Summary: Mrs X complained the Council’s previous commissioned care provider regularly did not provide the care as set out in her daughter’s care plan, causing frustration and decline in her daughter’s health and wellbeing. We found some fault with the care provider. The Council has agreed to apologise and pay a symbolic payment to recognise the injustice caused.

The complaint

1. Mrs X complains that her daughter’s previous care provider regularly did not provide the care as set out in her care plan. This related to issues such as carers not staying for the full duration of the allocated time, carers not doing the daily exercises her daughter needed, not properly cleaning her water bottles resulting in mould, and other aspects of her care and medication.
2. Mrs X says this caused her daughter physical pain, negative impact to her wellbeing, and deterioration in her body.

Back to top

The Ombudsman’s role and powers

3. 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)
4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council/care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
6. 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)
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

Back to top

What I have and have not investigated

8. Mrs X said the issues with Care Agency A had been ongoing for several years. This is more than 12 months before complaining to us in March 2024 and is therefore late (see Paragraph 4). I am satisfied Mrs X could have complained specifically about this period sooner. I have mentioned historical issues for context.
9. I am considering the period of 12 months prior to her complaint to us (March 2023 to March 2024). Since April 2024, Mrs X’s daughter’s care is with a different provider, Care Agency B. If Mrs X is dissatisfied with Care Agency B, she is entitled to make a new and separate complaint about its actions direct to the Council first.
10. I am investigating the provision of social care, not the health care or clinical aspects of Mrs X’s concerns with her daughter’s care. This should be a complaint made to the relevant healthcare body.

Back to top

How I considered this complaint

11. I considered Mrs X’s written views of the complaint, and the evidence she sent me.
12. I made enquiries of the Council and considered its written responses and information it provided, and those from Care Agency A.
13. Mrs X, the Council and Care Agency A had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

Law and administrative background

14. 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.
15. 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”.
16. In February 2023 we published guidance for care providers on good record keeping. We said, “We are likely to find a care provider at fault where records are illegible where they are inadequate for their purpose, or where they omit essential information or include misleading information”.

Background

17. Mrs X’s adult daughter (“Miss Y”) has had a care package funded by the Council, delivered by Care Agency A, for several years. Miss Y lives alone and has capacity. She has physical disabilities and mobility issues. Mrs X spends most of her time overseas and frequently contacted Care Agency A about Miss Y’s care. She is acting on behalf of Miss Y with this complaint.
18. During the period considered, Miss Y’s plan said she needed one hour calls, four times a day, with two carers. This was to assist with daily living activities, including catheter care, taking medication and daily exercises. If there were concerns about the catheter, carers should report to Care Agency A’s office.

What happened – summary of key relevant events

19. In March 2024, Care Agency A gave notice on Miss Y’s care package. Mrs X then complained to us. We advised Mrs X to complete the Council’s complaints process.
20. In April 2024, Mrs X formally complained to the Council raising several concerns, including many reported historical issues with Care Agency A. She said carers would not stay for the required times and neglected tasks in Miss Y’s care and support plan, which caused Miss Y pain and a decline in her health at various periods.
21. The Council carried out a safeguarding enquiry into her concerns. In late August 2024, the Council met with Mrs X to discuss the outcomes. In September 2024, the Council issued its complaint response, summarising the safeguarding findings.
22. Relevant to matters within the scope of my investigation, it found the following:
• Logging start and finish times – it found evidence substantiating Mrs X’s concerns that carers were not staying for the duration stated in Miss Y’s plan. Records showed inconsistencies with recorded times of visits, carers leaving early, with many logs being left open for numerous hours. Care Agency A noted technical and connection issues at Miss Y’s property affected the ability for carers to log onto the electronic monitoring system. It put an action plan in place and spoke to its carers about the importance of logging in and out to accurately evidence the duration of visits. It upheld this.
• Mould in water bottles - this was substantiated. Care Agency A acknowledged this was unacceptable and reminded its carers to ensure the cleanliness of Miss Y’s bottles each day.
• Lack of daily exercises – this was not substantiated. Care Agency A said carers would support Miss Y with these daily.
• Catheter concerns not reported by carers - it investigated a short period raised by Mrs X in August 2023. It found carers had identified issues with Miss Y’s catheter and reported this to the Care Agency A office, who then contacted the district nurse team. It found one issue where a referral had been rejected but Care Agency A were not aware, so the carers did not escalate concerns with the catheter later in the evening as they thought the district nurse would be attending. It fed back to the relevant team to prevent future recurrence and informed Mrs X.
• Medication – after a disagreement about how many pain relief tablets to give Miss Y in line with the prescription instructions, this had been confirmed with the GP. Carers were told to ask Miss Y how many she would like to take each time and record this.
23. The Council’s safeguarding enquiry noted numerous issues raised and it had substantiated aspects of Mrs X’s concerns. It said Care Agency A generally responded and addressed issues where it could.
24. In response to my enquiries, the Council said it did not consider compensation as Miss Y did not pay towards her care package. It also sent me some copies of Miss Y’s daily care logs and records from 2023. Our investigations are proportionate, so I have looked at a sample of these.

Analysis

25. Our role is to assess complaints of individual personal injustice and whether care providers act in line with CQC regulations, or if care falls below unacceptable standards. We assess evidence to make balance of probabilities findings on whether a care provider has met general standards of care.
26. The Ombudsman makes impartial decisions based on evidence. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means we look at the available relevant evidence and decide what we think was more likely to have happened.

Attendance concerns

27. The Council substantiated this part of the complaint. Care records should accurately reflect care given, including times spent at visits. It is clear Mrs X raised repeated concerns with carers regularly cutting visits short with inconsistent and inaccurate records of times. This was historical but continued into 2023. I recognise Care Agency A tried to take proactive and meaningful action, including spot checks and reminders to carers, but issues remained. In my view, it may have placed too much reliance on its electronic system. Mrs X also stated she had given carers the internet password so disputed Care Agency A’s claims. In this case, if technical limitations consistently affected reliability, it could have explored alternatives, such as handwritten notes.
28. Overall, this amounts to an element of poor record keeping which is in potential breach of Regulation 17. This is fault.
29. Although there is inconsistency with the recorded length of visits, the records I’ve seen show carers largely completed tasks in line with Miss Y’s plan in their calls. So, I am unable to say there is injustice to Miss Y. But for Mrs X, without accurate recordings of the timings, she had uncertainty with this and whether they potentially affected standards of care given – this is injustice to her. She also was put to time and trouble with raising this as a consistent issue.

Catheter concerns

30. Certain responsibilities around catheter care are the duty of district nurses, which I am not investigating (see Paragraph 10). But Mrs X raised concerns around carers not appropriately reporting any catheter issues on visits. The Council investigated a specific short period of incidents which Mrs X raised, and it found the carers did what was expected of them. I have seen Care Agency A’s care notes for this which generally support the findings, and I do not have significant concerns about this.

Daily exercises

31. Mrs X said the carers did not carry out daily exercises, resulting in periods of stiffness in Miss Y’s body causing her discomfort and pain. Care Agency A said its carers would complete these on their visits to Miss Y.
32. From the care notes I’ve seen, these generally recorded carers carrying out exercises, including on specific equipment, with Miss Y on most visits. I note this is in conflict with what Mrs X says and she strongly disagrees, but the records generally support Care Agency A’s position. On balance of probabilities, in the absence of further tangible supporting evidence, I do not find fault on this part. In addition, we would not be able to establish a direct cause to any alleged deterioration in Miss Y’s body or health.

Administration of pain relief

33. I appreciate the Council’s safeguarding enquiry was extensive with the number of concerns raised by Mrs X. But in my view, the Council only part addressed this issue.
34. In summer 2023, Mrs X said she and Care Agency A disagreed over how many pain relief tablets Miss Y could have. Both parties interpreted the limit stated in the prescription differently. Care Agency A gave her a lower dose, but Mrs X said Miss Y could be given more to help manage her pain better. She said she raised this several times and six months went by. In early 2024, Mrs X and Care Agency A (separately) confirmed with the GP Miss Y could be given the upper limit. It noted Miss Y said her pain had not improved as she missed the higher quantity of doses.
35. It is not fault for Care Agency A to want clarity from an independent medical professional about the quantity. However, the dispute was about the effect it was having on Miss Y’s wellbeing. Care Agency A should have acted to confirm this a lot sooner. This delay caused frustration for Mrs X and Miss Y. I cannot say it directly caused avoidable pain to Miss Y. However, there is uncertainty on whether this could have made a difference to Miss Y sooner, had it not been for the delay.

Care Agency A ending the package

36. Care Agency A gave notice on Miss Y’s package before the safeguarding enquiry was opened, and Mrs X said it was wrong as it had not tried to find a resolution before doing this. I am not persuaded this is the case.
37. Care Agency A records show it had regularly communicated with Mrs X over the years to try to address her regular concerns in a prompt manner, taking steps to do what it could. I note despite this history, Care Agency A provided Miss Y’s care for several years. This indicates a commitment from both sides to work through these.
38. It also always remained open to Mrs X to change provider if she wished. I appreciate her reasoning with having worked with Care Agency A for so long and wanting continuity and familiarity for Miss Y, however she was still free to do so if she was repeatedly dissatisfied.
39. It appears the difficulties in managing the relationship led to loss of trust and confidence by both parties. With ongoing disagreements and possible unmet expectations of Mrs X, Care Agency A previously advised she may prefer the services of another provider. On balance, given the longstanding service and based on the circumstances, I consider its decision to end its care to Miss Y is one it was entitled to make. I do not find fault with this. The Council also appropriately ensured a transitional period before a handover to Care Agency B, so Miss Y was not without service.

Remedy and injustice

40. The Council acknowledged some failings by Care Agency A, but it did not offer a remedy to recognise this as it said Miss Y did not contribute financially for her care. I disagree with this reasoning. Even if there is no financial injustice, this should not prevent the Council from considering other forms of injustice and appropriate remedies to recognise this. I have made recommendations below.

Back to top

Agreed action

41. 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. So, although I have found fault with the actions of Care Agency A, I have made recommendations to the Council.
42. To remedy the injustice set out above, the Council has agreed to carry out the following actions within one month of the final decision:
• Apologise to Mrs X and Miss Y in writing for the injustice caused by the faults identified (in line with our guidance on making an effective apology);
• Pay Miss Y a symbolic payment of £200 to recognise her injustice; and
• Pay Mrs X a symbolic payment of £200 to recognise her injustice.
43. The Council should provide us with evidence it has complied with the above actions.

Back to top

Decision

44. I found fault which caused injustice to Miss Y and Mrs X. The Council has agreed with my recommendations to remedy this, and I have completed my investigation.

Back to top

Investigator's decision on behalf of the Ombudsman