Summary: Mr X complained the Care Provider cancelled respite arranged for his father, Mr Y, without sufficient notice. Further the Care Provider did not provide a contract for the respite care. We find the Care Provider’s actions caused an injustice. We make several recommendations to address this injustice.

The complaint

1. Mr X complained the Care Provider cancelled respite care arranged for his father, Mr Y, without sufficient notice. Further, the Care Provider didn’t provide a contract for the respite care at either the beginning or end of the care.
2. Mr X says this caused his father and his family undue stress.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
4. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
6. 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)
7. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

8. I have considered:
• The information provided by Mr X and discussed the complaint with him;
• The Care Provider’s comments on the complaint and the supporting information it provided; and
• Relevant law and guidance.
9. Mr X and the organisation 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

Law and guidance

10. 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 below which care must never fall. The standards include:
• Person-centred care (Regulation 9): The service user must have care or treatment that is tailored and meets their needs and preferences. Assessments should be reviewed regularly and whenever needed throughout the person’s care and treatment.
• Safe care and treatment (Regulation 12): Providers must do all that is reasonably practicable to mitigate risks to the service user’s health and safety. The provider must have arrangements to take appropriate action if there is a clinical or medical emergency.
• Good governance (Regulation 17): Providers must maintain securely an accurate, complete and contemporaneous record in respect of each service user. This includes systems to assess, monitor and mitigate risk relating to health, safety and welfare of service users.

What happened

11. Mr Y suffers from dementia and was receiving care from his wife at home. Mr Y periodically received respite care to provide her with a break from her caring duties.
12. Respite was arranged in July at Nunthorpe Hall run by GMA Healthcare. Mr Y was due to stay at the home for around two weeks from the beginning of July 2022. He had previously stayed at the home for respite.
13. The family provided the Care Provider with notes about Mr Y on arrival. The Care Provider says it prepared a contract and bill for Mr Y on his arrival, but it accepts this was not provided.
14. At the start of the respite the Care Provider contacted Mr Y’s family due to concerns he had refused to eat breakfast and take his medication that day. The family confirmed that on occasion Mr Y did refuse to eat. There were no further instances of food refusal during Mr Y’s stay.
15. One week into Mr Y’s stay, he began to threaten staff and tried to escape, opening a window to climb through. He also got into the garden and tied bunting round his neck and tried to climb over the fence. The Care Provider contacted Mr Y’s GP about his behaviour that morning. The GP recommend treating him for a urine infection.
16. The Care Provider also contacted Mr Y’s family later that day to say it could not continue to provide care as his needs were beyond its capabilities. His family were asked to come and collect him.
17. Mr X says the family tried to find an alternative placement for Mr Y but were not allowed to do so before they had to take Mr Y home. He says they found a possible alternative Care Provider (Care Provider B) that would have been able to take Mr Y the following day.
18. Shortly after the respite ended the family had to call the police to assist them with Mr Y due to his aggravated and aggressive behaviour. The Police placed Mr Y at Care Provider B.
19. In mid-July Mr X asked for details of the complaint process. He tried using three different emails to request this information. One of the email addresses from the website was not a valid email address. The Care Provider gave the details eight days later.
20. Mr X raised a complaint about the termination of Mr Y’s care and the Care Provider’s actions. The response issued in late August denied there had been fault in the termination of care. It also explained that had it known about Mr Y’s aggressive behaviour it would not have agreed to provide respite care. It accepted the email address recorded was incorrect and agreed to correct the error.
21. The Care Provider waived its fees for the five days of care Mr Y received before he returned home.

Findings

22. The opening paragraph of the Care Provider’s contract states residents are accepted after an assessment. Regulation 9 is clear that all care providers should have a care plan tailored to meet a person’s needs that is determined by a care assessment, which are carried out regularly. We would, therefore, expect a Care Provider to carry out an assessment on each new admission for respite.
23. The Care Provider has provided assessment forms for Mr Y’s previous stays. No new form was completed for July at the beginning of his stay. Notes were added on to some sections of the form completed in at the start of his last stay relating to his stay in July.
24. The form included a section for Mr Y’s behaviour. However, this section was not annotated for July until the day Mr Y was asked to be collected. The Care Provider should be carrying out a full new assessment prior to accepting Mr Y in line with its contract and government guidance.
25. In mid-July Mr Y began displaying disruptive behaviour. The Care Provider carried out a new assessment of the behaviour and Mr Y’s care needs. This is in line with the government guidance. Having done so the Care Provider felt it could not continue to meet Mr Y’s needs. There was no injustice caused to Mr Y from the new assessment. The Care Provider had an obligation to ensure it could meet his care needs.
26. Mr Y was not a resident of the home at the time of the Care Provider’s decision, but on respite. As he was receiving respite it was appropriate for the Care Provider to ask Mr Y’s primary carer to resume care when it felt it could not meet his needs.
27. Had the Care Provider carried out an initial assessment Mr Y’s family may have advised them of his behaviour. The provider could have either refused respite or continued to offer care. Although Mr Y became aggressive after his respite stay, I cannot say this is an injustice caused by the Care Providers actions in not carrying out a new assessment. The actions have caused Mr Y and his family distress and uncertainty over whether the respite could have proceeded differently.
28. The Ombudsman’s guidance on remedies says when we find evidence the care someone received did not meet the fundamental standards a refund or reduction of fees can be appropriate. The Care Provider has already agreed to waive the fees for the care Mr Y received.
29. The Care Provider should complete a contract on the commission of care in line with its terms. It has accepted it did not provide a contract to Mr Y’s family on this occasion. This has caused them an injustice. The family did not raise concerns about the lack of contract at the time of engagement, but they sought to rely on this at the termination of care. Without this information they were confused as they were unaware of the terms of the agreement. I note the contract would not have given them any indication that the Care Provider would not have been able to meet Mr Y’s needs or how the Care Provider would deal with the situation.
30. When Mr X contacted the Care Provider to ask for information on raising a complaint, he was provided this within four days. There is no injustice caused in the time frame it took for the Care Provider to respond to his request. The Care Provider has accepted the email address appeared incorrectly on the website, has apologised to Mr X and has corrected this. This is an appropriate remedy for the confusion caused.
31. The Care Provider has carried out suitable steps to redress the injustice caused to Mr Y family by the failings identified above. The Care Provider has agreed to waive the cost of the care Mr Y received for the one week he stayed there.

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Recommended action

32. Within one month of this decision the Care Provider should:
• Apologise to Mr Y and his family for the distress and frustration caused by its failure to carry out an assessment of his needs in July.
• Remind its staff by email that they must carry out assessments of care needs in full on a new form for each period of respite care.
• Remind staff by email of the importance of providing clients with a contract and that this is completed and signed for each respite period.
33. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

34. I have completed my investigation. Mr Y has been caused an injustice by the actions of the Care Provider and I have recommended it take action to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman