Summary: Ms C complained about the care her father received from a homecare agency commissioned by the Council. We found there was fault with regards to some aspects of the care Mr F received, for which the Council has agreed to apologise.

The complaint

1. The complainant, whom I shall call Ms C, complained to us on behaf of her father, whom I shall call Mr F. Ms C complained about the care her father received from a homecare agency commissioned by the Council. She complained that:
• The care agency failed to keep the property to a reasonable clean standard. As a result, she had to clean it herself.
• Staff left Personal Protective Equipment (PPE) kit on a kitchen surface after use (on one occasion).
• Staff left her father outside his property on one occasion, because he refused to go back inside. The care agency failed to notify his family to enable the family to try and resolve the situation.
• The care agency mis-recorded food-intake.
• The care agency did not properly manage his medication
2. Ms C also complained the Council failed to inform her what the outcome was of its investigation into the above issues.

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The Ombudsman’s role and powers

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. 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. If we are satisfied with an organisation’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

6. I considered the information I received from Ms C and the Council. I also carried out an interview with a manager of the Council. I shared a copy of my draft decision statement with Ms C and the Council and considered any comments I received before I made my final decision.

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What I found

Relevant legislation and guidance

7. The Discharge to Assess process is aimed at reducing the time people spend in hospital once they are ready to be discharged. It says that:
• Wherever possible, people should be supported with short-term funded support to return to their home (or another community setting) for assessment.
• However, people should still be assessed before going home, to ensure they receive the services required for their safety at home.
8. Once they have been back and settled within their own home environment, the Council will carry out a full assessment for longer-term care and support needs.
9. The guidance above says the process should put people and their families at the centre of decisions.

What happened

10. Mr F has dementia. He was admitted to hospital due to shortness of breath, increased confusion and back pain. His Discharge Profile dated 31 March 2021 was a care plan written by the Intermediate Care Service hospital discharge team. It said that:
• Before Mr F went into hospital, he was able to mobilise with a tripod stick. He had private support from a care agency twice a day, with personal care and medication.
• His daughter has been supporting Mr F at home in the evenings. The care plan said she would also support him with kitchen tasks and domestic tasks. She lives nearby and is happy to continue with this on discharge.
• He needs assistance with personal care and can engage with tasks when prompted and encouraged. He needs an increase in his care calls and a ’72-hour wrap’ to support with discharge.
11. The Council arranged a homecare package from care agency A.
12. The care agency initially provided a support package of 24 hours a day to ensure he was safe and to see how he would settle. Mr F received this from 1 until 6 April 2021.

The complaint about cleanliness

13. Ms C said that, before care agency A started on 1 April 2021, she explained to the social worker what support her father had previously received from care agency B, with regards to cleaning. She said the social worker never told her during that conversation that cleaning would not be part of the support by care agency A.
14. Ms C complained the care agency failed to keep the property to a reasonable clean standard. She said it failed to:
• Keep the bathroom clean, including the toilet and the walk-in-shower.
• Clean the floors, including picking up clothes from the floor which were a trip hazard.
• Wash the dishes properly
15. The Council said its records show there was a discussion with Ms C on 30 March 2021 about the previous care in place. It said there is no evidence this included a discussion about cleaning.
16. As mentioned above, the care agency provided initially 24 hours of support a day to Mr F. I have not seen any indication that this aspect of Ms C’s complaint referred to this period.
17. At the end of this period, the Council carried out a review of Mr F’s assessments and support. As part of this, a social worker spoke to Ms C, who said she would prefer if the social worker would see her father alone, as she was working.
18. After the visit to Mr F, the social worker called Ms C. The social worker explained what she had observed. However, the records did not show there had been a discussion about what care workers would do during each visit. The social worker said she would monitor her father over the next few days and then discuss what his ongoing care needs would be, before moving him back to his privately paid for package with care agency B. Ms C said she was happy with the increase in his care package from two to four visits a day, as she had to work.
19. The care plan dated 6 April 2021 said that:
• He will continue to receive support from his family with shopping, domestics, accessing his medical appointments, managing his finances. His domestic tasks are overseen by his daughter
• Care staff keep areas tidy after use
20. It is unclear on what basis the Council concluded that Ms C would continue to (oversee) domestics from 6 April 2021, as there is no evidence in the records of a discussion with Ms C at that time or agreement about this.
21. Mr F subsequently received a package of four visits a day to provide support with: toileting, washing, (un)dressing, preparing meals and drinks and support with his medication. The care plan said that care workers should also tidy areas after use.
22. Ms C did not raise a concern about cleanliness until 12 April 2021, when she complained about the state of her father’s home, that day. The issues she raised at the time were:
• There was used PPE equipment (gloves and mask) in the kitchen
• The toilet was soiled, the carpet was not clean, and the dishes were not washed properly.
23. The Council looked into this and said:
• Care agency staff said they had limited time to clean, especially in the morning. Mr F was difficult to support in the morning so it would take more time to support him. This left less time for cleaning.
• Mr C was able to access the toilet independently. This meant the toilet could have become soiled when Mr F visited the toilet in between care visits.
• Cleaning the floor was not within the remit of the reablement support provided by the care agency. The floor is likely to require a thorough weekly clean and this task would fall on family or a private cleaner.
• The care agency said its staff cleaned the dishes properly. As such, the investigation could not come to a view on this aspect of Ms C’s complaint.
• The safeguarding investigation concluded that, on the balance of probabilities, it was likely the PPE belonged to the care workers. Since the incident, the care agency has told staff during a staff meeting to ensure PPE is disposed correctly. 
• The care agency has said it has revisited the importance of checking that the immediate environment utilised for care is left clean and tidy, within their recent staff meetings. It also asked care workers to give extra care when cleaning the dishes.
24. The care agency Mr F had before he went into hospital, took over his care again on 19 April 2021. Mr F has since moved into a care home permanently.

Analysis

25. There is a lack of evidence in the records to show if, what and when there was a discussion with Ms C about what domestic support she would continue to provide, and what care workers would do. This resulted in a lack of clarity for Ms C around this, which is fault for which the Council should apologise.
26. The Council acknowledged that it was probably a care worker who had left the PPE kit in the kitchen, for which it has apologised. I find this to be a sufficient remedy.
27. The care agency has indicated it has taken appropriate steps in response to the concerns.

The complaint about her father being left outside the property

28. Ms C complained care staff left her father outside of the property on one occasion. She said:
• He refused to go back inside, so staff should have contacted the family to enable them to resolve this.
• The care agency has said the staff member tried to call her, but she did not pick up. However, Ms C said she did not have a missed call that day.
29. The care provider’s version of events, as described in the investigation report, is different to Ms C’s. It said that care workers found Mr F in a confused state in his garden. They escorted him back into the property safely and into bed. However, the care worker was unable to locate the key to lock the back door. The care worker tried to call Ms C, but she did not pick up her phone. As such, the care worker closed and secured the back door and left the property. The same care worker tried to contact Mr F’s son the following day to alert him of the issue.
30. I have received a record (screenshot) from the care agency that shows the care worker tried to call Ms C that day at 19:27 and her brother the next day at 15:25.

Analysis

31. I found there was no fault as the care worker managed to get Mr F back into the house and in bed. She tried to call Ms C to discuss the events, but Ms C did not answer the phone.

Medication management

32. Ms C complained about the way her father’s medication was managed. She said her father should receive his medication from a blister pack on top of the fridge, and not from the supply on the top shelf. However, on one occasion, the care agency gave his medication from a blister pack located on the top shelf of the cupboard.
33. In response to Ms C’s concern, the Council tried to determine if Mr F could have reached out and taken the medication from the top shelf. As such, it asked Mr F to show where his medication was kept. The record states that Mr F mobilised to the kitchen with his frame. When he got to the cupboard where his medication was kept, he placed his frame to the side of him. When he did so, he was able to reach his medication on the top shelf.
34. However, Ms C does not accept this, saying her father could not reach the medication on the top shelf and never used the blister pack there.
35. The Council concluded that: As there was some doubt as to whether Mr F could have accessed his medication on the top shelf, Ms C’s concern could not be substantiated.
36. In response to my enquiries, the care agency said the team knew they should only use the medication on top of the fridge. The care team state this is the only medication they used. Mr F was mobile and could access all areas of his property including cupboards.
37. Ms C was also unhappy about another aspect of the way in which the care agency managed her father’s medication. She said the care agency did not provide some of his medication between 1 and 19 April 2021.
38. Ms C said she went through her father’s medication on 16 April 2021 and found four empty packets of medication that had already run out. She was concerned about how long ago it had run out. The medication was:
• To prevent blood clots and stroke
• To treat high blood pressure
• To prevent heart attacks and strokes
• To treat Dementia
39. Ms C said she immediately called the GP to request this medication, who agreed to send it out the same day. She said the pharmacist has since confirmed to her that not giving this medication put her father at an increased risk of a heart attack or stroke during this time.
40. The care agency said it received a bag of Mr F’s medication from hospital and entered the medication in it onto a Medication Admission (MAR) chart. It said the hospital did not provide them with a discharge summary, as it should have. The summary would have included a full list of all the medication Mr F was taking at the point of discharge. It said that, as such, it did not know that he was also on other medication not included in the bag.
41. The Council’s investigator said she would contact Mr F’s GP to ask what the impact could have been of not having this medication for 18 days. However, the Council said the GP did not respond to this request, despite various attempts. The Council has told me it will escalate this to the local Clinical Commissioning Group.

Analysis

42. I agree with the Council’s view that it is not possible to come to a view who accessed the medication on the top shelf.
43. With regards to the four types of medication Mr F did not receive between 1 and 19 April 2021, I found as follows. The discharge summary is an important document that entails important information about a person’s condition and care on discharge. Care agency A specialises in providing support to those who have been discharged from hospital. As such, the care agency should have chased the hospital, or contacted the Council, if they did not get a copy of the discharge summary. The care agency did not do this, which is fault. If they had done this, they would have seen that he was on four additional types of medication. Furthermore, the Council’s safeguarding investigation did not highlight this specific fault in its report, which is fault.
44. While this was a serious fault that is likely to have put Mr F at an increased risk of harm, I have not seen evidence that he suffered pain during this time, or any harm (immediately) afterwards. Mr F and his daughter should receive an apology for the above faults.

The complaint about food recording

45. Ms C complained the care agency mis-recorded food-intake. She said care workers put the food in front of her father and recorded it as eaten, even though care workers would not observe him eating it and he would occasionally not eat (all of) it.
46. The Council’s safeguarding investigation upheld this aspect of Ms C’s complaint and has already apologised for this. The care provider has since provided detailed instructions to its staff as to how this should be recorded.

Analysis

47. I found the care provider and the Council have already acknowledged there was fault, for which it has already apologised. I find this to be a sufficient remedy.
48. The care agency has indicated it has taken appropriate steps in response to the concerns.

Ms C’s complaint about the Council’s investigation:

49. Ms C complained the Council failed to inform her what the outcome was of its investigation. She told me the Council’s response did not fully respond to all of her concerns.
50. In response, the Council said the social worker spoke to Ms C on 24 June 2021 about the outcome of the enquiry. Following this, it provided a summary to Ms C in writing and provided further information in letters on 5 July 2021 and 6 August 2021.

Analysis

51. I found the Council provided feedback as to what it found, explaining what concerns were upheld and what actions would be taken to address these.

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Agreed action

52. 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, I have made recommendations to the Council.
53. I recommended that, within four weeks of my decision, the Council should:
• Provide an apology to Mr F and his daughter with regards to the faults identified in paragraph 25 and 42 and the distress this caused them.
• Ask care agency A to share the lesson identified in paragraph 43 with its staff.

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Final decision

54. I have found some fault, for reasons explained above. As such, I have upheld Ms C’s complaint.

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Investigator's decision on behalf of the Ombudsman