Summary: Mrs X complains Routes Healthcare (North) Ltd, failed to meet her father’s care needs. There is not enough evidence to say its actions caused injustice to Mr Y.

The complaint

1. The complainant, whom I shall refer to as Mrs X, complains Routes Healthcare (North) Ltd, failed to meet her father’s care needs.

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The Ombudsman’s role and powers

2. We investigate complaints about adult social care providers. If there has been fault, we consider whether it has caused an injustice and, if it has, we may suggest a remedy. (Local Government Act 1974, sections 34B, 34C and 34H(4), as amended)

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How I considered this complaint

3. I have:
• considered the complaint and the documents provided by Mrs X;
• discussed the complaint with Mrs X;
• shared a draft of this statement with Mrs X and Routes Healthcare, and taken account of the comments received.

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What I found

Key facts

4. Mrs X’s father, Mr Y, has arthritis, cellulitis in his legs and poor mobility. He needs help with personal care.
5. In November 2018 Mrs X arranged for Routes Healthcare (North) to visit her father to meet his care needs. Its carers started visiting him on 8 November. Their records show two carers visited twice a day, morning and evening. The key task was applying cream to Mr Y’s legs. They also helped with dressing/undressing, drinks and sometimes with showering. The calls lasted 20-30 minutes. Mr Y’s care plan says:
• “Care staff to support [Mr Y] to get properly dry, especially his feet and in between his toes, staff to put on his medicated talcum powder also to ensure we reduce the risk of further fungal infections. He is very independent and will do most of the washing himself, its our job to promote this and lend a helping hand where needed”.
6. On 6 December, Routes Healthcare updated Mr Y’s care plan:
• “[Mr Y] now has compression stockings for both legs, his legs are to be washed twice a day and dried thoroughly then apply cream and place on the stockings, they must be on properly with no folds or creases to avoid unnecessary swelling or further damage. The stocking must be two fingers down from the crease of the knee at the back”.
7. Mrs X says they asked Routes Healthcare (North) to increase two of the calls to an hour, so the carers could help Mr Y shower twice a week. She says this was because he could not wash his lower body.
8. The carers’ records refer to giving or assisting Mr Y with a shower on 13, 17, 24, 27, 30, 31 December 2018, and 3, 7 and 10 January 2019.
9. Mr Y went into hospital on 13 January with a chest infection. He also had a severe fungal infection in his groin and lower tummy which produced a pungent discharge. Mr Y told his daughter he did not mention the fungal infection as he was embarrassed about it.
10. Mrs X complained to Routes Healthcare (North) about the failure of its carers to take any action over the fungal infection. When Routes Healthcare (North) replied on 21 January, it told Mrs X its carers had never seen her father’s groin as he kept it covered.
11. Mrs X was not satisfied with this response so tried to pursue the complaint further with Routes Healthcare (North).
12. Routes Healthcare (North) did not respond until 16 September. It apologised for the delay and for mishandling her complaint. It said:
• the only carer who saw Mr Y from the front said she saw no evidence of soreness to his groin and noticed no odour;
• the other carers said, after removing Mr Y’s bathrobe from behind, he would get into the shower himself, sit down and wash himself. After getting out of the shower he would stand facing the sink and a carer would dry his back and legs, while Mr Y dried his front. Mr Y would then put on a long vest, covering his groin which the carers never saw. Nor did they notice any unpleasant odour indicative of infection;
• the daily notes for the morning of 13 January said Mr Y told the carers he had been up all night with diarrhoea. The carers helped with his legs as usual;
• the notes for teatime confirm Mr Y continued to experience diarrhoea and his daughters, who were with him, had arranged for him to go to hospital.
13. Routes Healthcare told Mrs X it had learnt these lessons from her complaint:
• it had improved care plan templates;
• branch complaint responses would be reviewed and checked for quality;
• all assessors had received care plan refresher training;
• Mr Y’s care team had all received feedback on the use of the words “assisted with”;
• the lessons learned would be shared with all managers.

Did the care provider’s actions cause injustice?

14. There is not enough evidence to say the actions of Routes Healthcare (North) and its carers caused injustice to Mr Y. Mr Y has the capacity to make decisions for himself. He could have told the carers or his family about the fungal infection but was too embarrassed to do so. That he was embarrassed also supports the claim that he kept his groin covered. Mrs X says the carers were not doing their jobs properly, as they should have been helping Mr Y in the shower. She points out that Routes Healthcare (North) did not update her father’s care plan to reflect the need to help him shower. While that was unhelpful, I cannot say it caused Mr Y injustice. It remained open to him to ask for whatever help he needed with showering. Finally, I cannot see any reason to question the carers’ claims not to have seen the fungal infection or noticed a smell.
15. Routes Healthcare accepts it mishandled Mrs X’s complaint and has apologised. There are no grounds to ask it to do more than that.

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Final decision

16. I have completed my investigation, as there is not enough evidence to say the actions of Routes Healthcare (North) and its carers caused injustice to Mr Y.

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Investigator's decision on behalf of the Ombudsman