Summary: Mr X complained on behalf of his relative Mr Y, about the live-in care given to Mr Y by the Care Provider. We decided not to uphold the complaint finding insufficient evidence of any fault in the Provider’s service causing injustice to Mr Y.

The complaint

1. Mr X makes a complaint on behalf of his relation, Mr Y. In December 2022, Mr X helped Mr Y to arrange live-in care from Alina Homecare Services Limited (the Care Provider). The care began in early January 2023 and stopped after six weeks in mid-February. Mr X and Mr Y complain about some aspects of the care Mr Y received. In particular;

• that a care worker ‘A’ assigned to work with Mr Y could not help calm him when he became distressed about a loss of money in January 2023;
• that a second care worker ‘B’, failed to provide suitable companionship for Mr Y, spending long periods of time in his own room and not supporting him.

2. Mr X says the standard of care Mr Y received contrasts poorly with that he received in a residential care home before January 2023. Also, with that he has received since February 2023 from a domiciliary care agency.
3. Mr X and Mr Y say those aspects of Mr Y’s care which they consider unsatisfactory caused distress. They wanted the Care Provider to consider a waiver of some charges, but it refused this. Mr X further complains at the Care Provider’s approach to collecting payment of outstanding invoices while his complaint was under consideration by this office.

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The Ombudsman’s role and powers

4. 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 a significant injustice or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(3 and 4) 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. Before issuing this decision statement I considered:

• Mr X’s complaint made on behalf of Mr Y and any further information he provided;
• correspondence between Mr X and the Care Provider pre-dating my investigation;
• information provided to me by the Care Provider in reply to written enquiries;
• any relevant guidance published by the care regulator, the Care Quality Commission (CQC) referred to below;
• any relevant guidance published by this office, referred to below.

7. I gave Mr X and the Care Provider a chance to comment on a draft version of this decision statement. I took account of any comments they made before finalising the decision statement.

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What I found

Relevant legal and administrative background

8. The care regulator, the CQC, publishes the ‘fundamental standards’. These arise from a set of Regulations that identify the basic standards of care that people should receive. We do not take a view on whether a care provider may have breached the standards, as this is for the CQC to decide. But we consider any evidence the standards may have been breached as relevant when deciding if a care provider’s service has been at fault.
9. I consider three Regulations potentially relevant to this complaint. First, Regulation 9, which covers ‘person-centred care’. This Regulation aims to ensure that people receiving care, have a personalised care plan. The CQC tells care providers they must take account of individual’s capacity to make decisions for themselves and ability to consent to care. They must also keep the care they provide under regular review. They must also offer choice, for example around meals or activities on offer.
10. Second, Regulation 10, which covers ‘dignity and respect’. This includes respecting care user’s privacy when they want it and respecting their independence and autonomy. The CQC says care staff should “respect people’s personal preferences, lifestyle and care choices”.
11. Third, I note Regulation 16 which covers ‘receiving and acting on complaints’. This requires care providers to have accessible complaint procedures. The CQC says that “information must be available to a complainant about how to take action if they are not satisfied with how the provider manages and / or responds to their complaint”.

Chronology of key events

12. In December 2022 Mr Y was in a residential care home following discharge from hospital. He wanted to return to his own home, where he lives alone. For this to happen, Mr Y needed care at home and Mr X agreed to help him arrange that. Mr X contacted the Care Provider to ask it about a live-in care service to begin in early January 2023.
13. The Care Provider undertook a risk assessment of Mr Y’s home with a social worker and occupational therapist present. It agreed it could meet his needs and the live-in care service began in early January, with Care Worker A moving in with Mr Y.
14. At the outset, the Care Provider completed an assessment of Mr Y’s care needs, which also served as his care plan. This document recorded Mr Y wanting to remain as independent as possible and having some resistance to needing help from care workers. It said he would need support with meals, cleaning and ensuring he used his walking frame. The document listed medications taken by Mr Y including two used to treat anxiety. The Care Provider has said not all of this information was included in the care plan initially, as it was updated after two weeks. The Care Provider recognises that its record keeping should have clearly recorded when it updated the care plan.
15. Mr Y also entered a signed service user agreement with the Care Provider. This said the Care Provider would deliver a personalised live-in care service for Mr Y as set out in its care plan. The agreement explained that Mr Y needed to give a two-week notice if ending the service. If he ended it before receiving six weeks care, then he would incur an administration fee.
16. During my investigation the Care Provider gave me copies of the following records:

• daily logs completed by the Care Workers supporting Mr Y;
• records of visits undertaken by managers including three spot checks it undertook; two when Care Worker A supported Mr Y and one when Care Worker B supported him;
• records of two reviews it completed with Mr Y, one when Care Worker A left the home and one while Care Worker B cared for him;
• emails between its managers and Care Worker A;
• email exchanges with Mr X concerning Mr Y’s care;
• mileage claims made by two managers of the service.

17. The daily log entries were generally brief, recording such matters as Mr Y taking his medication, having meals and sometimes referring to activity during the day. I noted there were references to some companionship given to Mr Y. For example, Care Worker A recorded watching certain television programmes with Mr Y. Care Worker B recorded going out to the shops with Mr Y.
18. I noted that in the first days after care began, Care Worker A recorded that Mr Y would be “fussy” about how she performed tasks. The first spot check also recorded this comment. Then, around a week after Care Worker A began supporting Mr Y, she asked the Care Provider to reassign her. She repeated Mr Y could be fussy and that he had “swings of being nervous and calm”. She also reported Mr Y not always understanding her and that she felt disrespected. Care Worker A also reported Mr Y displayed “aggressive behaviour" but did not say what this was.
19. The day after Care Worker A asked to leave, she recorded that Mr Y was upset because he had lost money. He called the police. Two days later Care Worker A again recorded Mr Y would have mood swings and could be angry at times.
20. The Care Provider suggests the difficult relationship Mr Y had with Care Worker A may have resulted from some clash in personalities. It comments that live-in care poses particular challenges for service users given the disruption caused to previous living arrangements. Mr X also recognises that this was a period of adjustment for Mr Y after his time in care.
21. Next, Mr Y reported concerns food had disappeared from his house. A manager from the Care Provider visited the home and compared items in the home to those bought on recent shopping trips. After that, as Care Worker B took over as Mr Y’s live-in care worker, the Care Provider agreed with Mr Y that Care Worker B would buy and cook his own food.
22. The review form Mr Y completed after Care Worker A left his home, recorded him saying that he felt “a little bit bad” because she “did everything asked” and that he “could have had worse”.
23. The Care Provider says that it was shortly after Care Worker B began providing care to Mr Y that it learnt Mr Y was due to review his medication with his GP. It says this was the first time it became aware Mr Y had treatment for any mental health issues.
24. During his time with Mr Y, Care Worker B recorded that Mr Y would sometimes challenge him. He said Mr Y was particular about issues such as recycling and using the ‘wrong towel’ to dry his hands. Also, that one day Mr Y ‘snapped’ at him, when Care Worker B was preparing his own food.
25. After Care Worker B had supported Mr Y for around a week, the Care Provider completed a review over the telephone with Mr Y to enquire how he found the support he received. It recorded Mr Y saying: “I clashed with my first live in carer however I am getting on well with her replacement”. And that Care Worker B was “much better – I now feel more understood by my carer and we communicate well”.
26. The day after the Care Provider reported this, Mr X reported concern that Care Worker B did not provide enough companionship for Mr Y. In particular, that he spent long periods of time in his room. Mr X said that not only did Mr Y tell him this, but also a neighbour of Mr Y’s who would regularly call-in to visit. Shortly after that Mr X told the Care Provider Mr Y wanted to end the live-in care service and gave two-week notice. Mr X told me they would have ended the arrangement sooner, but for the administration charge they would incur. In later emails with the Care Provider, Mr X repeated that he did not think Care Worker B provided Mr Y with the “care or companionship” he needed. He also said that he did not think the care workers coped well with Mr Y’s mood swings.
27. The spot check records show the Care Provider checked matters such as the care workers’ appearance, how they were interacting with Mr Y and that they treated him with dignity and respect. These recorded no concerns any of these matters.
28. The mileage claim forms provided say the Care Provider visited Mr Y’s home seventeen times, including the initial visit in December when Mr Y had not yet returned home. This is more visits than recorded in the other care records mentioned above.

The complaint

29. After the service ended, Mr X made a complaint on behalf of Mr Y. His concerns focused on two matters. First, that Care Worker A seemed unable to calm Mr Y when he became stressed, for example over the missing money. Second, that Care Worker B had not provided enough companionship for Mr Y. Mr X suggested the service was not good value for money.
30. The Care Provider’s complaint procedure says that it should investigate and respond to complaints in 28 days. It says that if the complainant is dissatisfied with the reply, then they should contact its Quality Manager. After that, the policy says complainants can complain to this organisation.
31. The Care Provider replied to the complaint after five weeks. It said that it had visited Mr Y’s home “approximately ten times” as well speaking to him by telephone and having email communications with Mr X. This was to “support a difficult situation and ensure the package ran well”. It said that it owed a duty of care to Care Worker A and arranged for her to leave the placement because of the negative comments Mr Y made about her.
32. It said that Care Worker B found Mr Y did not need the high level of care envisaged. So, he was “often not required for large periods of time, including when [Mr Y] left the property”. It said that it had made “many visits” to the house while Mr Y lived there and addressed with him the concerns raised by Mr X. The Care Provider concluded that it did not find any evidence that Care Worker B did not provide appropriate care or fail to assist Mr Y if asked to do so.
33. The Care Provider’s letter did not provide any advice to Mr X on what he could do if he wanted to escalate his complaint. However, a covering email provided Mr X with a contact telephone number for this office.

Invoices

34. Mr Y did not want to pay the invoices for his care until he had exhausted his complaint. By July 2023 Mr X had contacted us and said the Care Provider was pressuring him to pay. After taking our advice Mr X spoke to the Care Provider asking for a hold on any debt recovery but says the Care Provider would not agree. On 11 July it sent him an email saying that it had “no option but to commence litigation” for the debt. Consequently, Mr X decided to settle the invoices.
35. In answer to my enquiries the Care Provider has sent me an internal email chain from later on 11 July where it agreed to suspend recovery until it had heard further from this office. However, it did not pass on this information to Mr X.

Findings

36. I note at the outset that Mr X’s complaint does not allege serious or significant failings of care by the Care Provider. But it suggests the Care Provider could have better addressed some aspects of Mr Y’s care. In particular, Mr X draws attention to two issues. That of how Care Worker A responded to episodes where Mr Y became stressed, especially after he reported a loss of money. And that of Care Worker B and the level of companionship he offered to Mr Y.
37. I have considered these matters in turn. I note the episode where Mr Y became stressed at the loss of money, was not an isolated incident, albeit one where his levels of stress appear greater. There are also the reports Mr Y had concerns food was not accounted for and occasions when care workers said Mr Y was ‘fussy’. I consider these references and those to Mr Y sometimes ‘snapping’ at care workers, or displaying what they perceived as ‘aggression’, are likely examples of stress reactions by Mr Y.
38. I cannot say exactly what triggered these. There is evidence of Mr Y having some anxiety. There is also evidence that Mr Y is independent and both parties recognise he struggled to adapt to a situation where that independence became compromised through needing care.
39. I recognise individual incidents put Care Worker A in a difficult position. I quoted relevant fundamental standards above, which make clear that care workers must always respect the wishes of the users of their services, so long as they have capacity to make choices. So, Care Worker A had to respect Mr X’s wishes if he wanted to call the police. There is no suggestion he did not have capacity to decide that for himself.
40. That said, I recognise the point made by Mr X there may have been strategies Care Worker A could use to try and help reduce Mr Y’s stress. However, I am unclear what those were and there was nothing in the care plan to assist her.
41. I have questioned if more could have been done to prepare Care Worker A for the type of behaviour Mr Y presented. I am satisfied the Care Provider knew something of the medications Mr Y took at the outset and it may have asked more to find out why he took certain medication. But there was also some onus on Mr Y to alert the Care Provider if his anxiety may prove challenging to care workers. I cannot say that care planning for Mr Y was inadequate, although the confusion over when the Care Provider added information to the care plan could and should have been avoided, as it recognises.
42. I am satisfied that Mr Y found it stressful having live-in care workers sharing his home. I consider it must have been particularly stressful for him to find money missing or to believe food was missing. Possibly, a different care worker may have been better able to reassure Mr Y. But on balance, I cannot say his distress arose from any poor care, nor the care worker’s inability to diffuse his anxiety amounted to poor care. I am therefore unable to uphold this part of the complaint.
43. I have considered next the concern about the companionship Care Worker B provided to Mr Y. I noted there was nothing in the Care Provider’s assessment of Mr Y’s needs that referred to him needing companionship. Overall, I found there was little in the care planning documents that referred to how Mr Y would spend his time and if or how the Care Provider expected care workers to facilitate that. This is something the Care Provider might reflect on.
44. However, as I noted above, the care records show both Care Worker A and Care Worker B made some efforts to spend time with Mr Y outside of simply performing care tasks. It is also my observation from those records that Mr Y appears to have needed less care than initially foreseen, meaning care workers would have more time when they were not carrying out care tasks. And that Mr Y also liked to be independent. Further, there is nothing in the Care Provider’s checks made with Mr Y that suggest he wanted to spend more time with Care Worker B when asked about his care contemporaneously.
45. On balance therefore, while I do not doubt the account that Mr Y and Care Worker B spent periods of time alone as described by Mr X, I do not find the Care Provider at fault.
46. Turning to the Care Provider’s complaint handling, I find it offered a comprehensive reply to Mr X’s correspondence. I note this took longer than the Care Provider’s complaint procedure suggests. But I do not consider any injustice arose from this, noting Mr Y was no longer receiving care from the Care Provider and the delay was short.
47. I had some concern about whether the reply exaggerated the number of visits to Mr Y’s house undertaken by the Care Provider’s managers. It suggested they visited the house around 10 times in total and 'many times’ while Care Worker B supported Mr Y. But the care records did not support these statements. These only referred to five or six visits to Mr Y’s home, including on the day care began which would not offer opportunity for the service to be reviewed. And of those visits I found the Care Provider visited around the time of the handover between Care Workers A and B, and just once more to spot check Care Worker B. I found no record the Care Provider discussed with Care Worker B any concerns about the companionship he gave to Mr Y.
48. However, the mileage claims suggest the Care Provider did visit Mr Y at least as many times as it stated, if not more. It is disappointing there is not more record of these visits in the care records. But a failure to keep a record alone does not cause an injustice. In this case I accept any additional visits were short, outside of the Care Provider’s scheduled review of care and so unlikely to add to the overall picture of the care provided. I also could not criticise the overall number of visits, even if it were only those in the care records, which I consider appropriate for the length of time Mr Y received care.
49. I have some concern about the Care Provider’s signposting of Mr X to this office. This is an expectation we have, and one set out in the relevant CQC guidance. It would be preferable to see this in the body of the complaint response and to include our full contact details. But it was enough to enable Mr X to contact us and so I cannot find fault.
50. Finally, I noted the Care Provider did not tell Mr X that it would place invoice collection on hold, while we investigated this complaint. It took that decision on the same day it had earlier sent Mr X an email saying it would begin legal action to recover its debt. If this was no longer its immediate intent, then it should have told him this. However, I cannot say this caused Mr X or Mr Y an injustice. We think as a matter of best practice care providers should keep collection of invoices on hold to await the conclusion of a complaint. But that does not mean a care provider cannot legitimately raise an invoice, ask for its payment or explain any proposed debt recovery actions. So, the Care Provider’s omission here did not have any significant impact on Mr Y’s liability for the debt or the actions taken to recover it.

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Final decision

51. For reasons set out above I do not uphold this complaint. I find no fault by the Care Provider causing injustice to Mr Y.

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Investigator's decision on behalf of the Ombudsman