Summary: The complaint is about a home care provider commissioned by a council. Record keeping was poor around call timing and duration and there was a failure to discuss an informal carer’s expectations and preferences around delivering personal care. This caused avoidable distress and confusion. The Council will apologise and reduce the outstanding bill.

The complaint

1. Mr X complained Orchid Homecare Support Ltd (the Care Provider) commissioned by Bolton Metropolitan Borough Council (the Council). Mr X’s complaint is about the Care Provider’s service for 10 days in August and September 2022 before Ms Y moved into a care home.
2. He complained the Care Provider:
1. Falsified records regarding the duration of calls and completed entries retrospectively.
2. Overcharged him and refused to provide a breakdown of charges
3. Didn’t change Ms Y’s pad each occasion and left her with dirty nails
4. Provided staff who were rude and refused to leave the property when they attended to collect care records.
3. Mr X said this caused him avoidable distress.

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The Ombudsman’s role and powers

4. 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). The Care Provider delivers care on behalf of the Council to meet the Council’s duties under the Care Act 2014. We can investigate the Care Provider.
5. We provide a free service, but we use public money carefully. We do not start or continue an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any injustice is not significant enough to justify our involvement, or

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

6. We make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
7. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
8. 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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What I have and haven’t investigated.

9. I have investigated complaints(a) (b) and (c). I haven’t investigated (d) because it isn’t fault for care providers to collect care records when a service ends. And alleged rudeness is not a significant injustice.

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How I considered this complaint

10. I considered the complaint to us and the Council’s responses to the complaint. I discussed the complaint with Mr X.
11. Mr X, the Council and the Care Provider 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

Relevant law and guidance

12. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the Regulations) set out the requirements for safety and quality in care provision. When investigating complaints about council-funded care placements, the Ombudsman considers the 2014 Regulations when determining complaints about poor standards of care.
13. Care and treatment should be appropriate, to meet a person’s needs and to reflect their preferences. Care providers should carry out an assessment of needs and preferences and design a care plan to meet needs and preferences (Regulation 9)
14. A care provider should keep accurate, complete and contemporaneous records of care and treatment and decisions taken about care and treatment (Regulation 17)

What happened

15. Ms Y has dementia and Mr X was her main carer. In 2022, Ms Y’s condition declined. The Council completed an assessment of her needs and a care and support plan. The plan said the Council would commission the Care Provider to deliver four calls a day: morning and evening calls for 45 minutes and lunch and teatime calls for 30 minutes. Ms Y needed two carers for each visit. Carers were to provide personal care, washing and dressing and assistance with toileting.
16. Ms Y was a full-cost payer. This means the Council arranged the care with the Care Provider. The Care Provider billed the Council and the Council then invoiced Ms Y.
17. The Care Provider completed its own care plan for Ms Y’s care. This did not say anything about what carers should do if Mr X did not want them to complete all the personal care set out on the care plan. It said Mr X wanted to continue to support his mother with a large amount of informal support on a daily basis.
18. Mr X told me carers often didn’t change Ms Y’s incontinence pad or clean her nails. He said they often only stayed three minutes but logged 30 minutes in their paper records retrospectively.
19. The Care Provider told me its staff found Mr X hard to work with and he often refused to let carers get on with their job or to let them in the house. It said carers denied falsifying entries and on one occasion a carer wrote down the wrong time as they did not check their phone. It went on to say it had always been willing to provide a breakdown of charges. And, it said, Mr X would not allow carers to do anything other than change Ms Y’s pad and so they did not clean her nails.
20. The Care Provider and Council have provided me with:
• Electronic call monitoring records. These work in the following way: carers log in when they arrive at a property using a bar code which is usually attached to the client’s paper record which is kept in their house. Carers log out again in the same way at the time of leaving the property.
• A breakdown of the charge for each visit. This is by the minute.
21. Mr X provided me with some of the handwritten communication logs completed by carers. These are supposed to record carers’ arrival and departure times and give a description of the care provided during the visit. Sometimes carers haven’t recorded their departure times. Mr X also provided me with his own handwritten log of the times carers arrived and left and with invoices from the Council. But some of these invoices are not for the period I have investigated and may have been revised and updated due to adjustments applied as part of the complaint response (see next paragraphs).
22. Mr X complained to the Care Provider about the matters he has raised with us. The Care Provider responded saying:
• It had taken account of the evidence he had provided and would be speaking to staff about good record keeping.
• It would credit those invoices where he was overcharged
• It was aware Mr X was supporting his mother with personal care and would be ‘taking the learning from his experience around co-ordinating formal and informal care more effectively.’
23. Mr X was not happy with the Care Provider’s response and complained to the Council. The Council’s complaint response said:
• A quality officer had been through the communication logs where carers recorded pad changes and completion of some tasks on the care plan. The logs were not in order, some visits were missing and they were not concise.
• The Care Provider was introducing a book instead of sheets
• They would be carrying out spot checks.
24. The Care Provider has carried out spot checks of record keeping and records to evidence action taken to improve where it found poor practice.

Was there fault?

Falsified records regarding the duration of calls and completed entries retrospectively.

25. The carers’ paper communication logs do not match the electronic recording. And Mr X’s own contemporaneous record doesn’t match either the logs or electronic records. A care provider’s records of call times and duration should be broadly the same where it keeps electronic and paper records. They should be accurate. The broad variance I have described caused confusion and is not in line with Regulation 17, which is fault causing avoidable confusion and uncertainty.
26. The available evidence indicates calls were shorter than commissioned and this was at least in part due to carers not being required to complete all the tasks on the care plan because of Mr X’s reluctance to allow them to do so. We would not expect home carers to deliver personal care where the client’s informal carer does not want them to but the Care Provider would be entitled to charge for the full time commissioned on those occasions. The records indicate the Care Provider has only charged for the times recorded electronically.
27. The Care Provider should have had an open discussion at the outset with Mr X about how involved he wanted to be with his mother’s personal care. There should have been an agreement recorded on the care plan about what he wanted to do. This was a missed opportunity to reach an agreement about the division of care and how long visits would need to be taking into account what Mr X and Ms Y’s preferences. This is a failure to deliver care in line with Regulation 9 and was fault causing avoidable distress and confusion. The lack of clarity caused avoidable confusion. The Care Provider has recognised this and has made changes to practice.

Overcharged him and refused to provide a breakdown of charges

28. The Council/Care Provider gave me with a breakdown of charges by the minute for the period I have investigated. I am unclear why this was not provided to Mr X sooner; it was poor communication and fault. However, the information is available now and so there is no injustice requiring a remedy.

Didn’t change Ms Y’s pad each occasion and left her with dirty nails

29. The records indicate Ms Y did have her pad changed. Mr X was delivering most of Ms Y’s personal care as he wished. So I do not uphold the complaint about nailcare.

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Agreed action

30. 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 I found fault with the actions/service of the care provider, I have made recommendations to the Council.
31. Within one month, the Council will:
• Reduce the outstanding bill by £100 in recognition of the distress and confusion caused by poor communication and record keeping and
• Apologise to Mr X. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
32. The Council should provide us with evidence it has complied with the actions in paragraph 31.

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Final decision

33. Record keeping was poor around call timing and duration and there was a failure to discuss an informal carer’s expectations and preferences around delivering personal care. This caused avoidable distress and confusion. The Council will apologise and reduce the outstanding bill.
34. I completed the investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman