Summary: Mrs X complained the Council commissioned care provider, Carepoint services Limited, neglected her grandfather, Mr Y. She complained the care provider refused to acknowledge the neglect, despite the Council substantiating the safeguarding concerns. Mrs X said this distressed her family and Mr Y did not have his needs met. There was fault in the way the Council did not acknowledge the safeguarding concerns and complaint handling was poor. This distressed and frustrated Mrs X and Mr Y did not have his needs met in line with his care plan. The Council agreed to apologise, ask the care provider to apologise, make a financial payment and ensure the care provider completes additional training.

The complaint

1. Mrs X complained the Council commissioned care provider, Carepoint services Limited, neglected her grandfather, Mr Y. She complained the care provider refused to acknowledge the neglect, despite the Council substantiating the safeguarding concerns. Mrs X said this distressed her family and Mr Y did not have his needs met.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), 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 we are satisfied with a Council’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. 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, sections 24A(1)(A) and 25(7), as amended).
6. We normally name care homes and other care providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
7. 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

8. I read Mrs X’s complaint and spoke to her about it on the phone.
9. I considered evidence provided by Mrs X and the Council as well as relevant law, policy and guidance.
10. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Background information

11. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers that meet the fundamental standards of care, inspects care services, and reports its findings. It can also enforce against breaches of fundamental care standards and prosecute offences.
12. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
13. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)
14. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. A single stage procedure should be enough. The council should include in its complaint response:

• how it considered the complaint;
• the conclusions reached about the complaint, including any required remedy; and
• whether it is satisfied all necessary action has been or will be taken by the organisations involved; and
• details of the complainant’s right to complain to the Local Government and Social Care Ombudsman.
  (Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

15. The Council has a contract with the care provider. The contract states “the care provider must carry out the service in accordance with legislation and good practice”.
16. The contract also states “the care provider shall comply with the Council’s complaint policy”.
17. The Council complaint policy states the Council would acknowledge the complaint within three working days and respond within 15 working days.
18. The complaint policy also states the complainant can ask for an assistant director review and if this was not suitable, progress to the Ombudsman. The Council would acknowledge the complaint within three working days and provide a timescale for a response.

What happened

19. This is a summary of events, outlining key facts and does not cover everything that has occurred in this case.
20. The care provider supported Mr Y since early 2023. Mrs X first raised concerns about the care provider in late 2023. The Council advised Mrs X to raise concerns directly with the care provider.
21. Mrs X started to raise further concerns in August 2024. She explained the care provider did not ensure Mr Y had food or medication.
22. Between September 2024 and December 2024, Mrs X and professionals raised six safeguarding concerns.
23. The Council found a different care provider to support Mr Y from January 2025.
24. The Council asked the care provider to complete a safeguarding report into Mrs X’s concerns in February 2025.
25. The care provider sent its report to the Council in March 2025. The Council completed its safeguarding investigation a week later. The Council found the care provider was at fault. The Council “substantiated” the concerns. It recorded multiple concerns regarding the standard of care provided to Mr Y. These included medication errors, neglectful behaviours, failure to report Mr Y’s deteriorating health and non-compliance with protocols for reporting missed medication to the GP. The Council also noted missed visits. The Council agreed to refund Mr Y £500 because of missed visits. The Council advised Mrs X to complain to the care provider about other concerns and her request for compensation.
26. Mrs X complained to the care provider at the end of March 2025. She complained the Council substantiated her concerns, so the care provider neglected Mr Y. Mrs X said this caused the family upset and distress. She asked the care provider for compensation.
27. The care provider responded to Mrs X’s complaint at the end of May 2025. The response said the care provider was not aware of the issues until the end of the care package. The care provider said it dealt with the issues when Mrs X raised them. The care provider said it would not provide any financial remedy because the Council had refunded care contributions.
28. Mrs X was not satisfied with the Council’s response and has asked the Ombudsman to investigate. Mrs X would like the Council to get the care provider to accept liability and compensate her family.
29. In response to my enquiries the Council confirmed the care providers complaint response was not accurate. The Council confirmed Mrs X did raise concerns with the care provider throughout the package of care. The Council accepted the care providers response did not address Mrs X’s concerns. The Council confirmed it should have been clearer Mrs X could complain to the Council and the family spent significant time trying to resolve this issue.

My findings

30. When a Council commissions care services, they remain liable for the failures of the service provider. So even though Mrs X complains about a care agency, the Council is responsible for any failings.
31. The Council completed a safeguarding investigation into the concerns Mrs X raised and “substantiated” all points. The care provider missed visits, made errors with medications and did not report concerns. The Council considered this neglectful by the care provider. Mr Y did not receive support detailed in his support plan. The Council acknowledged this and refunded £500 of Mr Y’s care contributions to remedy the missed care visits.
32. Mrs X’s complaint is the care provider has not acknowledged the issues. The Council confirmed the care providers’ complaint response is not an accurate account of what happened. The Council confirmed Mrs X raised concerns with the care provider throughout its involvement. The Council also accepted the care provider has not acknowledged responsibility. Although the Council acknowledged the issues, the care provider did not. As the Council is responsible for the actions of the care provider, the Council has not taken responsibility for the safeguarding concerns. This is fault. This distressed Mrs X and her family.
33. The Council said it has not completed its complaint process and considered Mrs X’s complaint. The Council acknowledged it should have been clearer with the family they could complain to the Council.
34. However, the care provider considered the complaint. The contract states the care provider would comply with the Council’s complaint policy. The Council agreed the care providers response was not accurate. This is fault, frustrating Mrs X.
35. The Council policy also gives an 18-day timescale to acknowledge and respond to a complaint. The care provider took two months to provide its response, a 24 working days delay. This is fault, frustrating Mrs X.
36. Overall, the Council was at fault as the services provided on its behalf fell below an acceptable standard. This distressed and frustrated Mrs X and Mr Y did not have his needs met in line with his care plan.

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Agreed action

37. To remedy the outstanding injustice caused to Mrs X by the fault I have identified, the Council agreed to take the following action within 4 weeks of my final decision:
• Apologise to Mrs X for the distress caused by not acknowledging the impact of the substantiated safeguarding concerns and poor complaint handling. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• Ask the care provider to apologise to Mr Y and his family to recognise and acknowledge the impact of the safeguarding concerns.
• Pay Mrs X £300 to recognise the distress and frustration the Council fault caused.
38. Within three months of the final decision the Council should ensure the care provider:
• Provides evidence of the staff training and quality assurance it has carried out to improve its medication administration arrangements.
• Provides training and guidance to its staff on the complaint policy and how to respond to complaints, ensuring responses are timely and accurate.
39. The Council should provide us with evidence it has complied with the above actions.

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Decision

40. I have completed my investigation. I have found fault by the Council, which caused injustice to Mrs X and Mr Y.

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Investigator's decision on behalf of the Ombudsman