Summary: Ms Y complained care staff left her partner, Mr X, with urine in his bottle, faeces on both a sponge in the sink and on a towel in the bedroom on 31 January 2020. Ms Y complained about the care Mr X received and about the failure to respond to her complaints. Ms Y says this impacted Mr X’s mental health and her relationship with Mr X. The Ombudsman does not find fault, causing a significant personal injustice to Mr X or Ms Y, with the care provided or completion of Care Plan reviews. The Ombudsman does find fault with how the Council managed and responded to Ms Y’s complaints. The Council agreed to the Ombudsman’s recommendation to apologise to Ms Y and Mr X and provides each with a payment of £100 to reflect the frustration, distress, inconvenience caused.

The complaint

1. Ms Y complained care staff left her partner, Mr X, with urine in his bottle, faeces on both a sponge in the sink and on a towel in the bedroom on 31 January 2020.
2. Ms Y says she complained to a manager at the Extra Sheltered Unit about the incident who promised to investigate the situation but failed to respond. Ms Y says she complained many times following this about the care Mr X received. Ms Y says neither management at the Extra Sheltered Unit or the Council have responded to the original complaint.
3. Ms Y says the lack of action from the Council has impacted Mr X’s mental health making him anxious over his care. Ms Y says this has also impacted on her and Mr X’s relationship.

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The Ombudsman’s role and powers

4. We investigate complaints about ‘maladministration’ and ‘service failure’. In this report, we 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. We 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)
5. 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)

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How I considered this complaint

6. I have considered all the information Ms Y provided. I have also asked the Council questions and requested information, and in turn have considered the Council’s response.
7. Ms Y provided comments on my draft decision. I considered Ms Y’s comments before making my final decision.

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What I found

Standard of care

8. The Care Quality Commission (CQC) Guidance: ‘Essential Standards of Equality and Safety’ says that all independently-regulated health or social care provider services should ensure they meet the regulatory standards. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and the Care Quality Commission (Registration) Regulations 2009 outline the regulatory standards. The purpose of these standards are to ensure the risk of abuse or neglect is minimised for all adults in care.
9. The CQC guidance says that:
• The care and treatment of service users must be appropriate, meet their needs and reflect their preferences. The care and treatment must be provided in a safe way for service users. (regulation 9).
• Any complaint must be investigated and necessary and appropriate action must be taken in response to any failure identified (regulation 19).
• The Home must, as far as is reasonably practicable, ensure that service users are able to make decisions about their care or treatment (regulation 17) and obtain their consent (regulation 18).
• The Home must protect service users against unsafe or inappropriate treatment by keeping accurate records (regulation 20)

Care assessments and Care Plans

10. The Care Act 2014 says councils must provide or arrange to provide services, facilities or resources which help prevent, reduce or delay the need for support for adults and/or their carers.
11. Councils must assess anybody in their area who appears in need of care services. Following an assessment, the Council must decide which needs are eligible for their support. If the Council provides support, it must produce a written Care Plan.
12. The Council should review a person’s Care Plan each year and the Council should detail planned reviews within the Care Plan itself. In addition to periodic reviews a person, including those receiving care or a family member, can ask for a review of the Care Plan.
13. The Council should consider the following when reviewing a care plan:
• If a person’s needs or circumstances have changed.
• If the Care Plan was working.
• Is a person achieving the outcomes of a Care Plan or could the Council include new outcomes in a Care Plan.
• Is a person or their advocate happy with the Care Plan.
14. The Council must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Local authorities should tell the individual when their assessment will take place and keep the person informed throughout the assessment. (Care and Support Statutory Guidance 2014, Paragraph 6.24).
15. The Ombudsman Would expect a care assessment to take no longer than 28 days under normal circumstances and would consider this a reasonable timescale. However, the complexity of a care assessment or outside factors could impact on this timescale.

Complaints procedure

16. The Council says it will acknowledge a person’s complaint about Adult Social Care within three days of receipt.
17. The Council says it will provide a person with a written response within 10 working days.
18. A person can complain to the Local Government and Social Care Ombudsman if they dispute with the Council’s response.

