Summary: Ms X says carers from a care provider commissioned by the Council verbally abused, neglected and traumatised her and failed to carry out actions in the care plan. Ms X says the care provider withdrew care without notice and the Council delayed putting in place a new care package. There is evidence the care provider did not always carry out the tasks in the care plan, the care provider accepted carers had breached professional boundaries although not that they had verbally abused Ms X, the care provider failed to provide notice when withdrawing the care package and the Council failed to follow the right procedure, although that likely did not affect the delay putting in place alternative provision. The procedural actions carried out by the Council along with an apology and payment to Ms X is satisfactory remedy.

The complaint

1. The complainant, whom I shall refer to as Ms X, complained:
• carers from a care provider commissioned by the Council verbally abused, neglected and traumatised her;
• the care provider commissioned by the Council withdrew care without notice; and
• the Council delayed putting in place a new care package.
2. Ms X says as a result she suffered significant distress and did not have care over the Christmas period. Ms X says she is waiting for counselling for the trauma.

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The Ombudsman’s role and powers

3. 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)
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. As part of the investigation, I have:
• considered the complaint and Ms X's comments;
• made enquiries of the Council and considered the comments and documents the Council provided.
7. Ms 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

What should have happened

8. The Council’s hand back procedure (the procedure) says the process is triggered when an issue has occurred making it unviable to continue to deliver care and support to an individual.
9. The procedure says the provider will try to mitigate the issue by talking to the individual and their family/representative about any concerns to try to identify a solution.
10. It says the provider will contact the relevant locality team to discuss the problem and identify any solutions the team can help with. It says if no solution can be identified other than to hand back the provider must email the locality team to terminate the package with at least seven days notice.
11. The procedure sets out the responsibilities for the Council once it has received notice on the package of care. For locality teams it says it will:
• communicate regularly with individuals and their families to ensure they are aware the provider has given notice and that they remain up to date with progress;
• email details of the hand back to the commissioning team;
• begin a brokerage search;
• in the case of more than three hand backs from the provider or if the situation presents a level of risk that cannot be mitigated appropriately the locality team will escalate the issues to the head of service for awareness;
• explore options for alternative forms of provision where appropriate by liaising with commissioning and brokerage.
12. The procedure says the brokerage team will:
• begin a search for an alternative provider;
• notify the commissioning team;
• in high risk situations or multiple hand backs the brokerage team manager will be made aware.
13. The procedure says the commissioning team will:
• speak with the provider to explore any further possibilities for continuing with the package of care;
• log details of the hand back to the central hand back reporting risk management log;
• monitor/prompt for any updates and coordinate risk management meetings for multiple hand backs or where there are difficulties in sourcing an alternative provision;
• provide updates for heads of service and out of hours teams when necessary.

What happened

14. Ms X was receiving a package of care from a care provider commissioned by the Council on a Monday, Thursday, Friday, Saturday and on Sunday mornings. Ms X also received some provision from a different care provider.
15. On 20 December 2022 Ms X asked the care provider to change the carer due to issues. The care provider terminated the care package and told the Council it had done so as none of the three carers allocated for that area were willing to provide care to Ms X due to the home conditions. The Council tried to negotiate with the care provider to extend the package of care but the care provider refused. The Council contacted another care provider which was providing some support to Ms X as part of a direct payment and asked whether it could increase its support. It could not.
16. A representative for Ms X contacted the Council on 20 December to raise concerns about the carer allocated to Ms X calling Ms X names and sharing intimate information with her. The Council spoke to Ms X and obtained more details about issues with the care package. The Council completed a safeguarding referral. The Council asked the care provider to complete the necessary report.
17. The Council began looking for a new care provider on 21 December.
18. A Council safeguarding officer visited Ms X on 23 December and viewed the notebook she had kept about the care package.
19. The Council received contact from Ms X’s representative and her GP surgery in January 2023 to raise concerns about the delay identifying a new care provider. The Council identified a new care provider on 13 January. That care provider visited Ms X and carried out an assessment. The new care provider started to provide carers to Ms X from 23 January.
20. On 25 January the Council received the care provider’s report following its investigation. The care provider told the Council the carer had admitted breaching professional boundaries although she had denied verbally abusing Ms X. The care provider told the Council it would follow its own internal human resource procedure for carer conduct and breach of professional boundaries. The care provider told the Council it would conduct staff meetings to discuss professional boundaries and provide online courses to affirm staff knowledge and minimise the risk of professional boundaries breaches in future. The care provider also said it would discuss the issue at the next team meeting. The care provider said it would conduct more direct observations with the carer.

Analysis

21. Ms X says carers from the care agency commissioned by the Council verbally abused, neglected and traumatised her. Ms X also says the carers failed to follow the care plan with the result she developed sores as the carers did not wash her.
22. I am satisfied the care provider investigated Ms X’s concerns about how two of its carers acted. While the two carers disputed they had sworn at Ms X, called her names or shared personal information they accepted they had crossed professional boundaries. The care provider concluded the carers had treated the relationship as a friendship rather than a professional one. Given I was not present at any of the visits I cannot add to anything the care provider has concluded. I could not, for instance, reach a safe conclusion about whether the carers had sworn at Ms X or called her names as that is not something I can clarify from the documentary records and the carers dispute Ms X’s version of events. I am satisfied though the care provider has established the carers crossed professional boundaries with Ms X. That is fault. The Council has confirmed the care provider has provided professional boundaries training to all staff, the issue has been raised in team meetings and any issues relating to the carer are being pursued through the care provider’s HR process. I am satisfied this is an appropriate remedy to address the procedural issues.
23. For the concerns about the care provided by the carers I have relied on the documentary records from the care visits. Those records show carers washed and dressed Ms X on each occasion they visited. However, although the care plan shows carers should provide a shower to Ms X once a week on a Thursday the records I have seen show this did not always take place. On some occasions it is recorded a shower did not take place because Ms X refused it. However, on other occasions the care records show a shower did not take place as it was not required but there is no explanation about why it was not required or whether a strip wash was provided instead. The records sometimes refer to a wash being provided instead but it is not clear whether this was a full body wash. I am therefore not satisfied the care provider complied with the care plan on all occasions its carers visited. That is fault.
24. Ms X says because the carers did not wash her regularly she developed sores. It is not possible for me to say, on the balance of probability, Ms X’s sores were caused by failure to provide her with adequate care. That is because there is no mention in the daily records of any sores being identified. Although I recognise Ms X referred to having sores when the care provider withdrew in December 2022 it was 11 days before Ms X provided any evidence of sores. I therefore cannot be clear about whether those sores developed because of poor care from the care provider or whether they developed after the care provider withdrew. As I have made clear though, the documentary records do not show carers always provided the level of care they should have when visiting Ms X.
25. The other issue Ms X is concerned about is carers opening her windows and switching off the fan without her permission. When interviewed by the care provider the carer in question said she had only done this with the permission of Ms X. Ms X disputes that. The documentary records refer on various occasions to windows being opened and the fan switched off but there is no record of this being agreed with Ms X. I therefore cannot say it had been agreed.
26. Ms X says the care provider withdrew care without notice when she complained about the actions of one of the carers. The Council accepts the care provider failed to follow the procedure in this case because it did not give 7 day notice as it was required to do. Instead it gave Ms X 24 hours notice. That is fault. The Council also accepts it failed to follow the process as it did not notify the commissioning team of the hand back, the matter was not escalated to the heads of service and the Council did not arrange a risk management meeting. All of those actions are required under the Council’s procedure and failure to carry those out is therefore fault. I am particularly concerned about the Council's failure to arrange a risk management meeting given Ms X is a vulnerable adult.
27. I cannot say if the Council had followed those processes it would have made a difference to what happened in this case as the documentary records show the Council trying to get the care provider to reinstate care and it told the Council it had no available carers to do so. However, Ms X is left with some uncertainty about whether the situation could have been resolved and she also suffered distress at having her care removed without notice. I am satisfied the Council has taken action to address the issues that arose in this case by:
• reminding locality teams and the brokerage team about the procedure;
• discussing the complaint with the provider and reminding it of its contractual obligations in writing;
• strengthened the requirements around hand backs when it retendered its contracts for home care in December 2022. That will mean a longer notice period and the requirement for providers to liaise directly with commissioning teams as well as locality teams.
28. I welcome those actions and consider them an appropriate remedy in relation to the procedural issues that have arisen in this case.
29. Ms X says the Council failed to put in place a new care package until January 2023. Ms X says this means she had no support over the Christmas period and had to rely on friends for help. I understand the impact on Ms X and I have made clear withdrawing the care package without giving the proper notice is fault. I am satisfied though the Council tried to get the existing care provider to extend the period of care. I am also satisfied the Council began immediately looking for an alternative care provider. I do not consider it surprising the Council could not find a new care provider until January 2023 given the care provider ended the contract shortly before Christmas. I do not consider it likely in those circumstances the Council would have been able to identify an alternative care provider straight away. As I am satisfied the Council acted promptly when the care provider withdrew care though I do not criticise its actions here. I also note Ms X did have some support from an alternative care agency, although that does not change the fact the care provider should not have withdrawn without giving notice.
30. As I said earlier, I am satisfied the procedural measures the Council has undertaken are appropriate and should hopefully prevent similar problems occurring in future. I consider though Ms X has suffered an injustice as she was caused distress at having the care package removed without notice and the carers did not always carry out the actions required in the care plan. Ms X is also left with some uncertainty about whether the situation could have been improved if the Council had followed the right procedure. As remedy for that I recommended the Council apologise to Ms X and pay her £300. The Council has agreed to my recommendation.

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Agreed action

31. Within one month of my decision I recommend the Council apologise to Ms X and pay her £300.

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Final decision

32. I have completed my investigation and found fault by the Council in part of the complaint which caused Ms X an injustice. I am satisfied the action the Council will take is sufficient to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman