Summary: Miss X complained about the care her late father, Mr Y, received at home from a care provider acting on the Council’s behalf. Miss X also complained about how the Council charged for Mr Y’s care. The Council was at fault in how it transferred Mr Y to its long-term care team, for delay in carrying out a financial assessment, for a poor complaint response and for the Care Provider’s visits being too short and sometimes very late. This caused Miss X injustice for which the Council will apologise and pay her £300. The Council will also remind the Care Provider of proper practice in home care.

The complaint

1. Miss X complained about the care her late father, Mr Y, received at home after he moved to long-term care in late 2022. Miss X also complained about how the Council charged for Mr Y’s care. Specifically, Miss X said:
• the Council transferred Mr Y to the wrong long-term care team;
• once Mr Y started to receive long-term care, his care package was too big;
• Mr Y was unable to get upstairs and did not have access to his garden;
• the Council did not arrange physiotherapy for Mr Y;
• the Care Provider sent female care workers instead of male ones;
• care workers claimed they had washed, dressed and fed Mr Y when they had not;
• many of the visits were ten minutes long or less;
• care workers did not come on time;
• some care workers had not worn uniform or ID;
• the Council delayed Mr Y’s financial assessment; and
• the Council’s communication with her was poor.
2. Miss X said this caused her and Mr Y 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6)
5. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
6. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide we could not add to any previous investigation by the organisation.
7. 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)
8. 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

9. I have considered:
• all the information Miss X provided and discussed the complaint with her;
• the Council’s comments about the complaint and the supporting documents it provided; and
• the relevant law and guidance and the Ombudsman's guidance on remedies.
10. Miss X and the organisation 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

Relevant law and guidance

Reablement

11. Reablement services are those usually provided to people after a period of significant and sudden illness. They are provided for a limited period of time, often around six weeks, to help a person to maintain or regain the ability to live independently. They involve assessment of the person to determine what support they may now need. Reablement is provided free of charge.

Paying for care

12. A council has a duty to arrange care and support for those with eligible social care needs, and a power to meet both eligible and non-eligible needs in places other than care homes. To do this council’s carry out assessments of a person’s adult social care needs and prepare a care and support plan setting out how it will meet their needs.
13. A council can choose to charge for non-residential care following a person’s needs assessment. Where it decides to charge, the council must follow the Care and Support (Charging and Assessment of Resources) Regulations 2014 and have regard to the Care Act statutory guidance. (Care Act 2014, section 14 and 17). Where a council has decided to charge for care, it must carry out a financial assessment to decide what a person can afford to pay.

Fundamental standards of care

14. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the Regulations) 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.
15. Regulation 9 says care providers should provide person-centered care. To do this, they should meet the preferences of the person receiving care, where this is ‘reasonably practicable’.
16. Regulation 17 says care providers should keep an accurate and complete record of the care they give to a person.

The Council’s complaints procedure

17. The Council says it will acknowledge complaints about adult social care within three working days and send a final written response within 20 working days.

What happened

18. This section sets out the key events in this case and is not intended to be a detailed chronology.
19. Mr Y received Council reablement support after he was discharged from hospital. That support included physiotherapy to help him start using the stairs in his home.
20. In late October, the Council’s reablement service asked Mr Y’s social worker to refer him to long-term care services. The social worker’s referral noted Mr Y:
• had not left his home for several years;
• had a bedroom and bathroom upstairs but was receiving care downstairs due to his difficulty with the stairs;
• had refused to have his bed moved downstairs and refused a stairlift;
• needed help with personal care, meals and going to the toilet, twice a day; and
• needed a ramp to get in and out of his front door.
21. The Council reviewed Mr Y’s care and support plan in preparation for him to transfer to long-term services. The review noted Mr Y would need three care visits a day; 45 minutes in the morning, 30 minutes at lunch and 30 minutes at nighttime. The Council increased the number of care visits Mr Y had because he was having trouble managing his continence.
22. The Council identified a care provider which began to support Mr Y.
23. In mid-November, Miss X told the Council she was unhappy with how Mr Y had been moved from reablement to long-term care. The Council said it agreed the information reablement staff had given Miss X about the transition was unclear and it would feed that back to the team. Miss X also said she was not happy about the timings of Mr Y’s care calls and about the care provider’s support of him. The Council said it would contact Miss X to discuss those concerns further.
24. The Council and care provider shared a call with Miss X in late November. Records of the call show:
• Miss X said some of the care workers did not wear a uniform or carry an ID;
• Miss X said care workers were only staying for ten minutes or less;
• Mr Y would only allow care workers to empty his commode and urine bottle because he did not trust the care system;
• Miss X nonetheless wanted the care visits to continue because Mr Y needed help with toileting. She said Mr Y was able to manage his personal care, although with significant difficulty; and
• the care provider would respond to Miss X’s concerns by email.
25. Miss X subsequently asked the Council to remove the lunchtime visit from Mr Y’s care package and said she did not want to change care provider. The Council reduced Mr Y’s care package and transferred him to one of its long-term service teams in late November.
26. Miss X told me Mr Y’s family wanted him to have a fifteen-minute visit in the morning and evening but the Care Provider refused. The Care Provider has confirmed the shortest visit it provides is 30 minutes long.
27. In late December, the Care Provider responded to the concerns Miss X raised in the late November call. It said the care workers who first came to support Mr Y were new and there were no uniforms available in their sizes at first. It said all staff are required to wear ID but there was sometimes a delay in getting the ID’s if staff did not bring a photograph to their induction. The Care Provider explained it had assigned some more experienced care workers to Mr Y’s care package and asked Miss X to urge Mr Y to allow them to help him.
28. The Care Provider continued to support Mr Y until he died in September 2023.
29. I reviewed a sample of Mr Y’s care records. They showed:
• at almost 70% of the visits a care worker recorded they were at Mr Y’s house for exactly 30 minutes. None of the visits were recorded as taking fewer than 20 minutes;
• care workers mostly visited Mr Y within two hours of the visit start time. However, ten percent of the total number of visits were more than two hours late. This included a visit which started at 00:02 in the morning when it had been due at 19:30 the previous evening;
• care workers emptied Mr Y’s commode and urine bottle. They occasionally noted they had chatted with Mr Y and more often, noted they had done some light housework; and
• the majority of care workers who visited Mr Y were male.

Paying for care

30. The Council sent Miss X electronic financial assessment forms in November 2022, after Mr Y moved to long term care.
31. The Council chased Miss X’s response to the financial assessment form in late January 2023 and received some information from her in late February 2023. In early March the Council asked for more information and says it did not receive a response. It therefore asked the Department for Work and Pensions for information and in October 2023, completed the financial assessment. The Council concluded Mr Y needed to pay towards his care but did not need to pay full cost.
32. While the Council was carrying out the financial assessment, it sent Miss X invoices for Mr Y’s care. She did not pay the fees.
33. In September 2023, Miss X told the Council some of Mr Y’s care visits were shorter than planned for. The Council changed its records to reflect that Mr Y had not always received the full set of hours it had commissioned each week. The reduction was not significant enough to mean Mr Y needed to pay less towards his care each week.

Complaint

34. Miss X complained to the Council in late January 2023. She chased the Council again in February and asked to speak to a manager.
35. In early March, the Council told Miss X that it had allocated Mr Y to the wrong long-term service team and that had caused the difficulties she had experienced trying to get a response.
36. Miss X said she had still not received a reply to her complaint. The Council sent its response in late March 2023. It said:
• it had discussed her concerns about the transition from reablement and about the size of Mr Y’s care package with her in November 2022. It had addressed those concerns at the time, including agreeing steps to improve the transition to reablement; and
• it was sorry it had transferred Mr Y’s case to the wrong team. It had spoken to the team responsible to prevent the mistake happening again.

Findings

37. Mr Y has died so I cannot remedy any injustice he experienced due to any fault. I have therefore focused on the injustice to Miss X.

Transfer from reablement

38. The Council has accepted it was at fault in how it transferred Mr Y from reablement to long-term services. It recognises the information its reablement service gave Miss X was not clear and that it transferred Mr Y to the wrong long-term services team.
39. The fault caused Miss X undue frustration and distress. There was no significant personal injustice to Mr Y because the care provider was in place to support him.

Care package

40. The Council was not at fault in how it dealt with Miss X’s concerns about the size of Mr Y’s care package. After its phone call with her in late November, the Council agreed to remove the lunchtime visit, but kept the 30 minute morning and evening visits so care workers could continue to support Mr Y going to the toilet. Miss X wanted Mr Y to have two fifteen minute visits per day, but the Care Provider has a minimum visit length of 30 minutes. This is common practice to ensure visits are worthwhile and was not fault.
41. The records show care workers frequently stated a visit had taken the full thirty minutes it was commissioned for and never recorded they visited less than 20 minutes. However, Miss X was often with Mr Y when care workers visited him and she reports they stayed for no more than ten minutes. On balance, I am persuaded Miss X’s recollection is accurate given the care records show care workers mainly helped Mr Y with his commode and urine bottle. This was unlikely to have taken the full thirty minutes. Care records should accurately reflect the care given, including the time spent at a visit. The Care Provider did not do this, which was not in line with Regulation 17 and was fault. This caused Miss X uncertainty about how long care workers stayed with Mr Y when she was not there.
42. While the Ombudsman would not normally automatically find fault with a care provider if care visits were shorter than they should be, we do expect to see evidence that if care workers have extra time, they make efforts to talk with the person receiving care or record if they are asked to leave early. That is not often evident in the daily care records I have seen, which was fault and caused Miss X distress. When Miss X raised concerns about the length of the visits, the Council amended its records of the number of hours Mr Y had received each week to reflect the shorter visits. This was appropriate.
43. Some of Mr Y’s visits were very late. Mr Y would not accept much of the help he was assessed as needing, which reduced the impact of the late visits. It is nonetheless unacceptable for ten percent of his visits to have been more than two hours late including the occasion it was over five hours late. It is likely this would have caused Mr Y confusion and upset, which caused Miss X distress.
44. Miss X said care workers falsely claimed they had helped Mr Y get dressed, washed and have meals. I have seen no evidence of this.
45. Mr Y preferred male care workers and Miss X is upset the Care Provider sent female care workers at the beginning of the care package. Care Providers should make efforts to meet the preferences of a person receiving care, but this is not always possible. The majority of Mr Y’s care workers were male so I do not consider the occasional female worker amounts to fault.
46. The Care Provider accepted some care workers did not attend Mr Y’s visits wearing uniforms or ID. It explained to Miss X why this happened and arranged for different, more experienced care workers to support Mr Y so he would be more confident in their care. This was appropriate so I have not investigated the matter further.

Access

47. Miss X complained Mr Y was unable to go upstairs in his home or access his garden. However, Mr Y told his social worker he did not want to have a stairlift fitted in his home. Therefore, his inability to get upstairs was not due to Council fault.
48. The Council’s referral from reablement to long-term care noted Mr Y needed a ramp to use his front door. The Council did not provide this. This was fault. The Council also failed to consider what equipment or support Mr Y needed in order to have access to his garden. This was further fault. The faults caused Miss X distress and uncertainty about whether the ramps would have been successful in enabling Mr Y to access the community and his garden.

Physiotherapy

49. Mr Y received physiotherapy as part of reablement, which was intended to improve his independence, including his use of the stairs. However, after the reablement ended, any physiotherapy would be provided by the NHS and so the lack of it was not down to the Council. It was not at fault.

Financial assessment

50. The Council did not complete Mr Y’s financial assessment and confirm his accurate weekly care costs until October 2023, one year after it first arranged for the Care Provider to begin supporting him. Some of the delay was because the Council was waiting for Miss X to send it evidence. However, that does not account for the entire period so the Council nonetheless was at fault for delay.
51. The fault did not cause Mr Y or Miss X an injustice because Miss X did not pay the fees for Mr Y’s care during that time and the care continued despite this.

Complaints handling and communication

52. Miss X complained in late January 2023 but the Council did not acknowledge her complaint. This was contra to its complaints policy. It sent its complaint response in late March 2023, a month later than it should have. The Council’s failure to comply with its complaint policy was fault.
53. Some of the failure to respond to Miss X was because the Council had assigned Mr Y’s case to the wrong team. However, staff should be prepared to respond to contact from members of the public, even if that is just to direct the person to the correct service.
54. In addition, the Council’s complaints response in late March 2023 was poor. It did not state it was the Council’s reply to Miss X’s complaint, nor did it signpost her to the Ombudsman if she was still unhappy. This was fault. The faults in this section caused Miss X avoidable frustration and meant she went to undue time and trouble.

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Agreed action

55. Within one month of the date of my final decision, the Council will take the following steps.
1. Apologise to Miss X for the distress, uncertainty and frustration she felt due to the faults set out in paragraphs 38, 41-43, 48, 50, 52 and 54 and for the time and trouble she had to go to in pursuing her complaint. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance in making the apology.
2. Pay Miss X £300 in recognition of that injustice.
3. Remind the Care Provider that care workers should keep accurate records of the time spent at care visits and that where they have extra time, they should see if the person would like company or to talk.
4. Remind the Care Provider that care visits should happen as close to the intended time as possible.
5. Remind its staff that complaint responses should be clearly identified as such and should set out the person’s right to complain to the Ombudsman if they remain dissatisfied.
56. The Council will provide us with evidence it has complied with the above actions.

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Final decision

57. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice and prevent reoccurrence of this fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman