Summary: Mrs X complained about the quality of home care provided to her by the Council’s commissioned care provider, Choices Homecare. She also said the care provider failed to properly address her complaint. We find the Council was fault. This caused distress to Mrs X. The Council has agreed to several recommendations to address the injustice caused by fault.

The complaint

1. The complainant, Mrs X, complains about the quality of home care provided to her by the Council’s commissioned care provider, Choices Homecare. She said this left her without the right care and caused her discomfort and distress. Mrs X also said the care provider failed to properly address her complaint.

Back to top

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. Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act).
4. We normally name care homes and other care providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).
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)

Back to top

How I considered this complaint

7. I spoke with Mrs X about her complaint. I considered all the information provided by Mrs X and the Council.
8. Mrs X and the Council had an opportunity to comment on my revised draft decision. I considered their comments before making my final decision.

Back to top

What I found

9. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 sets out the fundamental standards those registered to provide care services must achieve. The Care Quality Commission (CQC) has issued guidance on how to meet the fundamental standards below which care must never fall.
10. Regulation 10 says care providers must treat all service users with dignity and respect.
11. Regulation 16 is to ensure people can make a complaint about their care and treatment. To meet this regulation providers must have an effective and accessible system for identifying, receiving, handling and responding to complaints from people using the service, people acting on their behalf or other stakeholders. All complaints must be investigated thoroughly, and any necessary action taken where failures have been identified.
12. Regulation 17 says care providers should “maintain securely” records and should have “an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided”.

What did happen?

13. This section sets out the key events in this case and is not intended to be a detailed chronology.
14. A package of care commenced in August 2022 for Mrs X. It consisted of four care calls per day with two care workers. The care plan states this was to assist Mrs X out of bed and with personal care.
15. In the same month, the care provider’s notes stated Mrs X had an unstageable pressure sore and had been told by the nurse to remain in bed on alternative sides. It was noted that Mrs X said the package of care was going well.
16. The care and support plan was reviewed in October 2022 and it was noted that Mrs X wanted to cancel the lunch time call. This was because Mrs X said her pressure sores had healed and the call was no longer required. This was agreed on 4 November 2022.
17. The care provider’s notes of visits stated care had been provided to Mrs X and no concerns were raised until 10 November 2022 when it was reported that Mrs X had been difficult with care workers, which Mrs X disputes. She said she did not know which care workers she could trust.
18. Mrs X rang the care provider on the same day. She said she was not happy about having different care workers and was not happy with the care workers provided. The care provider said it could swap her onto a different team of care workers. It also said it could contact social services to find a new provider if Mrs X remained unhappy.
19. On 15 November 2022, Mrs X called the care provider to report that the morning care worker had refused to give her the medication. She also said she had previously reported a care worker for repeatedly calling her darling but said nothing had been done about it. The care provider said it would look into what happened regarding the medication as it was not aware the care workers helped Mrs X with her medication. It also said it would ask a care worker to attend Mrs X’s address but said Mrs X told them not to bother. But Mrs X said she was due to attend an appointment at the time.
20. The care provider’s notes stated care workers no longer wanted to attend Mrs X’s property as it noted that she had become abusive towards them. A new care provider was sought to take over on 21 November 2022.
21. Mrs X contacted the care provider on 20 November 2022 to state that care workers had left her in bed with no duvet or clothes on her bottom half. The care provider agreed to send someone round to the property.
22. Mrs X complained to the care provider the following month. She said:
• the manager who she said broke the headboard on her profiling bed, said she would get it fixed twice but didn’t. Mrs X said she arranged for the repair herself;
• two care workers were not with her in the shower;
• soiled pads had been left on the bedroom floor;
• care workers were unable to hoist her into her powerchair correctly;
• she declined a male care worker from completing some personal care but said he was told to still complete the care by another care worker;
• care workers walked out of her house refusing to do her medication even though the care provider had been doing it for the last four months. When she brought this to the care providers attention, they admitted it was their fault and wanted to send the supervisor out to rectify it, but Mrs X had to attend a hospital appointment. She said she did not get her morning medication until 2:30pm;
• care workers left her with no clothes on her bottom half and no duvet laid on her back;
• care workers would often talk about their colleagues and other service users to her;
• one care worker kept calling her darling which she said she found patronising, despite her already raising this as an issue;
23. The care provider responded to Mrs X’s complaint on 25 January 2023. It apologised and said:
• the manager made a referral to report the damaged headboard and was informed that someone would be out to fix it. But it said once a referral is made, it does not get any further communication or updates. It said when the manager visited Mrs X at home and realised it had not been fixed, the manager followed up with the previous referral but said Mrs X had also made her own referral in the meantime;
• regarding the soiled pad left on the floor, it said this had been an accidental oversight and said the care worker had apologised;
• after reviewing the care plan, it said there was no requirement identified for two care workers to be in attendance during the actual showering task. It said there was no record of care workers raising any concerns over completing the showering task alone;
• the concerns regarding care workers incompetence with moving and handling tasks had been reviewed and had prompted further actions including additional observations and assessments from the office around moving and handling competencies;
• regarding staff discussing other clients and care workers, it has been identified there was a breach of confidentiality which has prompted communications to all care teams to include a refresher on its confidentiality policy. The care staff directly involved have been subject to individual supervision in line with its HR procedures;
• it had spoken to the safeguarding team regarding the male care worker being forced to carrying out personal care who said Mrs X had retracted this statement and instead stated that at the time she had not raised a concern about a male care worker providing personal care. But it said once Mrs X raised this concern with the office, it was agreed that the female care worker would provide the personal care and where the second care worker was male, he would support with non-personal care tasks and hoisting;

Analysis

24. Mrs X told us the care provider failed to properly address her complaint. In the complaint response, whilst it did respond to parts of the complaint in detail and took appropriate action where there was fault, it failed to respond to all the issues raised by Mrs X. It did not respond to Mrs X’s complaint regarding the medication, being left in bed with no clothes or duvet on her bottom half and the issues raised around the care worker repeatedly calling her darling despite previously raising it as a concern. This is fault and not in line with Regulation 16 of the CQC guidance on how to meet the fundamental standards of care. This caused uncertainty and stress to Mrs X.
25. Mrs X told the care provider a male care worker had been forced to carry out personal care despite Mrs X saying she didn’t want it. The care provider said it spoke with the safeguarding team who had previously spoken to Mrs X about this and stated that Mrs X had confirmed the male care worker was not forced upon her and said she did not say no on this occasion. But Mrs X disputes this. The care provider said once Mrs X raised this concern, it was agreed that the female care worker would provide the personal care. In these circumstances where there are differing of views we cannot make a finding. We are however satisfied that the appropriate action was taken.
26. Mrs X said the care workers refused to do her medication on 15 November 2022. The care provider said Mrs X had initially been passed her medication but said she was now struggling to open packets. It said it had advised Mrs X that if she needed daily help to get her medication out the packet, it would have to be put on a task sheet. There is nothing in the care plan which states that Mrs X had an identified care need regarding help with medication. But it appears the care workers were initially providing support with this. The failure to record this support provided is fault and not in line with Regulation 17 of the CQC guidance on how to meet the fundamental standards of care, which states care provided should be up to date, accurate and recorded. This meant that Mrs X went without her morning medication on that day causing her significant distress. But I do not consider this fault to have caused Mrs X significant injustice on the remaining days as the care workers were supporting her with her medication despite it not being an identified care need.
27. The care plan states Mrs X required assistance to dress. But Mrs X called the care provider on 20 November 2022 to report that she had been left in bed with no clothes or duvet on her bottom half. The care provider told us this was because the care workers had advised Mrs X if she continued to be rude, they would leave the property. Whilst the care provider has recognised that care workers should not have left the property and it agreed to send someone out to her at the time, this is fault and meant Mrs X was not treated with dignity and respect and is not in line with Regulation 10 of the CQC guidance on how to meet the fundamental standards of care. This caused distress to Mrs X who spent unnecessary time and trouble in contacting the care provider to seek support.

Back to top

Agreed action

28. 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.
29. To remedy the injustice caused by fault, within one month of my final decision the Council has agreed to:
• apologise to Mrs X for the faults identified in this statement;
• provide Mrs X with a detailed response to the remaining parts of her complaint which are stated in paragraph 24;
• pay Mrs X £300 to acknowledge the distress and uncertainty caused by the faults identified in this statement.
30. Within two months, issue written reminders to the care provider to ensure they are aware of:
• Regulation 16 - This regulation is to ensure people can make a complaint about their care and treatment. To meet this regulation providers must have an effective and accessible system for identifying, receiving, handling and responding to complaints from people using the service, people acting on their behalf or other stakeholders. All complaints must be investigated thoroughly, and any necessary action taken where failures have been identified.
• Regulation 17 which says care providers should “maintain securely” records and should have “an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided”.
• Regulation 10 says care providers must treat all service users with dignity and respect.
31. Within three months, provide evidence of the action the care provider said it has taken in regard to:
• the breach of confidentiality which prompted communications to all care teams to include a refresher on its confidentiality policy;
• the moving and handling tasks that had been reviewed and had prompted further actions including additional observations and assessments from the office.
32. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

33. I have completed my investigation with a finding of fault causing injustice for the reasons explained in this statement. The above agreed actions provide a suitable remedy for the injustice caused by fault.

Back to top

Investigator's decision on behalf of the Ombudsman