it took him 30 minutes to find the carer.
48. When the Care Provider responded to my enquiries, it said its normal procedure is for its carers to record all daily tasks on a digital system. If the system is not working, care notes should be emailed over. All notes are audited each day for completeness.
49. I have looked at the care notes of 27 and 28 September that the Care Provider sent to me when it responded to my enquiries. The Care Provider also sent Mr D a copy of the care notes. I have compared both sets of notes for the same period and I note there are differences. There is more information in the care notes that Mr D received for 27 September than the notes I received for the same day.
50. The care notes that I received for 28 September state Ms E refused all her medication. The care notes Mr D received for the same day state Ms E took her vitamin tablets.
51. The Care Provider has explained the original care notes it sent to Mr D did not include all the medical details. It says the inclusion of Ms E taking her vitamin tablet was a mistake. It also says because the carer was unwell, once it audited the care notes, it was aware they were incomplete and so it contacted the carer to provide additional information. It could not complete real time care notes because of internet connection problems, and it is looking at connection problems on a regular basis to ensure it is not repeated.
52. While I note the Care Provider’s explanation, the discrepancy in the care notes is concerning and calls into question the overall reliability of the care notes for the entire time the Care Provider was providing care for Ms E. As the carer had difficulties accessing the digital system, she should have instead recorded the care she was providing to Ms E on handwritten notes until the connectivity issues were resolved. Regulation 17 of the CQC guidance is clear that all care providers should maintain an accurate, complete, and contemporaneous record in respect of each service user.
53. Mr D raised a detailed complaint to the Care Provider. When it initially responded, it failed to address several of his concerns. This caused him frustration and therefore he had to repeat his complaints again.
54. When the Care Provider issued its final response to Mr D’s complaint, it did respond to the previous complaints that had not been addressed. However, Mr D also said in his letter that there were numerous things that had been inadequately responded to. The Care Provider failed to address these issues in its final response.
55. The Care Provider has apologised for the issues on the final day of care and confirmed it took suitable action, including suspending the carer while it was investigating the complaint and enrolling her on a food hygiene course. It has also amended its care plans to ensure more effective hygiene checks for fridges.
56. When the Care Provider responded to my enquiries, it offered to refund Ms E £128.57 which is the cost of care on the final day of the contract. It says it did this in response to Mr E’s demand of a full refund. While I welcome the steps the Care Provider has taken and the additional remedy it has now proposed, I consider it needs to go further to reflect Ms E’s and Mr D’s injustice.

Back to top

Agreed action

57. To remedy the injustice caused, by 21 July 2021 the Care Provider has agreed to:

• Make a further apology to Mr D for the further injustice I have identified in this decision statement.
• Pay Mr D £150 for the distress and uncertainty he has experienced and for the time and trouble he has been put to in pursuing his complaint.
• Pay Ms E £150 for the distress caused to her by the failure to provide adequate care.
• Refund Ms E £128.57 which is the cost of care on the final day of the contract.

58. By 18 August 2021, the Care Provider will explain in writing what action it will take to ensure that:

• Staff who deal with complaints are aware that complaint responses must address the issues raised.
• Staff are aware of what they should do if they are unable to administer a service user’s medication for any reason.
• Staff are aware of the need to maintain accurate, complete, and contemporaneous records in respect of each service user.

Back to top

Final decision

59. I have completed my investigation and find the Care Provider’s actions have caused an injustice. It has agreed to my recommendations and so I have completed my investigation.

Back to top

Investigator's decision on behalf of the Ombudsman