Summary: There were failings in the domiciliary care provided to Mrs Y, which the care agency acknowledged and dealt with before the complaint came to this office. However, it failed to communicate its actions to Mrs X and failed to apologise for the actions of its carers. We have made a recommendation to address this.

The complaint

1. Mrs X is dissatisfied with the way a care provider, acting on behalf of the Council, handled a complaint about the care provided to her mother, Mrs Y.

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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. 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)
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 information submitted by Mrs X;
• considered information the Council provided to this office;
• taken account of relevant legislation;
• offered Mrs 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.
7. Regulation 9 Person Centred Care says Care Providers must do everything reasonably practicable to make sure that people who use the service receive person-centred care and treatment that is appropriate and meets their needs.
8. Regulation 12 Safe Care & Treatment says people must not be given unsafe care or treatment or be put at risk of harm that could be avoided. Care Providers must assess the risks to a person’s health and safety during any care or treatment and make sure care staff have the qualifications, competence, skills and experience to keep people safe.

Background

9. Mrs Y is a senior citizen. She lives in her own home with her husband and receives domiciliary care from a care agency acting on behalf of the Council.
10. On 27 April 2024, Mrs Y had a fall whilst mobilising in her bedroom. Mrs X was not notified. Mrs Y told Mrs X about the fall the following day, following which the family checked footage from a camera’s installed in Mrs Y’s lounge and bedroom.
11. The camera footage showed two carers arriving at Mrs Y’s home early morning. One went upstairs and the other remained downstairs completing notes. Mrs Y was seen mobilising without support and without her walking frame, which the carer failed to place in front of Mrs Y.
12. Noticing Mrs Y had fallen, Mr Y asked if she was ok, which alerted the carer. The carer then asked if Mrs Y was ok and spoke to her about getting herself up. The carers did not record the fall in the daily care records, instead, reported ‘all was well’, neither did they seek medical advice.
13. Mrs X contacted the care agency to complain. She says the care agency did not respond so she contacted the Council’s safeguarding team to report abuse/neglect by the two carers. She also contacted the Care Quality Commission (CQC). She cancelled the care agency and family provided short-term support.
14. The Council instigated initial safeguarding enquiries. An officer from the safeguarding team contacted Mrs X to discuss the concerns. The officer asked Mrs X if she would like the Council to notify the police. Mrs X said not. Mrs X provided the Council with footage from the camera, photographs of bruising to Mrs Y and copies of the care notes for the morning in question.
15. An urgent review of Mrs Y’s needs was arranged, as Mrs Y’s family were able to provide short-term support only.
16. An officer from the Council’s safeguarding team contacted the care agency to discuss the allegations; and the camera footage. Following this, the care agency terminated the employment contracts of both carers involved. The care agency reminded all staff of its policy and procedures for reporting incidents and completing daily care records. It also identified areas of learning from the events, saying its training procedures in relation to manual handling would be amended. The care agency informed the Disclosure and Barring Service (DBS) about the conduct of the two carers involved.
17. The Council was satisfied with the action. It informed Mrs X of the action taken and said the safeguarding investigation would be closed.
18. The Council wrote to Mrs X on 3 June 2024 to confirm it had completed its investigation alongside that of CQC. It said the investigation had been concluded and was closed. No apology for the actions of the carers was extended to either Mrs Y or Mrs X.
19. Mrs X is dissatisfied with the way matters have been handled, both by the care agency and the Council. She feels the care agency failed to follow its own complaint procedure and that there has been no acknowledgment of the events, reassurance or apology offered to Mrs Y. She wanted to meet with the care agency to discuss the events.
20. In response to initial enquiries from this office, the Council says the concerns were not dealt with under its formal adult social care complaints procedure, they were dealt with under safeguarding. The outcome of the investigation was shared with the care agency. The care agency dealt with the matter under its HR policy, rather than a formal complaint.
21. Mrs X is dissatisfied with this and believes her complaint to be unfinished.

Analysis

22. 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.
23. In this case, the care provider acknowledged failings by two carers and took swift robust action in response. The Ombudsman has no criticism of these actions. However, the care provider fell short of expected standards in communicating with Mrs X and in keeping her updated. Consequently, Mrs X believes her concerns have not been properly dealt with.
24. The care agency dealt with the Mrs X’s complaints under its HR policy, rather than its complaints’ procedure, which is a decision it is entitled to take. Given the care agency acknowledged failings by the carers, and dismissed them both, there was little to achieve from any further complaint investigation. I also note the care agency identified lessons learnt from the complaint. Where the care agency fell short was communicating the reasons for its decision to Mrs X. Had the care agency met with Mrs X to explain the basis of its actions, then she may have been reassured her concerns had been properly acted on.
25. The Council responded swiftly to the safeguarding alert from Mrs X. Its actions were appropriate and proportionate. There was no fault by the Council in its decision not to progress the safeguarding investigation beyond initial enquiries, because it was satisfied with the action taken by the care agency. There is no fault by the Council here.
26. Overall, there were failings in the care provided to Mrs Y, which the care agency acknowledged, and dealt with before the complaint came to this office. However, it failed to properly communicate with Mrs X and failed to extend an apology for the actions of the carers.

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Agreed Action

27. The Council should:

• request the care agency provide Mrs X with a formal written apology for the failings by the carers in question, and for failing to keep her updated after she submitted her concerns.

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Final Decision

28. There were failings in the domiciliary care provided to Mrs Y, which the care agency acknowledged and dealt with, before the complaint came to this office. However, it failed to communicate its actions to Mrs X.
29. The above recommendation is a suitable way to settle the complaint.
30. 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