Events before 2020

19. Mr X sold his home in 2015 and moved into rental accommodation in the Council area.
20. Mr X travelled abroad in 2019 but suffered from a stroke. Mr X returned to the UK for hospital treatment.
21. The Council started a care assessment of Mr X on 6 November 2019 in preparation for his hospital discharge. The care assessment confirmed Mr X had capacity to make decisions and communicate his needs. The care assessment also confirmed Mr X needed sheltered accommodation that could also meet his care needs, which the Council detailed in the care assessment.
22. The Council decided Mr X met the relevant eligible care needs. The Council also provided Mr X within information about the six-week reablement care period and confirmed Mr X’s status as a self-funder through a financial assessment.
23. The Council produced Mr X’s Care Plan on 26 November 2019. The Council detailed the full care it would provide to Mr X. This included two carers four times a day at 45 minutes in the morning, 30 minutes at lunchtime, 30 minutes in the evening and 30 minutes at night every day.
24. Mr X agreed a tenancy with an Extra Sheltered Unit on 18 December 2019 and moved into a flat at this unit. The Council put in place the care detailed in the Care Plan.

Events from 2020

25. The manager at Mr X’s Extra Sheltered Unit, Ms M, contacted the Council to advise it was struggling to meet Mr X’s care needs on 23 January 2020. The Council said it would arrange a social worker for Mr X to discuss his care.
26. Ms Y attended Mr X’s flat on 31 January 2020. Ms Y left a letter of complaint about finding Mr X’s Convene urine bottle full, faeces on a sponge in the sink and faeces on a towel in the bathroom.
27. Ms M met with Mr X and Ms Y to discuss the complaint letter. Ms Y says Ms M told her she would investigate the complaint. The Extra Sheltered Unit’s notes say Ms M asked Mr X and Ms Y to report any future incidents to her so she could investigate these accordingly.
28. An Occupational Therapist completed a risk assessment on 3 February 2020 on the back of the concerns raised by Ms M and Ms Y with the Council. The Occupational Therapist noted issues with the bathroom flooring and appliances and a need for a bed rail.
29. Ms M contacted the Council on 6 February 2020 to advise the Care Plan was inadequate and Mr X needed longer care calls. Ms M asked for a review of Mr X’s Care Plan. Ms M told the Council about the incident on 31 January 2020 and about her promise to investigate any future incidents. The Council logged the request for a review of the Care Plan on 7 February 2020.
30. Mr X met with the Council social worker on 12 March 2020 as part of the Care Plan review. Mr X and Ms Y also complained to the Council on 17 March 2020 about the care provided.
31. Ms M contacted the Council on 30 March 2020 to reiterate her concerns about the lack of care hours for Mr X in the Care Plan.
32. The Council produced a new Care Plan for Mr X on 22 April 2020. This new Care Plan detailed increased care for Mr X. Mr X did not sign the Care Plan in April 2020 and asked the Council to include weekly cleaning of his flat within the Care Plan on 27 April 2020.
33. The Council responded to Ms Y’s complaint on 26 May 2020. The Council said it had sought an up-to-date care plan for Mr X but had not finished this yet. The Council also said it had contacted the Extra Sheltered Unit to request Convene training and to discuss communication skills with staff.
34. The Extra Sheltered Unit held a meeting on 20 June 2020 to discuss the incident on 31 January 2020 with staff. Staff noted that Mr X used the urine bottle between the care calls so this bottle would be full on occasions between staff calls. Ms M reminded staff about quality of care and recording and reporting incidents.
35. On 14 July 2020, the Council completed Mr X’s care assessment review. This review was attended by Mr X, Ms Y, the social worker, Occupational Therapist, Ms M and an interim care manager. During the meeting:
• Mr X expressed his concerns about the care provided.
• Ms M also outlined her concerns about certain aspects of care Mr X was asking staff to complete.
• Mr X, Ms Y and Ms M discussed the incident on 31 January 2020. Mr X confirmed he had experienced no harm since but felt neglected.
• Mr X and Ms Y discussed the potential of Mr X moving out of the Extra Sheltered Unit but advised would await the outcome of care review before deciding.
• The Occupational Therapist detailed the improvements needed to Mr X’s bathroom.
• All parties agree Mr X’s care package was inadequate to meet Mr X’s needs.
36. The Council produced a new Care Plan on 17 July 2020 which Mr X agreed to. This included two carers four times a day at 90 minutes in the morning, 60 minutes at lunchtime, 90 minutes in the evening and 60 minutes at night every day. This new plan proposed to include 1-hour of domestic tasks each week by staff.
37. On 17 July 2020, the Council also confirmed to Mr X the outcome of the staff meeting on 20 June 2020. Mr X confirmed he would wait to see if the care improves before deciding about moving out of the Extra Sheltered Unit.
38. Ms Y made a formal complaint to the Extra Sheltered Unit on 5 August 2020. Ms Y complained about issues with fire hazards, delays with staff preventing Mr X being able to use his urine bottle or toilet and an inability to access Mr X’s flat on one occasion because a member of staff took the key home.
39. Ms M visited Mr X to discuss the complaint on 18 August 2020. Following the discussion Ms M provided a response on 19 August 2020. Ms M explained that staff may be attending to other people at the Extra Sheltered Unit when Mr X needs the toilet which can cause delays in reaching him. Ms M said she visited Mr X to discuss the fire hazard and found an alternative place to charge his phone. Ms M also confirmed they had not cut spare keys for his flat and apologised for the key being taken home on the day in question.
40. Ms Y complained to the Council on 1 September 2020 about Ms M’s response to her complaints. Ms Y also complained about the call system not working at Mr X’s flat.
41. The Council accepted Ms Y’s complaint as a Stage 1 complaint. The Council promised it would respond to Ms Y’s complaint by 30 September 2020.
42. Ms M spoke with Ms Y about her complaint with the Council on 22 September 2020. Ms Y said the care package in place was not meeting Mr X’s needs and was causing him frustration. Ms Y complained about delays when Mr X pulled the alarm cord to get staff to help him use the toilet. Ms M said when an alarm cord is pulled staff will check if it is an emergency. An emergency would be something like a fall, fire or a person being unwell. If there was no emergency the staff member may have to prioritise other work. Ms M said she was in contact with the Council about appointing a new social worker and the potential for a review of the Care Plan.
43. The Council contacted Ms M about the call system who confirmed it had repaired this. The Council asked Ms M if she had investigated Ms Y’s concerns. Ms M confirmed she had spoken with Ms Y. The Council closed Ms Y’s complaint.
44. Ms M and Mr X’s social worker agreed to complete a review meeting of Mr X’s Care Plan.
45. The social worker met with Mr X and completed an interim support plan for Mr X’s care needs on 15 October 2020. This did not make any changes to the July 2020 Care Plan.
46. However, the Council failed to arrange a review meeting for Mr X’s Care Plan with meetings because of cancelled meetings in September 2020 and October 2020.
47. On 25 November 2020, Ms Y complained to the Council about the cancelled review meetings in September 2020 and October 2020. The Council logged this as a further Stage 1 complaint.
48. The Council responded to Ms Y’s complaint on 2 December 2020. The Council apologised for the cancelled meetings in September 2020 and October 2020. The Council said it had asked Mr X’s social worker to chair a new meeting before the end of December 2020.
49. Ms Y responded to the Council to complain about Ms M specifically. The Council officer investigating Ms Y’s complaint met with her and Mr X on 14 December 2020 to discuss the complaint. The Council officer wrote to Ms Y on 15 December 2020 to confirm a review of Mr X’s Care Plan would take place next week. The Council officer advised they would contact Ms Y on week starting 4 January 2021 to discuss how the meeting went.
50. The Council asked Ms M and the social worker to arrange and attend a review meeting of Mr X’s Care Plan on 22 or 23 December 2020. This meeting did not go ahead.
51. Ms Y complained to the social worked on 29 January 2021 about lack of action surrounding Mr X’s care plan but also about a medical issue Mr X was experiencing. The social worker addressed Mr X’s medical issue with Ms M but not the care plan.
52. Ms M also contacted the Council about a separate matter about Mr X’s care in February 2021. The Council met with Mr X who confirmed there was previously a long-term plan for him to move away from the Extra Sheltered Unit but he now wishes to remain there.
53. The Council completed a review of Mr X’s Care Plan on 3 April 2021. Within this Care Plan it confirmed that Mr X did not express any concerns about the quality of care provided by staff at the Extra Sheltered Unit. The Care Plan also detailed the full care provisions for Mr X’s care. However, this plan reduced Mr X’s care hours from the July 2020 Care Plan from 90 minutes in the evening to 30 minutes and from 60 minutes at night to 30 minutes. Mr X agreed to this care plan on 22 April 2021 with a further review scheduled for April 2022.

Analysis

Incident on 31 January 2020

54. Ms Y complained care staff left her partner, Mr X, with urine in his bottle, faeces on both a sponge in the sink and on a towel in the bedroom on 31 January 2020.
55. I have reviewed the full care notes for Mr X’s care for January 2020 and February 2020. None of the care notes reference the issues Ms Y complained about for 31 January 2020. However, the Extra Sheltered Unit has not directly disputed these events and I have no reason to question this either.
56. The Extra Sheltered Unit explained that Mr X uses his urine bottle between care calls meaning this bottle could be full when Ms Y visits.
57. The care notes on 31 January 2020 for the breakfast call and night call confirm the staff member emptied the urine bottle. While the lunch call and evening call reference Mr X’s use of the toilet and his pads. The care notes show the staff completed the relevant checks and tasks for Mr X’s care. The explanation behind why the urine bottle was full when Ms Y visited is logical. I do not find fault with this aspect.
58. Regulation 9 of the CQC Guidance says care and treatment of a service user must be appropriate and safe. Leaving faeces in a sink or a towel would not be appropriate or safe. This aspect is fault.
59. While this incident is fault, the events detailed on 31 January 2020 about staff leaving faeces in the sink and on a towel was a one-off occasion. There are no other care notes or complaints from Ms Y about a repeat occurrence. Mr X also confirmed during the meeting on 14 July 2021 there had been no further incidents.
60. Ms M also met with Mr X and Ms Y to discuss the incident and promised to investigate any repeat occurrences. Ms M also told the Council about the incident and identified a need for a review of Mr X’s care plan to ensure he received suitable care. Ms M’s response was proportionate to the incident and while there was a misunderstanding between Ms M and Ms Y about an investigation over this incident, I do not find fault with Ms M’s actions.
61. Given this incident occurred 19 months ago, and there has been no repeat incidents of the same nature since, I do not consider the fault caused Mr X a significant personal injustice.

Care assessments and care plans

62. Ms Y complained about the care Mr X received.
63. The Council will detail the care a person will receive in a person’s Care Plan.
64. The Council completed Mr X’s first care assessment and Care Plan in November 2019. The Council considered Mr X’s eligible care needs within the care assessment and took information from the relevant professionals including the Occupational Therapist and Social Worker.
65. Within the Care Plan dated 26 November 2019 the Council detailed the number of carers and both the timing and duration of the care calls to Mr X. The Council also detailed the relevant tasks the carers should be helping Mr X with during the care calls.
66. The Council produced a Care Plan which it considered would meet Mr X’s needs and was agreeable to Mr X in November 2019. I do not find fault with the Council’s November 2019 care plan or the care it put in place for Mr X.
67. After the Care Plan started Ms Y complained about the care Mr X was receiving and Ms M sought a review of the Care Plan from the Council on 6 February 2020.
68. The Care Act 2014 says a person can request a review of their Care Plan outside periodic reviews. Ms M made this request on Mr X’s behalf because of concerns about inadequate care. The Council was correct to accept this review request on 7 February 2020.
69. While the Council accepted the review request, it took until 22 April 2020 to produce a new Care Plan for Mr X. This took over twice as long as the Ombudsman considers a suitable timescale, 28 days, to complete a care assessment. I would normally consider this delay in completing Mr X’s care assessment as fault.
70. However, there are mitigating circumstances surrounding the Council’s delay. On 16 March 2020, England entered a national lockdown following the outbreak of the Covid-19 pandemic. This lockdown caused significant difficulties to councils and care services in completing care assessments. Given the Government imposed the lockdown midway through the Council’s review of Mr X’s Care Plan, I consider this explains the delay in producing the new Care Plan.
71. When the Council produced Mr X’s new Care Plan on 22 April 2020, Mr X declined to sign this Care Plan. Mr X had no obligation to agree to the new Care Plan and made his concerns to the Council about the Care Plan on 27 April 2020.
72. The Council should have reviewed Mr X’s concerns, completed a review of the new Care Plan in light of these concerns and updated the Care Plan if it agreed with Mr X’s concerns. Using the same 28-day timescale this would have given the Council until 25 May 2020 to complete the reassessment.
73. However, the Covid-19 pandemic lockdown remained in place until its easing on 1 June 2020. This would have impacted both the Council and Extra Sheltered Unit’s capacity to complete the care assessment within the expected timescales.
74. Given the impact of the Covid-19 pandemic on the Council and care services, I do not find fault with the Council taking longer than the Ombudsman would normally expect in completing Mr X’s care assessment.
75. When the Council completed Mr X’s care assessment on 14 July 2020, it agreed to increase Mr X’s care. Mr X said at this Care Plan meeting that he was planning to leave the Extra Sheltered Unit but wanted to see how the increased care went before deciding.
76. Mr X’s increased care has remained in place from 14 July 2020 until April 2021 with minimal changes. Mr X also remained at the Extra Sheltered Unit.
77. In September 2020, the Council agreed to complete a review of Mr X’s Care Plan but failed to complete this review until 3 April 2021. While the Covid-19 pandemic has continued to impact Council and care services during this time, this delay is fault by the Council. The Council failed to facilitate a care assessment meeting and allowed the matter to drift with minimal involvement. This is fault.
78. While this is fault by the Council, I do not consider this caused Mr X a significant injustice. This is because Mr X has received suitable care since July 2020. When the Council completed the care assessment on 3 April 2021 Mr X and Ms Y raised initial concerns with the care plan and discussed the care plan with the Council.
79. However, Mr X signed the care plan on 22 April 2021 and confirmed he did not have any concerns about the quality of care provided. Mr X has also chosen to remain at the Extra Sheltered Unit despite consideration of leaving before July 2020. This supports that the increased Care Plan from July 2020 to April 2021 has been suitable to meet Mr X’s needs and corrected the previous lack of provision in the original Care Plan.
80. The Council was at fault for delays in completing reviews of Mr X’s Care Plans from February 2020 to April 2021. However, I consider this fault is mitigated by the impact of the Covid-19 pandemic and it has not presented a significant personal injustice to Mr X.

Complaint handling

81. Ms Y complained about how both the Extra Sheltered Unit and the Council handled her complaints. Ms Y also complained about the lack of response to her original complaint about the incident on 31 January 2020.
82. As detailed in paragraph 59 I do not find fault with how the Extra Sheltered Unit responded to the incident on 31 January 2020.
83. Ms Y made her first complaint to the Council on 17 March 2020. The Council responded to this complaint on 26 May 2020. It took the Council 46 working days to respond to Ms Y’s first complaint. Even considering the potential impact of the Covid-19 pandemic this response took too long. This delay is fault.
84. While the delay was fault, the actions promised by the Council were appropriate and relevant to Ms Y’s complaint. The Council followed through on the Care Plan review, ensured Ms M spoke to staff about quality of care and arranged for Convene training for staff at the Extra Sheltered Unit. I do not find fault with the outcome of this complaint.
85. Ms Y made her next complaint to the Extra Sheltered Unit on 5 August 2020. Ms M, the manager of the Extra Sheltered Unit, responded to the complaint through a visit on 18 August 2020 to discuss the matter with Mr X and Ms Y. This response timescale was within the Council’s 10 working day response and Ms M addressed the relevant issues during this meeting. While Ms Y later complained about Ms M and similar issues, I do not find fault with how Ms M handled this complaint.
86. Ms Y next complained to the Council on 1 September 2020. The Council accepted Ms Y’s complaint as a Stage 1 complaint and promised a response by 30 September 2020.
87. The Council’s formal complaint procedure says it will provide a response in writing to a person. The Council says it was satisfied with Ms M speaking to Ms Y again in September 2020 to close this complaint. The Council has not followed its complaint procedure and failed to provide a suitable written response to Ms Y’s complaint on 1 September 2020. This is fault.
88. Ms Y complained to the Council again on 25 November 2020. The Council again logged this as a formal Stage 1 complaint. The Council provided a formal Stage 1 response on 2 December 2020. The Council provided a written response within its complaint timescales. Additionally, the Council provided a suitable response apologising for the cancelled meetings and promising to arrange a new meeting before the end of December 2020. I do not find fault with this complaint response.
89. While I do not find fault with the Council’s response on 2 December 2020, the Council failed to ensure it followed through on its promised actions. The Council did not facilitate a new meeting by the end of December 2020. The Council also failed to contact Ms Y as promised in the first week of January 2021. This is fault.
90. When Ms Y complained again on 29 January 2021 to the Council social worker, the social worker only addressed half of the complaint issue. The Council failed to address Ms Y’s concerns surrounding the care provided until the care review in April 2021. This was again fault by the Council.
91. Ms Y has complained to both the Extra Sheltered Unit and Council on various occasions from January 2020 to January 2021. The Council and Extra Sheltered Unit has failed to provide suitable or timely responses to some of Ms Y’s complaints or failed to follow through on promised actions on some occasions. This is fault. This fault caused Ms Y frustration, distress and inconvenience with the Council which will also have impacted on her relationship with Mr X.

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Agreed action

92. Within one month of the Ombudsman’s final decision the Council should:
• Provide an apology to both Mr X and Ms Y for the frustration, distress and inconvenience caused through the way in which it managed their complaints from January 2020 to January 2021.
• Provide both Mr X and Ms Y with a payment of £100 each to reflect the frustration, distress, inconvenience and impact on their relationship caused by the Council through its unsatisfactory management of their complaints.

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Final decision

93. There was fault leading to injustice. The Council accepted my recommendations. I have completed my investigation as I consider that a suitable remedy.

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Investigator's decision on behalf of the Ombudsman