Summary: Mr X complained about the quality of care provided to his father Mr Y. There were issues with communication between the care provider and Mr Y about late calls or staffing changes, and the support plan was not clear about which domestic tasks staff would carry out. This was fault and is likely to have caused Mr Y some anxiety. There was no fault in the way the care provider decided it could not support Mr Y with a bath or in the way it reached the decision to end the care package. It has already undertaken procedural changes to address these faults. It has also agreed to apologise to Mr Y and pay him £100 to acknowledge the impact of the faults.

The complaint

1. Mr X complained the care provider failed to provide adequate care to his father, Mr Y. It refused to bathe him and to carry out domestic chores even though this was part of the agreed care package. It failed to advise them when carers were running late and sent female carers when it had agreed to only send male carers. It also unfairly ended the care package, accusing Mr X of bullying staff without properly investigating the allegations. This has caused Mr X and his father distress.

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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 have considered the information provided by Mr X and have spoken to him on the telephone. I have considered the care provider’s response to my enquiries.
6. I gave Mr X and the care provider the opportunity to comment on a draft of this decision. I considered any comments I received in reaching a final decision.
7. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share the final decision with CQC.

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What I found

Relevant law and guidance

8. 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.
9. 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. This includes:
• that the care and treatment of service users must be appropriate, meet their needs and reflect their preferences (regulation 9); and
• providers must assess the risk to people’s health and safety during any care or treatment and prevent avoidable harm or risk of harm (regulation 12).

What happened

10. Mr Y lives with his wife. He has physical health conditions and uses a frame to walk. He has ulcers on his legs.
11. In May 2020 the care provider started to deliver a care package of one hour a day to Mr Y. Mr Y had requested a male carer. Mr X says the agreed visit time was 9am. The support plan listed this as at 9.30am each day to provide support with personal care including assisting Mr Y with a bath, applying creams, helping him to dress and put on surgical stockings. It also stated to ‘clean and tidy the bathroom, wash up the dishes in the sink, tidy around if time allows, please change bed if wet’.
12. In early June, a carer raised concerns with the care provider that bathing Mr Y was hurting their back. Following this the care provider assessed the risks of bathing Mr Y and decided it could no longer help Mr Y with a bath. It would provide him with a strip wash and recommended Mr Y get a swivel bath chair. The care provider contacted an Occupational Therapist (OT) at the Council who confirmed Mr Y was on a waiting list for a bathing assessment.
13. Mr X contacted the care provider by phone to discuss this. Following this he emailed it. In the email, Mr X set out that he did not agree bathing Mr Y was unsafe and explained the technique family members used to assist Mr Y. He also said the care provider had agreed that any time left at the end of the call would be for cleaning. He said, the care provider now said this was not part of the service but this was contradictory to the website which listed a number of domestic tasks as available from the service. Mr X also raised issues that the carers were arriving at 9.30 or later and not 9am as agreed and that on one visit new carers had attended for observation but Mr Y was not informed in advance.
14. The care logs show that from mid-June 2020 Mr Y received a strip wash daily. The logs show carers applied his creams and assisted him with dressing, regularly washed up and tidied the bathroom and on occasions emptied the bins. The logs show the majority of calls took place around 9.30am but that around a third of calls were at 10am.
15. On 23 August 2020 Mrs Y telephoned the care provider as the carer had not arrived. The care provider was short staffed and so sent a female carer to support Mr Y with his personal care.
16. Later that day, Mr X’s sister and Mr X telephoned the care provider about this. Mr X’s sister then emailed the care provider and copied in Mr X. In the email she said the care provider had failed to make a courtesy call and sent a female carer instead of a male, against her father’s wishes. Mr X’s sister said she was firm with the staff member who dealt with the call as it was unacceptable behaviour. In the email she raised concerns about not being told if carers were not turning up and carers not carrying out all the agreed tasks. She made comments about staff members style of management and said ‘do you want to comply with the actual contract my father signed to meet his specific needs with respect to both personal and domestic care or not. Once you have formed your judgement let me know’.
17. The care provider responded the next day. It stated ‘I can see from your email you are clearly not satisfied with our company and our delivery and service of care’. They went on to say ‘our on call operator was clearly distressed after both your brother and yourself called her. She felt intimidated and distressed’. It said ‘in an effort to prevent further upset between you and us, we believe it is now in everyone’s best interest if you seek an agency that you believe will better meet your expectations, I can only apologise that our best efforts fall short of your expectations’. The care provider referred to its contract which sets out that either party can serve 14 days notice to the other party and gave notice to terminate the contract. Mr X’s sister responded that ‘we accept your 14 day notice of service care termination for my father with no regrets’.
18. Mr X emailed the care provider that same day. He said that ‘since you have accused me of bullying [the on-call operator] can you please under the Freedom of Information act send me the voice recording of my call with [the operator] yesterday’. The care provider advised it would try to retrieve the call if available. It said the operator was upset by Mr X and his sister calling in short succession. It went on to say the operator felt intimidated by the way they were spoken to and felt the calls were of a hostile nature and under attack.
19. On 4 September 2020 Mr X emailed the care provider. He said he had received a call at 9.40am to say the regular carer was not coming as they had been injured by another client. Mr X was unhappy the care provider had again offered a female carer despite him making it clear they did not want one. They agreed to accept a visit from a male carer at 11.30am. He was also unhappy that no-one had called Mr Y to advise him the regular carer was not coming.
20. Mr X later emailed the care provider to say the carer who visited was unsure of what he was meant to do.
21. Mr X complained to the care provider about the quality of care provided to his father. He raised a number of issues including his unhappiness that carers would not bath his father, carers complaining domestic chores were not their responsibility, that the agreed time of service was 9am but carers generally came at 9.30 and sometimes 10, new carers attending to observe without prior warning and designated carers not turning up and being substituted with another carer. Mr X also said he was accused of bullying a staff member when there was a lack of communication and poor processes and had not been supplied with a recording of the call.
22. The care provider responded later that month. It did not find any major failings in the support provided to Mr Y but it accepted communication was slow when there were changes or delays in the care staff attending the call and the care plan had limited information and could have gone into more detail especially for domestic duties. It said it had made changes to its processes to address this:
• It had improved its communication process for when carer staff were running late to calls.
• It had stepped up its out of hours alert services.
• It will monitor office calls on a more regular basis; this will include telephone call audits.
• It will ensure any changes to care plans will be communicated and confirmed before being implemented.
• It will put supervisors on refresher care plan training to ensure they capture all relevant details in depth.
23. Mr X remained unhappy. In particular, he was unhappy the contract was terminated and one of the reasons being he had bullied staff. Mr X wanted evidence of this accusation and if none was available, asked that the accusation be withdrawn. In addition, he said he had made it clear carers should be male. The care provider said it had nothing further to add and referred Mr X to us.

Findings

24. In response to my enquiries and Mr X’s contact, the care provider said its visits were agreed as one-hour calls between 9am and 10am. However, the support plan listed the call times as starting at 9.30am and that is the time most calls were carried out. Around third of the time the carers arrived at 10am and there were two occasions when the carer did not arrive until 11am. There may be occasions, due to the needs of other service users or because of emergencies that carers do not attend at the agreed times. I fall short of calling that fault. In addition, the care provider says it was impacted by the restrictions on travel imposed by the COVID-19 pandemic. However, carers regularly attended at 10am which was at least 30 minutes, if not an hour, later than was originally planned for and there is no evidence this change in timing was agreed with Mr Y. This was fault. Mr Y did receive the care visits and he did not miss out on care though the late arrival is likely to have caused him some anxiety if he was unsure whether carers would arrive.
25. Mr Y preferred male carers and the care provider sought to accommodate this preference. However, this preference was not recorded in the support plan and this was fault. There is only one occasion when Mr Y’s care was provided by a female carer but there is no evidence this visit caused Mr Y any particular distress. The care provider had a duty to ensure Mr Y’s care needs were met and it did this. However, it should have given Mr Y notice of the change and the opportunity to refuse the care if his preference was not met.
26. On 4 September the care provider offered to send a female carer after a carer failed to arrive but agreed to send a male carer at a later time after Mr X raised concerns. Mr X later complained that carer did not know how to support Mr Y and sought advice from family members. Given the short notice and last-minute change in carer I am not critical of this and consider seeking advice from family members appropriate in the circumstances.
27. The care provider reassessed the risks of bathing Mr Y after a carer raised concerns. It decided bathing Mr Y was a potential health and safety risk to Mr Y and staff. It therefore offered Mr Y a strip wash and suggested Mr Y obtain a swivel bath seat to assist with bathing. The care provider must consider the risks to the health and safety of both its staff and Mr Y and there was no fault in the way it reached its decision not to bath Mr Y without appropriate equipment.
28. In its complaint response to Mr X the care provider accepted the care plan had limited information and could have gone into more detail especially for domestic duties. This was fault. The support plan lacked detail about what specific domestic tasks carers would carry out. In addition, the care provider was commissioned to provide care for Mr Y and not for other family members. It was therefore only required to carry out cleaning tasks to support Mr Y. The care logs show carers regularly cleaned the bathroom, washed dishes and emptied bins and so did carry out some domestic tasks. However, the lack of clarity meant there was friction between the carers and family about exactly what additional domestic tasks would be completed by carers.
29. The care provider also accepted communication was slow when there were changes or delays in the care staff attending the call. This was fault. There appeared to be a lack of clarity about who should be contacted when carers were not able to attend. On 4 September when the care provider was aware a carer could not attend it promptly contacted Mr X but not Mr Y who was left waiting for a carer.
30. The care provider gave notice to end the contract after it was unhappy with the tone of the emails and telephone calls from Mr X and his sister. Mr X says the care provider accused him of bullying staff. I cannot comment what was said in the telephone calls but note the care provider reported a staff member was distressed by them. The contract allows the care provider to terminate the contract with 14 days notice and it was entitled to do this. It was not at fault.
31. The care provider has already introduced some procedural changes to prevent a recurrence of the faults and I am satisfied these changes are appropriate.

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Agreed action

32. Within one month of the date of the final decision on this complaint, the care provider has agreed to apologise to Mr Y and pay him £100 to acknowledge the anxiety and frustration caused by the faults.

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Final decision

33. I have completed my investigation. There is evidence of fault leading to injustice for which the care provider has agreed to provide remedy.

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Investigator's decision on behalf of the Ombudsman