Summary: Ms A complains the care provider failed to act promptly when her mother Mrs X fell in the bath. We do not find fault with the actions of the care provider. This was an unwitnessed fall and the safeguarding alert was not pursued by the Council.

The complaint

1. Ms A (as I shall call the complainant) says a carer failed to alert her or the care agency when Mrs X fell in the bath before he arrived. She says her mother was hurt for some weeks afterwards and would have been treated sooner in hospital if the carer had acted properly.

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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 injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)

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How I considered this complaint

3. I considered evidence provided by Ms A and the care provider as well as relevant law, policy and guidance.
4. Ms A and the care provider 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

Relevant law and guidance

5. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs
6. 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.
7. Regulation 13 says service users must be protected from abuse and improper treatment. Care must not be provided in a way that significantly disregards the needs of the service user for care or treatment.

What happened

8. Mrs X, who has dementia, had a care package delivered by Haven Care and funded by Direct Payments from the local council. The care package (described by the care provider as ‘domestic care and cleaning’) began in August 2023 and Ms A signed the contract. The arrangement was for 3 calls a day: 45 minutes at breakfast and 30 minutes at each of lunch and dinner.
9. The care plan sets out Mrs X’s needs: she required minimal assistance with personal hygiene (the plan says she would normally have had a bath by the time the carer arrived); assistance with meal preparation and serving, and administration of medication.
10. By the beginning of 2024 correspondence between Ms A and the care agency made repeated reference to the likelihood that Mrs X would require residential care on account of her increasing cognitive impairment. She had begun to feed her own ready meals and hot drinks to her cats. Ms A was asking if more locks could be put onto the pantry and freezer doors to prevent Mrs X from accessing inappropriate foods. In March the care provider emailed Ms A to say she believed Mrs X now required 24-hour care and she would raise this again with Mrs X’s social worker.
11. On 2 April the carer arrived as normal for the lunchtime call but Mrs X was still upstairs. The carer shouted up to ask if she was alright. He said he went upstairs and found Mrs X in the bath, and helped her to get out, get dried and dressed then gave her lunch as usual.
12. Later that day Ms A alerted the care provider that Mrs X said she had fallen in the bath but had not told the carer. Ms A said her mother was in pain and she was taking her to the hospital. She said she was annoyed with Mrs X for not saying anything to the carer. Mrs X was not found to have any fractures or other damage as a result of the fall and was discharged from hospital with painkillers.
13. The care provider asked the carer for a statement. He said he did not suspect Mrs X had fallen and she did not mention a fall. He knew the protocol to follow in case of falls and said he would have alerted his manager so that Mrs X could receive appropriate treatment quickly.
14. Mrs X moved into a care home shortly after this incident. Ms A wrote to the care provider that she couldn’t wait – she said having “seen her fall once and coming away lightly” she was concerned about what happen another time.
15. Ms A complained to the CQC about the failure of the carer to report her mother’s fall. On 2 May she informed the care provider that there was now a safeguarding alert with the council. She also asked about the care provider’s complaints procedure. The care provider responded that it would now treat the matter as a complaint.
16. The local council’s safeguarding team wrote to the care provider on 16 May and said it would not take any further action. It said there were no grounds to suspect abuse or neglect had occurred.
17. The care provider responded to Ms A’s complaint. She said as part of the investigation they had read through all the daily handover notes and records. She said there was no evidence, including the CCTV footage, which supported the view that the carer had known Mrs X had fallen. She said however that as an agency they took such incidents seriously and reminded their carers of the need for good communication, regular reviews of care plans and attention to the falls protocol.
18. Ms A complained to the Ombudsman. She said Mrs X could have been seen in hospital much sooner if the carer had reported the fall. She said the incident, combined with poor experience of other care agencies, had left her with distrust of domiciliary care and she had placed Mrs X in a care home instead.
19. Ms A has supplied some video evidence which she says proves the carer heard the sound when Mrs X fell.
20. The care provider points out that the carers cannot always know what has happened preceding their visit unless the client tells them and in this case Mrs X did not do so (as Ms A agrees). She adds that the care agency had been recommending 24-hour care for Mrs X for some months.

Analysis

21. There is no evidence on the video Ms A has provided to show the carer reacted to any noise of Mrs X falling.
22. There is no evidence of a failure on the part of the care provider to take action. Mrs X did not tell the carer what had happened.
23. The care provider investigated the complaint appropriately and responded to Ms A in a timely manner.

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Decision

24. I have completed this investigation as I find no fault on the part of the care provider.

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Investigator's decision on behalf of the Ombudsman