Summary: Mr X complains the Council’s care provider, Expertise Homecare (Ashford), failed to meet his late mother’s needs, putting her at risk of harm. His mother did not always receive person centred care and was put at risk of harm by some of her care workers. This caused avoidable distress to her and Mr X. The Council needs to apologise to Mr X for the distress caused to him.

The complaint

1. The complainant, whom I shall refer to as Mr X, complains the Council’s care provider, Expertise Homecare (Ashford), failed to meet his late mother’s needs, putting her at risk of harm.

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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. 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, sections 30(1B) and 34H(i), as amended)
4. This complaint involves events that occurred during the COVID-19 pandemic. The Government introduced a range of new and frequently updated rules and guidance during this time. We can consider whether the council and care provider followed the relevant legislation, guidance and our published “Good Administrative Practice during the response to COVID-19”.
5. 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)

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How I considered this complaint

6. I have:
• considered the complaint and the documents provided by Mr X;
• discussed the complaint with Mr X;
• considered the comments and documents the Council has provided;
• considered the Ombudsman’s guidance on remedies; and
• invited comments on a draft of this statement from Mr X and the Council, for me to consider before making my final decision.

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What I found

What happened

7. Mr X’s mother, Mrs Y, lived at home with her son and with support arranged by the Council from Expertise Homecare (Ashford) – the Care Provider. Mrs Y was a retired nurse. The Care Provider took over Mrs Y’s package of care in May 2021. This was after the previous care provider gave notice on the basis its relationship with the family had broken down due to the number of complaints Mr X had made. The Care Provider started visiting Mrs Y on 24 May. The Council told Mr X to contact the Care Provider and the Council with any concerns.
8. According to the care and support plan in place, two care workers would visit each day at:
• 08.00 for 45 minutes
• 12.30 for 30 minutes
• 17.30 for 30 minutes
• 20.00 for 45 minutes
9. On 26 May the Care Provider asked the Council to agree a short-term increase to the care package, as calls were taking longer than planned. It said it would get in contact the following week if it believed the increase should be permanent.
10. On 11 June the Council told the Care Provider it would not increase the care package as it would not pay for a care worker to watch Mrs Y read all the labels on her medication. The Care Provider said it would have to hand the care package back. Mr X e-mailed the Council raising concerns about his mother’s care.
11. On 21 June the Care Provider told the Council Mr X was verbally abusive and intimidating its care workers. It said it had told him its care workers would only provide personal care and it had asked him to do his mother’s medication. It said it may need to hand the package back if things did not improve. It said Mr X was very stern with care workers and only left the room when they delivered personal care. It said some care workers were refusing to visit Mrs Y. It suggested asking Mr X to give Mrs Y her medication, leaving the care workers to deliver personal care and reduce the time they spent at the property.
12. Mr X says the care workers regularly hurt his mother, and once came close to overdosing her with one of her medication.
13. The Council spoke to Mr X. He agreed call times could be reduced if Mrs Y agreed to him giving her medication. He said he liked to help the care workers, but some did not want this. He said he had been caring for his mother for six months and knew how best to transfer her. He said he made sure the care workers did not leave Mrs Y slumped in her chair, as previous care workers had done. He said care workers were knocking Mrs Y’s toes on furniture and doorways when moving her in her wheelchair.
14. The Council arranged to visit Mrs Y and her son on 25 June. It appears the purpose of the visit was to discuss Mrs Y’s care and support plan, as the Council updated it on 29 June.
15. On 26 June Mr X complained to the Care Provider about changes in the call times. He said care workers arrived at 12.20 when they had been due between 11.35 and 12.05, and only spent 20 minutes with Mrs Y. He said they next arrived at 15.45 when she had not expected them until 16.25-16.55. He said the care workers spent less than 25 minutes in their home and did not need 45 minutes for the lunch and teatime calls. He said consistency was very important to his mother
16. The Council sent Mr X a care and support plan for his mother on 29 June. The care and support plan reflected the same call times as in May (see paragraph 8 above). However, the Council told Mr X for four weeks only the call times would be one hour in the morning and 45 minutes for the other calls. For toilet needs, the plan said:
• “I require support from 2 carers with toileting needs. I wear pads as I am not able to get myself to the toilet as I cannot mobilise. I do not always feel when I need to go to the toilet but carers may not be there when needed and I also use pads. I need to be hoisted to the commode when required.”
17. For medication, the plan said:
• “Carer to take the medicines that are due out of the basket, allow me to see the pharmacy label on the box to see how many tablets are due at that time then pop the right number of tablets into the dish. Once all of the correct tablets are in the dish the carer can help me put them towards my mouth in order to take them using the dish, with the water on the table. Please do not leave them in front of me as I do not have dexterity and may drop some.”
18. Mr X told the Council 45-minute calls at lunch and teatime seemed excessive. He said care workers were still not helping his mother use the commode, even when she asked, despite having enough time to do this. He said the Care Provider had told him the care workers would be an hour late that day. He said this was no good when she had wanted to go to the toilet since 10.00 and he had wanted to serve a meal shortly after midday. The Council said it hoped things would run more smoothly.
19. On 2 July Mr X again told the Council the care workers were not helping his mother use the commode and failed to encourage her to go, given that she would not know herself. He also said they were not cleaning her properly. He asked the Council to take this up with the Care Provider. He said a care worker had arrived almost an hour late at lunchtime, with the second care worker arriving 40 minutes later, leaving him to help the first care worker. He raised the same concerns with the Care Provider the next day.
20. The Council arranged a joint visit for 13 July to address Mr X’s concerns. It noted the Care Provider appeared to see Mr X “as a challenge rather than a really good resource”.
21. On 13 July the care workers said Mrs Y was often ready to open her bowels by the time they had got her on to the bed, so there was no time to use the commode. The Council agreed it would not be appropriate to use the commode in such circumstances. However, it noted other care workers had helped Mrs Y use the commode. The care workers then questioned the suitability of the hoist and its fitting. The Council confirmed it was suitable and did not need fitting in a different way for the commode. Mrs Y declined hoisting but the care workers agreed to try another time. After the visit Mr X raised concerns about a bag smeared with faeces which had been left close at the head of his mother’s bed.
22. On 15 July the Care Provider agreed to tell its care workers to offer and encourage use of the commode.
23. On 20 July Mr X told the Council and the Care Provider the care workers were still not helping Mrs Y use the commode.
24. The Council visited on 21 July to discuss Mr X’s concerns. The Council said it would get a copy of the Care Provider’s care plan and would ask that care workers always ask Mrs Y if she needed to use the commode, and to empty the washing bowl down the toilet and not the kitchen sink.
25. On 22 July Mr X complained the care workers arrived at 22.23 to put Mrs Y to bed.
26. On 23 July the Council asked the Care Provider to:
• review Mrs Y’s care package as the allocated time was not being used;
• let Mr X know if care workers would be more than 30 minutes late and provide an expected arrival time;
• offer to help Mrs Y use the commode;
• empty the washing bowl down the toilet, not the kitchen sink;
• remove soiled bedding for Mr X to wash;
• provide a copy of Mrs Y’s care plan; and
• provide a communication book for communication between Mr X and the care workers.
27. Mr X raised further concerns with the Council about:
• a near medication error;
• not rinsing Mrs Y’s dentures of sterilising solution before putting them in;
• not changing bedding;
• arriving late; and
• using a wet wipe to clean Mrs Y’s eyes despite the packaging warning against this.
28. On 26 July Mr X complained to the Council about increasing the length of his mother’s calls, which he said his mother had to pay for. The Council told him the increased call lengths would not affect what his mother had to pay for her care. He later disputed this, pointing out her charges had increased by £212.16 over the year. It seems likely the increase reflected annual changes to pensions and benefits.
29. On 27 July Mr X suggested changes to his mother’s care and support plan. He told the Care Provider its care workers had left his mother’s room in a mess by leaving equipment out, leaving pillows on the floor and not putting the hoist on to charge. He said there was a risk of kidney damage due to the short time between some calls which meant there was not enough time between doses of Paracetamol. He said there should be at least four hours between calls.
30. On 29 July, the Care Provider gave the Council notice on Mrs Y’s package of care. It told the Council:
• Mr X was rude to its care workers and criticised them no matter what they did;
• Mr X was recording its care workers while they were with Mrs Y in her bedroom, which they found intimidating;
• it could not provide calls at the times Mr X wanted;
• it could only continue to support Mrs Y if Mr X was not present; and
• care workers were refusing to visit Mrs Y.
31. Mr X complained the care workers arrived far too early (18.45) to put Mrs Y to bed, as she wanted to go to bed at 22.00, and consistently arrived late in the morning.
32. On 1 August Mr X told the Care Provider the care workers poured the water used to wash Mrs Y into the kitchen sink and had put her sling on inside-out, which could have caused discomfort or injury.
33. On 2 August the Council told Mr X the Care Provider had given notice and it may be difficult to find another one, as previous care providers had also given notice for similar reasons. It said Mrs Y may need residential respite care and possibly long-term residential care. Mr X said his actions had backfired and he did not mean to keep complaining. He said he installed cameras to provide himself with reassurance while giving the care workers space.
34. On 3 August Mr X agreed to give the care workers space when they visited and to send any complaints to the Council, so it could deal with them. The Council said it would ask the Care Provider to reconsider giving notice. The Care Provider agreed to extend its notice from 10 to 28 days and to continue providing care if Mr X’s behaviour improved.
35. On 4 August Mr X told the Council the Care Provider had agreed 20.20 for the bedtime call but the care workers had been arriving after 22.00, which was too late. The Care Provider said Mr X had turned down an earlier call, so it had to revert to a later slot. It said it could be difficult placing Mrs Y’s calls as few care workers were available to attend her. Mr X denied turning down an earlier call and said 20.20 would be fine. The Care Provider said it was aware of the preference for 20.30 but could not always provide a call at that time.
36. On 9 August Mr X told the Council the care workers had stopped offering Mrs Y the commode or a bedpan. He said she thought she had an infection, which would be the second or third since the Care Provider took over in May.
37. Following an e-mail from Mr X, on 23 August the Council told the Care Provider Mrs Y’s calls should be
• morning – 45 minutes
• lunch – 30 minutes
• teatime – 30 minutes
• bedtime – 30 minutes
38. The Care Provider told the Council things had improved so it was prepared to continue visiting Mrs Y. It said Mr X had asked for these call lengths:
• morning – 60 minutes
• lunch – 30 minutes
• teatime – 30 minutes
• bedtime – 30 minutes

Although it believed 45 minutes were needed at bedtime, it agreed to proceed with Mr X’s proposal.

39. On 31 August Mr X told the Care Provider and the Council his mother’s calls need to be at least four hours apart because of her pain medication. He also said 22.00 was too late for the bedtime call.
40. On 17 September the Care Provider told the Council Mrs Y shouted when her thumb got caught in the sling, but there was no injury. It said Mr X rushed into the room, knocked into one of the care workers and swore at her. Mr X says his swift action prevented his mother form suffering further pain or incurring an injury.
41. On 24 September Mr X asked the Council if all his mother’s calls could be for 45 minutes. The Care Provider said it was managing with the recently reduced call lengths.
42. On 26 September Mr X raised a safeguarding concern after finding medication on the floor. There were too few of a higher dose of a blood pressure tablet and too many of a lower dose tablet. The Council made safeguarding enquiries which it closed on 4 October, with a recommendation that Mr X give his mother her medication.
43. On 5 October a care worker used two tea towels to wipe the floor and then hung them back up where she had found them. Mr X told the Care Provider about this the next day. The Care Provider accepts this should not have happened. It also accepts the care worker should not have been wearing a bracelet
44. On 19 October the Council noted the need to review Mrs Y’s package of care as:
• an hour in the morning could not be justified;
• the medication routine was excessive; and
• a ceiling hoist could reduce the package of care.
45. On 20 October Mr X complained that the teatime call had been brought forward to 15.00, less than four hours after the lunchtime call and leaving a gap of six hours before the bedtime call. The Care Provider said it aimed to visit at these times: 07.00; 11.00; 15.05; and 20.40, but could not guarantee to do so. It asked Mr X to help Mrs Y with Paracetamol.
46. The Council spoke to Mr X on 26 October, after the Care Provider reported him being rude to care workers and taking photographs of them. Mr X said he took a photograph of his mother slumped in her wheelchair. He denied taking photographs of the care workers (the photograph he took did not include the care worker’s face). He denied being rude or swearing but said he said what he thought. The Council spoke to him about “body language and tone of voice”. It said he needed to allow the care workers to provide care and suggested taking a step back to enable this. The Care Provider told the Council it may soon not have enough care workers to cover Mrs Y’s calls.
47. On 29 October Mr X told the Care Provider it should be able to provide enough time between calls to safely give Mrs Y her Paracetamol. He said there were now six hours between the teatime and bedtime calls, which left Mrs Y in the same incontinence pad for too long. He said the agreed call times were:
• 07.00
• 11.00-11.30
• 16.00-16.30
• 20.00-21.00

He said care workers had arrived at 07.45, 11.45, 14.55 and 20.30 on 23 October. The Care Provider reminded Mr X of the times it endeavoured to meet (see paragraph 44 above) and that it could not guarantee to meet them.

48. On 30 October Mr X complained the care workers had not removed all the wet bedding from Mrs Y’s bed. He said on 28 October care workers had failed to use the commode on two calls, despite Mrs Y asking them to do so. He said she had complained that the care workers were not cleaning her properly. He said there was a risk of infection.
49. On 2 November, Mr X asked the Council to postpone a meeting scheduled for the next day, as his mother was taking antibiotics for an infection. He complained about a six and a half hour wait between the teatime and bedtime calls.
50. On 4 November, after the Care Provider reported another incident with the care workers, the Council spoke to Mr X. He agreed to give Mrs Y all her medication. The Council said it would reduce the length of the morning call to 45 minutes. Mr X denied shouting or swearing at a care worker but said he may have been assertive in his manner.
51. The Council visited Mrs Y on 8 November. After some discussion, she agreed Mr X could give her medication. The Council agreed to remind the Care Provider of the need to help Mrs Y use the commode when she wanted to.
52. On 11 November Mr X raised concerns about the size of the sling used to hoist Mrs Y. The Council said a larger sling would be too large for her.
53. On 12 November the Care Provider gave notice on Mrs Y’s package of care. It put this down to continuing problems with Mr X and constant complaints from the care workers.
54. On 15 November Mr X complained about a six-hour gap between the teatime and bedtime calls. He said a care worker had lied to him. He also said two care workers failed to wash Mrs Y or change her incontinence pad. The next day he told the Council the care workers were not offering Mrs Y the commode.
55. On 17 November the Council told Mr X the care provider had given notice. Mr X complained about the care workers not offering Mrs Y the commode. The Council said it had asked the Care Provider to make sure she was offered the commode. It asked Mr X to speak to his mother about residential respite care until another care provider could be found. It said it could consider capping her charge, rather than charge the higher residential rate. Mrs Y turned down the offer of residential respite care. The Council asked Mr X to explain how he would meet Mrs Y’s care needs, given that she need two care workers for each of her calls.
56. On 19 November the Care Provider asked Mr X to stay out of the room when the care workers were there, but he refused.
57. On 24 November Mrs Y was taken into hospital with a suspected lung infection. The next day Mr X complained about faeces on one of her sheets and the care workers lowering their masks when speaking to her. The Council considered making safeguarding enquiries into these concerns but decided they related to quality of care issues, not safeguarding concerns.
58. Mrs Y returned home on 1 December for palliative care arranged by the NHS. She died at home on 3 December. The death certificate said the cause of death was pneumonia.
59. Mr X complained to the Council about:
• poor care and a lack of good hygiene practices;
• care workers not wearing face masks; and
• the call times being too late in the evenings.
60. When the Council replied to Mr X’s complaint it said:
• all care workers were trained to spot changes in skin condition and would contact district nurses if any action was needed;
• Mrs Y told the Care Provider she was happy with the care provided (Mr X disputes this);
• it had discussed with the Care Provider alternative ways of communicating with people without removing a face mask;
• the care provider would remind its staff of the need to follow guidance on the use of personal protective equipment, but this would not prevent the circulation of winter viruses; and
• the Care Provider had told Mr X it could not provide a regular earlier evening care call, which reflected challenges within the homecare market.

Is there evidence of fault by the Council which caused injustice?

61. Continuity, both in terms of care workers and call times, is very important for many people who receive care. Care should be person centred and wherever possible people’s preferences should be met. The pandemic and other factors have made it difficult for care providers to meet these preferences. I have not found fault with the Council over the failure to meet the family’s expectations relating to call times. In addition to the factors affecting all care providers, Mrs Y’s Care Provider had the additional problem of the unwillingness of care workers to visit her home.
62. There is no dispute over the fact the care workers should not have removed their masks when communicating with Mrs Y. That was fault for which the Council is accountable. Mr X believes this is why his mother caught pneumonia, from which she died. There is not enough evidence for me to say that. According to information on the NHS website, pneumonia is usually the result of a bacterial infection. COVID-19 can cause viral pneumonia, but Mrs Y tested negative for COVID-19. Nevertheless, the failure to wear face coverings at least put Mrs Y at risk of harm.
63. The evidence also shows care workers did not always offer Mrs Y help to use the commode. It is clear from the meeting on 13 July (see paragraph 20 above) that some care workers had reservations about using the commode and/or the sling. I can see no reason to dispute Mr X’s claim that the problems persisted, despite the Council reminding the Care Provider of its responsibilities several times. That was also fault for which the Council is accountable.
64. The evidence also shows a care worker used two tea towels to wipe the floor and then hung them back up where she had found them on 5 October. This showed scant regard for hygiene. There were other occasions when care workers left unclean bedding on Mrs Y’s bed. While these amounted to fault, they did not cause injustice to Mrs Y as Mr X was able to resolve the problems himself. However, Mr X was understandably distressed by these incidents.
65. As well as being put at risk of harm, Mrs Y will have been caused avoidable distress by the problems with her care. Sadly, it is no longer possible to remedy the injustice to Mrs Y as she has died. However, the Council needs to apologise to Mr X for the lapses in his mother’s care and the distress caused to him.

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Agreed action

66. 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.
67. I recommend the Council within four weeks apologises to Mr X for the faults I have identified and the distress caused to him.
68. Under the terms of our Memorandum of Understanding and information sharing protocol, I will send the Care Quality Commission a copy of my final decision statement.

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Final decision

69. I have completed my investigation on the basis there has been fault by the Council causing injustice which requires a remedy.

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Investigator's decision on behalf of the Ombudsman