Summary: Mr X complained about poor care provided to his mother, Mrs Y, as part of a Council-commissioned care package. He also says a later safeguarding investigation was inadequate and the Council managed his complaint poorly. There was poor care which caused Mrs Y some distress. The Council will pay Mrs Y £250 to acknowledge the distress caused. The care provider, Sevacare, and the Council have acted to improve care services in future. The Council considered possible safeguarding issues appropriately but there was delay in its investigation of the concerns about poor care. The Council will pay Mr X and Mrs Y £100 each to remedy the frustration and uncertainty caused by the delay. Sevacare has apologised for its delay responding to Mr X’s complaint and that is an appropriate remedy.

The complaint

1. Mr X complains about a period from late June 2018 to early August 2018 when his mother, Mrs Y, received poor care as part of a Council-commissioned care package. He also says a later safeguarding investigation was inadequate. He says the Council managed his complaints about poor care badly and opened a number of safeguarding investigations into him because of his complaints. He says the poor care caused Mrs Y harm, distress and financial loss and the poor complaint handling caused him distress.

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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 cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
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, section 25(7), as amended)
6. 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)
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 have considered information from:
• Mr X’s complaint, a telephone conversation with him and further information he sent; and
• the Council’s responses to my enquiries which includes case records and details of the Council’s safeguarding enquiries.
9. Mr X and the Council had the opportunity to comment on a draft of this decision. I considered comments received before making my final decision.

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What I found

Legal and administrative background

Care and support services

10. Intermediate care and reablement support services are for people after they have left hospital or when they are at risk of having to go into hospital. They are time limited and aim to help a person to preserve or regain the ability to live independently.
11. The Health and Social Care Act 2008 (regulated activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve.
12. The fundamental standards say:
• the care and treatment of service users must be appropriate, meet the person’s needs and reflect their preferences. The care provider must assess the person’s needs and preferences and provide appropriate care and treatment to meet these needs.
• care providers must keep accurate, complete and current records for each person in their care, including a record of the care and treatment provided and decisions about care and treatment.
13. The Council says it aims to provide high quality services, supporting people in their own homes for as long as possible. It has a commissioning team which monitors the standard of care provided by external care agencies. The team uses a variety of data to evaluate the quality of care being provided and assigns each provider a risk rating. The risk ratings help the Council decides how much monitoring activity/visits to undertake.

Safeguarding adults

14. The Care Act 2014 requires each local authority to make enquiries, or instruct others to do so, if it believes an adult is, or is at risk of abuse or neglect.
15. The purpose of an enquiry is to decide whether or not the local authority or another organisation, should do something to protect the adult from any actual, or risk of, abuse or neglect.
16. The Council has a safeguarding policy to support its safeguarding practices. The policy says:
• After the Council receives a safeguarding referral, it should give it a high, medium or low priority and will decide what to do next within 2 days;
• The Council will decide whether to progress to making enquiries under
  Section 42 of the Care Act 2014 within 72 working hours;
• A Section 42 enquiry can be as brief or as detailed as necessary. On completion of the enquiry, the investigator should review the outcome with the adult and other relevant parties and consider whether a safeguarding plan is needed to protect the adult from harm.

The Council’s complaints procedure

17. The Council has a policy to support the effective handling of complaints. At the time of Mr X’s complaint, the policy said:
• Each complaint would be prioritised as low, medium or high;
• Complaints classed as low would be responded to within 20 days;
• Complaints classed as medium or high should be completed with 25 working days or up to a maximum of 65 working days.
18. The Council reviewed its policy in 2018. When Mr X made his complaint to the Council the Council was in the process of updating its policy and no longer graded complaints in this way. The current policy says the Council will try to resolve all complaints within 20 working days of their receipt.

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What happened

19. Mrs Y lives alone, but has support from her son, Mr X. Mr X does not live with Mrs Y.
20. Whilst Mrs Y was in hospital in May 2018, the Council received a report of safeguarding concerns. The report expressed concerns about several matters including Mr X’s relationship with Mrs Y. The Council considered the information and decided to open a case. It made initial enquiries, including discussing the concerns with Mrs Y and others involved in her care. It decided there was no evidence to support the allegations and decided not to progress to Section 42 enquiries. It closed the case.
21. In late June 2018, Mrs Y was discharged home after a period in hospital. The Council organised a reablement home care package for Mrs Y. Two carers called four times a day.
22. In early July, when walking with carers, Mrs Y ended up on the floor and unable to get up. There were different explanations of how this happened. The carers rang for an ambulance and rang Mr X and their office to tell them. The carers stayed with Mrs Y until Mr X arrived. Mr X says an ambulance never arrived.
23. The Council occupational therapist (OT) visited and provided Mrs Y with a wheeled commode and several pieces of equipment to help Mrs Y. The OT told Sevacare what equipment the carers should use to help move Mrs Y.
24. Towards the end of July 2018 Mr X rang Sevacare with complaints about the standard of care being provided. Sevacare said it would investigate the complaints.
25. A Council social worker met with Mrs Y and Mr X in early August 2018 to review Mrs Y’s care package. Mr X said he had complaints about the care Sevacare were providing. The social worker raised the complaints with Sevacare the same day. Later the same day Mr X sent the social worker a list of incidents of poor care and a spreadsheet recording the lengths of care calls made. His information included:
• the carers were not staying for the allocated call time and were incorrectly recording the times of their visits in the care log;
• there was insufficient time separating the tea and evening visits;
• the carers were not using the moving and handling equipment;
• an allegation that carers had “dropped” Mrs Y during a transfer;
• the carers were not enabling Mrs Y to use the commode and were only changing her pad.
26. The Council registered Mr X’s information as a complaint nine days later and asked Sevacare to start an investigation.
27. After this meeting, the social worker had concerns about whether Mrs Y’s wishes and feelings were being listened to by Mr X. They reported their concerns to the Council’s safeguarding team, who opened a case. They made some enquiries and decided they needed to speak with Mrs Y privately to discuss their concerns.
28. Two social workers met privately with Mrs Y later that month. After this meeting, the Council concluded there was insufficient evidence to substantiate the concerns. It decided not to progress to Section 42 enquiries and closed the case.
29. At the end of September, Sevacare responded to Mr X. It apologised to him for the delay in responding. It found no evidence carers had “dropped” Mrs Y when helping her. It said when her legs gave way, staff had followed procedure to lower her to the floor and call an ambulance. It upheld most other aspects of Mr X’s complaint and accepted:
• there were days where there was insufficient time separating the tea and evening visits;
• the documentation did not always make it clear whether carers had offered to help Mrs Y use the commode during their visits;
• there were times when morning calls were late and one occasion when no evening visit was carried out;
• care visits were often shorter than the allocated time.
30. Sevacare apologised to Mr X and said it would take action to train its staff and improve its service.
31. In October 2018, the Council considered Sevacare’s response. It decided some of the issues raised could meet the threshold for a safeguarding investigation and this needed further consideration by the Council’s safeguarding team. The safeguarding team prioritised the referral as high.
32. In November 2018 Mr X complained again to Sevacare. He described how on one day Mrs Y had received poor care, the carers had not left enough time between calls and the carers had recorded incorrect attendance times. He said, given the complaints already raised, he was disappointed to see the same problems again.
33. In December 2018, the safeguarding team considered the referral from October 2018. It decided some of the issues raised met the threshold to investigate and it should start a safeguarding investigation under section 42 of the Care Act 2014.
34. In mid-December, Sevacare gave notice on Mrs Y’s care package and stopped providing her care. The Council made alternative care arrangements for Mrs Y. Mrs Y later received a refund for care charges relating to Sevacare.
35. In January 2019, the Council received new information which caused them to have fresh concerns about Mr X’s relationship with Mrs Y and whether Mrs Y’s wishes and feelings were being listened to. They considered the information and decided to open a safeguarding case to consider the concerns.
36. Two officers met with Mr X and Mrs Y and also spoke separately with Mrs Y. After this meeting, the Council considered the case and decided there was insufficient evidence to substantiate the concerns. It decided not to progress to Section 42 enquiries and closed the case.
37. In March 2019, the safeguarding team started its investigation into the care provided to Mrs Y by Sevacare. The team decided to include the issues raised by Mr X in November 2018 as well as his complaints about events from June to August 2018. In mid-April a Council officer produced a report setting out their findings. The investigation identified “numerous practice issues” which needed to be addressed by Sevacare. It said “a lot of learning” arose from the incidents covered in the report. It recommended the Council work closely with Sevacare to monitor practices in future. However, the investigation did not find evidence of any specific harm caused to Mrs Y as a result of poor practices. The report noted Sevacare was no longer providing care to Mrs Y and did not identify any ongoing safeguarding concerns for her.
38. The Council met Mr X and Sevacare to review the investigation findings. Sevacare agreed to work with the Council to make improvements to its service. The Council concluded there were no ongoing safeguarding concerns and so closed the case.
39. Mr X complained to the Council that he was unhappy with the safeguarding investigation. He disagreed with some of the findings and said the investigation had not been thorough or included all his points of complaint.
40. In May 2019, the Council commissioning team visited Sevacare to complete a quality monitoring review and follow up on issues identified in the safeguarding report.
41. The Council responded to Mr X to say his opportunity to comment or express dissatisfaction with the report was during the safeguarding meeting, but he had not done this. It said the investigation had considered all his points of complaint and it addressed the issues Mr X raised in his last letter. It apologised to him for the delay in referring the complaint to its safeguarding team. It said it had now changed its procedure so all complaint responses from external care providers were screened by its safeguarding team before being issued. It said the Council commissioning team was working with Sevacare to improve services and follow up issues identified in the report. It said his complaint was now closed.
42. Mr X says he tried to raise many issues at the safeguarding meeting but did not get satisfactory responses. He remained unhappy and brought his complaint to us in June 2019. He believes the Council’s safeguarding enquiries into whether his mother had her wishes and feelings listened to, were about him and were in response to him making complaints about Sevacare or the Council.

Findings

Poor care

43. Sevacare upheld most of Mr X’s complaint about poor care. The safeguarding investigation also found evidence of poor practice which needed improvement and monitoring. I explain below that I find no fault with the way the Council reached its safeguarding conclusions.
44. I have reviewed the care logs from between June and August 2018 and agree with Sevacare’s and the Council’s findings. The care logs lack detail about what care was offered or provided. This includes a lack of detail about how Mrs Y ended up on the floor in early July 2018. Many of the care calls were shorter than the allocated time, and there was poor separation between some care calls. These failures are fault and a breach of the fundamental standards.
45. Sevacare has apologised to Mr X for the identified faults and said it would take action to improve its services. I have seen evidence of Sevacare’s actions which include:
• staff re-training to ensure a good standard of care on all aspects of care provision;
• staff training for recording and reporting;
• reinforcement of the need for accurate recording of call times and sufficient separation between calls.
46. After its quality monitoring visit in May 2019 the Council drew up an action plan for Sevacare. It required Sevacare to address a range of issues. The Council continued to monitor issues of refresher training, call length and recording.
47. Mr X believes poor care led to a deterioration in Mrs Y’s health. The safeguarding enquiry found that, despite the faults it identified, there was no evidence the faults caused Mrs Y harm. I cannot say the faults probably caused deterioration in
    Mrs Y’s health. However, the faults do show Mrs Y did not consistently receive the care she should have received. That will have caused her some distress and is likely to have impacted on her confidence. Sevacare has already apologised but the Council should now also make a payment to Mrs Y to acknowledge the impact on her of poor care.
48. I am satisfied Sevacare and the Council have acted appropriately to improve services in future.

Safeguarding investigation into care provision

49. There was delay referring Sevacare’s complaint response to the safeguarding team in October 2018. Also, despite the policy saying the Council should decide whether to start an investigation within 72 working hours, it took until December 2018 to do this, a further two-month delay. There was then a delay in starting the investigation which meant the investigation ended in mid-April 2019. Overall, there was six months between the safeguarding team receiving the referral and finishing its investigation. This delay is fault. The delay in the safeguarding investigation also delayed the Council confirming its closure of Mr X’s complaint about Sevacare. The Council has since reviewed its procedures and apologised to Mr X. However, the delay caused Mr X and Mrs Y prolonged frustration and uncertainty over several months. The Council should now also make a payment to them to acknowledge the distress and uncertainty caused.
50. Apart from the delay, the Council considered Mr X’s concerns appropriately. The safeguarding report investigated each point of his complaints and made appropriate recommendations. The issues were discussed at a meeting where Mr X was able to contribute his views. Mr X is still dissatisfied but, apart from the delay, there was no fault in the way the Council reached its safeguarding conclusions. Without fault I cannot criticise those conclusions.

Complaint handling

51. Mr X first complained to the Council at the beginning of August 2018, and Sevacare responded to his complaint at the end of September 2018. Sevacare acknowledged there was a delay in providing a response and apologised to him for this delay. This delay was fault. The apology was an appropriate remedy for the delay.
52. Mr X says the Council raised safeguarding alerts against him in response to his complaints, but there is no evidence of this. The evidence shows that when the Council opened safeguarding cases in June 2018, August 2018 and January 2019 into whether Mrs Y’s wishes and feelings were being listened to by Mr X, this was in response to reported concerns. It acted appropriately in each case by making initial enquires but considered in each case there was insufficient evidence to progress to Section 42 enquiries and so closed each case. This is the process we would expect the Council to follow. There is no evidence the Council’s actions were in response to Mr X’s complaints. The Council is not at fault.

Agreed action

53. Within one month of the final decision, the Council will:
• pay Mrs Y £250 to acknowledge the impact on her of poor care provided from late June 2018 to early August 2018; and
• pay Mr X and Mrs Y £100 each to acknowledge the distress and uncertainty caused by delays in completing the safeguarding investigation.

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Final decision

54. I have completed my investigation. I have found fault and the Council has agreed actions to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman