Summary: Mr X has complained about poor care delivered to his daughters by a care provider. The Council is at fault as there were instances of poor care delivered by the care provider which caused distress and avoidable time and trouble to Mr X and his family. The Council has agreed to remedy the injustice to Mr X by apologising and making a payment of £750 to him.

The complaint

1. Mr X complains that a care provider, Community Integrated Care (CIC) provided poor quality care to his daughters, Miss Y and Miss Z. In particular:
1. A carer placed Miss Y, Miss Z and their family at risk as they breached the national lockdown rules by visiting other parts of the country. Mr X did not feel the care provider took the matter seriously when he raised it.
2. Carers did not care for Miss Y and Miss Z in accordance with their continence care plan when taking them on a day trip as they did not check whether there were accessible changing rooms. This meant Miss Y and Miss Z were left for four to five hours in soiled clothes which worsened skin breakdowns and caused distress;
3. Carers did not regularly check Miss Y and Miss Z’s glucose readings which placed them at risk.
4. Carers did not use the communication book when handing over Miss Y and Miss Z’s care to the next carers coming on shift.
5. Carers did not notice for many hours that Miss Z had dislocated her thumb when falling. Mr X considers it is unlikely the injury occurred when Miss Z fell due to the severity of the injury and time taken to notice the injury so another incident must have occurred.
6. CIC have failed to consider Mr X’s claim for damage caused to his garage door by a carer and damage caused to his car by a carer despite undertaking to do so.
7. CIC and the Council failed to have sufficient oversight of the care package which enabled carers to deliver poor care
8. That the Council’s investigation into Mr X’s complaint fails to address the poor quality of care.

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The Ombudsman’s role and powers

2. 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)
3. 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)
4. 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)
5. 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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How I considered this complaint

6. I have:

• Considered the complaint and the information provided by Mr X;
• Discussed the issues with Mr X;
• Made enquiries of the Council and considered the information provided;
• Invited Mr X and the Council to comment on the draft decision. I considered any comments received before making a final decision.

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What I found

Law and guidance

7. A council must make enquiries if it has reason to think a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themself. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

What happened

8. Mr X’s daughters, Miss Y and Miss Z have physical and learning disabilities and require a significant amount of care. The Council commissioned CIC to provide care to them in their home. In July 2020 Mr X cancelled the care due to concerns about the risks of COVID-19 to Miss Y and Miss Z and about the standard of care.
9. In September 2020 Mr X made a complaint to CIC about the standard of care provided to Miss Y and Miss Z. Mr X raised a number of issues including:

• An incident in 2019 where Miss Z suffered a significant hand injury following a fall.
• Carers not regularly monitoring Miss Y and Miss Z’s glucose to control their diabetes.

10. The care provider responded and acknowledged there had been occasions when the care and support had not met the standards it expected. The provider considered a memorandum of understanding when the care provision commenced and regular feedback from Mr X would have helped highlight and address the issues. The care provider apologised and said it would use the family’s experience to improve care as it was no longer providing care to Miss Y and Miss Z.
11. The care provider notified the Council of the complaint but an officer failed to tell the customer service team so the Council did not investigate the complaint at this time. The Council acknowledged the oversight.
12. Mr X made a complaint to the Ombudsman. In this complaint he raised additional instances of poor care including carers not meeting Miss Y and Miss Z’s continence needs on day trips between 2018 and 2019 and a carer breaching the national lockdown rules. Mr X also raised incidents of carers causing damage to his car and garage. We discontinued our investigation as the Council decided to carry out a safeguarding investigation into the carer breaking national lockdown rules, carers not meeting Miss Y and Miss Z’s continence needs on day trips and the injury to Miss Z’s hand. The Council would also deal with the issues raised by Mr X as a complaint.
13. An officer carried out the safeguarding investigation. In doing so he discussed the issues with Mr X and the care provider. He also consulted a medical professional regarding the injury sustained by Miss Z.
14. The safeguarding investigation found:

• A carer had breached the lockdown rules and another carer did not report this to the care provider. Mr X also did not report it. The care provider would have removed the carer if it had been aware of the breach. The officer concluded the incident did not amount to abuse. But the actions of the carer increased the COVID risk to Miss Y and Miss Z . The Council recommended the care provider ensures such issues are raised with its management.
• Mr X had raised concerns with the care provider in 2018 and 2019 regarding carers not finding suitable places to change Miss Y and Miss Z’s continence pads on day trips. As a result they had on occasions soiled their clothes and would have been uncomfortable for them and they would have been unable to communicate that. The officer concluded there was no evidence of abuse but it was more an matter of planning as Miss Y required a hoist. The intentions of staff were good, there was no physical injury caused by this and the trips continued for 14 months without significant incident. The officer also noted Miss Z was mobile and could be changed in any toilet.
• Mr X raised concerns about Miss Z’s fall in October 2019 and considered her hand injury was caused by another unrecorded incident. This was because the injury was severe and was not apparent for some hours. The officer noted there was no evidence of another incident. He also spoke to Miss Z’s GP who said she expected Miss Z to be in pain at the time of the incident. She also said the she would expect the swelling to have started soon after the fall but it may have only become apparent later.

15. The Council then considered Mr X complaint. It set out the findings of the safeguarding investigation but noted the officer should have obtained Miss Y and Miss Z’s support plans to see if carers had followed the continence care plans.
16. The Council also said:

• The checking of Miss Y and Miss Z’s glucose levels was set out in their support plans. The care provider was not aware of any incidents where Miss Y or Miss Z required intervention due to high or low glucose levels. Staff had reported when readings had been high or low to enable intervention.
• The care provider believed it had sent an email to Mr X asking for details of the damage to his car but had not. It apologised for the oversight and asked Mr X to respond to the care provider’s email of 21 March 2021 with final costs for the damage.
• Mr X said staff did not use the communication book. The care provider reported staff had their own communication book to hand over care to the next staff coming on shift. The Council said it expected that staff should use the communication book put in place to ensure a smooth handover of care.
• Mr and Mrs X attended a meeting with the care provider and allocated social worker in March 2019 to support the working relationship between the care provider and family. The social worker remained in place until May 2019 when the care was stable and a review of their care would be carried out within 12 months. It was open to Mr X to contact the duty teams if he had concerns about the care.
• In reviewing Mr X’s complaint, the Council had identified service improvements. This included a memorandum of understanding where care is delivered in a service users home, the care provider to have proportionate oversight of staff delivering services, ensure staff adhere to the care provider’s code of conduct and the care provider is aware of the process of detailing any direct complaints which have been raised as part of its contract management.
• The Council acknowledged Mr X and his family experienced a significant amount of issues during the time the care provider supported the family.

17. In response to our initial enquiries the Council has offered a payment of £250 to Mr X to acknowledge the time, trouble and distress he experienced in raising his complaint. The Council acknowledged there was a missed opportunity to address Mr X’s concerns in a timely manner.
18. In response to my questions, the Council has said it has been unable to provide the relevant care records, care plans and communication books as Mr X has kept these. Mr X disputes he has kept the records and says the care provider removed these in 2020. The care provider introduced an electronic care planning system so such information is now stored centrally. It also provides an electronic handover system/communication log which staff are trained to use.
19. The Council has said the care provider has not received Mr X’s final costs for the damage to his car so cannot progress his claim.
20. The Council also said it has now restated the process for social workers to escalate and share care quality concerns and responding to complaints. It is also in the process of producing protocols.
21. The Council has provided evidence to show it held regular meetings with the care provider as part of its contract monitoring. These meetings focussed on the care and support of individuals and service delivery. The Council and care provider have carried out quality assurance reviews of the service.

Analysis

Carer breaching lockdown rules

22. The safeguarding investigation found that a carer breached the national lockdown rules. Mr X did not report the breach to the care provider. But another carer was aware of the breach and did not report this to her manager. This is fault. The breach and failure of the carer to report the breach will have caused distress to Mr X and his family as they were concerned the carer was putting them at significant risk of COVID-19.
23. The care provider has evidenced that it has procedures for employees to report such concerns. I am therefore satisfied it has taken appropriate action to ensure staff are aware of how they can report concerns about an employee’s conduct to prevent a reoccurrence of the issue experienced by Mr X.

Carers not caring for Miss Y and Miss Z in accordance with their continence plans on day trips

24. The safeguarding investigation found that the failure to ensure there were suitable changing facilities for Miss Y while on a day trip was a matter of poor planning. It did not address whether carers were able to change Miss Z’s continence pads. The safeguarding investigation also did not address whether the failure to change the continence pads was in accordance with their care plans. The failure to plan for adequate changing facilities may not amount to abuse. But the Council failed to consider if carers had met Miss Y’s and Miss Z’s continence needs and that this could be an indicator of poor care. The safeguarding investigation found there was no indication of physical harm caused to Miss Y and Miss Z. But the failure to plan for adequate changing facilities means their continence care needs were not met. This is likely to have caused them some distress and a loss of dignity.
25. I note the care provider resolved the matter when Mr X raised it with them in 2019. But the Council should remedy the distress caused to Miss Y and Miss Z.

Carers did not monitor Miss Y’s and Miss Z’s glucose levels

26. The care provider and Council have said Mr X actively managed Miss Y and Miss Z’s diabetes. Mr X has also provided an entry from the communication book which shows carers agreed to check Miss Y and Miss Z’s bloods every half hour. The care plan is not available but the communication book entry lends weight to Mr X’s view that carers should have been monitoring Miss Y and Miss Z’s glucose levels. Furthermore, the care provider, in response to Mr X’s complaint, acknowledged carers had not been as vigilant as they should have been. On balance, this is evidence of poor care as carers did not always monitor the glucose levels in accordance with the care plan. I consider this will have caused distress to Mr X.
27. The Council has said there is no evidence of harm caused to Miss Y and Miss Z by any failure to monitor their glucose levels. I have not seen the care records to know if this is the case. But events are now two to three years old and I do not consider further investigation will achieve more for Mr X, Miss Y and Miss Z.

Hand injury to Miss Z

28. The care provider and Council have investigated the events surrounding Miss Z’s fall and hand injury and I do not consider I can add anything more to those investigations. Further investigation will not establish if Miss Z’s injury was as a result of the fall or if there was another incident which caused the injury.

Failure to complete the communication book

29. I have not seen the communication book so I cannot know if carers were completing it as they should. But it is not proportionate to investigate the matter further. This is because there is no evidence that any fault in carers not completing the book caused significant injustice to Mr X and his family. The care provider has also introduced a new care management system to improve carers handovers.

Council and care provider’s oversight of the care package

30. The Council has evidenced it monitored the contract and performance of the care provider. We would not expect the Council to have day to day oversight of the delivery of the care package as that is the responsibility of the care provider. The Council should review how the care package is meeting users’ needs at the annual reviews of the care plans. It is open to service users and/or their representatives to raise concerns about the care with the Council outside of the annual review process. So, I am satisfied the Council is not at fault in how it monitored the care package.
31. I note the care provide carried out quality assurance reviews although I am not clear how the care provider monitored the day to day quality of care provided to Miss Y and Miss Z. But it is not proportionate to investigate this matter further as I cannot achieve anything for Mr X and his family. The care provider no longer delivers care to Miss Y and Miss Z. The care provider also recognised the need for service improvements, such as a memorandum of understanding, in response to Mr X’s complaints.

Damage to car

32. Mr X has said he sent details of the final costs of the damage to his car to the care provider. The care provider has said he has not responded to its last email about the matter in March 2021. I cannot reconcile the two positions. It is open to Mr X to send a further copy of his final costs to the care provider to progress the matter.

Council’s investigation into Mr X’s complaint failed to address poor quality care

33. As stated above, I consider the Council failed to address whether there were incidents of poor care when it carried out its safeguarding investigation such as whether carers followed continence plans. It also did not address this in its complaint response. The care provider had also acknowledged that on occasions the care provided did not meet the required standard. The Council also did not consider the impact of the carer breaching lockdown rules on Mr X and his family. I therefore consider, on balance, the Council’s failure to address the issue is fault and it missed the opportunity to remedy the injustice to Mr X and his family. This will have caused frustration to them.
34. The Council has acknowledged it should have passed the complaint to its customer service team when the care provider notified it of the complaint.

Remedy

35. The Council has offered a payment of £250 to Mr X to acknowledge the avoidable time and trouble he was put to by the Council’s missed opportunity to resolve it sooner. This is a sufficient and proportionate remedy. I also consider this is sufficient for the frustration caused by the Council failing to address and remedy the issue of poor care.
36. The Council should also remedy the distress caused by the failure to meet Miss Y and Miss Z’s continence needs on day trips, the distress caused by a carer breaching lockdown rules and another carer’s failure to report it and the care provider’s acknowledgement that care did not meet the required standard on occasions. In considering a proportionate remedy I have also taken account that Mr X concerns about the standard of care could have been resolved more quickly if he had reported them to the care provider or Council sooner. I therefore consider a remedy of £500 is proportionate to acknowledge the distress caused.

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Agreed action

37. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of the care provider in addition to the Council, I have made recommendations to the Council.
38. That the Council sends a written apology and makes a total payment of £750 to Mr X to acknowledge the avoidable time and trouble and distress caused to him and his family as outlined above. The Council should take this action within one month of my final decision.

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Final decision

39. The Council is at fault as there were instances of poor care delivered by the care provider which caused distress and avoidable time and trouble to Mr X and his family. The Council has agreed to remedy the injustice to Mr X as agreed so I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman