Summary: Ms X complains the Care Provider has not provided safe social care for her mother, Mrs Y. The Care Provider is at fault because care records were not fully kept. The Care Provider has already provided an appropriate remedy.

The complaint

1. The complainant, whom I shall refer to as Ms X, complains on behalf of her mother, Mrs Y, that Deeon Limited, (the Care Provider), hasn’t provided safe quality social care for Mrs Y, between 10 Dec 2022 and 14 January 2023 because it did not:
• properly recruit or provide a safe and suitable live-in carer;
• properly record care delivery or incident reporting;
• deal with her mother’s meals and nutrition properly;
• manage or record her mother’s medication properly;
• properly manage the provision and use of equipment/aids for care;
• provide consistent appropriate care for her mother;
• properly investigate or deal with issues raised by the family about Mrs Y’s care.
2. Ms X says her mother did not receive safe social care and no care at all was provided for several weeks.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers and decide whether their actions have caused injustice, or could have caused injustice, to the person complaining. I have used the term fault to describe this. (Local Government Act 1974, sections 34B and 34C)
4. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
5. Our role is not to ask whether an organisation could have done things better, or whether we agree or disagree with what it did. Instead, we look at whether there was fault in how it made its decisions. If we decide there was no fault in how it did so, we cannot ask whether it should have made a particular decision or say it should have reached a different outcome.
6. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
7. We can investigate complaints about actions by adult social care providers that can be regulated by the Care Quality Commission. Such activities include giving personal care or other practical support in the place where the person lives.
8. 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)

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How I considered this complaint

9. I spoke to Ms X about her complaint and considered documents she provided. I made enquiries of the Care Provider and considered its response and the supporting documents it provided.
10. Ms X and the Care Provider 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

Law, guidance and policies

11. The law defines ‘personal care and other practical support’ as ‘physical assistance (or prompting and assistance) given to a person in connection with eating or drinking, toileting, washing or bathing, dressing, oral care or the care of skin, hair and nails (except for nail care provided by a chiropodist or podiatrist)’.

(Health and Social Care Act 2008 (Regulated Activities) Regulations 2010)

What happened?

12. This is a brief chronology of key events. It does not contain everything I reviewed during my investigation.
13. Mrs Y began to receive live-in care from the Care Provider in December 2022.
14. Mrs Y’s family were unhappy about the care she received and asked the Care Provider to find another live-in carer for Mrs Y
15. The Care Provider stopped providing live-in care in mid-January 2023.
16. Ms X complained to the Care Provider about the care Mrs Y had received.
17. The Care Provider replied to Ms X’s complaint, acknowledging some issues and rejecting others.

Analysis

Carer recruitment

18. Ms X complained that the Care Provider did not:
• recruit the carer properly, denying the opportunity to meet via video link;
• ensure carer had adequate basic competencies;
• consider the COVID-19 vaccine status of the live-in carer;
• explain the way the service employed carers transparently.
19. The Care Provider, in its complaint response, said:
• it acknowledged that a video introduction prior to the placement starting would have been Ms X’s preference and apologised for this not taking place;
• a care consultation took place during which Mrs Y’s needs and preferences were documented and the carer identified had completed required training;
• no preference for a career who was COVID-19 vaccinated was expressed in the care consultation; and
• it explained the recruitment process for live-in carers.
20. I have reviewed Mrs Y’s care plan, and the signed service agreement between the parties. I am satisfied that Mrs Y’s Care Plan was updated with information about Mrs Y’s care provided by her family throughout the care period.
21. I have seen positive references, together with qualification certificates relating to food hygiene, fluids and nutrition and infection prevention and control for the live-in carer dated before she started to care for Mrs Y.
22. There is no reference to the carer’s COVID-19 vaccination status in Mrs Y’s care plan. There is no evidence this was raised as an essential attribute by Mrs Y’s family during the initial care consultation.
23. The Care Provider says, “we are not required to offer “video” introductions during the hiring process, neither is it common practice. The family also did not express a need for this at the consultation in which case, we may have offered it, as we do like to accommodate wishes of the family. However, following the complaint, we decided that in the future, we will adopt this as best practice. In accordance with our policy, we conducted a face-to-face introduction a day prior to commencement of the service with family present, who offered to help with settling in their mom through the Christmas period, when [the family] were living in the home with their mother until early New Year.”
24. The service agreement does not provide information about the recruitment process for live-in carers or make reference to a video consultation being required.
25. There was no requirement to hold a video introduction. This is not fault by the Care Provider.

Recording of care/incidents

26. Ms X complained that:
• The online application, (the App), was unavailable for 12 days;
• The live-in carer did not use the App to log in or record information properly;
• Incidents were not recorded using the App;
27. The Care Provider, in its complaint response, said:
• the App was not working correctly for a period of days;
• the carer was trained, the App did not update at times and guidance was given to address this problem;
• that logs were maintained by the carer and reported to the manager daily; and
• there was insufficient evidence that incidents or safeguarding matters had gone unreported.
28. Emails to the complainant from the Care Provider show that there were IT problems with the app.
29. I have reviewed emails, visit records, medication records and daily telephone records. My findings regarding medication is covered later in this decision statement. These records show that:
• There was incomplete recording of visits for the period that live-in care was provided;
• There was daily telephone communication between the Care Provider and the live-in carer; and
30. The incident specifically referred to in Ms X’s complaint was raised directly with the Care Provider by email and responded to.
31. This is fault by the Care Provider, as care provided was not fully recorded.

Meals and nutrition

32. Ms X complained that the Care Provider did not:
• Check competencies and provide adequate training;
• Deal with reports of concerns about food hygiene and handling; and
• Address concerns about Mrs Y’s independence regarding eating habits and routines.
33. The Care Provider, in its complaint response, said:
• Appropriate training had been completed;
• Observations of meal preparation demonstrated appropriate skills;
• The care plan set out Mrs Y’s food and nutrition requirements.
• The carer provided meals that they believed to meets Mrs Y’s needs and preferences;
• It acknowledged that Ms X’s expectations relating to food and nutrition weren’t met;
• The care plan could be enhanced to include the family preferences.
34. I have seen qualification certificates relating to food hygiene as well as positive references regarding meals and food provision for the live-in carer dated before she started to care for Mrs Y.
35. I have seen emails from Ms X to the Care Provider providing information about Mrs Y’s needs and mealtimes, including example meals.
36. Mrs Y’s care plan included some specific examples about breakfast but was not updated with the same level of detail for lunches, dinners or desserts.
37. The Care Provider says, “The live in carer was limited in the choice of menu for all meals, regardless of breakfast, lunch or dinner because the family were the only ones allowed to order food, therefore the live in carer had to rely on available stock in the home. We understand the grocery shopping was done online from Ocado.”
38. The Care Provider has also provided additional records showing the meals provided by the live-in carer, in accordance with the preferences set out by Mrs Y’s family.
39. Although The Care Provider acknowledged that Ms X’s expectations weren’t met, on the balance of probabilities, this was not fault by the Care Provider because of the detailed evidence of meal preparations for Mrs Y.

Medication

40. Ms X complained that the Care Provider did not:
• Properly record the administration of medication;
• Prepare and administer medication safely; and
• Deal properly with concerns about refusal of medication.
41. The Care Provider, in its complaint response, said:
• All medication records were retained;
• Medication was not recorded on certain days when the family administered it;
• An incident regarding preparation of medication was investigated and dealt with internally after which the carer was deemed competent to continue; and
• Refusal of medication had been recorded.
42. I have reviewed medication records for every day for Ms X between 11 December 2022 and 14 January 2023. These show:
• There were days consistent with the Care Provider’s explanation where medication was not administered by the carer and records show the family were responsible for this;
• There were days where the carer did not work, specified by Mrs Y’s family;
• There was one day where the medication records had no information, but other evidence shows a record of medication having been administered.
43. There was no record of medication refusal for the relevant day Ms X complained about on the medication records. Telephone records for the same day show Mrs Y’s medication having been administered jointly with the family in the morning. However, an email from Ms X shows that the medication was administered jointly at 6:40pm.
44. The Care Provider says, “As per our medication training – if a client refuses medication the Care Pro will try again later, possibly several times, and it will only be reported at the end of the day if the client has still refused. However, for specific medications which are time related, a refusal will be reported immediately. In this instance the medication was eventually taken and there was no requirement to report as refused, neither was the medication time related, in which case the medication refusal would have been done immediately.”
45. There is no indication that the medication Mrs Y was taking was time limited. I have therefore not investigated this aspect further as she did not suffer any injustice as a result.
46. This is not fault by the Care Provider.

Equipment/Aids

47. Ms X complained that the carer:
• wanted a stairgate installed; and
• was not competent with using the bath lift.
48. The Care Provider, in its complaint response, said:
• Suggestion of a stairgate was motivated by concern for Mrs Y’s safety and was discounted following a discussion with the family;
• A risk assessment was completed for the bath lift and the carer had experience using bath lifts;
• It acknowledged the bath lift may not have been used to Ms X’s specification. Ms X later demonstrated the use of the bath lift to the carer in the home.
49. There was no injustice caused as a result of a stairgate because one was not installed. I have therefore not investigated this aspect further.
50. I have seen the risk assessment for the bath lift.
51. Records show that the demonstration of the bath lift to the carer took place on 13 December 2022.
52. The Care Provider took steps to ensure the bath lift was used in the way the family wished. Although it acknowledged it may not have been used to Ms X’s specification, there is no evidence to show the use of the bath lift was unsafe. This is not fault by the Care Provider.

Care provision

53. Ms X complained that the Care Provider:
• Ignored guidance and modelled care delivery by the family; and
• Did not deal properly with concerns around Mrs Y refusing personal care on 11 January 2023.
54. The Care Provider, in its complaint response, said:
• It acknowledged that there were issues relating to personal hygiene routines and that the carer had been spoken with to prevent recurrence;
• Acknowledged that it was distressing to hear Mrs Y refusing personal care on a telephone call; and
• That Ms X had already met with managers from the Care Provider to agree a plan to replace the carer.
55. Mrs Y’s family raised multiple issues with the Care Provider by email on 19, 20 and 29 December 2022. On 3 January 2023, due to a specific issue, they asked for the carer to be replaced as soon as possible but understood this may not be possible.
56. The Care Provider agreed that the live-in carer was not a good match for Mrs Y and agreed to look for a replacement.
57. I have reviewed statements from a number of the Care Provider’s staff, which do not highlight any deficiencies in the provision of care to Mrs Y.
58. Mrs Y’s care plan states that she lives with vascular dementia so can sometimes have a ‘down’ day where she may feel tearful or frustrated for no reason but with emotional support and interaction/distraction she can often be easily reassured.
59. I am unable to attribute any distress directly to actions of the Care Provider. On the balance of probabilities, Mrs Y did receive consistent appropriate care. This is not fault by the Care Provider.

Investigation of issues

60. Ms X complained that the Care Provider:
• did not take her concerns seriously, did not take action when serious incidents happened and neglected to safeguard Mrs Y after the incidents occurred.
• Did not deal properly with a specific incident on 3 January where Mrs Y was left alone for several hours after she asked for details of measures the Care Provider would put in place to safeguard Mrs Y.
61. The Care Provider, in its complaint response, said:
• It acknowledged that the carer was unable to access the App; and
• The incident on 3 January was as a result of the carer mistakenly believing it to be their rest day and apologised for the error, which it acknowledged delayed care and support being provided to Mrs Y.
62. Mrs Y’s care plan was updated with information from the family about how her care needs should be met.
63. Medication preparation issues were acknowledged and addressed with the carer.
64. Personal hygiene routine issues were acknowledged and addressed with the carer.
65. The issue on 3 January was investigated and an apology was provided.
66. The Care Provider said it would look for a replacement carer on 4 January. Emails show a potential replacement was identified on 10 January and arranged an online meeting with the family for 17 January.
67. A meeting was held on 11 January to discuss issues raised by Ms X, which the Care Provider acknowledged was, “very urgent considering the frequency of …emails, tone, and issues.” This meeting was delayed due to Ms X’s availability.
68. On 12 and 14 January, a manager visited Mrs Y’s home to observe the carer.
69. Options were made available to Mrs Y’s family regarding potential replacements for the original carer, for the original carer continuing to work with addition support, and the original carer being withdrawn completely.
70. This is not fault by the Care Provider.

Action by the Care Provider

71. The Care Provider has identified necessary service improvements as a result of Ms X’s complaint, including:
• Before clients transition to live in care, it will ensure its system, together with the live in carer’s App, are synchronised and working effectively;
• An onsite competency assessment of the live in carer’s use of the App will take place;
• It will not longer accept that a client or representative will demonstrate how they would like a carer to use a bath lift;
• It will offer all clients and representatives the opportunity to have a video introductory meeting before signing the service agreement;
• It will expand the information available to clients and representatives about the sourcing of live-in carers.
72. I consider that the service improvements outlined by the Care Provider will address the fault I have found.

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Final decision

73. I have found fault by the Care Provider. The Care Provider has already provided an appropriate remedy. I have now completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman