Summary: The Council failed to properly respond to Ms X’s concerns about the care her sister received from a care agency acting on behalf of the Council. This led to a prolonged period of short care visits and significant frustration for Ms X. The Council also failed to deal with Ms X’s concerns about overcharging for care services. The Council has implemented widespread changes in response to this complaint.

The complaint

1. Ms X complains about the service her sister, Miss Y, received from a care agency. The care is commissioned and funded by the Council.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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)

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How I considered this complaint

4. I have:

• considered the complaint and discussed it with Ms X;
• considered correspondence between Ms X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Ms X and the Council an opportunity to comment on a draft of this document.

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What I found

Relevant legislation

5. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances.
6. The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs and their carers. The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing.
7. Where local authorities have determined that a person has any eligible needs, they must meet these needs. When a local authority has decided a person is or is not eligible for support it must provide the person to whom the determination relates (the adult or carer) with a copy of its decision.

Background

What Ms X says

8. Miss Y is a senior citizen. She has a learning disability and is hearing impaired. She lives in her own home and received home care services from Elite Care Agency. The care agency acted on behalf of the Council.
9. Ms X says daily wellbeing checks conducted by the care agency were not completed. Both she and Miss Y kept records of missed visits. The records show:

• Between 1 March 2022 and 31 December 2022, Elite carers attended only 46.5% of the scheduled visits (120 of 258 days)
• Between 1 January and 13 April 2023, attendance fell to 38.9% (40 of 103 days).

10. Ms X says carers falsified care records, and she has evidence which support this. She also had concerns about a male carer gaining entry to Miss Y’s home using unauthorised methods.
11. Ms X raised her concerns with the Council on numerous occasions. She is not aware of what, if any, action the Council took, she says despite her complaints, the service did not improve.
12. Ms X says, at her insistence, a meeting was convened in April 2023. Both Miss Y and Ms X were present, along with, two Council officers and the owner of the care agency. Ms X says the officers said they would follow-up the issues raised in the meeting and come back to her. She says this did not happen and she heard no more.
13. Ms X says she lost confidence in the care agency and after discussion with Miss Y decided to cancel the service. She says the Council offered no alternative service and she (Ms X) made an informal arrangement with the ‘warden’ of Miss Y’s accommodation. Ms X says she heard no more from the Council.
14. Ms X says she cannot recall the Council undertaking regular reviews of Miss Y’s care.
15. Ms X says the care agency also provides services to other people living in Miss Y’s building and she is concerned others may be similarly affected by the poor service. She believes some of the carers employed were not DBS checked.
16. Ms X says there have been issues with Miss Y’s contributions for care services, which have gone unresolved for two years. She says Miss Y overpaid for services. Ms X says she consistently raised this with the Council. The Council has reimbursed Miss Y £8,000, but Miss X says the calculations were not properly explained. She says there is still a ‘credit’ on Miss Y’s account, which is being used to pay her care-call bill. This is expected to continue until 2025.

Information from the Council

17. In a letter to this office the Council acknowledges all the issues Ms X raised and says there are failings in the way it responded.
18. It confirms Ms X raised complaints about short visits and financial issues in 2022, and in response a social worker was allocated. Following enquiries by the social worker the Council discovered anomalies in the contract for Miss Y’s care. However, due to an oversight the contract was not amended, and this resulted in continued overpayments from Miss Y. The Council apologised to the Ombudsman that the “…matter took time to resolve, and the anxiety that this caused… this falls below our expected standard of practice and we have introduced measures for further management oversight and assurance to ensure actions are followed up in a timely manner”.
19. During a further review of the records, prompted by this investigation, the Council acknowledged there had been no contact with Ms X or Miss Y, regarding the outcome of the investigation. It says there should have been an identified lead officer that fed back to the family.
20. As part of this investigation, the Council provided minutes of the meeting held at a local community centre in April 2023. The document details the concerns and the agreed follow-up actions. This included clarification from the Council’s finance team on Miss Y’s client contributions, and clarification about the payments to the care agency. The Council requested detailed information from the care agency in respect of timings/dates of care visits.
21. The Council says, due to the absence of the allocated social worker the agreed actions were not followed-up, and the requested information from the care agency was not received. The Council apologised to the Ombudsman for this oversite and says as a result of learning from this complaint practice has been amended. Managers now review the cases of officers absent from work, and this will ensure any outstanding actions are followed-up.
22. The Council also acknowledges Ms X was not provided with feedback following the meeting. It says this should have happened.
23. The Council acknowledges it failed to offer Miss Y a reassessment of her care needs after the cessation of services from the care agency. It has no records to show Miss Y was offered an alternative service, and acknowledges this was an omission, for which it apologises. It says this has been addressed with the social worker involved and has been a learning experience for the service as a whole. Further practice guidance was issued “…across the service highlighting duties and responsibilities to individuals, and their carers under the Care Act to reinforce best practice standards”.
24. The Council has also explained the changes to care visit monitoring since Ms X’s complaint. Systems are now in place to confirm the delivery of care visits to service users and ensure this correlates with the financial records.
25. The Council also confirmed the action taken to monitor the care agency involved in this complaint.
26. The Council has reviewed and restructured the way in which concerns about care providers are raised internally and a new system was implemented in September 2022 which ensures a clear audit trail of all concerns, and appropriate action is taken by the appropriate team. Ms X says some of her complaints were submitted after September 2022.
27. The Council has also revised its complaints procedure for adult social care. It now appoints a head of service as the lead investigating officer and point of contact for complainants.

Analysis

28. There are numerous failings by the Council in this complaint, which it acknowledges. These failures led to a prolonged period of shortened care visits for Miss Y, and the possibility of some financial disadvantage due to delays in addressing the overcharging issues.
29. I do not consider Miss Y suffered any tangible injustice as a result of the shortened care visits, but she may have been disadvantaged because of the Council’s failure to ensure her ongoing care needs were met.
30. Ms X has also been put to significant time and trouble pursuing her complaint with the Council over a prolonged period.
31. The Council has offered a formal apology for the failings to this office, but this needs to extend to Miss Y and Ms X
32. To its credit, the Council has taken robust action in response to this complaint. It implemented widespread procedural changes to ensure service improvements in all areas highlighted in this complaint. The Ombudsman welcomes this action and considers no further recommendations in this area to be necessary.
33. However, Ms X and Miss Y both suffered a personal injustice, for which a remedy is required.

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Agreed action

• provide Ms X and Miss Y with a formal apology, from a senior officer, for the failings set out above;
• pay Ms X £250 in acknowledgement of her time & trouble pursuing the complaint with the Council and this office;
• offer Miss Y a reassessment of her care needs and develop a support plan setting out how any eligible needs will be met;
• consider if Miss Y suffered any financial loss through overcharging, and if so, reimburse her in full;
• provide us with evidence it has complied with the above actions.

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Final decision

34. There is evidence of fault by the Council.
35. The above recommendations are a suitable way to settle the complaint.
36. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman