Summary: The Council acknowledges there were failings in the domiciliary care provided to Ms Y. It has agreed to apologise and reimburse some of the fees Ms Y paid towards her care.

The complaint

1. Mrs X complains the Council failed to offer a suitable remedy following her complaint about the domicillary care provided to her mother by Medacs Healthcare, on behalf of the Council.

Back to top

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. 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)
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)

Back to top

How I considered this complaint

5. I have:

• considered the written complaint and discussed it with Mrs X;
• considered the correspondence between Mrs X and the Care Provider (Medacs) and Mrs X and the Council;
• considered relevant legislation;
• offered Mrs X and the Council an opportunity to comment on a draft of this document.

Back to top

What I found

Relevant legislation

6. The Care Act 2014 and the Care and Support Statutory Guidance 2014 (updated 2017) set out the Council’s duties towards adults who require care and support.
7. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs.
8. 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.
9. Regulation 9 Person Centred Care says Care Providers 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.

Key Facts

10. Mrs X’s mother, Ms Y is in her eighties. She has health issues and has more recently been diagnosed with dementia. She lives in her own home and needs full assistance with all aspects of daily living. She requires a hoist for transfers and can use one arm.
11. When Ms Y was discharged from hospital she needed increased care visits, which her usual care provider could not accommodate so the Council commissioned an additional two visits per day from Medacs Healthcare.
12. Mrs X became aware that carers were not staying for the full duration of the planned visits, and that they were not delivering all the care needed. One visit lasted only three minutes. Mrs X says this caused Ms Y distress and left her feeling vulnerable.
13. Mrs X complained directly to Medacs. It investigated and upheld the complaint. It accepted carers had not stayed for the duration of the planned visit and that it had failed to inform the Council. It recommended the Council to refund Ms Y 36.73% of the charges.
14. As the care was commissioned by the Council, it was responsible for ensuring the care met Ms Y’s needs. It was also responsible for reviewing her care needs. During the period Medacs provided Ms Y’s care, the Council carried out three reviews on 4 July 2019, 26 May 2020 & 11 May 2021. No concerns about the service were raised in 2019 and 2020. Mrs X says she had no knowledge of the reviews.
15. The Council became aware of Mrs X’s concerns on 13 April 2021 when she made a referral to social services to request a change of care provider. A social worker subsequently spoke to Ms Y who said that she did not want to change provider. Mrs X says Ms Y has dementia and has difficulty recalling events and the social worker should have contacted her. The social worker informed the Council’s commissioning team who in turn informed the Council’s complaints team. A complaints officer asked to be kept updated.
16. In May 2021 Medacs made a referral to social services to say Mrs X had telephoned it to request a reduction in the care package and a review of Ms Y’s care needs. Mrs X refutes this and says Medacs made this claim after its shortcomings were identified and she believes it was attempting to cover its failings. A social worker subsequently spoke to Mrs X following which a safeguarding referral was made. The Council’s commissioning team and complaints team were also alerted to issues with care provision.
17. Mrs X spoke with an officer from the Council’s complaints team on 2 June 2021. She said she had made a complaint directly to Medacs. The officer contacted Medacs to say it would monitor the progress of the investigation; and asked it to ensure the investigation went back to the date it began providing care to Ms Y.
18. The complaints team chased Medacs for a response in late June and July 2021. Medacs provided Mrs X with a complaint response on 15 July 2021. Mrs X contacted the Council the following day to say she was dissatisfied with the response. The Council contacted Medacs to ask it to investigate further and to calculate how much care had been underdelivered.
19. The Council met with a senior manager at Medacs on 9 September 2021 to discuss the issues and to review Medacs final complaint response before it was sent to Mrs X.
20. Medacs identified that it had underdelivered 36.73% of Ms Y’s care.
21. Mrs X received a final complaint response from Medacs in September 2021. The letter was incorrectly dated as 17 August 2021.
22. The Council accepts fault. It says Medacs had not identified the fact that Ms Y’s care visits were being completed in less time than that specified in its agreement with the Council.
23. The Council says after taking account of the care undelivered, the cost of the care Ms Y received still exceeded the amount that she contributed towards her care. However, the Council wishes to provide a remedy to acknowledge the shortcomings in the service provided. It has agreed to apologise to Ms Y and Mrs X and reimburse Ms Y 36.73% of her contribution to her care fees.
24. In response to my enquires about how the Council monitored the service commissioned from Medacs, it said its usual monitoring procedures were suspended during the pandemic, and contract monitoring visits were not undertaken. These were replaced by weekly telephone calls to providers by commissioning officers.
25. The Council has now resumed contract monitoring visits to all care providers. In March 2022 it visited Medacs and inspected the audit and monitoring records of timings and duration of care visits. It confirms Medacs now has a system in place to identify when staff are not staying for the full planned duration of a visit. However, it found Medacs did not have proper procedures in place to ensure written recording of telephone calls from service users. The Council has taken action to ensure this is addressed.

Back to top

Agreed action

26. The Council has agreed to:

• provide Ms Y and Mrs X with a written apology for the identified failings;
• reimburse Ms Y 36.73% of the fees paid towards her care.

27. In addition, the Council should, within four weeks of the final decision:

• pay Mrs X £250 to acknowledge her time and trouble pursing the complaint with the Council and this office.

Back to top

Final decision

28. The Council acknowledges there were failings in the domiciliary care provided to Ms Y. It has agreed to apologise and reimburse some of the fees Ms Y paid towards her care.
29. It is on this basis; the complaint will be closed.

Back to top

Investigator's decision on behalf of the Ombudsman