Summary: Ms X complains the Council’s care provider, Reline Care, consistently failed to meet her needs, causing her significant distress. Based on the evidence seen so far, the care and support planning was poor and failed to explain how Ms X’s needs would be met by the support put in place. Reline Care did not update its own support plans and some of its support fell below the accepted standard. However, there is not enough evidence to say these faults caused injustice to Ms X which requires a remedy.

The complaint

1. The complainant, Ms X, complains the Council’s care provider, Reline Care Ltd, consistently failed to meet her needs, causing her significant distress.

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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 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)
3. 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)
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)

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How I considered this complaint

5. I have:
• considered the complaint and the documents provided by Ms X;
• considered the comments and documents the Council has provided in response to my enquiries;
• considered the Ombudsman’s guidance on remedies; and
• invited comments on a draft of this statement from Ms X, NELFT, Reline Care and the Council, for me to consider before making my final decision.

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What I found

What happened

6. Ms X has obsessive compulsive disorder (OCD). She has severe mobility problems and is largely cared for in bed. She lives with her parents. Her care and support is managed by North East London NHS Foundation Trust’s (NELFT) Community Mental Health Team (CMHT). In so far as this relates to services under the Care Act 2014, the services are provided on behalf of the Council. However, the Council’s brokerage team arranged for Reline Care to meet Ms X’s social care needs under the Care Act. Her July 2022 care and support plan provided for a package of care comprising 25 hours a week. This was to meet her need for help:
• Managing toilet needs
• Maintaining personal hygiene
• Being appropriately clothed
7. The care and support plan said Ms X’s mother was meeting her need for help:
• Maintaining a habitable home environment
• Managing and maintaining nutrition
8. The care and support plan did not say how Ms X would use the 25 hours a week. However, Reline Care’s October 2022 care plan said care workers would visit for eight and a half hours three days a week. Ms X says her care package was increased to 40 hours a week in October 2022. But neither NELFT nor Reline Care updated their plans to reflect the increase.
9. On 9 June a care worker left Ms X (with another care worker) when she was still naked. Reline Care asked the care worker to return to support Ms X get dressed.
10. Ms X complained to Reline Care about its support for her, including the incident on 9 June. When Reline Care replied, it said:
• Its care worker had been working 12-hour shifts without their mandatory breaks
• It had encouraged her to prioritise personal care so the care worker could meet her eligible needs, but she asked them to complete repetitive cleaning tasks
• It denied the claim that care workers were deliberately working slowly
• They had agreed the care workers would remind Ms X two hours before the end of their shifts of the need to complete personal care, but Ms X ignored this
• Ms X only started complaining about the care workers after it told her they could not stay beyond their shift
• It could not ask Ms X’s preferred care worker to work all the shifts she wanted them to work
• A care worker had left Ms X undressed “out of frustration” after reminding her of the need to complete her personal care. They left her with another care worker, after their shift had ended, but were asked to return.
11. It appears from NELFT’s updated care and support plan from July 2023, that the increase was because Ms X’s mother could no longer meet all her needs for help with cleaning and providing meals. Ms X had asked for 12 hours a day (84 hours a week). As in 2022, the care and support plan did not say how Ms X would use the hours. Nor did Reline care update its care and support plan. However, I understand Ms X continued to split the hours over three days a week.
12. On 18 July Ms X complained about Reline Care. Among other things, she said its staff:
• shouted at her;
• left her for days without food, water, medicine, bedding or her phone;
• deliberately worked slowly and left care tasks incomplete;
• damaged or lost items;
• caused losses of over £1,600, relating to her assessed charge for her care;
• gave her no privacy when calling Reline Care;
• made false accusations against her.
13. The Council decided to deal with the issues as safeguarding concerns. It made enquiries into them under Section 42 of the Care Act. It consulted Ms X and her advocate about the concerns.
14. Her advocate told the Council Ms X:
• Wanted equipment to help her get to the bathroom – the Council said Ms X had not fully engaged with a wheelchair assessment. Ms X says she was not given enough support to take part in the assessment.
• Wanted a bed/mattress assessment as she felt the current bed was causing bruising – the Council said Ms X had refused to let a nurse enter her bedroom to assess her skin integrity on 13 July.
• Wanted the Council to manage her support, not the CMHT- the Council said it would discuss the request with the CMHT, but noted Ms X’s primary need related to her mental health.
• Wanted 24-hour support in her current accommodation – the Council said an assessment for living in her own flat with assistive technology had been offered but Ms X did not want this (Ms X disputes this). She had asked for a period of respite care but later asked for a supported living placement (Ms X says this was never explored).
• Had problems with care workers which resulted in going without personal care or meals for long periods – the Council said Ms X used her care package (40 hours a week) over three days. She had been encouraged to prioritise personal care and meals before other tasks, but she was not open to this and prioritised cleaning. Care workers sometimes stayed until 02.00 or 03.00. Sometimes they left after completing their hours, which meant Ms X had not eaten or had personal care.
15. According to its records, the Council contacted Ms X on 27 July (Ms X disputes this). She said:
• She did not want to discuss the safeguarding concerns.
• She was concerned care worker B was leaving and that another care worker was not skilled enough - the Council said it would speak to Reline Care about getting new care workers to shadow care worker B before they left.
16. On 10 August the Council held a safeguarding adults planning meeting with the people involved in Ms X’s care. Ms X’s advocate attended the meeting on her behalf. They discussed ways of supporting Ms X and agreed to:
• Offer her a Care Act assessment;
• Refer her for an occupational therapy assessment;
• Arrange for a change in care provider;
• Arrange a short-term residential placement.
17. In August NELFT updated Ms X’s care and support plan. It continued to provide for 40 hours of support a week. It said care workers would visit for five hours each day and set out how three of those hours would be used to support Ms X with:
• medication;
• brushing teeth;
• washing and combing hair;
• cleaning face and contact lens;
• full body wash;
• cleaning private area and applying antiseptic healing cream;
• laundry;
• fresh bedding;
• cleaning the room and disposing of rubbish.
18. The plan did not explain how the other two hours would be used each day. However, it said the remaining five hours were to help with:
• unpacking parcels and storing the contents – one hour a week;
• shopping – one hour a week;
• collecting medication – one hour a week;
• emotional support – one hour a week;
• liaising with professionals (GP, district nurse etc) – one hour a week.
19. Ms X says Reline Care did not do most of these things, only unpacking parcels.
20. The care and support plan said Ms X’s mother would support with maintaining a habitable home and help with managing and maintaining nutrition “whenever she can”. Ms X says her mother could not do this as she was caring for two other members of the family.
21. Reline Care stopped visiting Ms X in January. It said she would only accept support from specific care workers, who were not available. Ms X says this was not true, as one of the care workers told her they had no work to do. It told the Council it would have to find another care provider, as its care workers were refused entry to Ms X’s home.
22. In February the Council’s brokerage team arranged for another care provider to take over Ms X’s package of care. However, Ms X would not accept the new care provider. She said there was a lack of communication, a lack of information provided to the care workers, inefficient timing schedules, no assessment and no induction training. The new care provider said it was because she wanted its care worker’s to shadow care worker B from Reline Care before visiting on their own, but care worker B was not available.
23. Ms X identified another care provider and asked the Council to commission her care from it. But the Council said it could not do this, as the care provider was not on its list (nor does it appear to be registered with the Care Quality Commission to provide home care). The Council offered Ms X direct payments, but she did not want them. Ms X said she would accept residential care.
24. When the Council replied to Ms X’s complaint in February 2024, it said:
• Reline Care had shown that it responded to all Ms X’s concerns and had made every attempt to support and meet her needs.
• It had arranged for another care provider to take over Ms X’s package of care. But she had refused the services of the new care provider, as she wanted care worker B to shadow staff from the new care agency, but care worker B was absent from work.
• It had asked NELFT to contact Ms X about her ongoing care.
• NELFT confirmed it carried out safeguarding enquiries into Ms X’s concerns, which it completed in September 2023. It found no evidence of abuse but acknowledged the issues related to the complexity of the support provided to her and possible quality issues when delivering her support.
25. Later in February Ms X was admitted to hospital, where she was, until recently, detained under section 3 of the Mental Health Act.
26. Reline Care’s records of the support it provided to Ms X in June and July 2023 show:
• Care workers spent between 12 hours and 16 hours 45 minutes in her home on each visit, sometimes leaving in the early hours of the morning.
• Ms X sometimes prioritised cleaning over other personal care tasks, so the care workers were sometimes unable to complete the latter.
• In June a care worker left before the end of the shift without telling the office and later said they did not want to go back.
• Other care workers said they did not want to return, as the work never finished on time.

Is there evidence of fault by the Council which caused injustice?

27. The care and support planning for Ms X was poor. Neither the 2022 nor the July 2023 care and support plan identified how Ms X would use her assigned hours. NELFT only updated her care and support when doing her annual review in July 2023, despite having already increased her hours from 25 to 40. Under the Care and support statutory guidance, care and support plans should be updated whenever changes are made to the way care is delivered. The July 2023 care and support plan did not explain how NELFT was satisfied that 40 hours were enough to meet Ms X’s needs. Given that she had asked for 12 hours a day, it needed to do this. It is unclear why NELFT agreed to Ms X continuing to use her hours over three days a week, when it appears she needed support seven days a week.
28. It appears NELFT recognised the inadequacy of the care and support planning in August 2023, as it updated the plan setting out how the hours would be used over seven days and what tasks were to be carried out. However, it only set out how three of the five hours would be used each day. It is therefore unclear what the purpose of the additional two hours was.
29. It is not possible to say what the outcome would have been if the care and support planning had been more thorough. On balance, there is not enough evidence to say these faults caused injustice to Ms X.
30. Reline Care failed to update its own support plan for Ms X to reflect the increase to 40 hours a week, or the decision to split the hours across seven days, rather than just three. Reline Care’s records show the support it provided for Ms X did not always meet the expected standard (a care worker left Ms X undressed with another care worker, but returned after being told to do so). However, the key failings were in support planning and failing to address the challenges posed by Ms X’s condition. However, given the difficult circumstances under which Reline Care was working, including Ms X’s unwillingness to prioritise personal care over other tasks which were not part of her care and support plan, there is not enough evidence to say the problems caused injustice to Ms X which requires a remedy.
31. I have not made other recommendations, given the significant change in Ms X’s circumstances since the events I have investigated and the fact the Council accepts the need for more detailed care planning with Ms X.

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Final decision

32. I have completed my investigation on the basis there has been fault, but this has not caused injustice which requires a remedy.
33. Under the terms of our Memorandum of Understanding and Information Sharing Protocol with the Care Quality Commission, I will send it a copy of my final decision statement.

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Investigator's decision on behalf of the Ombudsman