Summary: Ms X complains about poor care provided to her mother, Ms Y, and poor communication from a Council-commissioned home care provider between June 2021 and February 2022. She said the poor care and poor communication have caused her and her mother distress. The Council was at fault. The care provider did not administer Ms Y’s medication safely, there was poor record keeping which has caused uncertainty and poor complaints handling. The faults did not cause Ms Y any harm, but the Council has agreed to apologise to Ms X and pay her £200 in recognition of the distress and uncertainty caused.

The complaint

1. Ms X complains about poor care provided to her mother, Ms Y, and poor communication from a Council-commissioned home care provider between June 2021 and February 2022. She said the poor care and poor communication have caused her and her mother distress. She wants the Council to ensure the care provider improves its services and provide a financial remedy for the poor care provided to her mother and the distress caused.

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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. 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 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)
5. 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.

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How I considered this complaint

6. I read Ms X’s complaint and spoke with her about it on the phone.
7. I made enquiries of the Council and considered information it sent me. This included detailed care and medication records from the care provider from within the period covered by this complaint.
8. Ms X and the Council had the opportunity to comment on the draft decision. I considered comments received before making a final decision.

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What I found

Background information

Provision of care and support

9. The Health and Social Care Act 2008 (regulated activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve.
10. The fundamental standards say:
• the care and treatment of service users must be appropriate, meet the person’s needs and reflect their preferences. The care provider must assess the person’s needs and preferences and provide appropriate care and treatment to meet these needs.
• care providers must keep accurate, complete and current records for each person in their care, including a record of the care and treatment provided and decisions about care and treatment.
• Any care and treatment provided must be safe. Medicines must be supplied in sufficient quantities, managed safely and administered appropriately to make sure people are safe.

The care provider’s complaints procedure

11. The care provider has a procedure to promote the effective handling of complaints. The procedure says it will provide a formal acknowledgement of the complaint within three working days. The acknowledgement will include an invitation to meet and discuss the complaint.

It says following the investigation, it will send a response letter. This letter will set out:

• the investigation’s findings.
• a conclusion stating whether the complaint is upheld, partially upheld or not upheld
• an explanation of the outcome, remedial actions and learning points.
• an apology where the complaint is upheld, or where failings have been found.
• details of how to escalate the complaint if necessary.

What happened

12. In June 2021, Ms Y was receiving home care from a Council-commissioned care provider, provider A. Provider A was commissioned to provide Ms Y with four care visits a day. The care tasks included assisting Ms Y with personal care, preparing meals and administering medication four times a day.
13. The records show that in June 2021, provider A did visit Ms Y four times a day and the length of the visits were broadly in line with the care plan. Care workers appropriately supported her with personal care and preparing meals, and left drinks and snacks for in between visits. The medication records show that care workers administered Ms Y’s medication from a pharmacy-filled blister pack at each visit. Ms Y’s medication included paracetamol four times a day, and the instructions stated there must be at least four hours in between doses. However, the records show multiple days in June where the care workers administered paracetamol doses with a gap of between two and three hours.
14. In September 2021, Ms X complained that a new care worker had not shadowed an experienced worker prior to their visit, and so did not know what the visit entailed. Provider A agreed to contact her going forward to tell her when new workers were visiting. She also complained the care workers were not visiting at the allocated times and were putting Ms Y at risk by giving medication early. The care provider rearranged the last visit that day to a later time to allow for a larger gap. It also contacted the pharmacy to seek advice on the gaps needed between medication administration. It queried if administering the medication one hour earlier or later than the recommended time was acceptable. Provider A’s records say “no concerns were identified” but there are no further details of the pharmacist’s response.
15. Care records from September 2021 show several days where the times of the care workers visits are not recorded. On days where it is recorded, there are further examples of gaps of less than three hours between visits, usually between the teatime and bed visits. The records show Ms Y was appropriately assisted with her personal care and to prepare meals.
16. Ms X’s daughter made a formal complaint to provider A on Ms X and Ms Y’s behalf. She said:
• The care workers were not giving Ms Y her medication at the right time.
• There were times when the tea and bed visits were very close together meaning there was only a short time between tea and bedtime medication.
• Ms Y was not comfortable with one of the care workers allocated to her. They had requested many times for Ms Y to be allocated a different care worker.
• The family had found it difficult to communicate their concerns to the office and office staff had been rude and put the phone down.
• The family wanted a specific care worker allocating to Ms Y but provider A was not listening or agreeing to the request.
• Provider A’s actions and the poor care had caused her, Ms X and Ms Y distress.
17. Provider A responded two days later. It said:
• It acknowledged Ms X had contacted its office to express concerns, however, her approach and the manner in which she addressed office staff was unacceptable.
• It had got to the point where no staff were willing to talk to her as they had been traumatised by her aggressive manner.
• It could not allocate their preferred care worker to do all of Ms Y’s visits as the care worker had a full rota already. It could not disrupt the care of other services users just to comply with Ms X’s request.
• It had suggested to Ms X that it could allocate a later bedtime call to increase the time between the last two visits, but Ms X had declined this and asked for the last visit be no later than 6pm.
• It said it would replace one of Ms Y’s care workers as soon as it could, but at present it had no one else available.
18. Provider A informed the Council of the complaint and sent it a copy, along with its response.
19. Care records in November 2021 show visits were completed in line with the care plan and Ms Y was appropriately assisted with her personal care and meal preparation. The medication records show the prescribed medication continued to include paracetamol and was administered but there were multiple days where there were gaps of less than three hours between two of the doses.
20. In December 2021, the Council met with provider A and Ms X to discuss Ms X’s concerns and try to improve the working relationship. After the meeting, provider A agreed it would inform Ms X if new care workers were visiting Ms Y, so Ms X could ensure they understood what was required at each visit. It also ensured Ms X was aware how to raise any ongoing concerns and had contact details for provider A’s management team.
21. In January 2022, the care records show care tasks were completed in line with the care plan and Ms Y was appropriately assisted with personal care and meal preparation. The medication records show medication was administered at each visit except for one day at the end of January where the lunchtime medication was missed. Once it became aware, provider A rang 111 for advice and followed the advice provided to ensure Ms Y had not been caused any harm by the error. There were multiple days where there were gaps of less than three hours between two of the doses of paracetamol.
22. Ms X continued to express dissatisfaction with some of the care workers and asked for specific care workers to be allocated to Ms Y. She said on one morning visit in January, the care worker had left without assisting Ms Y to dress. The care record for the visit Ms X referred to says Ms Y was “supported with dressing and mobilised safely back to her arm chair”.
23. In February, provider A gave the Council notice that it could no longer deliver Ms Y’s care package. It asked the Council to source another care provider.
24. Ms X remained dissatisfied with provider A’s service and brought her complaint to us.
25. In its response to our enquiries, the Council said it accepted provider A’s complaint response was insensitive in its language.
26. Provider A said it had told Ms X when new carers were visiting as this was part of its daily duties to keep service users informed of any changes. However, provider A accepted that there were times when it did not keep full and accurate records of all phone calls made. It said it would learn a lesson to keep accurate and sufficient recordings of conversations going forward.

Analysis

Standard of care provision

27. Provider A did not agree to Ms X’s request for specific care workers for all Ms Y’s visits, but it did not have to do this. There is evidence provider A tried to allocate Ms X’s preferred care workers when they were available, which is what we would expect. It is not fault that provider A declined to rearrange its care workers rotas to comply with Ms X’s requests.
28. I have reviewed the care records and am satisfied provider A met Ms Y’s care needs in the areas of personal care and meal preparation. The records show that Ms Y was appropriately assisted to either shower or stripwash during visits, meals were provided in line with the care plan and drinks and snacks were left for Ms Y for in between visits.
29. Ms X says the care worker did not assist Ms Y to dress on one day in January 2022. Although I cannot know what happened as I was not present at the visit, the care record says she was supported with dressing and so does not support this view. I have seen no other evidence to support Ms X’s allegation.
30. The evidence does show multiple days where there are gaps of less than three hours been visits and medication administration. The paracetamol administration instructions on Ms Y’s records say to leave four hours between doses. Ms X raised this issue as a concern in her complaint in September, but records show that short gaps of less than three hours between doses continued after this. The records show provider A did seek professional advice about gaps one hour shorter than prescribed between doses in August 2021 and recorded in response that “no concern was identified”. However, records show the gap between doses was less than three hours on multiple days throughout the period investigated. There is no evidence it sought or received professional advise that gaps of less than three hours between medications was safe.
31. In its complaint response, provider A said Ms X would not agree to the bed visit being later than 6pm which made creating sufficient gaps between visits difficult. However, this does not absolve provider A of its duty to provide safe care. It should have worked with Ms X to resolve the issue or instructed care workers to not administer the paracetamol where the last dose was administered less than three hours previous. It did not do this and this is fault. This is unsafe medication administration which is fault and a breach of the fundamental standards.
32. There is no evidence this caused Ms Y harm, but Ms X had complained to provider A about this issue on several occasions. The lack of action to resolve the issue caused Ms X frustration and uncertainty about whether provider A was delivering safe care to Ms Y.

Communication

In September and December 2021, provider A agreed to contact Ms X to tell her when new care workers were visiting Ms Y, so she could discuss Ms Y’s care needs with them and ensure the care workers were aware of what the visit entailed. On the balance of probabilities, it is likely at least one new care worker and maybe more visited between September 2021 and February 2022, but there is no evidence provider A informed Ms X of any new care workers during this time. Provider A says it did inform Ms X when new carers visited, but the records do not evidence this. Because of this, I cannot say whether provider A did inform Ms X of new carers or not. The lack of accurate and complete records is fault and has caused uncertainty about whether provider A appropriately communicated with Ms X about new carers, as it had agreed.

Complaint handling

33. The complaint response provided to the family in September 2021 is unprofessional in its tone and not in line with provider A’s policy. It does not:
• Invite Ms X to meet with them to discuss the complaint;
• Present findings in a professional manner;
• State whether the complaint is upheld or not upheld;
• Explain how she can escalate the complaint if she remained dissatisfied.

This is poor complaints handling and is fault. The response is likely to have caused Ms X distress. Provider A sent the Council a copy of its complaint response, but the Council did not raise concerns with provider A about the content or tone of the response at the time. In its response to our enquiries, it has accepted the response was insensitive, which I agree with. The Council should have raised this as a concern with provider A at the time and the failure to do this was fault.

34. In December 2021 when the Council became aware the problems were ongoing and Ms X remained dissatisfied, it arranged a meeting with provider A and Ms X to try and address Ms X’s concerns. This was an appropriate action to try and resolve the complaint.

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Agreed action

35. Within one month of the final decision the Council will:
• Write to Ms X to apologise to her and Ms Y for provider A’s unsafe administration of Ms Y’s medication, the lack of action to address the issue and the uncertainty this caused. It should also apologise to Ms X for provider A’s poor handling of her complaint.
• Pay Ms X £200 as acknowledgment of the frustration and distress caused by poor communication and poor complaints handling.
36. Within three months of the final decision, the Council will hold a quality assurance meeting with provider A to discuss:
• the safe administration of medications. It should take appropriate action to assure itself that provider A is administering medications safely to its clients and that its staff are appropriately trained to do so.
• Provider A’s record keeping. It should discuss the need to keep accurate and complete records and assure itself that provider A is now doing so.
• Provider A’s handling and responses to complaints. It should consider whether any action e.g. an audit or period of monitoring is required to satisfy itself that provider A is responding to complaints appropriately and in line with its policy.

It should provide us with evidence it has completed these actions, to include the minutes of the quality assurance meeting setting out any actions it will take to monitor or improve provider A’s service.

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Final decision

37. I have completed my investigation. I have found fault and the Council has agreed actions to remedy the injustice caused and improve services.

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Investigator's decision on behalf of the Ombudsman