Summary: We could not achieve anything further by continuing to investigate this complaint.

The complaint

1. Ms X complained for her mother Mrs Y about Ethical Homecare Ltd (the Care Provider). She complained two care workers gave Mrs Y medication in a way that was not prescribed and the Care Provider gave an inadequate explanation of what happened.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers. We provide a free service, but we must use public money carefully. We may decide not to start or continue with an investigation if we believe:

• it is unlikely we could add to any previous investigation by the care provider, or
• it is unlikely further investigation will lead to a different outcome.

(Local Government Act 1974, sections 34B(8) and (9))

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How I considered this complaint

3. I have considered:
• The Care Provider’s response to the complaint
• CCTV footage of Mrs Y’s bedroom provided by Ms X. Speech is muffled and the clip shows only a partially obscure view of a care worker handing something over to someone who is not on the screen
• Information from the local council which considered Ms X’s concerns under safeguarding procedures.
4. Ms X 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

5. Ms X contacted the local authority to raise concerns about Mrs Y’s care. Councils have a legal duty to consider reports about vulnerable adults which may indicate abuse or neglect and decide whether to take any action to minimise the risk of future abuse or neglect. The council’s safeguarding team considered her concerns. The council sent us its record of discussions a safeguarding officer had with Mrs Y and Ms X.
6. Mrs Y told the safeguarding officer:
• She had no concerns about the care workers, in particular about administering her medication and she was not aware of the particular incident Ms X raised
• She had asked the care workers to give her the medication in smaller doses throughout the day to manage her pain better, which was not in line with the GP’s advice
• She was not aware of a particular time when she had been given a smaller dose than prescribed. She did not want any further action taken against the agency and had mental capacity around medicines.
7. The safeguarding officer noted she had seen copies of the Care Provider’s medication charts for Mrs Y and they were all in order.
8. The safeguarding officer also spoke to Miss X. The record of their discussion said:
• Miss X said she had CCTV footage of the care workers counting out the medication and it appeared to be a smaller dose than prescribed. But the care worker said they had given the correct dose.
• The safeguarding officer was satisfied with the Care Provider’s explanation.
• The safeguarding officer advised that care workers should only administer medication as prescribed.
9. The Care Provider’s response to Ms X’s complaint said:
• The care worker did not decrease the medication before the GP changed the prescription, but she did mimic Mrs Y’s dialogue about the new regime
• As a result, Mrs Y’s medication would be kept out of her room so staff could get it ready with no distractions.
• Staff would be instructed not to say anything that is inaccurate.
10. Ms X said on her complaint form to us that:
• The medicine was for pain relief. On the day in question, Mrs Y went from being ok to being in tears and unable to eat or speak. This was not a normal pattern for her, her pain attacks generally came on gradually over a few days
• Mrs Y’s GP told her to reduce and taper down the medication to go on to a new drug but the Care Provider had not been told this and the medicine charts had not been updated to reflect the GP’s advice
• Two care workers reduced the dose down but signed the chart to say they gave the higher dose. When asked, the care workers said they counted out the lower dose, but in fact gave the correct dose
• On the CCTV one can hear the care workers counting the dose out. They counted one tablet then signed to say they had given two tablets on the medicine chart.
• She had another clip (which she has not shown us) showing the medication being given at lunchtime when it is not prescribed
• A team leader later from the Care Provider spoke to Mrs Y’s GP and the GP came up with a plan to reduce the pain medicine gradually and change it to a different pain medicine over a few weeks. This was then put on the medicine chart and a laminated copy put near Mrs Y’s tablets so carers could understand it. As a result, the medicine was increased back to the prescribed dose and within a day Mrs Y was much better.

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Final decision

11. Nothing significant could be achieved by further investigation of this complaint. I have taken into account that:
• The CCTV footage does not determine the matter one way or the other
• Ms X was not present.
• When asked, Mrs Y said she was not aware of missing any medication.
• The care workers have already given their account to their employer and would be unlikely to add any further relevant or useful information
• The Care Provider has already taken appropriate action to improve the service to Mrs Y: it liaised with the GP, and provided written instructions to care workers as well as telling them not to make inaccurate verbal statements that could cause confusion
• The local authority considered the matter under safeguarding processes and decided not to proceed
• There are no irregularities in the information the Care Provider has disclosed. Both the complaint response and information to the safeguarding team was that Mrs Y had received the correct dose of her medication.
12. Accordingly, I have stopped investigating the complaint.

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Investigator's decision on behalf of the Ombudsman