Summary: We uphold Mrs X’s complaint about the way the Care Provider responded to her concerns when her care visit times were changed. We found the Care Provider failed to properly consider Mrs X’s preferences. As a result, Mrs X was caused unnecessary frustration and upset. We recommend the Care Provider apologises to Mrs X and reviews its processes.

The complaint

1. Mrs X complains about Home Instead Warrington & Lymm (the Care Provider) which is a private home care provider run by Warrington Care Services Ltd. Mrs X uses a wheelchair and has specialised care needs.
2. Mrs X complains about the Care Provider’s decision to change the times of her daily care visits times. She says the earlier time slots were not possible to accommodate for several health-related reasons, however the Care Provider refused to offer any flexibility.
3. Mrs X said the change of time would have had a significant impact on her and her husband’s health. As a result, she felt she had no choice but to change to a different care provider, which was stressful and upsetting.
4. Mrs X would like the Care Provider to accept that the situation was handled poorly.

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The Ombudsmen’s role and powers

5. 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 (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A (1), as amended).
6. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
7. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies 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

8. I discussed the complaint with Mrs X. I reviewed information provided by the Care Provider including the responses to my enquiry questions and copies of correspondence between Mrs X and the Care Provider. In addition, I took account of the relevant guidance and legislation. I carefully considered all the written and oral evidence submitted to us, even if I do not mention specific pieces of evidence within the decision statement.
9. I have shared this draft decision with Mrs X and the Care Provider and they had an opportunity to comment. I have considered the comments I received.

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What I found

Key legislation and guidance

Fundamental Standards of Care - Guidance for Health and Social Care Act 2008 (Regulated Activities) Regulation 2014: Regulation 9

10. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve.
11. ‘Regulation 9(1) Providers must do everything reasonably practicable to make sure that people who use the service receive person-centred care and treatment that is appropriate, meets their needs and reflects their personal preferences, whatever they might be.
12. 9(3)(b) A person’s care and treatment must be designed to make sure it meets all their needs. There may be times when a person’s needs and preferences can not be met. In these instances, providers must explain the impact of this to them and explore alternatives so the person can make informed decisions about their care…
13. Providers must make every reasonable effort to meet people’s preferences. When any preferences about the choice of care and treatment can not be met, providers must fully explain why so that people use the service understand the reasons. The explanation should show how the provider has considered the impact of this on the person.
14. Providers must actively seek the views of people who use their service…about how care and treatment meets their needs. Providers must be able to demonstrate that they took action in response to any feedback’.

What happened

15. Mrs X uses a wheelchair and has highly specialised care needs. Mr X, Mrs X’s husband, is her main carer. Mrs X also receives additional support from a care agency via daily home visits. Mrs X pays for her care, along with a contribution from her personal health budget.
16. Mrs X had been with the same care agency (the Care Provider) since 2018 and was happy with her care. She received morning care visits at 8am every day and some afternoon visits at 4.45pm.
17. In April 2023, following a companywide review of its visiting structure, the Care Provider notified Mrs X of a change to her visit times. As of 22 May 2023, Mrs X’s morning visit would move from 8am to 7.15am and her afternoon visit would move from 4.45pm to 4pm.
18. Mrs X replied promptly that she was unhappy with the new times. She explained she can experience dizziness in the morning and can struggle to move from lying in bed to sitting in her wheelchair, needing time to adjust before moving. She also said 4.45pm visits were important for dietary reasons. Mrs X sent a further response, questioning why her visit times had moved earlier, when the new structure had all carers starting their visits later. Mrs X said she would be content to receive visits at 8.15am and 5.15pm. She asked for someone to come and see or call her to discuss her concerns.
19. The Care Provider replied by email that the whole visits structure was changing, not just simply moving visits 30 minutes later. The Care Provider said ‘I can come out to see you regarding changing your tea time visit or give you a call, but as a company it has been decided that the times are changing, therefore the proposed times for daily visits are going to start at 7.15am’.
20. The Care Provider sent a further email response which said it had reviewed and changed times to better meet their clients’ needs and visit more clients. It said care workers now worked in blocks and therefore there was no flexibility to change times.
21. Mrs X served notice and sourced a new care provider.

Analysis

22. An organisation should not adopt a blanket or uniform approach or policy that prevents it from considering the circumstances of a particular case. We may find fault in the actions of organisations that fetter their discretion in this way.
23. In response to my enquiries, the Care Provider explained its reasons for changing its visiting time structure. This includes increasing availability for clients, creating more teatime and bedtime visiting slots and improvements for staff. The Care Provider is entitled to make such business decisions, where it sees fit.
24. However, even where there are wider benefits, the individual’s needs should not be lost in the process. The Care Provider is always obliged, under Regulation 9 of the Health and Care Act (the Act), to provide person centred care. This includes taking a person’s preferences into account and making every reasonable effort to meet them. Where a person’s preferences cannot be met, a care provider must be able to demonstrate that it has properly considered a person’s preferences and how its decision will affect that person. It must also properly explain its decision and discuss other options.
25. When questioning the changes, Mrs X explained to the Care Provider her health-related reasons for finding the new earlier visit times unacceptable. During this investigation, Mrs X has also explained to me further reasons relating to Mr X’s medication regime, the timings of which impact on how he is able to care for her. Mrs X says the earlier visit times would have had a significant impact on her and Mr X’s mental and physical health.
26. I have not seen any evidence to suggest the Care Provider properly considered Mrs X’s concerns about the changes to her visit times and the impact this would have on her and her husband. When Mrs X raised her concerns, the Care Provider did not meet or call Mrs X, as requested. The Care Provider did not make sufficient attempt to explore Mrs X’s concerns further, to understand why she felt unable to accept the new visit times. The Care Provider simply repeated that there was no flexibility.
27. In response to my draft decision, the Care Provider said it was not previously aware of Mrs X’s dizziness, prior to her April 2023 email. It was also not aware of Mr X’s medicine and health needs. However, this compounds the importance of thoroughly exploring the reasons for Mrs X’s concerns with her at the time. The Care Provider has acknowledged there is a learning point around properly exploring the impact of any changes on its customers and their family carers.
28. I have seen no evidence that the Care Provider properly considered Mrs X’s individual circumstances when she raised concerns. Instead, the Care Provider has fettered its discretion by applying a blanket approach. This is not in line with the relevant legislation and is fault.
29. We cannot know, had the Care Provider considered Mrs X’s request for later visits properly, whether suitable times could have been found. However, the decision was not taken properly. This is fault.
30. The Care Provider noted that Mrs X was asking for times outside their new block system, and therefore could not provide these. Mrs X could not have known the exact details of the new visits times to be able to request a ‘correct’ block time. Mrs X suggested alternative times to the Care Provider. This showed a willingness to accept different times, providing these were later than her current visits, not earlier. Had the Care Provider met or spoken with Mrs X, as she requested, then the new blocks times could have been discussed with her to see if a suitable alternative could be found.
31. I appreciate that the Care Provider was restructuring its entire visit structure and needed to balance the needs of all of its clients, which comes with scheduling challenges. However, I have not seen any evidence to suggest the Care Provider tried to explore alternative visit times for Mrs X. This is fault.
32. In response to my enquiries, the Care Provider said there was the possibility of moving Mrs X’s visits to more suitable times. The Care Provider told us that Mrs X’s 4pm visit could potentially have been moved to 5.15pm, a time that Mrs X had suggested herself. It also suggested that 8.30am was a possibility for her morning visit. These would have depended on availability. We cannot confirm whether Mrs X’s visits could have been changed, but alternatives should have been discussed with Mrs X and properly explored to see if it was possible. I have seen no evidence the Care Provider presented these options to Mrs X or discussed them with her.
33. During the course of this investigation, the Care Provider accepted that its communication with Mrs X fell below an acceptable standard. However, I am not assured the Care Provider fully understands that its blanket approach also failed to meet fundamental standards of care.
34. When commenting on my draft decision, the Care Provider said it recognises the importance of considering individual preferences. It further explained the process of changing times was intended to take customers’ views into account, and cannot explain why this failed to happen in Mrs X’s case.
35. This issue has the potential to impact on any person using the Care Provider’s services. Whether it be a full restructure, or a single person asking for a change to their visits, such decisions must be taken in a person-centred way. The Care Provider must ensure this approach is applied, consistently, for all service users at all times.
36. Mrs X had been with the Care Provider for six years. She was settled with her care workers and happy with her care. As a result of the Care Provider’s actions, Mrs X felt she had no choice but to change to another care provider. Mrs X found this worrying and time consuming as she has specialised needs and had been with the same care provider for so long. Mrs X has been caused frustration and upset by the Care Provider’s handling of the situation.

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Agreed actions

Care Provider

37. Within one month of my final decision statement, the Care Provider will:

• Apologise to Mrs X for failing to properly consider her concerns;
• review its policies to ensure that all requests for amendments to visit times are properly considered on a case-by-case basis, in line with Regulation 9 of the Health and Social Care Act 2008. The Care Provider will also ensure that all staff are aware of any changes arising from this.

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Final decision

38. I have found that the Care Provider failed to properly consider Mrs X’s concerns about her new visit times, instead applying a blanket decision contrary to the relevant legislation. This caused significant frustration and upset for Mrs X.
39. I have now completed my investigation.

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Investigator's decision on behalf of the Ombudsman