Summary: Mr X complains on behalf of his wife, Mrs X, about the standard of care she received from a Care Provider the Council had arranged. Mr X said the care was not always delivered in accordance with her care plan and visits were not made at the agreed times. We uphold part of Mr X’s complaint as the Care Provider did not deliver care in line with Mrs X’s care and support plan. We also find fault with the way the Council responded to Mr X’s complaint. The Council has already waived the outstanding balance on Mrs X’s account and has agreed to apologise, make a symbolic payment and service improvements.

The complaint

1. Mr X complains on behalf of his wife, Mrs X, about the standard of care received from a Care Provider the Council had arranged. Mr X said care was not always delivered in accordance with her care plan and visits were not made at the agreed times.
2. Mr X says this has caused uncertainty, distress and confusion to him and his wife.

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The Ombudsman’s role and powers

3. 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)
4. 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)
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. I considered the information provided by Mr X and discussed the complaint with him. I made enquiries of the Council and considered its response.
7. Mr X and the Council had the opportunity to comment on my draft decision. I considered all comments before reaching a final decision.

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What I found.

8. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. We consider the 2014 Regulations when determining complaints about poor standards of care.
9. Regulation 9 says the care and treatment of service users must be appropriate, meet their needs, and reflect their preferences.
10. Regulation 10 says people using care services should be treated with dignity and respect.

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What happened

11. Mrs X lived at home with her husband, Mr X. On 29 January 2023, Mrs X was discharged from hospital and received care in her home from a provider called Gemini Care Agency (the Care Provider).
12. Mrs X’s support plan said she required support with personal care, continence needs and safe transfers between her bed, chair and commode. The plan stated the carers would administer Mrs X’s medication and Mr X was responsible for ordering and collecting the prescriptions.
13. The support plan said Mrs X needed four care visits each day: morning, lunchtime, teatime and in the evening. The morning calls were scheduled for 45 minutes and all other calls for 30 minutes. Mr and Mrs X set out their preferred call times as, 09:00, 12:30, between 16:30 and 17:00 and 20:00 hours. The Care Provider’s schedule of visits did not entirely reflect this. In response to our enquires the Care Provider said it told Mr and Mrs X that it would provide calls as close to their preference. The Care Provider also told us it did not agree specific times for visits as Mrs X was not on time specific medication.
14. The Care Provider’s electronic call logs for February and March show that some calls were made up to 40 minutes earlier than the scheduled time. Also, many calls were under the schedule call time of 30 minutes. The Care Provider told us that when Mrs X did not require personal care the duration of the visits were shorter and when carers had completed their tasks, they would leave early to allow the family privacy.
15. On 25 February, Mr X complained that carers attended the evening call at 19:05 instead of 20:00. Mr X said he was having his dinner at the time and the early call disrupted his meal. On the same day, Mr X said the carers presented him with an empty box of Mrs X’s diabetic medication. He said the carers had failed to notify him sooner that the medication had finished, and he had to obtain an emergency supply.
16. The following day, Mr X said carers had moved Mrs X using the wrong sliding sheet causing a skin sore. The Care Provider said it spoke to the carers and they confirmed they had used the correct sliding sheet and that Mrs X’s bottom was red before the alleged incident took place.
17. On 27 February, Mr X said relief carers attended for three days without wearing masks. The call records show the same two carers providing care for Mrs X on 26 and 27 February. The Care Provider and the Council have failed to clarify whether they were wearing masks at the time.
18. The following day, the care provider gave two weeks’ notice to terminate the care package.
19. On 2 March, Mr X complained to the Council about the standard of care provided by the Care Provider. In addition to the issues detailed above, Mr X said carers had parked on his front garden, narrowly missing a concrete feature. Mr X said their private life had been affected by the uncertainty of call times and spoiled meals. Mr X said because of this he had been prescribed tranquilisers and anti-depressants.
20. At the same time, the Council completed a financial assessment and advised that Mrs X did not meet the criteria for funding and was required to pay the full cost of her care.
21. On 7 March, the Care Provider changed the morning call from 08:40 to 07:40. In response to our enquiries the Care Provider confirmed the times were changed for 8 March and 9 March due to administrative error. Mr X sent a further email to the Council. He said the carers had arrived over an hour earlier than scheduled, disrupting their breakfast. Mr X said the Care Provider had not contacted him about changing the call times. Mr X refused to pay for the care.
22. The Council wrote to Mr X under stage one of its complaint’s procedure. The Council said it could not respond to Mr X’s complaint about the actions of the Care Provider, however it had passed the information to its Quality Team. Mr X remained unsatisfied and asked for his complaint to be escalated to stage two.
23. On 16 April, the Council wrote to Mr X under stage two of its complaint’s procedure. The Council said it could not answer Mr X’s questions regarding the quality of service Mrs X received from the Care Provider because it did not have access to care records. The Council advised Mr X to contact the Care Provider directly.
24. Mr X remained unsatisfied and bought his complaint to the Ombudsman. At the time there was an outstanding balance of £288.40 on Mrs X’s account. In response to our enquiries the Council confirmed it had cleared this balance on the basis there had been a breakdown in the relationship between Mr and Mrs X and the Care Provider.

Analysis

25. The Council commissioned Mrs X’s care with Gemini Care Agency. 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. Any fault by the Care Provider is therefore fault by the Council.
26. There was fault by the Care Provider. The Care Provider’s call time records indicate Mrs X’s calls were at times earlier than scheduled. The lack of consistency in call times caused uncertainty and distress to both Mr and Mrs X, as they felt the carers could turn up at any time.
27. In response to my draft decision the Council said its practice was to complete a care act assessment with the client and their family. It is during this assessment the Council would explain that very specific timed calls were not possible, and calls would normally be within a two hour window and may fluctuate. The Council explained that because the contract was terminated within four weeks of commencing the care act assessment was not completed. This meant that Mr and Mrs X were not properly informed about the timings of calls.
28. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. I acknowledge the Council did not complete an assessment due to the care package ending within four weeks. However, the support plan implemented by the Care Provider did specify call times within a specific timeframe. I acknowledge the Council’s comments that calls would normally be within a two hour window, however, in the absence of any information provided to Mr and Mrs X about this it was reasonable for Mr and Mrs X to expect the visits to take place within the timeframe specified in the support plan which already made allowances for any delays.
29. The records also indicate that Mrs X’s calls were at times far less than the agreed time. The Care Provider said that when Mrs X did not require personal care the duration of visits was shorter and when carers had completed their tasks, they would leave early to allow the family privacy. The Care Providers call monitoring records support this statement.
30. I acknowledge there was an administrative error which resulted in the morning call times being amended for two days in March. I do not consider this was a deliberate error nor was there intent to cause disruption to Mr and Mrs X, nevertheless the error meant that Mrs X’s morning call was one hour earlier. This interrupted Mrs X’s routine and added to her distress.
31. The Care provider has confirmed that from 30 January, it was not mandatory for staff to wear face masks in care settings unless risks were identified. The Care Provider said no risks for Mrs X were identified. On this basis, I find no fault with the actions of the carers who attended to Mrs X without wearing masks on 27 February.
32. Mr X said that the carers presented him with an empty box of Mrs X’s diabetic medication. He said the carers failed to notify him sooner and he had to obtain an emergency supply. I have reviewed the care and support plan in place for Mrs X. The carers were responsible for administering the medication. They were not responsible for ordering or collecting prescriptions. On this basis, I find no fault.
33. With regards to the use of the sliding sheet, there is conflicting information from Mr X and the Care Provider about the equipment that was used to move Mrs X in bed. As I was not present, I cannot determine what happened. Furthermore, the carers attending to Mrs X no longer reside in the country and therefore further investigation into this aspect of Mr X’s complaint is not possible.
34. Mr X also complained that carers had parked on his front garden, narrowly missing a concrete feature. The Care Provider has no details of this incident and therefore I cannot determine what happened and have not investigated this issue any further.
35. I have also considered the Council’s handling of Mr X’s complaint. The Council’s response to Mr X is poor. The Council commissioned the care package following Mrs X’s discharge from hospital and therefore it should have investigated the specific issues Mr X raised. The Council had the ability to request records from the Care Provider, scrutinise the care being delivered and provide a clear and detailed response to Mr X. Failure to do so is fault and meant that Mr X was put to the time and trouble of complaining to the Ombudsman.
36. To remedy the injustice caused to Mr and Mrs X the Council has already waived the outstanding balance of £288.40. I welcome this action by the Council. However, in my view it does not go far enough to remedy the injustice caused by the poor handling of Mr X’s complaint. I recommend an apology, a symbolic payment of £100 and service improvements.

Agreed action

37. Within four weeks of my final decision the Council will:
1. apologise to Mr and Mrs X for the faults identified in this statement;
2. write to Mr and Mrs X confirming its decision to waive the outstanding balance;
3. pay Mr X £100 to remedy the injustice caused by the poor handling of his complaint;
4. ensure it has procedures in place to fully consider and respond to all complaints about services it commissions; and
5. remind the Care Provider of the importance of adhering to care call times as specified in the care and support plan.
38. The Council should provide us with evidence it has complied with the above actions.

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Final decision

39. I have found fault by the Council causing an injustice to Mr and Mrs X. I have completed my investigation on this basis.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman