Summary: The Care Provider accepts there were errors in the administration of Mrs Y’s medication. I am satisfied the Care Provider took appropriate action to deal with the matter before the complaint came to this office. There is no outstanding injustice that requires a remedy from this office.

The complaint

1. Mrs X complains about the quality of care provided to her mother and how the company dealt with her complaints about this.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. If they have caused an injustice we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34H(3 and 4) as amended)
3. We can decide whether to start or discontinue an investigation into a complaint within our jurisdiction. (Local Government Act 1974, sections 24A(6) and 34B(8), as amended)

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How I considered this complaint

4. I have:

• considered the complaint;
• considered the correspondence between Mrs X and the Care Provider, including the Care Provider’s response to the complaint;
• made enquiries of the Care Provider and considered the responses;
• considered relevant legislation;
• offered Mrs X and the Care Provider an opportunity to comment on a draft of this document.

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What I found

Relevant legislation

5. 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.

What happened

6. Mrs Y is in her eighties. She lives with Mrs X and her husband.
7. Mrs Y requires support with personal care, dressing and the administration of medication. Mrs X commissioned home care services from Joy2Care Limited (Care Provider) to provide two visits a day to Mrs Y, a 45-minute am visit and a 30-minute teatime visit. The morning visit involved assisting Mrs Y to get up, showered, dressed, provide tea & toast, and give any medication needed. The 30-minute teatime visit involved assisting Mrs Y to wash, put on pyjamas, provide a cup of tea, and give any medication needed.
8. I have had sight of Mrs Y’s care plan; it is sufficiently detailed and sets out the care tasks required at each visit.
9. Mrs X was responsible for ordering and storing Mrs Y’s medication.
10. Mrs X says she first complained to the Care Provider in May 2021, because a carer was not staying for the full allocated visit. She says the carer was rushing Mrs Y and was not assisting her to wash. The Care Provider has no written record of any complaint from Mrs X regarding this issue.
11. Mrs X says the carer gave Mrs Y out of date medication for approximately three weeks, and on another occasion, the same carer recorded she had given medication when she had not. Mrs X says the Care Provider told her the carer would face disciplinary action and that she would not visit Mrs Y again. Mrs X says the carer did attend again. She says the Care Provider later said it had not taken disciplinary action but had instead provided further training in handling medication. Mrs X did not believe this to be sufficient.
12. The Care Provider’s records confirm Mrs X was told the carer would not attend Mrs Y from 10 May 2021. The following week a deputy manager from the Care Provider discussed the medication error with Mrs X and asked her if she would consider allowing the carer to return.. Mrs X agreed to this, “…but not all the time”. The carer returned on 22 May 2021. She made a total of nine visits to Mrs Y. Mrs X had no complaints until the second incident occurred, when the carer recorded she had given medication when she had not. Mrs X complained to the Care Provider and the carer was removed from the visiting rota permanently.
13. The Care Provider has provided detailed information which confirms the action taken against the carer.
14. The Care Provider met with Mrs X on 7 June 2021. I have seen the notes from this meeting. The medication errors were discussed, and the Care Provider confirmed it would be addressing the issues with the carer in question. Mrs X says she told the Care Provider that she had reported the issues to the Care Quality Commission and the Council’s safeguarding team.
15. The Care Provider says, after the first medication error, the out-of-date medication was removed from the medication box, but the medication was returned to the box by Mrs X as a test for the carer. Mrs X refutes this. The Care Provider referred the matter to the Council’s safeguarding team. I have had sight of the correspondence between the Care Provider and the Council which confirms the safeguarding referral, and the reasons for it.
16. The Care Provider wrote to Mrs X on 21 June 2021. The author, a care manager, acknowledged the medication errors, and says the incidents had been investigated and the company had followed the relevant procedures for dealing with such matters. No apology was offered.
17. Mrs X submitted a complaint to the Care Provider. I have had sight of a copy of the Care Provider’s response letter dated 25 June 2021. The author, one of the owners of the company, offered a sincere apology for both medication errors and explained how it addressed this with the carer concerned, and as a company in respect of lessons learnt.
18. The author also acknowledged that its previous complaint response was inadequate, in that it failed to apologise for the medication errors. The author went on to acknowledge Mrs X’s expressed view, that she no longer had confidence in the company, and that she had said she was looking for a new care provider.
19. The Care Provider gave notice to terminate its contract and proposed an end date of 10 July 2021. Mrs X says she did not want the Care Provider to cease providing care on that date, as it would leave Mrs Y without care.
20. In its response to my enquiries, the Care Provider acknowledged the medication errors and provided detailed information about how it addressed this through its disciplinary process, and the action taken to improve procedures.

Analysis

21. The Care Provider acknowledged the medication errors before the complaint came to this office.
22. Having considered all the information provided by the Care Provider, it is clear from the information I have seen, it took Mrs X’s complaints seriously and responded appropriately. Once alerted to the fact Mrs Y had been given out-of-date medication it contacted her GP and established that she would suffer no ill-effects. It also referred the matter to the Council’s safeguarding team.
23. Whilst it is clear the carer was at fault for administering out-of-date medication, the carer was not responsible for the storage of the medication, that was Mrs X’s role. I am unclear why out-of-date medication was in the medication box.
24. The Care Provider acknowledged the carer also signed to say she had given Mrs Y medication when she had not.
25. The Care Provider has provided this office with detailed information which demonstrates the action taken against the carer. Such matters are private, and I am not at liberty to detail this further. However, I can reassure Mrs X that the Care Provider followed its disciplinary procedure, and the action was proportionate.
26. It has not been possible for me to come to a finding about Mrs X’s complaint that a carer was inappropriately dressed. Mrs X and the Care Provider each have their own interpretation of events and without being present, it is simply not possible to establish the facts.
27. For the same reasons set out above, I am also unable to come to a finding about a carer rushing Mrs Y when supporting her to wash and dress.
28. I have considered if there is outstanding injustice arising from the Care Provider’s failings and I do not consider there is. The Care Provider dealt with matter properly before Mrs X made a complaint to this office. I consider the action taken by the Care Provider to be adequate. There is no outstanding injustice that requires a remedy from the Ombudsman.

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Final decision

29. The Care Provider accepts there were errors in the administration of Mrs Y’s medication. I am satisfied it took appropriate action to deal with matter before the complaint came to this office. There is no outstanding injustice that requires a remedy from this office.
30. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman