Summary: Ms X complained the Council commissioned care provider made unfounded allegations about her mother Mrs Y’s behaviour, carried out short visits and the Council failed to reduce Mrs Y’s care package from two care workers to one care worker per visit. The Council was at fault. It failed to discuss the allegations with Ms X and Mrs Y and failed to properly respond to her complaint about this. The care provider also failed to properly document all its concerns in the care records. This caused Ms X frustration and distress and meant Mrs Y paid for double handed care longer than necessary. There was no fault in the care provider’s decision not to agree to single handed care or in the length of care visits. The Council has agreed to apologise to Ms Y and pay her £500 to acknowledge the extra care she paid for. It has also agreed to apologise to Ms X and pay her £150 to acknowledge the frustration caused. It has agreed to take action to prevent a recurrence of the faults in future.

The complaint

1. Ms X complained the Council failed to reduce her mother Mrs Y’s care package from two carers to one carer per visit despite the installation of single-handed care equipment. In addition, she said the Council commissioned care provider, Astra Care, made unfounded allegations Mrs Y was abusive to carers, carried out short visits and sent male carers without Mrs Y’s consent. This meant Mrs Y paid for more care than was necessary, for care that was not provided and this has caused Mrs Y and Ms X frustration and distress.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
4. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
5. If we are satisfied with a council’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

6. I have considered the information provided by Ms X and have discussed the complaint with her on the telephone. I have considered the Council’s response to my enquiries which included records form the care provider.
7. I gave Ms X and the Council the opportunity to comment on a draft of this decision. I considered the comments I received in reaching a final decision.
8. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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What I found

9. Mrs Y is elderly with physical health conditions that have significantly reduced her mobility. In late August 2020, following a five month stay in a residential care home, the Council arranged for Mrs Y to receive a care package of four visits a day from Astra Care, the care provider (three one hour visits and one 30 minute visit). It assessed Mrs Y as able to fully fund the care package.
10. The Council’s needs assessment noted Mrs Y needed the support of two care workers and a hoist for all mobility and transfers and support should be provided by female care workers. She also needed support with continence and personal care and food and fluid. The Council referred Mrs Y to the single-handed care team to look at installing a different hoist which would enable the care visit to reduce to one care worker per visit. The assessment stated a review would be completed once this was fitted.
11. During September 2020 the care provider contacted the Council as three care workers had injured their backs using the hoist. The Council arranged with Ms X for an Occupational Therapist (OT) visit.
12. During early October Ms X contacted the care provider to ask what had happened at a care visit as Mrs Y said care workers had hit her head with the hoist. The care provider found nothing documented in Mrs Y’s care records and spoke to staff. The care workers said at the time Mrs Y said the sling hit her but it had not. Mrs Y was not marked or injured and the care provider updated Ms X.
13. The OT visited on 7 October 2020. They reviewed Mrs Y and recommended a different hoist and slings to enable a reduction to one care worker per visit. Ms X says the new hoists were in place on 9 October
14. A few days later, the care provider recorded in its secure notes that a care worker called the office and said they refused to visit Mrs Y in future as she was aggressive and abusive towards them.
15. The care provider spoke to Ms X on 13 October. It raised concerns Mrs Y was verbally abusive to care workers. Ms X said she would speak to her mother. Ms X said some of the care workers were clumsy and had hit Mrs Y with the hoist. The care provider noted it had investigated this and this was not the case. Ms X was concerned staff were not competent to use the hoist, were not washing their hands or using full PPE, although Ms X had not witnessed this herself. The care provider sent a staff member to review staff using the hoist. It also sent a reminder too staff to wash their hands and use full PPE.
16. The social worker spoke to the care provider on 15 October. Although the new hoists had been delivered the care provider did not want to reduce to one carer because of Mrs Y’s behaviour. It said Mrs Y was verbally abusive to care workers and staff were frightened to go on their own in case they were accused of wrongdoing as Mrs Y had accused staff of hitting her with the hoist. The social worker agreed to discuss the concerns with Ms X and Mrs Y and to keep the care package as two care workers for now.
17. The single handed care team spoke to the care provider on 20 October to ask if it would reduce to one carer. The care provider refused due to Mrs Y’s behaviour. At this point it asked all staff to log in the care notes any accusations made by Mrs Y. It later asked staff to call the office if Mrs Y was rude or nasty. The single handed care team contacted the social worker who said they would discuss it in their team meeting as Mrs Y had capacity to make her own decisions.
18. On 27 October the single handed care team spoke to the care provider. It said it did not want care workers visiting on their own as Mrs Y could make accusations. It said care workers had not noted their concerns in the care records of visits but on the care provider’s secure documenting site. The single handed care team advised it to ensure care workers recorded concerns in the daily care records so these could be seen when any professionals visited. Care workers started to note any concerns in the daily care records. Concerns were noted on nine occasions in the following 20 days. A further two instances were reported to the care provider and recorded in their electronic records but were not noted in the daily care records.
19. The single handed care team discussed Mrs Y’s case at the end of October. It agreed a change of provider may be required and it would liaise with the social worker and Ms X. On 2 November the care provider reminded all staff to document if Mrs Y was nasty or if they had any concerns about Mrs Y’s behaviour.
20. Ms X contacted the Council on 6 November. The Council recorded Ms X was not happy with the care provider and wanted to change it. She did not think double handed calls were necessary and wanted one carer at each visit and said carers were not staying the full time.
21. During early November the care provider sent a male care worker to support Mrs Y on two occasions. Ms X contacted the care provider as Mrs Y did not want male carers. The care provider agreed not to send male staff in future.
22. In mid-November 2020 Ms changed care provider. She did not pay the outstanding invoices due for the previous provider. She complained to the Council about:
• the care provider’s refusal to reduce to one carer,
• care visits were short,
• care workers allegations of verbal abuse from Mrs Y,
• male care workers had visited without consent and
• it had failed in its duty of care with tea time care visits taking place too early, not ensuring Mrs Y brushed her teeth and not staying to ensure she ate.
23. The Council responded and advised Ms X to complain to the care provider in the first instance. Ms X says she did not get this response. Following further communication with Ms X, in February 2021 the Council passed the complaint to the care provider and asked it to respond.
24. The Council responded to Ms X’s complaint in March 2021. It said the decision to remain with two carers was made in discussion with the Council following concerns raised by the care provider. It had reviewed six weeks of electronic call records and was satisfied in the main carers had spent an adequate length of time at the visits. It found 34 out of 368 visits were under 45 minutes (which included 10 minutes allocated travel time) however these were not below 30 minutes and so the Council was satisfied it was appropriate to commission a one-hour care package. With 10 minutes of travel time included there were 70 instances of over delivery.
25. It said a male care worker visited on two occasions, in an emergency, as care workers had a positive COVID-19 test result and care calls needed covering urgently. When Ms X raised her concern the care provider ensured this did not happen again.
26. It found most tea time visits were in line with the scheduled visit time of 15:30 to 16:00. Care workers prepared and cut up meals. Mrs Y sometimes ate in the presence of care workers but would sometimes ask for it to be left to one side stating she would eat later. Records showed instances of Mrs Y being taken to the bathroom to have her teeth brushed.
27. Ms X remained unhappy. She considered the Council had not addressed her main concern regarding the questionable allegations made. She said Mrs Y fully funded the care and the allegations were not documented in the care records until days after conversations about reducing the carers. Ms X was unhappy she was not informed of the decision to keep two carers given the costs involved. The Council signposted Ms X to us.

Findings

Refusal to reduce to one care worker

28. When Mrs Y returned home following a care home stay, the Council assessed Mrs Y as needing two care workers at each visit. There was no evidence of fault in the way it carried out this assessment.
29. The equipment was in place to enable single handed care visits to take place from 8 October and the social worker was aware the new equipment was in place by 15 October. At this point the Council should have reviewed Mrs Y’s needs and made a decision over whether Mrs Y should be supported by one care worker. It did not do so and this was fault.
30. The care provider raised concerns about Mrs Y’s behaviour with the Council and also discussed these concerns with Ms X. The care provider had noted in its electronic records an allegation Mrs Y made that she was hit by the hoist and one care worker had said they did not want to work with Mrs Y again due to her behaviour. However, care workers were not noting their concerns in the daily records. This was fault and meant Ms X and professionals who visited Mrs Y were not aware of the concerns at the time they arose and so could not consider what, if any, action to take to address them.
31. Following discussion with the single handed care team, care workers started to note concerns in the daily records. The daily care records and electronic records note several incidents reported by different care workers on several different dates where Mrs Y made comments to care workers or accusations they had hurt her. The Council sought to gain agreement with the care provider to reduce to one care worker per visit. The care provider set out its concerns staff could be open to accusations and that it would only provide double handed visits. The care provider set out the basis on which it was willing to provide care. This was a decision the care provider was entitled to make and was not fault.
32. The care provider had concerns about Mrs Y’s behaviour and the social worker agreed to discuss these concerns with Ms X and Mrs Y. There is no evidence they did so. There is no evidence the Council discussed the concerns directly with Mrs Y at any point to make her aware of the concerns and the implications for her, in that she had to continue to pay for two care workers. This is fault.
33. The single handed team agreed at the end of October it needed to discuss an alternative care provider with Ms X and Mrs Y. That did not happen.
34. Had the Council reviewed the care arrangements sooner and discussed the options with Ms X and Mrs Y, on the balance of probability, it is likely they would have decided to change care provider at least 10 days sooner. That had caused Mrs Y an injustice as she paid around £750 a week for her care package of two carers. That meant over 10 days she paid around £500 more than if her care were provided by a single carer.

Visits by male care workers

35. There were two occasions when a male care worker attended, despite Mrs Y’s preference for female only care workers. In the complaint response the care provider explained this was due to last minute staff changes. The care provider had a duty to ensure Mrs Y’s care needs were met and it did this. There is no evidence that at time of the visits this caused Mrs Y particular distress and when Ms X raised her concern it did not send a male care worker again. Given the particular circumstances, I fall short of calling this fault.

Timing and Duration of visits

36. I have examined electronic records from 1 October until the care package ended and agree with the Council’s findings in its complaint response to Ms X. The majority of care visits that took place were within half hour of the scheduled visit time. The Council’s response says the one hour care visits included 10 minutes for travel time. The majority of calls were over 45 minutes in duration and therefore an hour call time was appropriate. There were 27 visits which were 30 minutes or less but there were 34 visits over 50 minutes long. Overall the evidence shows the care visits were of the appropriate length.
37. Ms X has identified two occasions in September 2020 when electronic records show one of the care workers was there for only 5 minutes. Contemporaneous notes from the care provider’s electronic system notes record on the first instance a care worker had arrived at the same time as their colleague but had not clocked in and on the second occasion they were rushing and had forgotten to log in. The failure to log in is fault and caused Ms X distress as she believed Mrs Y was not cared for appropriately. However, the records support that the care worker was present at the visit and Mrs Y did receive care so this did not cause Mrs Y an injustice.

The Council’s complaint response

38. When Ms X complained to the Council, it failed to respond properly to the main crux of Ms X’s complaint regarding the decision to keep two care workers. This was fault. When Ms X contacted the Council following its complaint response to say it had not addressed the main part of her complaint it did not respond but referred her to us. The Council’s failure to properly respond to Ms X’s complaint caused her frustration.

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Agreed action

39. Within one month of the final decision the Council has agreed to apologise to Mrs Y and pay her £500 to acknowledge that she paid for double handed care for longer than was necessary. It has also agreed to apologise to Ms X and pay her £150 to acknowledge the distress and frustration caused by its failure to discuss with her and Mrs Y the decision not to reduce to one care worker and for its failure to respond properly to her complaint.
40. Within two months of the final decision the Council has agreed to remind staff to discuss any concerns with service users and/or their representatives which could affect their care package, ensure they communicate the options for moving forward and document these discussions in the care records.
41. Within two months of the final decision the Council has agreed to ensure the care provider reminds staff to:
• properly records concerns about service user’s behaviour in the daily care records and
• clock on the electronic system at all care calls.

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Final decision

42. I have completed my investigation. There was evidence of fault causing injustice which the Council has agreed to remedy.

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Investigator's decision on behalf of the Ombudsman