Summary: Miss F complains on behalf of her mother, Mrs B, about the domiciliary care provided by COOCI Associates. There is no evidence that the care provider’s actions have caused injustice to Mrs B.

The complaint

1. Miss F complains on behalf of her mother, Mrs B, about the domiciliary care provided by COOCI Associates. In particular she complains that since July 2022 the care provider:
1. Has failed to support its staff or deal with allegations of bullying, has not put a team leader in place and has allowed staff to work over 90 hours a week.
2. Has not treated Mrs B with dignity and respect and there have been incidents of rough handling.
3. Has not adhered to her diet and exercise programme.
4. Has not followed her mother’s care plan in relation to socialising and community activities.
5. Wrongly advised staff not to perform CPR despite her mother not having a DNR in place.
6. Does not have sufficient arrangements in place for out of hours care or emergencies.
7. Did not deal with safeguarding concerns.
2. Miss F says this has caused her mother distress and puts her at risk of harm.

Back to top

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. (Local Government Act 1974, sections 34B and 34C)
4. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (Local Government Act 1974, section 26A or 34C)
6. We normally name care homes and other care providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
7. 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)

Back to top

What I have and have not investigated

8. I am not investigating part a) of the complaint. This is because the law says we cannot investigate a complaint if it is about a personnel issue. (Local Government Act 1974, Schedule 5/5a, paragraph 4, as amended)

Back to top

How I considered this complaint

9. I spoke to Miss F about her complaint and considered the care provider’s response to my enquiries.
10. Miss F and the care provider had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

What I found

Relevant law and guidance

Fundamental Standards of Care

11. 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.
• Food and drink (Regulation 14): Service users must have enough to eat and drink to keep them in good health while they receive care and treatment.

Safeguarding vulnerable adults

12. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

Mental capacity

13. A person aged 16 or over must be presumed to have capacity to make a decision unless it is established that they lack capacity. The Mental Capacity Act 2005 describes how and when to assess a person’s capacity to make a decision, and how to make a decision in that person’s best interests. If somebody lacks the mental capacity to make decisions for themselves the Court of Protection may appoint a deputy to make decisions for that person.

What happened

14. Mrs B has physical disabilities and complex needs including short term memory loss and epilepsy. She lives at home with 24-hour carers who support her with her personal care, meals and community activities including a weekly singing club.
15. Mrs B has a deputy for her financial affairs. She receives direct payments from her local council and the deputy uses these to employ the carers.
16. COOCI Associates (“the care provider”) provides a direct employment service to oversee the recruitment, retention and management of the carers on Mrs B’s behalf. The care provider employs a case manager who ensures the carers are trained, coordinated and meet Mrs B’s needs. The case manager liaises with the deputy and the local council.
17. In April 2022, Mrs B started a diabetes prevention programme. In July 2022 the carers’ team leader (Ms D) resigned and was not replaced.
18. Mrs B’s daughter, Miss F, complained to the care provider in February 2023. She said that since Ms D had left, the care provided to Mrs B had deteriorated. She said:
• There had been incidents of rough handling and where Mrs B had not been treated with dignity.
• Carers had refused to provide full oral care including flossing.
• Carers did not provide meals in line with the diabetes programme and had missed sessions.
• Some carers had asked Mrs B’s hairdresser to cut their hair at Mrs B’s home.
• Carers had been instructed to take no action if Mrs B stopped breathing.
• Mrs B had not been taken to her singing club.
• Miss F also raised concerns about staffing rotas, lack of support for carers since Ms D had left and that there were insufficient arrangements in place for out of hours care or emergencies.
19. The care provider met Miss F and responded to her complaint on 20 and 22 March 2023. It said:
• It had received no concerns from Mrs B’s friends, family members or staff about her not being treated with dignity or respect.
• Carers were following the agreed meal and exercise plans and monitoring Mrs B’s weight. The diabetes prevention programme had been informed that Ms D had left, but there had been problems accessing two diabetes support sessions.
• Staff had been informed that it was not acceptable to have their hair cut in Mrs B’s home. The care provider would take disciplinary action if necessary.
• At a team meeting staff had been informed there was no DNAR in place and in an emergency to call 999 and carry out first aid as instructed by the ambulance service.
• Mrs B had not attended the singing club as it had been held in a different location which was not suitable for Mrs B.
• It did not provide an on-call service but the case manager was available out of hours. If a night support worker became unwell, support would be provided by other members of the team or by a family member.
20. Miss F came to the Ombudsman.
21. In response to my enquiries, the care provider said Mrs B had missed four singing club sessions; once because of the unsuitable location, once because Mrs B was poorly and twice because Ms D was volunteering at the club. It also sent evidence that Mrs B was no longer pre-diabetic.
22. The care provider said staff had had mandatory training on communication, dignity and respect, had been trained on how to deal with challenging behaviour, followed the behaviour support plan and had regular supervisions which considered professional conduct. It had interviewed staff about the incidents reported by Miss F but had found they were not substantiated.

My findings

23. I have reviewed the care provider’s care plans for Mrs B and have seen the supporting information it used to respond to Miss F’s complaint. I have also seen information from the local council. I am unable to share this evidence with Miss F as it is confidential third-party information.
24. There is no evidence that staff were instructed to take no action if Mrs B stopped breathing.
25. I find no fault in the care provider’s provision for support in emergencies and its contingency planning to use other staff and family members if necessary. I have seen no evidence that Mrs B was put at risk of harm due to a lack of cover.
26. There is a food and drink plan which is in line with the diabetes guidance. The care provider monitors Mrs B’s weight, measurements and blood sugar levels. I have seen no evidence of fault in Mrs B’s nutrition support.
27. Mrs B missed two sessions of the singing club as staff did not want to meet Ms D. This is fault as the care provider should ensure Mrs B’s care plan is implemented. But I have seen no evidence that this caused injustice to Mrs B.
28. Miss F says there were times when Mrs B was not treated with dignity and incidents of rough handling. I have reviewed eth daily records for the incidents reported by Miss F. There is no evidence that Mrs B’s care plan and the behaviour support plan, which allows carers to remove themselves from Mrs B for a short time if there is challenging behaviour, was not complied with, or of potential breaches of the regulations. I therefore do not find fault.

Back to top

Final decision

29. There was no fault causing injustice. I have completed my investigation.

Back to top

Investigator's decision on behalf of the Ombudsman