Summary: Ms X complained on behalf of her father, Mr Y, about the Council-commissioned home care provided to him at weekends. Ms X says the care provided at weekends was rushed and caused harm to Mr Y. We found fault by the Council and the Council has agreed to apologise to Mr Y and review the charges made by the care provider.

The complaint

1. Mr Y received daily homecare from a Council-commissioned care provider between May 2021 and March 2022. Ms X complained on behalf of Mr Y about the quality of homecare provided to him at weekends. She said the care provided to Mr Y at weekends was rushed and caused him harm. Ms X would like appropriate training to be given to the carers involved so that similar incidents do not happen to anyone else.

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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 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)
4. 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)
5. 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

6. I discussed the complaint with Ms X and considered the information she provided. I also made enquiries to the Council and considered the information it provided.
7. Ms X and the Council have had the opportunity to comment on a draft of this decision. I have considered their comments before making a final decision.

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What I found

Provision of care and support

8. The Health and Social Care Act 2008 (regulated activities) Regulations 2014 set out the fundamental standards those registered to provide care services must achieve.
9. 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

The Council’s terms and conditions for the provision of live at home services

10. The Council produces an Individual Support Plan (ISP) for service users which sets out the type of care the service user requires.
11. The Council’s ‘Terms and conditions in relation to the framework and call-off for the provision of live at home services’ (Terms and Conditions) apply to care providers commissioned by the Council to provide care to service users in their homes.
12. The Terms and Conditions state:
• This agreement applies to the procedure and terms upon which the Council may place Adults with the Service Provider to deliver the Services or any part of them. (Terms and conditions in relation to the framework and call-off for the provision of live at home services, 4.2.1)
• The Service Provider shall provide the Services in accordance with the provisions of Schedule 1 (Service Specification), any issued ISP and any relevant Care and Support Plan in a manner which complies with the Council’s Policies detailed in Schedules 9 (Council Policies),… as and when required to do so by any ISP and in accordance with the terms of this Agreement and the ISP. (Terms and conditions in relation to the framework and call-off for the provision of live at home services, 4.2.2)
• Within 10 Calendar Days of the end of each 4-weekly payment period, the Service Provider… shall submit to the Council an invoice and an accompanying schedule which details:
1. The name of the Adult; and
2. The Actuals Data for time spent delivering Services to the Adult for each week of the 4 week period. The Service Provider should round up care delivered to the nearest 15 minutes per day, per Adult. (Schedule 3, Payment Schedule, 4.3)
13. The Terms and Conditions also state:
• The Service Provider is required to submit an invoice to the Council in accordance with paragraph 4 (Invoicing) of this Schedule 3 (Payment Schedule) for actual time spent with the relevant Adult. (Schedule 3, Payment Schedule, 3.1)
• Timesheets for Staff and the log kept with the Adult’s records must reflect the actual time spent by Staff in attendance with the Adult. (Schedule 3, Payment Schedule, 3.2)
• The Council reserves the right to review the timesheets and any other records kept by the Service Provider…of visits to Adults to verify the invoices submitted. (Schedule 3, Payment Schedule, 3.3)

Background

14. This chronology includes key events in this case and does not cover everything that happened.
15. Mr Y has a medical condition and in early 2021, he underwent surgery. When Mr Y returned home from hospital, he received reablement care from a care provider, Premier Care, to support him with his care needs.
16. Mr Y’s reablement care ended in April 2021. Mr Y subsequently received care and support at home from another care provider.
17. The Council carried out an assessment of Mr Y’s care needs and in May 2021, produced an ISP detailing the type of care Mr Y required. The ISP specified Mr Y required two carers to attend four times a day, seven days a week to provide support with maintaining Mr Y’s personal hygiene, nutrition and toileting needs. The ISP said the carers’ morning visit should be for 45 minutes, followed by 30-minute visits at lunch, teatime and bedtime. The ISP stated Mr Y’s wife, Mrs Y, would provide support with all Mr Y’s meals, fluids and medication.
18. The Council commissioned Premier Care to provide care and support as identified by the ISP.
19. The Council carried out a financial assessment which identified Mr Y was required to pay a contribution towards the cost of his care package.

What happened

20. Mrs Y complained to the Council on 20 January 2022 about the care provided by Premier Care. She said Premier Care was inconsistent with its timed care slots at weekends and said this caused problems in trying to arrange meals and medication for Mr Y. Mrs Y also said poor standards of care at the weekend had resulted in harm caused to Mr Y. She referred to an incident which took place over the weekend of 15 and 16 January 2022 in which she said the carers had caused the skin on Mr Y’s leg to be broken. Ms X also says the carers who attended during that weekend incorrectly placed Mr Y’s catheter tube under his leg and strapped it too tightly. Ms X says this resulted in a blood blister to Mr Y’s leg and a blockage to the catheter tube which caused severe pain to Mr Y. In her complaint, Mrs Y said the service provided at weekends did not meet the service provided during the week.
21. Premier Care provided its complaint response on 21 January 2022. It said it had reviewed the carers’ call times in June, July and August 2021, and for December 2021 and January 2022 and found they were consistent with weekday call times. Premier Care said Mr and Mrs Y had previously advised they were happy with the service provided to Mr Y. Premier Care acknowledged the carers’ visit records from 15 and 16 January 2022 and the blood blister on Mr Y’s leg and said it had updated its records for carers to check pressure areas and skin integrity at each visit.
22. Ms X says there was a further incident on 21 January 2022 in which Mrs Y heard Mr Y tell a carer to stop what they were doing because they were hurting him. Ms X says Mrs Y considered the carer was not using the required skincare products when attending to Mr Y, and this had caused him pain and discomfort.
23. Mr and Mrs Y raised their concerns about this incident to the Council on 27 January 2022.

What happened next

24. The Council began a safeguarding enquiry regarding the concerns raised by Mr and Mrs Y. The Council spoke to Mrs Y who confirmed she considered the carer had not used the recommended skincare products for Mr Y on 21 January 2022. Mrs Y also repeated her concerns about the blister on Mr Y’s leg and about the weekend carers, who she said always rushed their visits.
25. The Council made enquiries with Premier Care. Premier Care responded to the Council’s enquiries and said the weekend visit times were the same as the weekday visit times. Premier Care told the Council it had spoken to its carers and said the carers who visited Mr Y on 21 January 2022 stated they had used the correct skincare product. With regards to Mr Y’s blister, Premier Care said the carers had discovered this and had told Mrs Y about it. Premier Care said that following this, Mrs Y called the District Nurse who visited Mr Y. Premier Care said Mrs Y told its carers the District Nurse had shown her how Mr Y’s catheter straps should be placed.
26. Premier Care said it had given notice to cease providing care to Mr Y due to a breakdown in their relationship.
27. Ms X remained dissatisfied with Premier Care’s response and brought the complaint to us.
28. Mr Y changed care provider after Premier Care gave notice to stop providing its care and support package.

Analysis

29. Ms X complained the care provided by Premier Care at weekends was rushed and caused harm to Mr Y. Mrs Y also complained Premier Care’s weekend visits were inconsistent with its weekday visits. I have reviewed Premier Care’s records and the safeguarding enquiry carried out by the Council.
30. Ms X says the inconsistencies in the weekend carer’s visit times developed over time, but stated it became noticeable from December 2021. I have reviewed Premier Care’s records for the period 13 December 2021 to 26 January 2022. The evidence shows the times and duration of the weekend visits were representative of the times and duration of the weekday visits. As a result, there is no evidence of fault regarding weekend visits being made at different times or for a shorter duration than weekday visits.
31. I have reviewed Premier Care’s records regarding the incident reported on 16 January 2022. This relates to Ms X’s complaint the weekend carers strapped Mr Y’s night-time catheter tube too tightly, causing a blood blister to Mr Y’s leg. It also relates to Ms X’s complaint the weekend carers taped the catheter tube under Mr Y’s leg, causing a blockage and discomfort to Mr Y.
32. The care records show dates prior to 16 January 2022 where the carers recorded blood and/or a blister on Mr Y’s leg. The care records also provide evidence of dates prior to 16 January 2022 where the carers recorded no flow from Mr Y’s catheter. The records state the District Nurse was contacted as a result to address this issue. Care notes from 21 January 2022 also refer to a conversation between Mrs Y and the carers which indicate the carers usually positioned the catheter tube over Mr Y’s leg. Premier Care’s training records also show it provides training to its staff regarding catheter care.
33. I have reviewed Premier Care’s records regarding the incident of 21 January 2022 and have also reviewed the Council’s safeguarding enquiry. The safeguarding enquiry could not conclude the carers failed to use the required skincare product during the visit in question. It said the pain and discomfort caused to Mr Y may have been due to an existing sore. Premier Care’s records indicate the carers used the required skincare product at the visit, and I have seen no evidence to offer an alternative view to that identified by the safeguarding enquiry.
34. I acknowledge Ms X’s comments regarding the pain and discomfort experienced by Mr Y on 16 and 21 January 2022, and I do not dispute the distress this caused to Mr Y and his family. Whilst the information reviewed records the events of these dates, there is not enough evidence on balance to find what happened during these visits to be fault by the carers who attended. The care records show Mr Y experienced similar issues relating to his catheter and the presence of blood and/or a blister on his leg prior to 16 January 2022, and the safeguarding enquiry was unable to conclude whether the discomfort caused on 21 January 2022 was due to the carers’ actions or an existing sore. Without any evidence to demonstrate the matters complained about were due to the carers’ actions, I do not find Premier Care at fault regarding this aspect of the complaint.

Review of care visits

35. As previously stated, I have reviewed Premier Care’s visit records for the period 13 December 2021 to 26 January 2022. The Council’s ISP states Mr Y required four visits per day by two carers, with the initial morning visit to be 45 minutes, followed by three 30-minute visits.
36. Premier Care’s records show several occasions where only one carer visited Mr Y. However, in its response to the draft decision, Premier Care states all visits to Mr Y were undertaken by two carers, and at no time did Mr Y receive care from only one carer.
37. I acknowledge Premier Care’s comments regarding this matter. However, care visit records show visit times for only one carer on two occasions in December 2021 and two occasions in January 2022. The ISP specifies Mr Y required two carers, and the Council’s Terms and Conditions state “The Service Provider shall provide the Services in accordance with the provisions of …any issued ISP”. Based on Premier Care’s visit records which indicate occasions when only one carer attended, I have found Premier Care to be at fault.
38. Premier Care’s records also show discrepancies with the times the carers visited Mr Y, with visits regularly recorded as being considerably shorter than the required visit times specified in the ISP. This includes weekday and weekend carers. Premier Care’s records also show some instances of discrepancies between the times recorded by individual carers for the same visit. For example, on one occasion in January 2022, the records show one carer visited Mr Y in the evening for six minutes, and the second carer attended over an hour later and stayed for less than a minute.
39. Premier Care says its recording system for care visits is app-based and accessed via mobile phones. It says network connectivity issues can impact the ability to accurately record visits and can lead to carers recording visits outside the normal visit time.
40. I acknowledge Premier Care’s comments, however, we expect councils to maintain effective and robust administrative processes. As part of these processes, we would expect councils to keep records to clearly demonstrate the times and duration of the carers’ visits to service users. This is particularly relevant when these records are used to calculate the cost to the service user. The evidence provided indicates Premier Care failed to maintain clear and accurate records regarding the carer’s visit times. This is a failure to maintain a robust administrative process and is therefore fault.
41. Having identified fault, I must consider whether this caused a significant injustice to Mr Y. The Council’s Terms and Conditions specify service providers must submit an invoice to the Council for the actual time spent with the service user, and that service providers should round up care delivered to the nearest 15 minutes per day. The discrepancies in the carer’s time recording causes uncertainty regarding the period of time the carers attended, and subsequently the charges made to Mr Y. In addition, Ms X also says the Council’s actions caused avoidable distress to Mr Y.
42. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although we consider there is fault with the actions of the care provider, we have made recommendations to the Council.

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Agreed action

43. The Council has agreed to take the following action within one month of the final decision:
1. Provide an apology to Mr Y;
2. Make a payment of £200 to Mr Y to recognise the distress and uncertainty caused;
3. Review Premier Care’s charges to Mr Y to ensure they are correct regarding the number of carers in attendance and the duration of the visits;
4. Make any necessary refunds to Mr Y if the Council’s review identifies Mr Y has overpaid care charges based on the number of carers in attendance and the duration of the visits, and
5. Remind Premier Care of the importance of accurately recording visit times and assure itself Premier Care is completing records accurately.
44. The Council should provide us with evidence it has complied with the above actions.

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Final decision

45. My investigation has found fault and the Council has agreed to take the above action to remedy the complaint. I have therefore concluded my investigation.

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Investigator's decision on behalf of the Ombudsman