Summary: The Council identified failings in some areas of care provided by a domiciliary care agency acting on its behalf before the complaint came to this office, but it failed to offer a remedy for the injustice caused.

The complaint

1. Mr X complains about the care provided to his mother, Mrs Y, from a domiciliary care agency commissioned and funded by the Council.

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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 future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. It is our decision whether to start, and when to end an investigation into something the law allows us to investigate. (Local Government Act 1974, sections 24A(6) and 34B(8), as amended)
4. 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

5. I have:
• considered the complaint and supporting information submitted by Mr X;
• considered the correspondence between Mr X and the Council, including the Council’s response to his complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mr X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

6. 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.

Key facts

7. Mrs Y has physical health and mobility problems resulting from a stroke; she also has a diagnosis of dementia. She lives at home and receives home care services from a care agency commissioned by the Council. The service commenced on 30 October 2023.
8. Mrs Y receives five visits a day to assist with rising from and retiring to bed, personal care, medication prompts, and other activities of daily living. A hoist and two carers are needed for transfers. Timings of care visits were agreed at the outset to accommodate Mrs Y’s preferences.
9. Mr X says both he and Mrs Y were initially happy with the service provided, but as time went on, they became concerned about some aspects of the service. He sent numerous emails to the care agency from November 2023 onwards complaining about:

• carer visit times;
• discussions with Mrs Y about timings of visits;
• positioning of Mrs Y in her armchair;
• carers rushing personal care, catheter care, and bed controls;
• medication timings and delayed administration of antibiotics;
• two carers continuing to visit Mrs Y on seven occasions after she requested different carers;

10. I have had sight of the emails Mr X sent to the care agency. Initially the care agency responded with an apology and explained the action it intended to take to resolve matters. In respect of timings of calls, the care agency said some of the issues had been caused by adverse weather.
11. Mr X says despite further emails to the care agency saying the issues had not resolved, no action was taken. He submitted a formal complaint to the Council on 15 January 2024. The Council responded and sought Mr X’s agreement to forward the complaint onto the care agency, which it did on 22 January 2024.
12. The Council investigated the complaint and responded to Mr X in writing on 21 February 2024. I have had sight of this letter, and the evidence the Council relied on in its investigation. In its response letter, the author addressed each point of complaint in detail. The following five points of complaint were upheld:

• carer visit times;
• continuation of early calls;
• incorrect timing of medication;
• delayed administration of antibiotics.

13. The point of complaint relating to carers rushing personal care was partially upheld.
14. Three points of complaint were not upheld. These related to carers discussions with Mrs Y about timings of visits, positioning of her legs in her armchair, and carers opening a medication dosette box incorrectly. A complaint about violation of Mrs Y’s human rights was deemed to be inconclusive.
15. The author went on to say the care agency “…offered apologies in the areas it has found it could have done things better, which includes call time punctuality and the instance where communication systems around medication have broken down. The provider has also recognised instances when contacts from you to the company have not previously been responded to and it is working to address this”. The author set out the action the care agency intended to take to address its shortcomings.
16. Mr X remained dissatisfied and submitted a complaint to this office.
17. In response to enquiries from this office, the care agency says it has “…spent the last 6 months improving our complaints management and now have a robust system in place to ensure every complaint is dealt with in an appropriate and timely fashion. Each Care Manager has since undergone compliance/complaints training and we have an escalation system in place to support them with any difficulties they might face”.

Analysis

18. When Council’s commission care services for a person they remain liable for the service failures of the service provider. So even though Mr X complains about the care agency the Council is liable for the faults of the care agency.
19. The evidence shows the Council took Mr X’s complaint seriously and that it conducted a full and thorough investigation into the issues he raised. Any investigation by this office would be unlikely to result in a different outcome.
20. However, the Council failed to provide a remedy for the distress caused to Mrs Y and for the time and trouble Mr X has been put to pursuing the complaint.
21. The care agency took robust action in response to this complaint. It implemented procedural changes to ensure service improvements in areas shortcomings were identified. The Ombudsman welcomes this action and considers no further recommendations of the care agency to be necessary.

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Agreed action

22. The Council should, within four weeks of the final decision:

• make a payment of £250 to Mrs Y to acknowledge her distress caused by the identified failings;
• make a further payment of £150 to acknowledge Mr X’s time and trouble pursuing this complaint with the Council and this office;
• provide us with evidence it has complied with the above actions.

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Final decision

23. The Council identified failings in some areas of care provided by a domiciliary care agency before the complaint came to this office, but it failed to offer a remedy for the injustice caused.
24. The above recommendations are a suitable way to settle the complaint.
25. It is on this basis; the complaint will be closed.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman