Summary: Mr X complained on behalf of his wife about the actions of Comfort Call, the care agency commissioned by the Council. The Council was at fault for the delay in telling him about the concerns carers raised, carers changing last minute and often arriving late. This resulted in avoidable distress and uncertainty for Mr X and his wife. The Council agreed to pay Mr X and his wife £150 each for the injustice its faults have caused them.

The complaint

1. Mr X complains on behalf of his wife, Mrs Y. He says Comfort Call, the care agency commissioned by the Council:
• did not tell him the carers reported concerns about their safety whilst delivering the care to his wife until after he made a complaint about the care agency;
• assigned carers without experience and understanding of caring for patients with a diagnosis of dementia who often arrived at wrong times;
• changed the carers that attended his property at short notice or without any notice; and
• changed the call times on multiple occasions.
2. Mr X says this caused him stress and anxiety and meant that his wife was not as comfortable during the care calls as she should and could have been.
3. He would like the care agency to review its practice to ensure this does not happen to other families it provides services to. He would also like the care agency to provide more training to its staff about working with people diagnosed with dementia.

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The Ombudsman’s role and powers

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. 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)
6. 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.
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 the information Mr X sent me, and I have spoken to him about his complaint.
9. I considered the Council’s and Comfort Call’s response to my enquiries.
10. Mr X, the Council and Comfort Call have had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Legislative background

11. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan for adults with eligible care and support needs.
12. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings.
13. The National Institute for Health and Care Excellence (NICE) has published guidance for care providers who provide support to people living in their own home. These are based upon the CQC fundamental standards, which in turn are based on the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The NICE guidance recommends care providers should:
• promote continuity of care so that the person knows the home care workers;
• inform people in advance if staff will be changed; and
• tell people how they can make a complaint and how to escalate the complaint.
14. Regulation 17 of the 2014 Regulations requires care providers to keep accurate, complete and contemporaneous records of care and treatment.
15. Regulation 9 of the 2014 Regulations requires care providers to deliver a person-centred care and treatment that is based on an assessment of their needs and preferences.
16. Councils should have clear procedures for dealing with social care complaints. Regulations and guidance say they should investigate a complaint in a way which will resolve it speedily and efficiently.

What happened

17. In March 2020 the Council commissioned an agency, Comfort Call, to provide care to Mr X’s wife at their home. The care consisted of two calls per day at 9am and 4pm.
18. In November 2020, Mrs Y was admitted to hospital. The daily care records show the carer noted they would raise an incident with their manager, but Comfort Call has no contemporaneous notes from that time. In December 2020, Mrs Y went into respite care.
19. The plan was for Mrs Y to go home in January 2021. When the Council asked Comfort Call to resume providing care the agency requested an amendment to the care plan and asked for two carers to deliver Mrs Y’s care. It said this was because of concerns its workers reported over their safety during the calls.
20. In December the social worker spoke to Mr X who agreed to two care workers attending the calls, however he questioned why Comfort Call did not tell him about the concerns the carers raised. He said the carers had been coming since March 2020 and never mentioned they were worried about their safety during the visits.
21. In January 2021 Mr X complained to Comfort Call. He said that:
• it did not tell him about the concerns the carers raised about Mrs Y’s behaviour at the time they were made;
• the carers rarely turned up at the agreed times; and
• the carers changed without any prior notice.
22. The agency responded to his complaint in early February 2021. It said that:
• it could continue providing Mrs Y’s care with two carers attending each call, to which Mr X initially agreed. However, after it said the morning call would have to change to 10am, as opposed to 9am, Mr X was not happy; and
• it received two concerns from carers and provided two emails dated January 2021.
23. Mr X was not satisfied with Comfort Call’s response. He said the concerns it shared with him referred to events that occurred before January 2021, and at the time neither the Council nor the agency told him about them.
24. In the same month Mr X complained to the Council. The following day, the Council told Mr X that it was aware of Comfort Call’s investigation and that it agreed with its findings.
25. In February 2021 Comfort Call reviewed its original complaint response and partially upheld Mr X’s complaint. It accepted that it changed several calls on short notice, but it could not find an instance where a carer arrived two hours early.
26. In July 2021 Mr X complained to the Ombudsman.

The Council’s response to our enquiries

27. The Council told us that in November 2020 the carers raised concerns about their safety during visits to Mrs Y. Comfort Call did not tell the social worker about the carers’ concerns until mid-December 2021. The care agency asked the carers to write their concerns down in early January 2021, when the Council asked if the agency would continue caring for Mrs Y.
28. The Council sent us copies of training records for the carers that delivered Mrs Y’s care. These showed that they were trained in caring for patients with a diagnosis of dementia, among other care related subjects.
29. The Council agreed Comfort Call did not speak to Mr X about the concerns the carers raised, as the care was commissioned by the Council.
30. Because of the complaint Comfort Call said that:
• its staff would receive further training; and
• it was implementing an electronic management system which will allow staff to immediately report concerns in writing.

Our analysis

Information about the concerns the carers raised with the agency

31. Comfort Call has not provided any contemporaneous notes about the concerns the carers raised in November 2020. Instead, it asked the carers to write them up two months later. We consider this to be contrary to Regulation 17 and therefore fault.
32. It is important that Comfort Call documents any concerns at the time they arise.
33. Furthermore, the care agency did not tell the Council about the concerns until mid-December. We estimate this is around a month after the carers reported them. We consider this to be fault.
34. Comfort Call told us that when the care was commissioned by the Council, it expected the social worker to discuss any concerns with Mr X. However, the delay in reporting the concerns to the Council led to a delay in the social worker discussing these with Mr X.

Carer experience and their times of arrival

35. The Council sent us the training records of the carers that delivered Mrs Y’s care. These show, that among other subjects, the carers were trained in “Dementia Care and Mental Capacity”. This evidences the carers had the required training to deliver Mrs Y’s care. There is no fault in who the agency assigned to visit Mrs Y.
36. The Council provided daily records for Mrs Y’s care between March 2020 and December 2020. In that time the carers arrived for their morning call on time 14 times. On 16 occasions they arrived early. The rest of the time the carers were late, mostly by 30-40 minutes. On one occasion, the carer was late for the morning call by two hours. We consider this to be contrary to Regulation 9 and therefore fault.
37. Routine and consistency are important parts of delivering care to people in their homes. We consider that this lack of consistency has caused Mr X and Mrs Y avoidable distress and uncertainty.

Last minute changes to the carers that delivered Mrs Y’s care

38. The Council accepted there were many last-minute changes to carers who delivered Mrs Y’s care. It said that all the changes were made because of staff absence, however Mr X should have been told in advance, and this did not always happen. This is fault.
39. We consider this has further contributed to Mr X and Mrs Y’s avoidable distress and uncertainty about who would turn up on the day, despite having a rota with scheduled carers.

Service improvements

40. The Council told us that since March 2021 Comfort Call implemented a new electronic system that enables carers to report concerns as they arise. The system sends the concern to the relevant manager and allows the care agency to keep a written record of what was reported and when. It also enables Comfort Call to better monitor the services it provides. We consider this is a suitable service improvement.

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Agreed action

41. 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 we found fault with the actions of the care provider acting on behalf of the Council, we have made recommendations to the Council.
42. Within four weeks from the date of our final decision the Council will pay Mr X and Mrs Y £150 each in recognition of the avoidable distress and uncertainty the late changes to carers and their delayed arrivals have caused them.
43. Comfort Call has already made several service improvements which we consider satisfactory. Because of this, we did not make any further service improvement recommendations.

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Final decision

44. I uphold Mr X’s complaint. The care agency was at fault for not informing the Council about the concerns the carers had at the time. We also found the carers often arrived late, and not as per the scheduled rota.

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Investigator's decision on behalf of the Ombudsman