Summary: Mrs X complained about home care provided to her late mother that was arranged by the Council. We have not found the Council to be at fault.

The complaint

1. Mrs X complains about the home care provided to her late mother (Mrs B) by a private care agency, Wisdom Healthcare Ltd (the Agency) arranged by the Council.
2. In particular, Mrs X complains about:
1. Mrs B being left unsafe and neglected.
2. Being told not to visit her mother during the Covid-19 lockdown.
3. Mrs B being asked for money to pay for cleaning.
4. The attitude and conduct of the Agency manager towards her.
3. Mrs X says the Agency’s actions have caused her significant distress and prevented her from spending valuable time with Mrs B.

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The Ombudsman’s role and powers

4. 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)
5. 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)
6. 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.
7. 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

8. I considered:

• Mrs X’s complaint;
• the Agency’s response to the complaint; and
• the Council’s response to my enquiries.

9. I also discussed Mrs X’s complaint with her.
10. Mrs X and the Council had an opportunity to comment on a draft version of this decision. I considered any comments received before making a final decision.

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What I found

Relevant legislation

11. 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.
12. Regulation 9 Person Centred Care says Care Provider must do everything reasonably practicable to make sure that people who use the service receive person-centred care and treatment that is appropriate and meets their needs.
13. Regulation 12 Safe Care & Treatment says people must not be given unsafe care or treatment or be put at risk of harm that could be avoided. Care Providers must assess the risks to a person’s health and safety during any care or treatment and make sure care staff have the qualifications, competence, skills and experience to keep people safe.

What happened

14. I have set out below a summary of the key events. But it is not meant to show everything that happened.
15. In 2019, Mrs B was discharged from hospital with a home care package arranged by the Council and provided by the Agency.
16. Mrs X became concerned about some aspects of care being offered to Mrs B and raised these with the Agency. These included the following matters:

• A key safe was left unsecure and was reported as being so by paramedics.
• There was a failure to provide key safe number to paramedics.
• The brakes were not put on Mrs B’s bed.
• The height of Mrs B’s bed was set incorrectly.
• Mrs X was left without access to her mobile phone.
• There was a failure to ensure Mrs B took her medication on one occasion that was identified by paramedics.
• Mrs B was asked to pay for a cleaning service, despite not having capacity to deal with her finances.
• Mrs X was told she could not visit her mother during the Covid-19 lockdown.

17. The Agency provided a formal response and addressed each of Mrs X’s concerns. In summary, it reached the following conclusions:

• The back brakes were always left on, so the bed was safe.
• The height of the bed was adjusted according to Mrs B’s needs.
• An initial payment for cleaning was made by cheque and subsequent payment were made via Mrs B’s court appointed deputy.
• Mrs X was not told she could not visit Mrs B, rather to time visits outside of care calls to reduce the risk of infection.
• There were occasions when staff did not jumble the key code because Mrs X was still in the property.
• There were also some isolated incidents when some minor mistakes were made but not such a degree that Mrs B was ever put in danger.

18. Mrs X says the Agency manager (the Manager) demonstrated a generally uncaring attitude and was hostile towards her. She says the Manager’s actions contributed to her losing valuable time with her mother at the end of her life.
19. As part of my investigation, the Manager was asked to comment on the allegations made against her. She presented a different version of events and was confident Mrs B received good quality care, subject to some minor mistakes. She strenuously denied what Mrs X said about her personally and professionally.

Analysis

20. From discussions with Mrs X during my investigation, it is clear that overall she was satisfied with the care provided to Mrs B by the carers on a day to day basis. She said the carers were kind and Mrs B was very fond of them. While Mrs X has raised some incidents of concern, the main focus of her is about the Manager.
21. My assessment of Mrs X’s complaint is set out below.

Mrs B being left unsafe and neglected

22. The records show that there were, albeit isolated incidents, when the carers did not scramble the code for the key safe. One such incident was highlighted by the paramedics they were called out in an emergency in March 2021. The Manager referred to other times when Mrs X had been in the property when the carers left, and so it was Mrs X’s responsibility to scramble the code.
23. I have seen no evidence that Mrs B’s bed was left unsafe and the Manager has provided an explanation, demonstrating she was aware of the issue, but satisfied there was no risk to Mrs B from the bed.
24. A paramedic also left a note reminding care staff of the need for medication to be administered in accordance with the prescription. They believed Mrs B had not taken the required number of antibiotics that day. The Agency has provided the relevant Medication Administration Record showing that medication was given once it was available. It also showed three tablets had been prescribed per day, not four as the paramedic had believed. Based on this evidence, I have not found there to be fault here.
25. Overall, I find the overall quality of care provided to Mrs B was acceptable and I have found no evidence of fault.

Being told not to visit her mother during the Covid-19 lockdown

26. Mrs X and the Manager have differing recollections over what happened here. The Agency has accepted it told Mrs B it would prefer her to visit outside of care calls. In the context of the restrictions in place at the time, I do not consider this to be an unreasonable request. It was Mrs X’s decision not to visit Mrs B at all.
27. I have not found fault.

Mrs B being asked for money to pay for cleaning

28. Mrs B did not have capacity to deal with her own money and following concerns about her finances, the Council had applied for a deputyship order. Mrs X says this meant the Agency should not have asked Mrs B for money directly.
29. The Agency explained that there was an occasion, shortly after the deputy was appointed that Mrs B was asked to write a cheque but thereafter an invoice would be sent to the deputy for payment. The cleaning call was priced in accordance with the Agency’s standard rates.
30. As Mrs B did not have capacity, the Agency should not have accepted the cheque from her, regardless of whether she wanted to pay or not. But as this was an interim measure, pending proper arrangements being made with the deputy, I do not consider this to be so serious as to make a finding of fault.

The attitude and conduct of the Agency manager towards her

31. I have seen no evidence that the Manager acted either unprofessionally or inappropriately towards Mrs B. While Mrs X has reported that a paramedic, having overheard the Manager speak on the phone, was surprised at her tone, this is not, in itself, evidence of fault. The Ombudsman makes decisions on the balance of probabilities. In this aspect of the complaint the issues relate to one person’s word and perception against another. As I am unable to prefer one account over another, I have not found fault.

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Final decision

32. I have not found the Council to be at fault and on this basis I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman