Summary: Mr X complained that the Council made hasty arrangements for his mother’s care and failed to manage the commissioned service properly. There is evidence the Council’s commissioned service did not always provide the care for which it was contracted. The Council, which accepts some delays in the complaints process, has also offered Mr X £500 and now agrees to go further to recognise the injustice caused by a poor service.

The complaint

1. Mr X (the complainant) says the Council arranged care for his mother Mrs A without prior consent, the care provider often failed to provide proper and timely care and the Council itself was slow in responding to complaints. As a result of the ongoing stress and frustration he decided to contract directly with the care provider.

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The Ombudsman’s role and powers

2. Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions. Part 3A is for complaints about care bought directly from a care provider by the person who needs it or their representative, and includes care funded privately or with direct payments using a personal budget. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act)
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. 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)
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

6. I considered evidence provided by Mr X and the Council as well as relevant law, policy and guidance.
7. Mr X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

8. Mrs A is an elderly lady with dementia, living alone since February 2022 when her husband died. Mr A had received care services from Care Provider A for some time, but the family was dissatisfied with their care provision and had changed providers.
9. The care agency which looked after Mrs A between February 2022 and September 2023 gave notice that they were terminating the contract. Mr X says he and his sister tried hard to engage another care provider but could not do so on the terms they wanted. As a result, the existing care provider notified the Council of the continued need of support for Mrs A from 10 October.
10. The Council’s brokerage team emailed care providers urgently for their availability and Care Provider A was able to provide the care starting on 11 October.
11. Mr X says he and his sister were shocked to receive an email from the Council saying that Care Provider A had been appointed to provide a twice-daily care service for Mrs A, particularly as the Council was aware of their previous concerns. He says over the next few months he contacted the Council numerous times to discuss the care provider's performance but there was no improvement in the quality of care. He says between October and December 2023 carers turned up at inconsistent times, used the entry code although asked not to, accepted Mrs A’s assertions she had taken medication and did not need help, and often overstated the amount of time they spent at the home.
12. Mr X also says the carers were frequently male although Mrs A did not feel at ease with male carers and Mrs A often had difficulty understanding their use of language.

The complaint

13. In March 2024 Mr X complained to the Council. He complained both about the way the Council had acted in appointing Care Provider A and failing to deal with his concerns – he said four different social workers had been involved between October and March – and about the poor performance of the carers. He wanted the Council to write off the charges (about £1600) for the care received between October 2023 and March 2024.
14. The Council investigated the complaint and responded in July. It made six recommendations in its investigation report:

To share Mr X’s concerns at a practice learning group;

To remind practitioners to support service users and their families to make complaints;

To use this complaint as part of the quality review;

To share the findings with staff responsible for implementing a new complaint process;

To ensure that complaints made to the Director received a response in acknowledgement explaining the next steps.

15. The Council partially upheld the complaint about the involvement of the social workers: it accepted that four social workers within a short space of time was not optimal and said that while their conduct had been professional, at times they had failed to respond to his queries in a timely manner.
16. The Council also partially upheld the complaint that the Council had appointed Care Provider A without consultation. It said Care Provider A was the only agency available at short notice and it had commissioned the care to prevent Mrs A being put at risk. It accepted he had raised many concerns about the carers but said the Council had been working with the agency to make improvements.
17. The Council upheld and partially upheld the way it had responded to Mr X’s complaints. It also partially upheld his complaints that the service was fragmented and difficult to navigate.
18. The Council did not accept Mr X’s suggestion that it should write off the charges, as it said regular care and support had been provided to Mrs A during that time, and Care Provider A had already adjusted their charges to reflect the hours actually provided. It said however that it could offer £500 (which could be offset against the charges) to recognise the time and trouble he had been put to and the frustration caused.
19. Mr X was dissatisfied with the response and complained again. He rejected the offer of £500. He said the Council’s report “fails to acknowledge that my family have been, and continue to be, charged for a service from (Care Provider A) that is simply not good enough and so is poor value for money. Indeed, the service my Mother receives from (Care Provider A) continues to lack a reasonable standard of care and, as a family, we continue to experience deficiencies in the quality”. He said there had been no real improvement in (Care Provider A’s) performance until after he complained in March 2024 and so he questioned how the Council had worked with it to make improvements as it said, from October 2023 onwards.
20. The Council said in response that it would not offer a larger sum than the £500 already offered.
21. Mr X complained to the Ombudsman. He said the Council seemed to accept the complaints he had made about its performance but not the other issues about he care provider.
22. The Council says the care provider has been subject to a quality improvement process focusing on call times. It says it has an electronic time monitoring system which is audited on a monthly basis by the care provider and the Council. The Council has provided me with details of the action plan for the care provider. In terms of the short visits it says, “On review of this concern we have found that care staff often stay over their allocated duration within visits, which is completely impacting the runs’ timeliness causing visits to be attended to later”. Actions to respond to this issue were identified as, “Monitoring administrator to identify where staff have not stayed the full duration and alert manager, and ring service user and staff member to find out why. Request increase in care for visits that are requiring a longer duration have been declined Care plan review required to discuss this with SU and Social worker.”
23. Mr X says since October 2024 he has commissioned Care Provider A directly. He says he can now complain direct to the care provider and resolve matters rather than undergo the increased frustration of complaining through the Council.

Analysis

24. It was not fault on the part of the Council to arrange for care to be provided for Mrs A when the family had been unable to source another care provider.
25. The Council acknowledges that it was unhelpful for so many social workers to be involved with the family without proper continuity.
26. The Council has also upheld most of Mr X’s complaints about its own complaints service and the poor service given at times by Care Provider A, particularly in terms of the timeliness of the care.
27. However, while the Council has offered £500 to Mr X in recognition of its own poor service, it does not appear to have accepted responsibility for the performance of Care Provider A, for which it remains responsible as the commissioner of the service. It should go further and recognise that as well, although I see no grounds for its to waive the charges in their entirety.

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Action

28. Within one month of my final decision the Council has agreed to offer again the £500 it offered previously;
29. Within one month of my final decision the Council will offer a further £500 in recognition of the poor service given at times by its commissioned care provider.
30. The Council should provide us with evidence it has complied with the above actions.

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Decision

31. I found fault causing injustice on the part of the Council and its commissioned care provide. Completion of the recommendations at paragraphs 28 and 29 will remedy that injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman