Summary: Mrs X complained that a care provider commissioned by the Council to support her adult daughter, Miss D, failed to properly investigate injuries to Miss D’s arms, prevented her from entering Miss D’s home pending the outcome of a safeguarding investigation in relation to another resident and disclosed information about the situation to a third party. We found the Council was at fault in that the care provider failed to keep Mrs X informed about Miss D’s injuries, delayed in collecting Miss D’s prescribed medication for the injuries and disclosed confidential information to a third party. In recognition of the injustice caused, the Council has agreed to apologise and make a symbolic payment.

The complaint

1. Mrs X complains that a care provider commissioned by the Council:
• dismissed her concerns about burns to her daughter's arms and made decisions based on photographs rather than seeing the injuries in person;
• prevented her from entering her daughter’s home pending the outcome of a safeguarding investigation in relation to another resident without making a best interests decision and without allowing her a right of appeal; and
• disclosed information about the situation to a third party.
2. Mrs X says the care provider’s actions caused her daughter and herself significant distress.

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The Ombudsman’s role and powers

3. 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)
4. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
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 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 all the information provided by Mrs X, made enquiries of the Council and considered its comments and the documents it provided.
9. Mrs X and the Council 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

Legal and administrative background

Safeguarding

10. When a council thinks an adult with care and support needs may be at risk of abuse or neglect, it must make enquiries and determine what action may be needed to help and protect them. It must also ensure that such action is taken.
11. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency investigation. (Section 42, Care Act 2014)

Supported living

12. Supported living is housing where support and/or care services are provided to help people live as independently as possible. Supported living provides people with individual tendencies and allows them to retain their independence or interdependence by being supported to live in their own home.

Fundamental Standards of Care

13. 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.
14. Regulation 12 - Safe care and treatment. The intention of this regulation is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Medicines must be supplied in sufficient quantities, managed safely and administered appropriately to make sure people are safe.

CQC

15. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers that meet the fundamental standards of care, inspects care services, and reports its findings. It can also enforce against breaches of fundamental care standards and prosecute offences.

Key facts

16. Mrs X’s daughter, Miss D, is a vulnerable adult living in supported living accommodation provided by Healy Care Ltd. Her care is commissioned by the Council. Miss D is non-verbal and requires support with all aspects of her daily life.
17. On 19 June 2022 staff caring for Miss D noticed marks on her arms. They were not concerned at that stage and took no further action.
18. The care provider says that, on 29 June, staff sought advice from Miss D’s GP about the injuries and the GP advised them to let the wounds dry out and apply Sudocrem. They told staff to send a photograph to the surgery if the injuries worsened.
19. On 7 July staff sent a photograph of the wounds to the GP who prescribed antibiotic cream. Staff did not collect the cream until the following day.
20. The same day staff delivered Miss D to Mrs X’s home for overnight contact. Mrs X says they made no reference to having contacted her GP. Mrs X found marks on Miss D’s arms which she thought looked like burn marks and took her to A & E. The hospital raised a safeguarding alert with the Council which asked the care provider to investigate and report back. The care provider completed an investigation and interviewed staff supporting Miss D.
21. A safeguarding strategy meeting was held later in July. At the meeting Miss D’s GP stated they had no record of staff contacting them on 29 June about her injuries. The care provider said staff believed the injuries were caused by Miss D biting her arms and then picking at the wound. Mrs X considered the marks were burns. Professionals agreed Miss D had come to harm, but this was not significant. They found this had not been deliberate but due to a lack of coherent care. The chair said the care provider should have informed Mrs X about every incident at the earliest convenience. Mrs X asked the Council to move Miss D to alternative supported accommodation. The Council agreed it would do so because there had been several incidents where she had allegedly come to harm and Mrs X was no longer confident in the care provider.
22. In October the care provider discovered a bruise on D’s elbow and one on her thigh. It completed a safeguarding referral to the Council.
23. On 22 November Mrs X sent an email to the care provider alleging another tenant, Mr Z, was causing the bruising. The care provider responded saying there was no evidence Mr Z was causing harm to Miss D and that all shared time was witnessed by staff.
24. On 30 November Mrs X collected Miss D for overnight contact and suggested to staff that her injuries had been caused by Mr Z. Although he was not in the room, Mr Z overheard the allegation and was distressed. His family raised concerns. As a result, the care provider raised a safeguarding alert on Mr Z’s behalf and put in place a protection plan to safeguard him from further distress. It decided Mrs X should not enter the property until the safeguarding investigation was completed. The care provider informed Mrs X of the situation.
25. The same day Mrs X raised a safeguarding concern with the Council saying the care provider could not explain where Miss D’s injuries had come from.
26. On 8 December Miss D’s sister, Ms C, visited her. A staff member told her she could not visit Miss D and advised her to “ask her mother” about the restrictions. Mrs X informed the Council of this. It undertook mediation with Mrs X and the care provider to try to resolve the situation.
27. In the meantime, Mrs X made a complaint to the care provider about its restriction of her access to Miss D’s home and the fact that staff disclosed confidential information to a third party. She also complained that the manager had reached a decision on what had happened from photographs and discussions with staff before the safeguarding investigation had begun.
28. The care provider did not uphold Mrs X’s complaint about the decision to suspend her access to Miss D’s home until the safeguarding investigation was completed. It explained that the decision had been sanctioned by the safeguarding team. The care provider upheld Mrs X’s complaint about a member of staff disclosing information to Ms C. It accepted the information given to her was confidential and incorrect and that there was a “lack of clear written direction for staff to follow”. It apologised for this and explained that the staff member had been informed of this error and educated.
29. The care provider also responded to Mrs X’s complaint about the procedure followed by the manager in response to the marks found on Miss D’s arms. It found there were no reported accidents or incidents to explain these marks and concluded they were consistent with how Miss D leans on her arms when washing up which is something she enjoys and likes to do frequently. The care provider viewed photographic evidence of how Miss D positions herself while washing up, with pressure on both elbows, and agreed with the manager’s conclusion that the marks were caused by this.
30. In early February 2023 Miss D moved to alternative accommodation sourced by the Council.

Analysis

Injuries

31. Mrs X says the care provider dismissed her concerns about the injuries to Miss D’s arms and made decisions based on photographs rather than seeing the injuries in person.
32. In its response to Mrs X’s complaint, the care provider investigated the procedure that had been followed in response to the marks found on Miss D’s arms and agreed with the manager’s conclusion that the marks were caused by the way she positions herself when washing up. Having spoken to staff and considered the available evidence, the care provider was entitled to reach its own view on how the injuries occurred.
33. Mrs X has a different opinion about how the injuries were caused. However, it was for the safeguarding investigation to consider all the evidence, including the views of all parties, when reaching its decision. The matter was considered in some detail, but professionals did not reach a conclusion on how the injuries occurred. However, they concluded that Miss D had suffered harm, although this was not significant.
34. It is clear from the safeguarding investigation that the care provider acted appropriately by seeking medical advice about Miss D’s injuries although there is conflicting evidence about when staff first did so. The care provider delayed in collecting Miss D’s prescription for antibiotic cream by 24 hours. This was potentially a breach of Regulation 12 and was fault causing an injustice to Miss D as it is likely the wounds were causing her pain.
35. The safeguarding investigation also found the care provider delayed in informing Mrs X about Miss D’s injuries. This was also fault and caused Mrs X distress and uncertainty.
36. I have made recommendations to remedy the injustice suffered by Miss D and Mrs X.
37. I find the Council acted appropriately by completing a safeguarding investigation and by acting on Mrs X’s request to move Miss D to alternative accommodation.

Decision to prevent Mrs X entering her daughter’s home

38. I find no grounds to criticise the care provider’s decision to prevent Mrs X entering Miss D’s home in the best interests of Mr Z, another vulnerable adult. The Council agreed with the action taken by the provider and was satisfied the protection plan was in the best interests of both tenants. In the circumstances, there was no need to hold a best interests meeting.
39. In any event, Mrs X was not prevented from spending time with her daughter but only from going into the property when collecting her or dropping her off. In addition, this situation only lasted for a few weeks until Miss D moved to alternative accommodation.
40. Mrs X says Miss D was agitated by being dropped off at the door. But the Council says the care provider reported no evidence of this. There is a conflict of evidence on this point. In the absence of independent evidence to establish exactly what happened, I cannot reach a view on this point.

Disclosing information to a third party

41. I find the care provider was at fault in disclosing confidential information to Ms C.
42. Mrs X says the care provider should have had policies in place to deal with the situation. I do not consider this to be the case. A care provider cannot have policies in place for every eventuality. However, the care provider accepts that, once it decided to place restrictions on Mrs X entering the property, it should have provided some written instructions for staff to ensure they were clear on what to do. This may have avoided the member of staff refusing entry to Ms C.
43. However, I consider the actions taken by the care provider represent a satisfactory remedy for the injustice caused to Mrs X. Accordingly, I have made no further recommendations for the Council in relation to this issue.

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Agreed action

44. 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 I found fault with the actions of the care provider, I have made recommendations to the Council.
45. The Council has agreed that, within one month, it will:
• apologise to Mrs X for the care provider’s delay in informing her about Miss D’s injuries and pay her £250 in recognition of the distress and uncertainty caused;
• pay Mrs X a further symbolic payment of £250 to use for Miss D’s benefit in recognition of the potential harm caused by the care provider’s delay in collecting her prescription; and
• ensure the care provider issues a reminder to all staff that family and other representatives must be kept updated and prescriptions should be collected in a timely fashion.
46. The Council should provide us with evidence it has complied with the above actions.

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Final decision

47. I find the Council was at fault in that the care provider:
• delayed in collecting Miss D’s prescription;
• delayed in informing Mrs X about Miss D’s injuries; and
• disclosed confidential information to a third party.
48. I have completed my investigation on the basis that the Council has agreed to implement the recommended remedy.

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Investigator's decision on behalf of the Ombudsman