Summary: There is no evidence the care provider unnecessarily put in place additional care without agreement or failed to provide a good standard of care. There were some minor concerns about carers’ actions and the care provider apologised for these. The actions of the care provider did not cause injustice to Mr and Mrs X.

The complaint

1. Ms A (as I shall call the complainant) complains that the care provider unnecessarily provided additional night-time care for her father Mr X, failed to communicate properly with the family and would not provide a ‘handover’ to new carers, were disorganised about where medication was kept, damaged some clothes and shouted at her father.

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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)

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How I considered this complaint

3. I considered the information provided by Ms A and by the care provider. I spoke to Ms A. Both Ms A and the care provider had the opportunity to comment on an earlier draft of this statement before I reached a final decision.
4. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I found

Relevant law and guidance

5. 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.
6. Regulation 9 says the care and treatment of service users must be appropriate, meet their needs and reflect their preferences. It says people using services must be given relevant information including about the cost of care. It also says assessments must be reviewed regularly and throughout a person’s care and treatment.
7. Regulation 12 says “Sufficient …medicines that are necessary to meet people’s needs should be available at all times. They should be available when needed and within a reasonable time without posing a risk.”

What happened

8. Oxleycare began providing care for Mr and Mrs X in April 2020. The care provider had previously provided respite care for Mrs X in 2016 when she broke her arm.
9. The care provider sent a copy of the care plan and agreement to Ms A with a brochure about the company’s services, a copy of the terms and conditions, a fees list and details of the carers’ entitlement to time off. The terms and conditions stated:

“2.13. you acknowledge that Carers require a minimum of 8 hours sleep per night. Carers will however, answer any night call which you may make, and such night calls will be charged in accordance with the Fees Schedule. You further acknowledge that if a Carer is called upon to deliver the Service at night:-

2.13.1. on more than 2 occasions for 14 consecutive nights or more

2.13.2. or where night calls regularly exceed 1 hour duration

OxleyCare shall be entitled to provide additional support for night care and in these circumstances the Fees will increase to reflect the additional level of care.”

10. Ms A held Power of Attorney for Mr X’s property and finances jointly with her brother Mr B. Mr B signed the agreement for the provision by Oxleycare of 24-hour live-in care services for Mr X on 11 April 2020. Care started on 14 April.
11. Mr X required a period of time in hospital in May. On 8 June Mr B telephoned the care provider to say his father was being discharged home and would need two carers for the time being. On 7 July the care provision reverted to one carer only.
12. The care provider says Mr X’s needs started to increase. On 5 September Mr X had fallen during the night and an ambulance had to be called. On 7 September the care provider emailed Ms A and Mr B and said, “As you may be aware we asked the doctor to visit last week as the carer reports your father is struggling. This is exacerbated by lack of sleep as he is reported to be up every hour with the need to urinate. The carer has emailed the surgery over the weekend with her concerns. Until his nights become more settled Oxley care will need to provide additional support as one carer cannot provide safe care 24/7”. The email continued “We are aware this has a financial impact however short term your father’s safety and welfare of the carer is paramount. If you would like to source an alternative care provider in the long term to suit your costs we would understand.”
13. Mr B replied “Thank you very much. As you say Dad’s safety and care is a priority and one carer cannot manage him day and night”. With the family’s agreement, the care provider started a second carer on 7 September. On 9 September Oxleycare's care manager visited and then provided a detailed report to Mr B and Ms A.
14. In November 2020 Ms A wrote to Oxleycare giving notice on the contract. She said, “We have decided that we are going to start using a local carer for the future…. You have been incredibly helpful and supportive and stepped in so fast at the beginning when we were so stressed and lost and thank you so much for all your help and advice. And if we need you again in the future, we shall be in touch and will also pass on your details to others that might be in the same position as us”.
15. Ms A asked Oxleycare to hand over to the new care company but the care provider says it is up to each care provider to undertake its own assessments and create its own care plan. The care provider says the care manager explained to Ms A by email on 19 November why the carers would not “hand over” to the new care provider as she requested. Although the care package was due to end at noon on 14 December, Ms A emailed Oxleycare to ask the carers to leave by 10am on 14 December so she could have some family time with her parents before the new carers started. It was not therefore possible for any informal information to be given.
16. On 8 December Mr B emailed the care provider to say he was against the changes to Mr X’s care as Oxleycare had “done a great job”.

The complaint

17. In January 2021 Ms A wrote to Oxleycare with a complaint. She said since she had employed new carers she now believed it had not been necessary to employ two carers at the time Oxleycare suggested it as the new carer said Mr X slept through the night. She said the household costs were now much lower and she discovered the Oxleycare carers were taking more than the legal minimum requirement of time off. She said medication was now better organised and she received a weekly report about her parents’ care from the care provider. She said her father’s clothes and some household items had been damaged by the Oxleycare carers, the house was dirty and carers had taken some of her mother’s food. A carer had shouted at Mr X.
18. The care provider’s compliance manager replied to the complaint. He said the amount of care and support had been increased in line with Mr X’s needs and with the agreement of the family. He pointed to the note in the email from the care manager offering the opportunity to source alternative care. He also pointed out the terms and conditions which had been signed which described the costs for night services.
19. The compliance manager said the terms and conditions agreement detailed the amount of time off its carers were entitled to. He said all information and decisions about care had been shared with the family at the relevant time.
20. The compliance manager apologised that some items of clothing had been damaged and explained why this was so; he said full reimbursement had been made. In respect of the alleged theft of food he apologised that it had happened and agreed it was unacceptable.
21. Ms A complained to the Ombudsman. She said she did not believe she had received a full response to her complaint. She said the care provided by Oxleycare had cost a significant amount and she was concerned it had not been of the standard expected.
22. Solicitors responded on behalf of the care provider. They say at no time during the care provision had complaints been made by Mrs A (or Mr B) about the standard or cost of care. They say there was frequent communication by telephone and email between the care provider and the family. They say Mrs A emailed during the notice period to say there was a “communication problem” with the current carers but also asked them to stay until the end of the notice period.
23. The solicitors point out that not only was the provision of two carers deemed necessary due to the needs of Mr X, it was also agreed by the family at the time. They say there were 70 night calls needed in September, 74 in October and 38 in November. Ms A never asked for the night carers to be removed or sourced alternative provision as the care provider suggested she might wish to do.,
24. In respect of the medication, the solicitors say at the start of the care package Mr X managed his own medication. As time went on and the carers took over its administration, the medication was moved to the hall, where carers completed their administrative tasks, at the suggestion of Mrs X. They say medication risk assessments were carried out in April and June 2020. No harm was caused to anyone by the storage of the medication and no complaint raised until after the termination of the care package. They point out the care notes were also kept in the hall and were always available to family members.
25. The solicitors accept some trousers were damaged by carers with Mr X’s knowledge and permission to enable the flow of urine from his convene. The care provider subsequently reimbursed Mr X for the cost of the trousers.
26. The solicitors point out that the carers were not employed to act as cleaners and had in fact suggested to Ms A that a cleaner was needed. In terms of excessive food bills, they say one carer offered to do the household shopping but Ms A arranged for her friend to do it instead: they say at no time were the carers able to influence the household spending. On one occasion two carers shared a packet of crisps which was Mrs X’s particular favourite; the care provider apologised for this action. The solicitors say no-one complained at the time about a carer shouting at Mr X, but sometimes it was necessary to raise voices as he was hard of hearing.
27. Finally the solicitors confirm all changes to the care package were made with the agreement of the family and were not questioned during the term of the contract.

Analysis

28. There is no evidence the care provider failed to provide proper care and treatment for Mr and Mrs X.
29. The cost of care and the terms of the contract were fully notified to the family before the contract started. No changes were made without the agreement of the family. The care provider was proactive in pointing out the increased cost before the agreement was made. Ms A knew the costs of care before the provision of care began. That another care company provided a service at a lower cost does not mean any injustice was caused by the fees charged by Oxleycare.
30. There is no evidence to suggest the way in which medications were kept caused any risk or harm to Mr or Mrs X.

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Final decision

31. I completed this investigation as no injustice was caused to Mr and Mrs X by the actions of the care provider.

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Investigator's decision on behalf of the Ombudsman