Summary: Mr X complains about the care provided to his brother at home by Prompt Healthcare, along with damage to his property caused by the carers. We find fault with Prompt and have made recommendations to the Council for the injustice caused to Mr X.

The complaint

1. Mr X complains about the care provided to his brother (Mr Y) at home by Prompt Healthcare (Prompt), who were providing services for the Council, along with damage to his property caused by the carers.
2. He complains the carers:
• Failed to give some or all of Mr Y’s medication;
• Put Mr Y to bed at 7.30pm rather than 9.30pm;
• Failed to give Mr Y his glasses;
• Left the back door unlocked on several occasions;
• Overfilled the kettle to make 1 cup of tea;
• Could not open the front door lock so were unable to attend on occasions;
• Failed to ask Mr Y regularly if he needed to use the commode;
• Emptied urine from a bottle into the toilet and failed to flush;
• Made porridge and served it in the same hot bowl;
• Left the bedroom, landing and hall lights on;
• Mr X had to remind staff to wear a mask;
• Damaged the bedroom door, living room door and phone socket in hall way when using the wheelchair;
• Left stains to the carpet after changing soiled sheets.
3. Mr X would like Prompt to train staff properly so adults get the care they need and there is no further damage to property.
4. He would also like a refund for the repairs he has carried out to his property.

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What I have and have not investigated

5. I have not investigated c) to k) in paragraph two above. This is because there was limited injustice caused and it would not be proportionate for us to investigate every single part of this complaint (see paragraphs 8 and 9).
6. During the course of my investigation Prompt made a payment to Mr X for the repairs to the damage to his property. So I have not considered i) and m) above any further as any injustice has been remedied.
7. I investigated the failure to give medication to Mr Y, and the early bedtimes.

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The Ombudsman’s role and powers

8. 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)
9. We provide a free service, but must use public money carefully. We do not start or may decide not to continue with an investigation if we decide any fault has not caused injustice to the person who complained, or any injustice is not significant enough to justify our involvement. (Local Government Act 1974, section 24A(6))
10. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
11. 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)
12. We normally name care homes and other providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
13. 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

14. I spoke to Mr X and considered the information he provided. I asked the Council for information and I considered its response to the complaint.
15. I considered relevant parts of the Care Act 2014 and the accompanying care and support statutory guidance.
16. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Legislation and Guidance

17. 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.
18. Regulation nine states the care and treatment of service users must: be appropriate; meet their needs; and reflect their preferences.
19. Regulation 12 states providers must assess the risks to people’s health and safety during any care or treatment and make sure staff have the qualifications, confidence, skills, and experience to keep people safe. This rule is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm.
20. Regulation 17 states that providers must securely keep accurate, complete, and detailed records about each person using the service.

Council complaint procedure

21. Once a complaint is made to the Council it will issue an auto acknowledgement to confirm receipt of the complaint.
22. In response the Council will say how long it thinks it will take to look into the complaint and when a response is likely to be sent.
23. The complainant has the right to refer any complaint to the LGSCO after the domiciliary care agency has had an opportunity to investigate and resolve the complaint.

Prompt Healthcare complaint procedure

24. The complaint procedure from Prompt is as follows:
• “All complaints or concerns are taken seriously.
• All complaints are thoroughly investigated.
• All agencies must be informed where appropriate.
• Every written complaint is acknowledged within five working days.
• Investigations into written complaints are held within 28 days.
• All complaints are responded to in writing.”

Council responsibility

25. When a council commissions another organisation to provide services on its behalf it remains responsible for those services. It also remains responsible for the actions of the organisation providing them.
26. As commissioners of the care, it is the Council’s responsibility to ensure the care provider completed a formal robust investigation.
27. If a person raises concerns with the Council about the quality of care provided by a commissioned care provider, the Council must make whatever enquiries it thinks is necessary to decide whether any action should be taken to protect the adult. Care Act 2014 S.42

What happened

28. Mr Y received care from a Council commissioned care provider, Prompt Healthcare (Prompt), from January 2022 when he came out of hospital.
29. Mr Y lived with his brother Mr X who took care of him until his condition declined and the Council arranged a care package to support Mr Y in January.
30. Two carers came in twice a day to help Mr Y with personal care, hygiene, feeding and medication needs.
31. Mr X was unhappy with the service carers from Prompt were giving to Mr Y.
32. Mr X would leave notes to remind the carers to do things like turn the lights off and lock the back door.
33. Mr X says the first time he made a note of missed medication for Mr Y was on 13 January 2022.
34. Prompt sent a member of staff to have a meeting with Mr X about his complaints on 15 February. He says the staff member said all care staff would receive fresh instructions and he would get a copy of them, but he never did.
35. When we made our enquiries the Council sent us a copy of the report from Prompt about the visit. It said Mr X was rude and refused to understand the medication policies and procedures in place.
36. In his response to the draft decision Mr X says he was not rude.
37. The report said they were told about the back door not being locked on one occasion and they apologised, immediately told the staff and it did not happen again. It also said carers do have a supply of masks and they ask the service users what they would prefer, while following government guidelines.
38. In March Mr X moved Mr Y into a care home as he was unhappy with the service from Prompt. He made a formal complaint to the Council for various failings including failing to give Mr Y his medication, putting him to bed too early, and causing damage to Mr X’s property when using the wheelchair.
39. Mr X says he raised these concerns with Prompt earlier but nothing changed. He left notes all over the house and on the logbook to remind the carers what they needed to do.
40. Mr X says the carers failed to give Mr Y his medication on at least 13 occasions, and sometimes gave it at the wrong time.
41. The carers put Mr Y to bed at 7.30pm, which meant he would spend up to 15 hours in bed, until their visit the next morning.
42. The damage to his property included the scratches to his bedroom and living room doors, damage to the phone socket, and he had to pay to get the carpets cleaned after the carers removed soiled clothes and bedding and left stains on the floor.
43. Mr X had receipts for the repairs he did to his property and photos of the damage. He sent these to the Council and to Prompt in March.
44. The Council responded to the complaint on 23 June saying Mr X should claim any money from Prompt. Mr X was unhappy with the response as it did not cover all his complaints.
45. The Council gave a final response on 19 July saying it raised a provider concern with the Service Placement Team and raised a safeguarding enquiry.
46. The complaint response from Prompt is dated 11 July, four months after Mr X’s original complaint. Mr X says there was a delay by the Council in sending it to Prompt.
47. The response from Prompt just states there is no proof the carers did the damage to his property so it is not liable for it. Mr X was not given any information on Prompt’s complaint response.
48. The Council did raise a safeguarding enquiry which concluded “there were occasions when medication was missed, and this was eventually rectified with the intervention of a Support Worker”. It also said “it was apparent there were some communication difficulties between Prompt” and Mr X.
49. The safeguarding enquiry dated 13 May recommended Prompt “to promote stronger communication links with family, carers to report any concerns to their supervisor, carers to report any medication issues to their supervisors ASAP, and action plans to be implemented to rectify medication difficulties ASAP”. However Mr Y had already moved into a Care Home by then.
50. Mr X was unhappy as he says between himself and the Council he has about 55 emails to and from Prompt. He feels frustrated by the amount of time and effort taken by him to sort out the repairs to his property and get a response to his complaint. He brought a complaint to the Ombudsman in September.
51. Mr X got a phone call from Prompt in November who refunded him for the repairs to his property in December.
52. In my enquiries I asked the Council for daily care sheets which it could not provide. Firstly the Council said it “cannot provide care sheets as they sit with the care provider and the Council do not ask for these. They would normally remain in the person’s home for a period of time and then archived by the agency. Council would only review these in person at a review, or if a specific care issue to review retrospectively from the written records.”
53. As this is a “specific care issue” I asked the Council again in my further enquiries, and the Council responded “daily care notes not accessible by the care provider Prompt, as at the time of this care package, they were using hard copy log book which would have remained in the service users home.”
54. I asked Mr X if he still had the care sheets and he said Prompt collected the logbook on their last day in March.
55. I also asked the Council about contract monitoring and quality assurance in my further enquiries. It said Prompt were in Tier three, but in September 2022 were re-assigned Tier Two status so a contract monitoring visit took place in October.
56. Prompt had a quality audit in April 2021 and the overall outcome was “requires improvement”. Prompt had an action plan which it met in December 2021. It was agreed a further audit would take place after six months but this is yet to be done.

Analysis

57. Mr X brought a complaint to the Council. He had to continually chase Prompt and the Council for a response. The Council told him to sort out the repairs with Prompt’s insurers, but did not help him obtain them when Prompt failed to respond to all his emails.
58. Prompt did not respond to all of Mr X’s complaint. It did not address the medication issues at all. This is fault as the complaint response was inadequate.
59. The safeguarding enquiry shows there was fault by Prompt failing to give Mr Y his medication. This breaches Regulation nine (paragraph 18). Recommendations were made and I have asked for evidence that Prompt has complied with them.
60. The Council and Prompt could not provide me with the care records I requested. Prompt said they were in Mr X’s home, Mr X said they were not. This means there is uncertainty as to when Mr Y was put to bed so, on the balance of probabilities, I take Mr X’s evidence and find fault with Prompt breaching Regulation nine.
61. Prompt is required under Regulation 17 (paragraph 20) to maintain accurate and contemporaneous records. If these are paper records they should remove these periodically from the service users home and place them in archive. Prompt should keep care sheets for a certain period after care has ended so this is fault. The Ombudsman thinks that a three-year retention policy is a good guide and reflects good practice in the care sector. I have recommended a service improvement in this regard.
62. The complaint handling by both Prompt and the Council was unsatisfactory. The responses to Mr X were late and they failed to address his whole complaint. This is fault. Prompt failed to comply with its own complaint procedure, carrying out no investigation until the Ombudsman was involved.
63. The carers caused damage to Mr X’s property, and Prompt have already paid Mr X for the repairs he made. I am satisfied that this is a suitable remedy.

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Recommended action

64. 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 we found fault with the actions/service of Prompt, we have made recommendations to the Council.
65. Within one month of the Ombudsman’s final decision the Council should:
• Apologise to Mr X for the delay in responding to his complaints;
• Pay Mr X £200 for his frustration, time and trouble in having to pursue his complaint and distress for missed medication and early bedtimes;
66. Within three months of the final decision the Council should:
• Check the action plan, agreed as a result of the safeguarding investigation has been put in place by Prompt, and provide a report back to us of the quality monitoring visit;
• Ensure Prompt has a system in place to retain records from a service users home and check Prompt’s policies around record storage and retention.
67. The Council should provide us with evidence it has complied with the above actions.

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Final decision

68. I find fault with the Council for the complaint handling, and with Prompt Healthcare for service failure causing frustration to Mr X. I have recommended service improvements to ensure this does not happen again.

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Investigator's decision on behalf of the Ombudsman