Summary: Ms C complained there was a lack of continuity in the homecare support provided to meet her partner’s care needs. This meant he was not supported with the equipment he needed for his medical condition. Ms C said as a result her partner’s life could have been at risk and, because she was the only person who could use the equipment, her return to work was delayed. There were failings in the care provider’s communication with Ms C and in the Council’s failure to provide a copy of the revised care plan. They will apologise to Ms C and pay her £200 to recognise her distress and inconvenience.

The complaint

1. I refer to the complainant as Mr B. He is represented in bringing this complaint by his partner Ms C. They complained about the homecare support arranged by Coventry City Council and provided by Allied Healthcare, which later became the responsibility of NHS Coventry and Warwickshire Integrated Care Board (the ICB). They complained there was a lack of continuity in the support provided for Mr B’s care needs. This meant Mr B could not be supported at home with the equipment he needed for his medical condition. Ms C says as a result Mr B’s life could have been at risk and, because she was the only person who could use the equipment, her return to work was delayed.

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The Ombudsmen’s role and powers

2. The Ombudsmen have the power to jointly consider complaints about health and social care. Since April 2015, these complaints have been considered by a single team acting on behalf of both Ombudsmen. (Local Government Act 1974, section 33ZA,as amended, and Health Service Commissioners Act 1993, section 18ZA)
3. The Ombudsmen investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, the Ombudsmen consider whether it has caused injustice or hardship. If there has been fault which has caused an injustice, we may suggest a remedy. (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
4. If the Ombudsmen are satisfied with the actions or proposed actions of the organisations that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

5. I considered the complaint and documents provided by Ms C and spoke to her. I asked the Council, Allied Healthcare and the ICB to comment on the complaint and provide information. I sent a draft of this statement to Ms C and the bodies in jurisdiction and considered their comments.

Fundamental care standards

6. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards registered care providers must achieve. The Care Quality Commission (CQC), as the statutory regulator of care services, has issued guidance on how to meet these standards below which care must never fall.
7. It is not our role to decide whether any failings in care or treatment by a care provider are breaches of the fundamental standards. These are matters for the CQC with which we share our decisions.
8. But we will consider the 2014 Regulations when deciding complaints about poor standards of care. Regulations, relevant to this complaint, require care providers to:
• provide appropriate and person-centred care and treatment based on an assessment of the person’s needs and preferences (regulation 9);
• maintain accurate, complete and detailed records in respect of each person using the service (regulation 17).

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What I found

Summary of the key events

9. Mr B has a medical condition and has support from non-invasive ventilation via a mask. I refer to this as the NIV mask. This was first introduced into Mr B’s care in around March 2021, as part of his care from an NHS Respiratory Team.
10. Mr B lives at home with care from Ms C. At the time relevant to this complaint he also received care visits in the morning. There was a care and support plan in place from January 2021. At this point care was provided by Allied Healthcare and was commissioned by the Council. In May Ms C asked for an increase in care. A revised care plan was issued in June. This increased the care to two carers in the morning. Neither care plan refers to assistance with the NIV mask. It did refer to Ms C’s intention to return to work at the end of June.
11. Ms C says that from April onwards she had regular contact with a manager at Allied about the care provided for Mr B. She said the key issue was there needed to be continuity in the carers who visited. In part this was so Ms C could show them how the NIV mask worked so they could support with that if she wasn’t present.
12. In the middle of July Ms C made a telephone complaint to Allied. At around this time the NHS took over responsibility for funding and commissioning Mr B’s care. This followed an assessment in early July which found his needs had become so significant and complex that his care should be fully funded by the NHS. This July assessment referred to Mr B needing the NIV mask when he was being hoisted, and said support with the NIV mask could be provided by a family member or a member of care staff.
13. In mid-August Ms C said she would be returning to work at the end of September and Mr B would need additional support on Mondays and Tuesdays during the day, including help with the NIV mask.
14. In early September the NHS assessed Mr B and identified there was a need for more support. The assessment said when Ms C returned to work in early October Mr B would need an increased care package on Mondays and Tuesdays. The existing care provider Allied said it would not be able to provide the increased care package from 4 October, so a new care provider was found.

Analysis

Support with the NIV mask

15. The key issue in this complaint is the support that was needed with the NIV mask. Mr B’s needs were increasing and he needed to use the mask more. Assistance with the mask was not included in the support plans that were in place for the support provided by Allied Healthcare over 2021. However, Ms C is clear she had instructed carers in how to use the mask and that was why continuity in the carers was so important so they could provide that support. She says that without a carer being able to support with the mask she was unable to go out or have a shower.
16. Ms C contacted Allied over April and May. There is no documentary evidence of the detail of these contacts. I accept it was likely to have been about the care provided as by June there was a re-assessment of Mr B’s needs. This showed his increasing needs but did not identify specifically for the carers to provide support with the NIV mask. Ms C said she never received a copy of the revised care plan and the only one that was at home was from January 2021. The Council has not been able to provide any evidence to show the updated care plan from June was sent to Ms C. Therefore I consider that, on the balance of probabilities, the plan was not sent to Ms C. Section 10.87 of the Care and Support Statutory Guidance requires that a copy of the care plan should be given to the person whose plan it is and anyone else who acts on their behalf. So this was fault by the Council.
17. This is significant because if Ms C had seen the care plan she could have questioned why it did not include support with the NIV mask. Had this happened support would have been incorporated into a revised plan sooner. I consider this to be the case because support with the NIV mask was identified by the ICB assessments shortly afterwards in July. If the need for this support had been identified sooner, when care was still being commissioned by the Council and provided by Allied, Ms C would have been able to return to work from furlough sooner, possibly in July rather than at the end of September. Ms C has commented that would have been better for both her mental health and financially.

Communication

18. When Ms C complained in July to Allied the notes of the complaint refer to her concerns about new carers not knowing Mr B’s complex needs and her needing to train them in tasks. Allied did not respond to the complaint as the manager, Mr X, who was dealing with Ms C, considered it was resolved. Although the body responsible for commissioning Mr B’s care changed at this time from the Council to the ICB it was still Allied who were providing the care on the basis of the care plan from the Council.
19. Ms C complained to Mr X in early September. She said Mr B needed carers who were trained in the use of the mask. She said she had trained several carers in the use of the mask but as she was returning to work that would no longer be possible. Although this was the first written expression of the key point about support with the mask it is more likely than not that Ms C was, as she said, raising this with Mr X from at least July when she made the first complaint.
20. Allied and then the Council responded to Ms C’s complaints. It was recognised that some of the communication by Allied was not adequate and Allied apologised. But both the Council and Allied emphasised that the support with the mask was not specified in Mr B’s care plan and therefore not something that carers should be doing.
21. Ms C’s communication was with Allied but it has no record of her contacts. This is fault as Regulation 17 requires that a proper record should be kept in respect of a service user. Allied has accepted there were failings in its communication with Ms C. As I say above the key issue was the failing in not sending the revised June 2021 care plan to Ms C. But the poor communication by Allied meant that an opportunity was also missed to establish exactly what Ms C’s concerns were.
22. These failings meant that the issues of support with the NIV mask were not addressed at the time Ms C started raising them, and this is one of the reasons Ms C was not able to return to work when she wanted. But I recognise that there may have been other issues such as when furlough ended. But, nonetheless, there should be a remedy for that injustice.

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Final decision

23. There was fault by Allied Healthcare and the Council which caused injustice to Ms C. They will apologise to Ms C and pay her £200 (£100 each) to recognise her distress and inconvenience. They should do so within one month of the final decision and provide evidence to us that they have done so.

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Investigator's decision on behalf of the Ombudsman