Summary: The care provider was not at fault in its decision to withdraw care from Mr X after it became clear it could no longer safely meet his needs.

The complaint

1. Mrs A (as I shall call her) complains about the way Nightingale withdrew care from her elderly father without notice, leaving the family to provide care for two weeks until a new care provider was found.

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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 injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)

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How I considered this complaint

3. I considered the information provided by Mrs A. We spoke to Mrs A. Both parties had an opportunity to comment on a draft of this statement before I reached a final decision.

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What I found

Relevant law and guidance

4. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
5. Regulation 12 says safe care and treatment must be provided for service users. It says to comply with that requirement, “the things which a registered person must do to comply with that paragraph include—

(a) assessing the risks to the health and safety of service users of receiving the care or treatment;

(b) doing all that is reasonably practicable to mitigate any such risks;

(c) ensuring that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely;

(d) ensuring that the premises used by the service provider are safe to use for their intended purpose and are used in a safe way;

(e) ensuring that the equipment used by the service provider for providing care or treatment to a service user is safe for such use and is used in a safe way;

(f) where equipment or medicines are supplied by the service provider, ensuring that there are sufficient quantities of these to ensure the safety of service users and to meet their needs.”

6. The terms and conditions signed by Mrs A say in respect of notice, “No Notice is Required from the Client to end or modify the service, save when it is received too late to stop the carer visiting, in which case the fee for that visit will be chargeable. If we have to give notice we endeavour to give the Client sufficient time to make alternative arrangements, save where fees are not being paid when the service may be ended Immediately.”

What happened

7. Mr X started receiving a package of care from Nightingales in September 2020. By 2022 the agreed care package was for an hour’s call every morning for personal care and meal preparation, and 45 minutes every evening for personal care.
8. The care provider’s notes record that problems arose with the care package in December 2021 when Mr X was no longer able to bear his own weight. The care agency made a referral to the local council’s Occupational Therapy (OT) department for equipment to assist the carers to transfer Mr X safely. A note for 14 December reads, “I phoned (Mrs X) to make her aware I had put the referral in and she said there is no room for any equipment. She was not happy about this.”
9. By January 2022 the number of reported concerns increased. A carer spoke to the OT on 11 January and explained how they managed Mr X’s care. She said they had to move the large commode over to his bedside for him to pull himself up, then once he had transferred to the wheelchair the carers had to lift it round the bed as there was insufficient space. She said his armchair in the lounge had controls but Mrs X would not let him use them. She raised concerns about the difficulty of managing Mr X since his condition had deteriorated.
10. Carers also began reporting that Mrs X wouldn’t allow carers to change Mr X’s incontinence pads often enough because of the price of the pads. A carer reported that Mr X’s pad was so wet on one occasion it had soaked through to the outside and was causing red areas of skin on Mr X’s thigh. She said she had pointed this out to Mrs X who said not to worry about it. Carers reported back to the care agency that it was very hard for one person to manage Mr X’s care because there was no equipment to help.
11. Following the OT involvement some equipment was delivered to the house. Mrs X told carers she would put it in the shed as there wasn’t room in the house for it. The carer who attended on 26 January recorded Mrs X was ‘very angry’ with her and told her the carers had made her life a misery. The carer told the agency she could not continue to attend Mr X’s calls as every time Mrs X became angrier with her.
12. The care agency notes record a discussion with Mrs A later on 26 January. The notes state, “I explained that all carers are now refusing to go in there due to the rudeness and the shouting of her mum. I have explained that we will have to give notice and that they will have to look for another care company due to no carers going in there. (Mrs A) was understanding and asked if we could send her apology over to (the carer).”
13. The carer who attended on 28 January reported she found Mrs X hostile when it was suggested Mr X’s pads should be changed more often. The carer said she had told Mrs X the carers needed the right equipment to carry out the tasks or they would injure themselves. She said she could not continue to attend the call in the circumstances.
14. The second carer who attended on 28 January reported Mrs X was angry with her and said the agency was trying to change things and she felt bullied.
15. Mrs A contacted the care provider. She said she felt the problems reported had only very recently arisen and there had been a number of changes suggested verbally to her elderly mother in quick succession. She added she had been horrified when she had been contacted by a social worker from the local council who said the agency had told her the care package was being cancelled. She asked for a copy of the agreement and said she hoped the agency would honour the contract and continue to provide care. The care provider responded that she was trying to find cover but 5 carers were refusing to attend the call.
16. The care provider then wrote to the family on 29 January to say they no longer had any carers willing to attend the call. The manager added, “In order for the carers to carry out their role they have to have sufficient equipment in place which has been delivered but unfortunately your mum has informed carers that it will be going in the shed and will not be used. In these circumstances I hope you understand, it's illegal for them to provide safe care without the facility of appropriate equipment and enabling this to be used within the property.”
17. The manager added that the agency had to give an early notice period due to the inability to use the proper equipment and insufficient staff to support Mr X safely. She said she had offered to contact other agencies on the family’s behalf but this offer had not been accepted.

The complaint

18. In February Mrs A wrote to the care provider to complain about the way it had withdrawn its service without proper notice or giving them time to make alternative arrangements as the contract terms stated. She said the withdrawal of care had caused Mr X to become upset and disturbed by the number of visits from new care companies: she said he was now refusing to get out of bed. She added that Mrs X had been so tired as a result of the extra care for Mr X she had fallen and had to be admitted to hospital. She asked why the care provider had not discussed carers’ concerns with the family sooner.
19. The director emailed the family after a telephone call on 2 March. She said as a gesture of goodwill the latest bill would be reduced by £250 She said she was aware this would not resolve any upset but said it might go towards funding further care. She added, “On a personal note, I wanted to keep the option open for you to call me any time. This is inclusive of last minute support, guidance, signposting or generally a point of contact for the future.”
20. Sadly Mr X died a few weeks after the care provider withdrew the care.
21. In May Mr A wrote to the care provider again. He said he had no intention of paying the final bill but would refer the matter to the Ombudsman.
22. Mrs A complained to the Ombudsman. She said the care provider had withdrawn care abruptly and she and her elderly mother had to care for Mr X for two weeks until a new agency was found. She said this was exceptionally stressful for both Mr and Mrs X.
23. The care provider says it made the family aware it did not have the resources to continue providing care due to refusal from the care staff to attend, Mrs X’s refusal to use equipment, refusal to provide personal care when needed and verbal abuse of the care staff. It says this was mentioned to the family during December and January.

Analysis

24. The care provider was unable to continue providing safe care for Mr X in line with the regulations. There were concerns Mrs X would not allow carers to use the recommended equipment to move Mr X safely, personal care was compromised by Mrs X’s refusal to allow the proper number of incontinence pads to be used, and staff were suffering some verbal abuse from Mrs X which caused them to refuse to attend the calls.
25. The agreement between the care agency and the family does not specify a notice period. It states the agency will ‘endeavour’ to give the family time to make alternative arrangements. In this case that was not possible as no carers would attend the calls. The agency offered to find other suitable care but that offer was refused.
26. The care provider reduced the final bill by £250 as a goodwill gesture in recognition of the upset caused by its need to withdraw services. It was exceptionally distressing that Mr X died shortly after the service was withdrawn.

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Final decision

27. I have completed this investigation on the basis the care provider did not act with fault in withdrawing its services when it could not provide them safely.

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Investigator's decision on behalf of the Ombudsman