Summary: Mr X and Mr Y complained on behalf of Mrs Y about the actions of Midshires Care Limited when providing live in carers for Mrs Y. We found the Care Provider did not tell Mr X and Mr Y certain information about carers, made an unannounced visit to their home, did not communicate properly about care arrangements for Mrs Y after a live in carer placement ended and continued to ask them for payment despite saying a hold was on their account. To remedy the injustice caused the Care Provider agreed to apologise, make a payment for the distress caused and carry out a service improvement.

The complaint

1. Mr Y and Mr X complain on behalf of Mrs Y that Midshires Care Limited:
1. Did not use a suitable selection process to select a Live in Carer (LIC) for Mrs Y and did not carry out a proper risk assessment until September 2023.
2. Did not properly support Mrs Y’s first LIC which caused them to leave the placement.
3. A manager made an unannounced visit to Mr and Mrs Y’s home.
4. The second LIC provided a poor standard of care to Mrs Y.
5. Made it difficult for the family to organise a trip with the LIC’s attendance.
6. Did not send hourly paid carers to Mrs Y after the second LIC placement ended.
7. Provided invoices which were not clear or transparent.

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The Ombudsman’s role and powers

2. 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 34 B, 34C and 34 H(3 and 4) as amended)
3. 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. (section 26A or 34C, Local Government Act 1974)
4. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))

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How I considered this complaint

5. As part of this investigation I considered the information provided by Mr Y, Mr X and the Care Provider. I discussed the complaint over the telephone with Mr Y and Mr X. I made enquires with the Care Provider and considered the information received in response. I sent a draft of this decision to Mr X and the Care provider and considered comments received in response.
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I found

Law and guidance

7. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
8. Regulation 10 says people using care services should be treated with dignity and respect.
9. Regulation 17 says care providers must “maintain securely an accurate, complete and contemporaneous records in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided”.
10. Regulation 19 says care providers give people information about the terms and conditions of their care, treatment or support, including the expected costs and the requirement to pay for their care, treatment and support. 

Background

11. There has been extensive communication between Mr X and Mr Y and the Care Provider. In this section I have just summarised a brief chronology of the key points. This section does not contain all the information I considered during my investigation.
12. Mrs Y has eligible care needs and lives with her husband Mr Y. Mr X is Mrs Y’s son.
13. Following a stay in hospital Mrs Y needed a LIC. The Care Provider sent Mr Y and Mr X profiles of possible LICs to choose from and set up a zoom meeting. The Care Provider also sent its terms and conditions and LIC brochure. Mr Y and Mr X chose Carer A.
14. Carer A started their placement as Mrs Y’s LIC in mid-July 2023. Shortly after Carer A started as Mrs Y’s LIC they had to attend an appointment about their immigration status. This meant Carer A had to be away from Mrs Y for over four hours if they travelled to their appointment on public transport. As a result Mr X drove Care A to the appointment.
15. During Carer A’s placement they suggested the Care Provider set up a rotational placement to care for Mrs Y. Mr X and Mr Y said they did not oppose a rotational placement.
16. In early August 2023, a manager from the Care Provider made an unannounced visit to Mr and Mrs Y’s home. Mr Y and Mr X said the Care Provider did not tell them the purpose of the visit. After this Carer A decided they wanted to leave the placement as Mrs Y’s LIC
17. In late August 2023, Mr X wrote to the Care Provider and complained about the following:
• The Care Provider did not tell them about Carer A’s immigration meeting before they signed the contracts.
• The Care Provider gave Mr and Mrs Y a separate direct debit mandate for LICs and told them it could not use their direct debit mandate for hourly carers.
• A Care Provider manager made an unannounced visit to Mr and Mrs Y’s home. The family believed management actions had contributed to Carer A wanting to leave the placement.
18. In early September 2023, the Care Provider responded to Mr X’s complaint. The care provider said:
• It should have told the family about the immigration meeting for Carer A. This would have given the family the choice of postponing the start date of Carer A or seek another carer.
• As there was a dispute about invoicing, It should have placed a hold Mr and Mrs Y’s account while it investigated this. The Care Provider said it gave Mr and Mrs Y the wrong information on their direct debit mandate and apologised for setting up the wrong mandate.
• It did not tell the family about a care manager’s unannounced visit. The Care Provider said the unrest this caused to family was embarrassing. The Care Provider said it should book all visits to customers in advance.
• It was Carer A’s choice to leave the placement. The Care Provider said communication between Carer A, the Care Provider and family had broken down. If the family had access to the logs earlier, the Care Provider could have opened a dialogue between the parties. Going forward the Care Provider said it would ensure it made families aware about concerns or comments that may need their attention.
19. The Care Provider offered Mr X £2,414 reimbursement for 10 days of care and a new LIC manager to oversee communication between the family and Carer.
20. Carer A’s placement as LIC for Mrs Y ended on 18 September 2023 and Carer B took over. Carer B’s placement lasted until 26 September 2023 and ended following a breakdown in relationship between Carer B and Mrs Y’s family. In October 2023, Mr Y and Mr X raised concerns about the conduct and care provided by Carer B.
21. After 26 September 2023, the Care Provider was due to send hourly paid carers to support Mrs Y. This did not happen as the carer who was supposed to attend Mrs Y’s home was on sick leave. The Care Provider told the family it did not have any other carers available.
22. Between October 2023 and January 2024, Mr X and the Care Provider were in communication about the payment Mr and Mrs Y owed the care provider.
23. In late January 2024, Mr X asked the Care Provider to consider his complaint at stage three. Mr X complained:
• The Care Provider prevented the family from properly taking part in the carer selection process. They could not ask the prospective carers questions around their suitability.
• The family were unhappy that Carer A left the placement. Mr X said if the Care Provider properly supported Carer A they would have stayed and a rotational placement set up.
• The Care Provider did not tell the family about Carer A’s immigration appointment. Mr X drove Carer A to their appointment as it would have taken over four hours by public transport.
• A manager from the Care Provider carried out an unannounced visit to Mr and Mrs Y’s home.
• Carer B provided a poor standard for care to Mrs Y. This included running out of prescription medication, leaving Mrs Y to go shopping when Carer B was supposed to be going to the toilet, arguing with Mr Y, not disclosing dietary needs, being untruthful about no hot water in the home and leaving Mrs Y in an unsafe position.
• The Care Provider made it difficult to arrange for Mrs Y’s LIC to go with the family on a trip. The family had to make other arrangements.
• The Care Provider did not send hourly carers after Carer B left despite agreeing to.
• There were problems with the Care Provider’s billing system and the invoices were not clear or transparent.
24. The Care Provider provided its final response to Mr X complaint in February 2024. The Care Provider said:
• It sent the families profiles of carers to consider and set up teams calls between the carer and family so they could assess the carers suitability.
• It apologised for not telling the family about Carer A’s immigration appointment. The Care Provider offered to pay Mr X the taxi fare to cover his costs of driving Carer A.
• The manager who made an unannounced visit was acting within their remit. The Care Provider said the manager had a duty duty of care towards Carer A and Mrs Y.
• Carer B was not a good fit for the family, however they did go through all the necessary training and sign off and had the correct employee checks in place. The Care Provider said it had no concerns about Carer B’s performance however there was behaviour from Carer B and the family which showed Carer B needed removed from the placement. The Care Provider said for the specific concerns about Carer B, it was the family’s word against Carer B’s word so it was difficult to know what happened. Because of this, it decided to remove Carer B. The Care Provider said it had already offered Mr X and Mr Y £2,414 for upset and miscommunication and this was sufficient to remedy the concerns raised.
• It would support carers accompanying customers on trips but needed to ensure the safety of the carer. This included having details of the travel arrangements and accommodation etc.
• It did not leave Mrs Y without carers. The Care Provider said it removed Carer B at the family’s request. The Care Provider recognised there was some poor communication and a breakdown in relationship between Carer B and the family.
• It would be happy to work through any billing issues Mr X and Mr Y have.
25. Mr X and Mr Y remained dissatisfied and complained Ombudsman.

Findings

Carer selection and a lack of risk assessment for Mrs Y

26. Mr X and Mr Y said the Care Provider stopped them from asking carers questions to decide on their suitability. They also said the Care Provider did not carry out a proper risk assessment until September 2023, after they complained. The Care Provider said it sent the family carer profiles and arranged video calls for the family to meet carers.
27. The evidence provided showed the Care Provider told the family it could only ask carers questions about Mrs Y’s care needs, not about personal issues. While sending the families copies of profiles and arranging video calls with prospective carers was right, the Care Provider did not disclose information about Carer A’s immigration meeting and Carer B’s dietary needs. As these carers were LICs, and would spend so much time with the family and customer, failure to tell the family this information before a placement was fault.
28. Had the family known about Carer A’s immigration meeting they could have either decided to start the placement later or chosen a different carer. Also if the family had known about Carer B’s dietary needs it may have affected the family’s decision to select this carer.
29. In relation to a lack of risk assessment, I cannot see the Care Provider only did this in September 2023. There was a care plan in place for Mrs Y which contained a risk assessment and information about how carers should care for her. Following the stage two investigation into the family’s complaint, the Care Provider said it did not consider any environmental changes were needed at Mrs Y’s home. Without further evidence to show the Care provider failed to carry out a risk assessment in July 2023, I cannot find it at fault.

Carer A leaving the placement

30. Mr X and Mr Y said the Care Provider did not support Carer A during their placement and this caused them to leave the placement. They said Carer A wanted a rotational placement for Mrs Y and the Care Provider told Carer A the family were against this which was not the case.
31. I have considered the evidence provided by Carer A, which shows their views about the placement and reasons for asking to leave. I cannot summarise this evidence because it contains personal data belong to Carer A. Carer A has not given permission to share this. I am satisfied the placement ended because Carer A wanted to leave and not because of lack of support from the Care Provider. I am also satisfied Mr X and Mr Y’s concerns that the Care Provider told Carer A they did not want a rotational placement did not impact on Carer A’s decision to leave the placement.

Unannounced visit to Mr and Mrs Y’s home

32. The Care Provider in its stage two response apologised for this and recognised it should not have happened. However in its final complaint response it said the manager was acting within their remit.
33. I considered the Care Provider was at fault here. The unannounced visit caused Mr Y and Mr X upset, particularly as they had guests at their home. It would have been correct for the Care Provider to have warned the family about a visit or arranged a suitable time to visit.

Standard of care from Carer B

34. Mr X and Mr Y raised several concerns about the care provided and attitude of Carer B.
35. I considered the allegations made by Mr X and Mr Y and the notes provided by the Carer in the care logs. Carer B refuted the issues Mr X and Mr Y raised. The care logs showed Carer B made counter allegations about the behaviour of Mr Y. The care logs also provided details about the care Carer B provided to Mrs Y. On balance I do not consider the care provided by Carer B was poor.
36. However in relation to the complaint about Carer B running out of medication for Mrs Y, Carer B said they told Mr X about renewing Mrs Y’s prescription earlier that week. There are no notes to support this in the care logs, so I cannot say whether this did happen. This is fault and will undoubtedly cause uncertainty to Mr X and Mr Y about what did happen.
37. From the care logs and complaints made by Mr X and Mr Y, it was clear there were disagreements between Carer B and Mr Y about how certain things should be done for Mrs Y. As a result Carer B’s placement ended.

Family’s attempt to arrange a trip with the LIC

38. I do not consider the Care Provider was at fault here. The Care Provider asked the family for details about the trip so it could find out the LIC’s travel arrangements, where they would be staying, and how the carer and customers saftey would be met. This is what we would expect the Care Provider to do.
39. While I recognise it may have been frustrating for Mr Y and Mr X to provide much of this information on top of arranging their trip, I do not consider this amounts to fault.

The Care Provider did not send hourly paid carers to Mrs Y after Carer B’s placement ended

40. From the records Carer B wanted the placement to end and so did Mr X and Mr Y. After Carer B stopped being Mrs Y’s LIC in late September 2023, the Care Provider provided no further carers.
41. The notes showed from the end of October 2023, the Care Provider was due to arrange for a rotational LIC placement for Mrs Y. Meanwhile Mrs Y also received help from another carer who attended on an hourly basis. This carer could not attend Mrs Y’s home due to sickness. It is not clear what the Care Provider did to arrange further care for Mrs Y after Carer B’s placement ended. This was fault.
42. On the one hand the Care Provider told the family it had no carers available but would let them know once it had availability for hourly carers. Then in the complaint response, it said due to verbal abuse of Carer B from Mr Y the Care Provider was not the right care company for the family. The Care Provider should have properly communicated its position to the family after Carer B’s placement ended. If it did not want to provide care anymore due to behaviour carers experienced, it should have told the family this.
43. As a result the family were left in a position where for a time they were expecting the Care Provider to provide carers for Mrs Y. As this did not happen they decided to use a new care company. This caused Mr X and Mr Y avoidable distress and uncertainty. Mrs X went longer without carers after Carer B’s placement than she otherwise would have had the Care Provider told the family it was not the right care company for them.

Provided invoices which were not clear or transparent

44. At first Mr X complained the Care Provider set up the wrong direct debit mandate for Mr and Mrs Y. The Care provider recognised this in its complaint response at stage two and apologised. The Care Provider also recognised it should have put a hold on the account.
45. Mr Y has also raised concerns that the invoices are not clear and itemised. I have not found the Care Provider at fault for this. The individual invoices show the amount due for each day the LIC worked. What is not clear is whether the Care Provider has applied discounts in the stage two response, i.e. £2,414.
46. The Care Provider continued to write to Mr Y to ask for money despite previously agreeing it would put his account on hold. This was fault.
47. It appears Mrs Y has several different accounts with the Care provider relating to LIC and hourly rates. In light of this it would be beneficial for the Care Provider to engage with Mr X and Mr Y to clarify and explain what costs are outstanding.

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Agreed action

48. Within one month of my final decision the Care Provider agreed to carry out the following:
1. Provide Mr X and Mr Y with a written apology for the faults identified.
2. Pay Mr Y and Mr X £400 to recognise the avoidable distress and uncertainty caused by the above faults.
49. While the Care Provider has already offered £2,414 as a resolution to the complaint. This was before Carer B’s placement started, therefore the remedy offered by the Care Provider does not take into account any events after Carer A’s placement ended.
1. Consider its policy for matching live in carers with customers and whether there are any steps it could take to ensure prospective carers and customers are adequately introduced and have sufficient time to get to know each other before deciding on whether they are a match.
2. Write to Mr Y setting out what charges are due and what accounts these relate to. The Care Provider should ensure it clearly shows how and where it has applied any discounts such as the £2,414 previously offered after the stage two response.
50. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

51. I have completed my investigation and found the actions of the Care Provider caused injustice. I have made recommendations to remedy the injustice caused.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman