Summary: The Council acted properly and in accordance with law in addressing Mrs X’s social care needs. It also properly addressed Mrs X’s concerns about the quality of the care provided. However, the delay in formally informing Mrs X of the outcome of a safeguarding investigation and the lack of a formal apology for identified failings was poor practice. And for this, the Council should apologise.

The complaint

1. Mrs X complains about the quality of care provided by three separate care agencies. The care was arranged and funded by the Council. She says:

• carers turned up late & cut visits short
• carers failed to prepare suitable food and offered unsuitable food
• she was verbally abused by a carer
• carers failed to put things away properly, causing a hazardous environment, Mrs X is visually impaired
• she was left without care, leaving her daughter to assume a role as her carer

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The Ombudsman’s role and powers

2. 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)
3. The Council commissioned and arranged Mr Y’s care under its duties set out in the Care Act 2014 to meet his eligible needs. So, any fault in the care provider’s service is fault by the Council.
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)

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How I considered this complaint

5. I have:

• considered the complaint submitted by Mrs X;
• considered the correspondence between Mrs X and the Council, including the Council’s response to the complaint;
• considered correspondence between the Council and the Care Provider;
• made enquiries and further enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mrs X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

6. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs.
7. Section 42 of the Care Act 2014 says a safeguarding duty applies where an adult:

• has needs for care and support
• is experiencing, or at risk of, abuse or neglect and
• as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

8. If the section 42 threshold is met, then the Council must make enquiries or cause others to do so. An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect and if so, by whom.

Key facts

9. This statement is not an exhaustive description of all the events that occurred in relation to this complaint, but an outline of the key issues as a background to the investigation’s findings.
10. Mrs X is in her seventies and lives in her own home. She has physical health problems, is registered blind and reported to be at risk of falls.
11. Mrs X received home care services from three care agencies between 10 August 2002 & 2 November 2022:

• care agency 1 - 10 August - 1 September 2022
• care Agency 2 - 3 September - 27 September 2022
• care agency 3 - 19 October - 2 November 2022

Care agency 1

12. Mrs X says carers were constantly late and by the time they arrived her daughter had completed the necessary care tasks. On one occasion a carer arrived 45 minutes late and failed to apologise. On another occasion, Mrs X said two carers arrived late and failed to assist/support her. When Mrs X and her daughter asked them to leave, the carers failed to respond. Mrs X says one carer was abusive towards her, shouted at her and insulted her home, and that her daughter overheard the shouting. As she entered the room the carer left and slammed the door. Mrs X said the care agency told her it had no care plan for her.
13. Mrs X had positive feedback on two carers, she said they were polite, respectful, and arrived on time.
14. Mrs X says telephone calls to the care agency office were often unanswered. She also says the office did not inform her when carers were running late.
15. Mrs X complained to the care agency on 10 August 2022. On 18 August 2022 a supervisor from the care agency visited Mrs X. The supervisor promised her that things would improve and that weekly checks to monitor the care would be completed. This did not happen. When Mrs X contacted the care agency’s office, she says the supervisor did not get back to her.
16. Mrs X cancelled the care on 1 September 2022 and contacted the Council to raise a safeguarding alert about the quality of care provided and the actions of carers.

Council’s response/actions

17. The Council allocated a social worker and instigated section 42 safeguarding enquiries. The allocated social worker wrote to the care agency setting out the allegations and asked it to investigate and respond back by 12 October 2022.
18. The social worker visited Mrs X on 30 September 2022 to discuss the allegations and review the care arrangements. The social worker discussed the option of direct payments, and suggested this could be the best option. Mrs X did not want to pursue this option.
19. The care agency provided the Council with a copy of its investigation report. The report sets out each allegation, how these were investigated, and the conclusions drawn. Issues with time keeping and poor communication were upheld. The allegation of abusive behaviour by a carer was unsubstantiated. Overall, the care agency partially substantiated the complaint and set out an action plan to improve service. It reported, “training has been in place to improve in this area. They also agreed that any changes to care call times or care workers’ rota must be communicated at all times to all their service users and update all care staff on duty”.
20. At Mrs X’s request the Council commissioned a different care agency to provide care

Care agency 2

21. Care agency 2 was commissioned to provide care.
22. The records show the care agency contacted Mrs X to arrange a visit and complete an initial assessment and care plan. It reported Mrs X delayed the assessment twice, that a further appointment needed to be rearranged by the care agency, following which, Mrs X was unable to meet for a week due to medical appointments. The visit took place on 23 September 2022.
23. On 26 September 2023, the care agency sent an email to the Council reporting concerns about ‘hoarding’ in Mrs X’s property, it said the house required a deep clean and posed a trip hazard for Mrs X. Mrs X was reported to have requested a carer do domestic work only. The care agency said the initial decluttering and cleaning would need to be completed by a professional team.
24. The care agency’s records show the care agency provided a service to Mrs X for one month. During that month Mrs X accepted carers visits on 15 days and of those days she allowed carers to assist her with personal care on only a few occasions. This was after the care agency advised Mrs X that it been instructed by the Council to provide support with personal care and that she could not use all the allocated hours on domestic tasks.
25. The records show the care agency informed the Council on each occasion Mrs X refused visits from carers.
26. Mrs X contacted the social worker on 27 September 2022 to cancel the care, saying the care agency was not listening to her. The social worker asked Mrs X how she would manage without care, Mrs X said her daughter would support her until a new care agency could be found. The social worker agreed to visit Mrs X on 30 September 2022.

Council’s response/actions

27. The social worker visited Mrs X on 30 September 2022. Parties present/consulted were listed as, Mrs X and her daughter, care staff from care agency’s 2 & 3, a supervisor, and an operational manager. The social worker recorded a summary of the issues, the lateness of carers, the safeguarding alert about care agency 1 and Mrs X’s dissatisfaction with the care agencies in the Council’s area. The forward plan included, liaising with the Council’s commissioning team to source a new care provider, a case discussion with senior council officers and contact with Mrs X’s GP.
28. Carers continued to visit Mrs X until 4 October 2022. Mrs X contacted the Council to complain and say she felt harassed by the visits. The Council contacted the care agency to end the care package.

Care agency 3

29. The Council sourced a different care agency to provide Mrs X’s care. Visits commenced on 19 October 2022 and ceased on 2 November 2022.
30. Mrs X complained carers were not turning up on time and were not wearing personal protective equipment. Mrs X also complained that one carer was pregnant.
31. The social worker telephoned Mrs X on 2 November 2022 and spoke to her daughter. Mrs X’s daughter said her mother had terminated the service due to lack of attendance by carers, and that she would ‘bridge the gap’ until an alternative agency could be found. The officer sent an email to Mrs X confirming the discussion with her daughter and to say it would look to source a different care agency.

Council response/actions

32. An officer telephoned Mrs X later the same day and again offered the option of direct payments. Mrs X said she would be unable to manage the associated paperwork, and that she was expecting to hear of a new care agency from another officer the following day. The officer also said it was unlikely a care agency could be found so quickly.
33. The social worker and her manager visited Mrs X’s home on 11 November 2022. Mrs X refused to see them or allow them into her home. Mrs X’s daughter spoke to the officers outside and explained Mrs X wanted to discuss matters by telephone. Both officers explained Mrs X had not responded to telephone contact, which had prompted the visit. A hard copy of Mrs X’s care plan was given to Mrs X’s daughter, who said her mother would get back to them.
34. The social worker telephoned Mrs X on 18 November 2022 and left a voicemail. Mrs X did not respond so the social worker sent her an email on 21 November 2022, confirming the reason for her visit, that she wanted to discuss her care needs and the difficulty in sourcing a new care agency, the option of direct payments, and discuss the outcome of the safeguarding investigation.
35. An entry in the Councils records show Mrs X had previously used other care agencies in the Council’s area, and that she had been dissatisfied with all of them, and that all care agencies had been exhausted.
36. Mrs X’s GP wrote to the Council on 22 December 2022 expressing concern about Mrs X’s vulnerability, that her daughter worked full-time and was struggling with caring for Mrs X. The GP requested a care review. The social worker responded saying such a review had been completed and the Council was awaiting Mrs X’s response regarding care options.
37. On 23 December 2022 a social worker wrote to Mrs X to inform her of the outcome of the safeguarding investigation. She explained the identified failings in communication between carers and Mrs X and that “…training has been in place to improve in this area. They also agreed that any changes to care call times or care workers’ rota must be communicated at all times to all their service users and update all care staff on duty”.
38. The social worker also referred to a previous discussion about direct payments and reiterated the benefits, that Mrs X would have more control to employ someone with greater understanding of her needs. The social worker said she was still waiting to hear back from Mrs X about this.
39. The records show a case discussion between the social worker and her manager on 20 January 2023. The social worker was advised to write to Mrs X again requesting contact, and if this was unsuccessful, to end her involvement.
40. On 31 January 2023, the social worker wrote to Mrs X again to say she had not heard back from her and her involvement would cease. The letter was sent via recorded delivery.
41. Mrs X did not respond. The social worker’s involvement ceased, and Mrs X’s case was suspended pending contact from Mrs X.

Actions of OT and Linkline service

42. On 6 February 2023, a linkline service contacted Mrs X’s daughter to say it had not received a response to a request to visit to update the communication equipment. Mrs X’s daughter said Mrs X was unwell and said her mother would contact the service when she felt better.
43. In March 2023, Mrs X accepted a visit from an Occupational Therapist (OT). After assessment, she agreed to accept a bathing aid.
44. The linkline service contacted Mrs X’s daughter again in April 2023 to say it had received several alerts from the alarm unit in Mrs X’s home, saying the device required charging and needed to be ‘plugged in’ to charge and work properly. The risks of not doing so were explained. Neither Mrs X nor her daughter responded. The service recorded its concern.
45. An OT visited Mrs X again in early May 2023 to advise on personal aids. A follow-up visit was arranged for the following week. Mrs X cancelled this appointment and further attempts by the OT to rearrange the appointment were unsuccessful.

Mrs X’s formal complaints

46. Mrs X submitted a formal complaint to the Council on 18 November 2022 about the care she had received and that she had been left without any care.
47. The Council responded in writing on 5 December 2022. The author of the letter, a senior manager, responded in detail to the points raised. She (author) did not uphold the complaints relating to care provision. She said complaints about care agency 1 had been investigated and some areas of improvement identified but Mrs X cancelled the service before such improvements could be implemented.
48. The author said many of the complaints about care agency’s 2 & 3 had been investigated and found not to be factual. That the evidence showed Mrs X would “…cancel the care calls and then contact the Gateway to inform them that the carers did not turn up. The supervisor of one of the agencies noted that carers are tracked as they are required to log in on their phones. Joint visits were also completed in order to verify these complaints and they were found not to be true”.
49. The author did not uphold Mrs X’s complaint that she had been left without any care. She said officers had “…raised concerns as to how you would manage whilst they source alternative care agencies. Our records show that you reassured them that your daughter would step in as an interim”.
50. The author did identify some areas where communication could have been better. For example, she said despite Mrs X having the direct contact number for the social worker, she continued to make contact via the Council’s gateway service, and it was unclear if Mrs X had been made aware that her first point of contact should be the social worker. She also said there had been some miscommunication regarding a visit to Mrs X’s home on 11 November 2022 and sincerely apologised for any upset this may have caused.
51. Mrs X was dissatisfied with the response and with the lack of care arrangements.

Analysis

52. It is not the Ombudsman’s role to decide if a person has social care needs, or if they are entitled to receive services from the Council. The Ombudsman’s role is to establish if the Council has assessed a person’s needs properly and acted in accordance with the law.
53. The care Mrs X received from care agency 1 was below an acceptable standard. The safeguarding investigation completed by the care agency on behalf of the Council was appropriate and proportionate. The information I have seen shows the care agency investigated each allegation thoroughly and the conclusions arrived at were fair. It acknowledged its failings and explained the action it had taken to improve its service. It is unfortunate Mrs X did not allow the service to continue and demonstrate its improved service.
54. The Council reviewed the information provided by the care agency and was satisfied with its action. There is no evidence of fault here. However, it is not clear why the Council waited until December 2022 to formally notify Mrs X of the outcome of the investigation. It should have done so sooner. I also note the lack of apology for the poor service Mrs X experienced.
55. I am satisfied the Council responded appropriately to Mrs X’s complaints about care agency’s 2 & 3 and its attempts to engage with her following the cancellation of each service. Council officers made numerous attempts to contact Mrs X by telephone, email, letters, and an unannounced visit. Ms X’s refusal to engage was not the fault of the Council. There is no fault by the Council here.
56. Mrs X’s decision to cancel services left her without any care. Whilst there may have been elements of the service she was dissatisfied with; it would have benefited her to address the issues with the care agency and Council to allow the service the opportunity to address and resolve the matters. I do not find fault by the Council here.
57. Mrs X is without care, but that is not due to failings by the Council. The Council cannot assist Mrs X if she refuses to engage. I would urge Mrs X to engage with the Council to explore possible solutions.
58. I do not find fault in the Council’s suggestion of direct payment. If all the local care agencies have been exhausted, then direct payments would seem a reasonable approach. It is not clear if the Council has explained to Mrs X the support available with the administrative aspects of direct payments. It may reassure Mrs X to understand she does not have to have sole responsibility for the administrative duties.
59. Overall, I am satisfied the Council acted properly and in accordance with law in addressing Mrs X’s social care needs. It also properly addressed Mrs X’s concerns about the quality of care provided. However, the delay in formally informing Mrs X of the outcome of the safeguarding investigation and the lack of a formal apology for identified failings was poor practice. And for this, the Council should apologise.

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Agreed action

60. The Council should, within four weeks of the final decision, apologise to Mrs X for delaying in providing a formal written response to the safeguarding investigation, and apologise for the failings identified in the safeguarding report.
61. The Council provide us with evidence it has complied with the above actions.

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Final decision

62. The Council acted properly and in accordance with law in addressing Mrs X’s social care needs. It also properly addressed Mrs X’s concerns about the quality of care provided.
63. However, the delay in formally informing Mrs X of the outcome of a safeguarding investigation and the lack of a formal apology for identified failings was poor practice. And for this, the Council should apologise.
64. The above recommendation is a suitable way to settle the complaint.
65. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman