Summary: Mr X complained the Care Provider did not provide the necessary care for his mother and breached her privacy and that it terminated care because he raised a complaint. The Care Provider’s actions caused an injustice to Mr X and it will apologise for the injustice caused.

The complaint

1. Mr X complains the Care Provider did not provide the care his mother, Mrs Y, needed and breached her privacy. He believes the Care Provider ended its care because he raised a complaint.
2. Mr X says the poor care unsettled his mother and the family had to meet her care needs for two months while he sought a replacement Care Provider.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. If they have caused an injustice we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
4. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 34C(2), 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 have considered:
• The information provided by Mr X and discussed the complaint with him;
• The Care Provider’s comments on the complaint and the supporting information it provided; and
• Relevant law and guidance.
7. Mr X and the organisation 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

Law and guidance

8. 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. The standards include:
• Person-centred care (Regulation 9): The service user must have care or treatment that is tailored and meets their needs and preferences. Providers must involve a person acting on the service user’s behalf in the planning of their care and treatment.
• Dignity and respect (Regulation 10): Service users must be treated with dignity and respect and in a caring and compassionate way.
• Safe care and treatment (Regulation 12): Providers must do all that is reasonably practicable to mitigate risks to the service user’s health and safety. The provider must have arrangements to take appropriate action if there is a clinical or medical emergency.
• Safeguarding from abuse (Regulation 13): Service users must be protected from abuse and improper treatment, this includes neglect.
• Good governance (Regulation 17): Providers must maintain securely an accurate, complete and contemporaneous record in respect of each service user. This includes systems to assess, monitor and mitigate risk relating to health, safety and welfare of service users.

Care Provider’s contract

9. The Care Provider’s contract says it can end and if it does it must either:
• give 14 days’ written notice for any reason,
• give seven days’ written notice if fees have not been paid, or
• give 14 days’ notice that it is unable to meet the person’s needs.

What happened

10. Mrs Y suffers from dementia and other medical issues. She was receiving care in the home from a Care Provider, HWH Homecare Ltd. The provider was providing one hour of care in the morning and one hour of care in the evening every day.
11. Mrs Y’s care needs were for taking medication, helping with food preparation and personal care. The Care Provider carried out a review and provided a care plan in 2018. The care plan was available to staff using a QR code and actions completed could be ticked off. The scheduled visits were between 08:00 and 09:00 and 20:00 and 21:00. The evening visit moved to an hour later in early June 2022.
12. Due to a risk of falls Mrs Y has a safety pendant. Mr X has also installed cameras in her home, so that he can ensure her safety when she is alone.
13. In mid-May a member of staff recorded that they had dropped Mrs Y’s medication whilst carrying it through to her. They stated they picked up all drugs apart from one which they couldn’t find. They provided Mrs Y with the next day’s medication to ensure she took all her drugs and reported this to the care provider.
14. In early August the care worker attending Mrs Y could not locate the new drug packet for Mrs Y’s medication. Mr X witnessed this on the camera and attended the property to show the care worker where she could find the drug packets.
15. In late August two care workers visited Mrs Y. During their visit the fire alarm went off. The fire brigade attended and checked everything was ok. The Care Provider tried to call Mr X on his landline but did not reach him. A neighbour told him about the incident when he came back from holiday.
16. In early September Mr X contacted the Care Provider and asked that care staff take Mrs Y’s blood pressure before giving medication. The Care Provider added the task to Mrs Y’s care plan.
17. The care worker attending Mrs Y that same evening noted her blood pressure monitor had run out of batteries. The blood pressure monitor remained without batteries on the following morning and no reading was taken. The care staff recorded blood pressure readings in the evening visit. The next evening Mr X said he would be taking the blood pressure readings for his mother.
18. In mid-September 2022 Mr X contacted the Care Provider to raise concerns that his mother’s handbag was missing. He told them it had been missing for some time. The Care Provider opened an investigation to ask staff about when it was last seen and made a safeguarding report.
19. In late-September 2022 work was completed on a downstairs bathroom for Mrs Y. Following this care staff began using the downstairs bathroom rather than the upstairs bathroom for Mrs Y.
20. Care staff found a tablet in the kitchen in late September. They called the Care Provider who recommended throwing the tablet away. Mr X called up to say he would come and review the tablet.
21. Mr X raised a complaint in late September to the Care Provider. He complained the Care Provider had given medication incorrectly, missed visits, failed to tell him about the fire brigade, not taken blood pressure correctly, and repeatedly reported issues it was aware a doctor was investigating.
22. On one occasion in early October Mrs X undressed in the living room and refused a request to use the bathroom because it was cold. Mr X raised concerns about using the downstairs bathroom for changing in early to mid-October 2022 and the staff began taking Mrs Y upstairs. On one occasion after this care staff used the downstairs bathroom when Mrs Y asked.
23. A meeting was held in mid-October to discuss Mr X’s complaint. The Care Provider considered several issues during the meeting including - missed medication, missed visits, dressing in the living room and the missing handbag. No notes of the meeting were retained. Following the meeting the Care Provider wrote to Mr X in mid-October and noted the agreement they had reached. It agreed to amend Mrs Y’s care plan, provided Mr X with mobile access to care records, and agreed to have more regular set of care workers attend Mrs Y.
24. In mid-October 2022 the Care Provider wrote to Mr X and explained it would not be able to continue providing care for Mrs Y. It said that its staff felt they could not provide person centred care for Mrs Y in line with her wishes because Mr X was directing them via the cameras. It provided Mr X with two weeks’ notice.
25. During the investigation the Care Provider has said that Mr X called to request the blood pressure monitoring and emailed. It says during the call it informed Mr X that staff would need to be trained on the blood pressure monitors and that it would arrange training for this. It says it agreed to take blood pressure readings whilst it was awaiting training. Mr X says this admission was made during the meeting to discuss his complaint.

Findings

26. Mr X complained the care staff had not given medication because it was out of date, mislaid tablets and not known where to locate medication. I will consider each of these issues in turn.
27. A member of staff did raise concerns that medication was out of date in April and did not provide Mrs Y with a laxative. The following day staff checked and confirmed the medication was in date and provided the medication. While the Care Provider did miss medication it is not sufficiently flawed as to cause injustice.
28. In May a member of staff dropped Mrs Y’s tablets before providing them to her. They opened the next day’s tablets as they could not find all the tablets, as recorded in the notes. No injustice was caused to Mrs Y because of this and as such there is no fault.
29. I appreciate Mr X’s comments during the investigation that there was a tablet left on the kitchen counter which was disposed of by staff relating to Mrs Y’s water retention. This still is not sufficiently flawed as to cause an injustice.
30. In early August a member of staff was not able to locate a blister pack and Mr X came over to locate these. I have seen no other instances of staff being unable to locate medication. I appreciate coming over would have been a frustration for Mr X but there was no significant injustice caused to Mrs Y or Mr X by the Care Provider’s actions.
31. In late August the fire brigade attended Mrs Y’s property. The Care Provider tried to contact Mr X using his landline on the day but could not reach him. There is no suggestion it tried to leave a message and it did not look to contact him again. The Care Provider could have done more to contact Mr X to tell him about the incident. However no significant injustice was caused to Mr X.
32. Mr X also complained the Care Provider did not take blood pressure readings correctly. It updated Mrs Y’s care plan in early September following a request from Mr X. It has accepted that its staff had not had specific training on the blood pressure monitor. There is some disagreement as to when this acknowledgement was made. The care home has not kept records of the call in September or the meeting in October to allow me to confirm when this was discussed. This is not in line with Regulation 17. Although it says training was arranged it has not provided any evidence of this. Had the Care Provider continued to carry out blood pressure monitoring I cannot be certain that it would have got accurate readings.
33. The lack of notes has left Mr X uncertain as to whether he was able to ensure his mother received the proper care. And whether her medication investigation was carried out without delay. I recognise this situation has left Mr X frustrated that staff carried out blood pressure readings without training. He would not, though, have been prevented from the time and trouble of taking the readings himself had the Care Provider ensured staff were trained prior to carrying out readings as there would have been a delay to arrange training.
34. In late September 2022 the staff started providing Mrs Y with personal care downstairs following the installation of a new bathroom. This continued until Mr X raised concerns about this in early October. Whilst I understand Mr X’s concerns about the use of the downstairs bathroom the care staff were following the instructions of Mrs Y at the time, who has capacity to make decisions. It was appropriate for care staff to follow Mrs Y’s wishes and as such no injustice has been caused.
35. We cannot question a decision where a Care Provider has followed the right process, considered the information at the time and came to a reasoned decision. Mr X raised a complaint with the Care Provider in mid-October, following the investigation the Care Provider gave notice to end Mrs Y’s care. I appreciate the timing, but the Care Provider explained this was because it could not provide person centred care whilst Mr X was providing instructions to care staff through the camera.
36. The Care Provider decision is based on information from staff about concerns in providing patient care. It has given a reason for ending the care not linked to the complaint and allowed the two weeks’ notice in accordance with the contract. This is a decision the Care Provider was entitled to make. There is no fault.

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Agreed action

37. Within one month of this decision the Care Provider will:
• Apologise to Mr X and his family for the frustration and uncertainty caused by its failure to maintain accurate and complete records of Mrs Y’s care.
38. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

39. I have completed my investigation. Mr X has been caused an injustice by the actions of the Care Provider and I have recommended action to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman