Summary: Mr B complained about the domiciliary care provided to his mother. He also complained the Care Provider failed to provide access its care notes system, pursued him for additional costs after the contract was agreed and signed and inadequately responded to the concerns he raised about sub-standard carer performance. We find that Mr B and Ms C suffered an injustice. The Care Provider has agreed to our recommendations to address this injustice.

The complaint

1. Mr B complained about the domiciliary care provided to his mother (Ms C). He says the Care Provider provided three different carers for the first trial period. He also says the Care Provider failed to provide carers who met the person specification for seven out of eight weeks and the carer in the second trial period had no experience as a live-in carer for someone with Alzheimer’s which resulted in sub-standard care.
2. Mr B says the Care Provider failed to provide access to its care notes system. Finally, Mr B says the Care Provider pursued him for additional costs after the contract was agreed and signed and it inadequately responded to the concerns and complaint he raised about sub-standard carer performance.
3. Mr B says the Care Provider’s poor performance left Ms C feeling unhappy and distressed. He also says he had to spend a lot of time calming Ms C’s distress which was upsetting.

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What I have investigated

4. We investigated a previous complaint from Mr B (20007621) and found the Care Provider’s actions caused him and Ms C an injustice. This investigation will cover different complaints and an earlier period.

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The Ombudsman’s role and powers

5. 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)
6. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
7. 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)
8. 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)
9. Under our information sharing agreement, we will share this decision with the Care Quality Commission.

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How I considered this complaint

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

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What I found

Relevant law and guidance

12. The Care Quality Commission (CQC) is the statutory regulator of services. 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.
13. 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.
14. Regulation 9 says care and treatment must be appropriate and meet service users’ needs.
15. Regulation 12 says care and treatment must be provided in a safe way for service users.
16. Regulation 17 care providers should maintain an accurate, complete, and contemporaneous record in respect of each service user.

What happened

17. Mr B employed the Care Provider (Bluebird Care) in July 2020 to provide a package of domiciliary care for Ms C.
18. Ms C has Alzheimer’s disease. The Care Provider agreed to provide a live-in carer for a four-week trial period, and then Mr B would look after Ms C for a week, and then the cycle would repeat itself.
19. The customer file sets out the service the Care Provider agreed to provide. The initial agreement was for the carer to have a one hour break mid-morning and a one-hour break during the evening. There was no requirement in the agreement for the breaks to be covered by another carer.
20. Ms C’s care plan said she needed the live-in carer to prompt her with her morning shower, prepare her meals and drinks throughout the day and provide social support. It also said she needed the live-in carer to administer all her medication. This included administering her inhaler twice a day (morning and afternoon).
21. The first carer (Carer A) started providing care to Ms C on 27 July.
22. The care notes show Carer A gave Ms C her inhaler once a day. Ms C did not get on well with the Carer A, and she became distressed. Therefore, the Care Provider had to find a replacement. Carer B was employed on 3 August. She also administered Ms C’s inhaler once a day.
23. A manager from the Care Provider sent a WhatsApp message to Mr B. She said she could understand why he felt the Care Provider had let him down. She also said it was not normal practice to have such a change of carers.
24. Mr B emailed the Care Provider on 8 August. He said it had not kept to the agreement because the carers kept changing. He asked to extend Carer B’s stay for a second week.
25. The Care Provider responded on 10 August and said it would have liked to have seen Ms C settled with a carer, but as she was not happy with Carer A, it had to find a replacement. It said Carer B could not stay for a further week because she had other commitments. It also attached the profile for another carer (Carer C) and said she would start the next day. Finally, it said it would need to put breaks in place for the carer, with someone coming in to cover the breaks daily or every other day with longer breaks. This is because the carer could not relax with the current arrangements.
26. Carer C started providing care to Ms C on 11 August.
27. Mr B emailed the Care Provider on 13 August. He said at the outset he had asked for an English, Scottish, or Welsh white carer, but Carers B and C did not fit this specification. He also said it had not previously told him about additional costs when he signed the contract.
28. The care notes show Ms C’s inhaler was not available from 14 August. Carer C contacted the chemist. It said it would check to see if she still needed the inhaler.
29. Mr B sent a further email to the Care Provider on 18 August and said it had not mentioned the costs of carer breaks at the outset. He also said the contract referred to a one and not a two-hour break.
30. The Care Provider responded to Mr B’s emails on 19 August. It said with hindsight it should have explained at the beginning that if the split two-hour carer breaks did not work, it would have to find someone to cover. It said Ms C needed more one on one support, and therefore it had to adjust the initial agreement. It also asked Mr B if he had access to the care notes system. Mr B responded the following day and said he had received an email saying his access to the care notes system had been removed. He asked what he needed to do to log into the system.
31. The Care Provider responded to Mr B’s email on 21 August and said he should have received an email for him to activate his account to view the care notes.
32. Ms C left the house on her own on 21 August while Carer C was using the toilet. Carer C eventually found Ms C walking on the street. The care notes say Ms C was fine, but tired. Carer C informed Mr B and her manager.
33. The care notes from 22 August show that Carer C’s supervisor told her to contact Ms C’s GP and ask for new inhalers. Carer C administered Ms C’s inhaler in the morning for the following three days.
34. Mr B emailed the Care Provider on 23 August and said he had still not been able to gain access to the care notes system. He asked for help.
35. The Care Provider emailed Mr B on 25 August and asked if he had now been able to view the care notes. It also said a carer it had identified as a good permanent match for Ms C (Carer D) would start on 1 September. Mr B replied on 28 August and said he still not been able to get access to the care notes.
36. Carer D started providing care for Ms C on 1 September. She gave Ms C her inhaler in the morning on 2 and 3 September.
37. Carer D contacted the doctor on 4 September after Ms C refused her inhaler. The doctor said it was not dangerous for her to refuse her inhaler as her asthma was under control. However, it was important that she did not stop altogether.
38. Mr B emailed the Care Provider on the same day and asked for technical support to get access to the care notes system.
39. There is no evidence Carer D attempted to give Ms C her inhaler on 12,13 or 14 September.
40. Mr B emailed the Care Provider on 18 September and said the situation had not changed regarding access to the care notes system. The Care Provider responded and said it could not deal with the issue remotely and would address the issue when he returned to the country.
41. Ms C had an asthma attack on 20 September. Carer D gave Ms C her inhaler and she recovered quickly.
42. Mr B emailed the Care Provider on 24 September and said how frustrating it was that he did not have access to the care notes system.
43. The Care Provider stopped providing care to Ms C after 28 September.
44. Mr B complained to the Care Provider on 30 October. He chased it for a response on 21 November. The Care Provider responded on 23 November and referred Mr B to its response to a previous complaint he had made.
45. The Care Provider wrote to Mr B on 23 December and said his letter of 30 October was a duplicate of a previous complaint. It advised him to contact the Ombudsman or the CQC.
46. The local council contacted the Care Provider in February 2021 to find out some further information about the care it provided to Ms C. This was after Mr B had reported his concerns to the CQC. It issued its findings on 1 March. It said staff who complete dementia training and have some experience in the community is different to a live-in carer who provides full time care. It said the Care Provider needed to be consider this when matching people.

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Analysis

47. Ms C had three different carers during the first trial period. This was not part of the initial agreement. However, Ms C did not feel comfortable with Carer A, and so the Care Provider had to find a replacement. Carer B had other commitments and could only stay for a week. Carer C provided care for the final two weeks. While it was unfortunate the Care Provider could not stick to the original agreement, it would not have known in advance that Ms C was going to become distressed with Carer A looking after her. It therefore had to find alternative carers during this time.
48. I note Mr B’s concern that Carers B and C did not fit the specification of an English, Scottish or Welsh white carer. Mr B emailed the Care Provider on 13 August, and he referred to the initial discussions about his choice of an English, Scottish or Welsh white carer. I have not seen any evidence of the initial discussions and the specification of the carers was not in the customer file. It is true Carers B and C did not fit Mr B’s required specification. However, there is no evidence this caused an injustice to Ms C. The care notes do not show Ms C was distressed or caused harm by the fact Carers B and C did not fit the required specification.
49. Mr B says the Care Provider pursued him for additional costs after the contract was agreed and signed. This is in relation to carer breaks. The customer file shows the agreement was that two one-hour breaks would be enough, and that Ms C did not need cover during the breaks. The Care Provider reviewed this arrangement after several weeks and recommended that Ms C needed more support and therefore required cover when the carer was on a break. While I accept the Care Provider did not provide this information to Mr B at the outset, the first four weeks was a trial period. The Care Provider suggested a cover for the carer breaks when it reviewed matters and realised the initial arrangement was not working.
50. Mr B was not able to get access to the care notes system. He repeatedly raised this with the Care Provider, but it failed to resolve the issues he was experiencing. This meant Mr B was not able to see what care Ms C was receiving, which caused him frustration.
51. Mr B says Carer D had no experience as a live-in carer for someone with Alzheimer’s. He says this resulted in sub-standard care. Carer D was experienced in looking after customers with dementia in care homes and in the community. She had no experience as a full-time live-in carer for someone with Alzheimer’s. The council picked this up when it reviewed the file, and it recommended the Care Provider needed to ensure it was matching customers with carers that had the appropriate experience. I agree with the council’s view. The Care Provider needs to evidence it has implemented this learning.
52. In terms of sub-standard care, Mr B says Carer D did not stick to Ms C’s routine, gave her wine at lunchtime, did not provide her with her favourite meals and failed to ensure she went on her daily walks.
53. I have reviewed the care notes during the time Carer D was providing care. I have identified several occasions where Carer D gave Ms C wine at lunchtime. Ms C’s care plan said she liked wine with her dinner. However, I also cannot identify anywhere in the care plan where it says that Ms C could not have wine at lunchtime. There is no evidence that Ms C having wine at lunchtime caused her harm or impacted her health.
54. I am satisfied that Carer D largely gave Ms C her preferred meals. The care notes also show that Ms C sometimes declined to go on her daily walk.
55. Mr B says Carer D failed to stick to the routine and Ms C often had lunch late and went to bed at 9 or 10pm, rather than 7-7:30pm. The care notes do not set out when Ms C had her lunch. However, they do show that Ms C went to bed at 9pm most days. Ms C’s care plan does not set out a specific time that she had to go to bed. There is no evidence that Ms C going to bed later than Mr B required adversely impacted her health.
56. Ms C’s care plan said she needed to have her inhaler twice a day. Carers A, B and C failed to administer Ms C’s inhaler twice a day. There is no evidence Carer D gave attempted to gave Ms C her inhaler on 12,13 or 14 September. While I note Carer D had referred Ms C’s refusal to take her inhaler to the doctor, she should still have attempted to administer Ms C’s inhaler every day. I consider the Care Provider’s failure to act in accordance with the care plan gives Mr B some uncertainty about whether Ms C’s asthma attack on 20 September could have been avoided.
57. The Care Provider did not respond to Mr B’s complaint of 30 October. It said his complaint was a duplicate of a previous complaint. I have compared both complaints and it is clear Mr B raised many more issues in his second complaint. The Care Provider should have therefore responded appropriately to Mr B’s concerns. Its failure to do so caused him avoidable time and trouble in complaining to the Ombudsman.

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Agreed action

58. To remedy the injustice caused, by 17 December 2021 the Care Provider has agreed to:

• Apologise to Mr B and Ms C.
• Pay Mr B £200 which is a symbolic gesture to acknowledge the frustration, uncertainty and avoidable time and trouble he was put to.
• Provide evidence it has implemented the learning from the council’s enquiry about matching customers with carers that have the relevant experience.

59. By 14 January 2022, the Care Provider has agreed to explain in writing what action it will take to ensure that:

• Relevant staff are aware they must administer medication as set out in service users care plans.

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Final decision

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

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Investigator's decision on behalf of the Ombudsman