Summary: Mrs X complains about the actions of her care provider. She says the carers did not wear correct personal protective equipment, care was rushed and inadequate, care was cancelled without discussion, and that a carer falsified her timesheet. She also complains the care provider’s communication with her son was poor. We find some fault with the care provider’s actions. We have made recommendations.

The complaint

1. Mrs X complains about the actions of her care provider. She complains:
• Some carers did not wear correct personal protective equipment (PPE) during care calls.
• Care provided was rushed and on one occasion, the carers had not cleaned the bathroom adequately.
• A carer falsified her timesheet.
• The care provider cancelled her care package at short notice without discussing it with her first.
• The care provider’s communication with her son was poor.
• The Council’s complaint responses were abusive and threatening.
2. Mrs X says the care provider’s actions caused significant stress for her and her son.
3. Mrs X is represented by her son, Mr P.

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The Ombudsman’s role and powers

4. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
5. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))

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How I considered this complaint

6. I spoke with Mr P and considered the information he provided.
7. I made enquiries with the care provider and considered the information it provided.
8. I sent a draft decision to Mr P and the care provider and considered their comments.
9. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I found

Fundamental standards of care

10. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set 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.
11. Regulation 12 deals with safe care and treatment. The intention of this is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Providers must assess the risks to people’s health and safety during any care or treatment. Providers must also prevent and control the spread of infection.
12. CQC notes there are inherent risks in carrying out care and treatment and they will not consider it to be unsafe if providers can demonstrate they have taken all reasonable steps to ensure the health and safety of people using their services and to manage risks that may arise during care and treatment.
13. Regulation 17 deals with good governance. It notes providers must securely keep accurate, complete and detailed records in respect of each person using the service and the overall management of the regulated activity.

Council’s complaint policy

14. This policy sets out the care provider’s procedure for responding to complaints.
15. The policy notes that when the investigation report is sent to the complainant, the complainant must be advised they have 10 working days to comment on the report.
16. Where the complaint cannot be resolved to the complainant’s satisfaction, they should be reminded of their right to take the complaint further with the appropriate bodies, including the Ombudsman.

The Ombudsman’s principles of good administrative practice

17. These are our benchmark for the standards we expect when we investigate the actions of bodies within our jurisdiction.
18. Our fourth principle is acting fairly and proportionately. This includes being impartial and treating people with respect and courtesy. We also note bodies should deal with people and issues objectively.

What happened

19. In May 2020, Mr P arranged domiciliary care for his mother. The care plan set out the care provider would provide support for personal care, medication, and general housekeeping.
20. A record noted Mrs X wished for care staff to follow all hygiene procedures and to wear personal protective equipment (PPE), including face masks, during the Covid-19 pandemic. Mrs X’s care plan also noted that carers should wear correct PPE. The care plan did not provide any further information on what PPE carers should wear.
21. In June 2020, Mr P sent the care provider an email noting a carer had left a call early, after 25 minutes. He also raised concerns the carer’s timesheet did not accurately reflect the time she left the call.
22. At the end of June 2020, Mr P told the care provider the call times he would like in place. He also confirmed these would not be changed.
23. In July 2020, Mr P gave notice to the care provider, asking for care to end in August 2020. Mr P also raised some concerns about Mrs X’s bathroom being dirty.
24. On 4 July 2020, Mr P asked the care provider to pause or cancel the care after the lunchtime call on 9 July 2020. Mr P explained Mrs X would be entering respite care at a care home. Mr P also noted he was not sure of the duration of the respite care.
25. Three days later, Mr P emailed the care provider asking it to pause the care from 10 July 2020. In this email, Mr P said he would confirm the date the next day. Mr P also raised concerns about carers arriving to calls without appropriate PPE.
26. Mr P later told the care provider he needed to change the date to pause the care due to care home availability. The care provider told Mr P it was not possible to change the date as it had already amended the rota for carers. The care provider was able to provide some care calls but not all the calls Mrs X wanted.
27. In August 2020, Mr P made a formal complaint. He raised the following issues:
• Carer falsifying timesheet.
• Carer not cleaning bathroom appropriately.
• Care being rushed.
• Care staff not wearing appropriate PPE.
• Care provider cancelling care package without agreement.
28. The care provider responded to Mr P’s complaint. The care provider said:
• it had spoken to the carer regarding the timesheet and the carer said she was in the call longer than 25 minutes. The carer also said Mrs X told her she could leave early.
• Care was not rushed and the carers had worked at Mrs X’s pace. The care provider also said Mrs X could have asked carers to slow down if she was unhappy.
• It did not accept the carer would have left the bathroom dirty. It said Mrs X could have used the bathroom after the carer had left.
• Mr P had told it, in his email of 4 July 2020, to pause or cancel the care after the lunchtime visit on 9 July 2020.
• Carers should be wearing PPE to carry out their duties.
29. The Council’s complaint response did not detail the next stage of the complaints process or refer Mr P to the Ombudsman.
30. In October 2020, Mr P contacted the director of the care provider to discuss his complaint. The emails exchanged between Mr P and the director were tense and direct. One email from the care provider noted it would contact Mr P’s employer about his conduct. The director told Mr P it had fully dealt with his complaint but did not refer him to the Ombudsman.
31. In response to our enquiries, the care provider confirmed its risk assessments for Covid-19 were contained within Mrs X’s care plan. It did not provide any other risks assessments or documents which stated what PPE carers were required to wear when attending calls.
32. The care provider did not provide the call notes for May and for most of June 2020. The rest of the call records do show carers leaving early on some occasions. It was noted either Mrs X or Mr P agreed for the carers to leave early.

Analysis

Carers not wearing correct PPE

33. The care provider did not provide any specific risk assessments related to the Covid-19 pandemic. The evidence shows the care provider did note in Mrs X’s care plan that carers should wear correct PPE. However, there is no detail about what this means or what is correct PPE. Therefore, it is not clear what PPE the care provider expected care staff to wear during calls.
34. One of the fundamental standards of care is related to safety. The regulations set out that providers must assess the risks to people’s health and safety during any care or treatment. It also states that providers must prevent and control the spread of infection.
35. Having reviewed the care provider’s records, I am not satisfied the care provider took all reasonable steps to manage the risks that may arise during care and treatment during the Covid-19 pandemic. This is because the risk assessments contained within Mrs X’s care plan is not specific or detailed enough to show the care provider had given proper consideration to managing the risks associated with Covid-19. This is fault.
36. I cannot make any findings on whether Mrs X’s carers were wearing correct PPE during the calls. This is because, without any risk assessments detailing what PPE was required, this is a subjective matter. However, I do consider the fault identified has caused as injustice as it is clear Mr P felt the carers were not wearing appropriate PPE. This in turn would have caused him some distress and worry for his parent’s health and safety.

Care provided was rushed and occasionally inadequate

37. The care provider did not provide all the care records for the time period it provided care to Mrs X. However, from the available call notes, I am satisfied the care provided to Mrs X was in line with her care plan.
38. There is some evidence of carers leaving earlier than the allocated visit time. This might explain why Mr X felt the carers were rushing Mrs X’s care. However, I note this was infrequent and the carers had completed their tasks and sought agreement from Mrs X or Mr P first before leaving early.
39. Given the conflict in evidence, I do not consider I can make a decision, even on balance, whether the care provided was rushed. Therefore, I cannot comment further on this matter.
40. With regards to the bathroom, I note the carer had recorded they had tidied the bathroom and wiped around in the morning. Mr P raised concerns about the state of the bathroom in the afternoon. Therefore, it is possible Mrs X could have used the bathroom after the carer had left. Therefore, I do not consider it possible for me to make any further comments on this matter.

Falsified timesheet

41. The care provider has not provided me with a copy of the timesheet for the carer who attended the call. The care provider also did not provide me with a copy of the relevant visit notes.
42. I note the care provider said it had spoken with the carer and they had said Mrs X told them they could leave early as they had completed all tasks. However, the care provider could not provide me with any record of this conversation or meeting.
43. Therefore, I find fault with the care provider’s record keeping as there should be a record of this discussion to show what was discussed. Further, as the care provider could not provide me with a copy of all visit notes, this suggests it is not properly keeping its records.
44. I consider the fault identified could potentially cause an injustice to others in the future. However, I do not consider the fault identified caused any personal injustice to Mrs X or Mr P. This is because there is no evidence to suggest the carer failed to complete any tasks they should have done in line with the care plan. Further, there is some evidence to suggest Mrs X told the carer they could leave the call early.

Cancellation of care package

45. Mr P first emailed the care provider at the beginning of July 2020. In his email, Mr P told the care provider his mother would be going into respite care while he was away. He asks the care provider to pause or cancel the agreement after the lunchtime visit on 9 July 2020. I note Mr P mentions uncertainty about how long the respite care will be, but not on the date of when he wanted the care to be paused or cancelled.
46. A few days later, Mr P sent the care provider another email asking for the pause to care to start on 10 July 2020. In this email, Mr P does tell the care provider he will confirm the dates for the pause the next day.
47. While Mr P told the care provider he would confirm the date for when the care should be paused in his later email, I do not consider the care provider has acted with any fault in cancelling the care package. This is because there is clear evidence Mr P asked for the care to be paused or cancelled from 9 July 2020 in his email of 4 July 2020. This meant he provided five days notice to the care provider for the care to be paused.
48. Therefore, I consider it was reasonable for the care provider to have amended its rotas for its carers to ensure they had other work given the short notice.

Communication and complaint handling

49. The evidence shows Mr P and the care provider communicated mostly through email. I note the care provider responded to most of Mr P’s emails in a timely manner. There is also evidence the care provider responded to Mr P’s wishes and concerns at the time.
50. Therefore, I do not consider there has been any fault with the care provider’s communication with Mr P.
51. The care provider provided a response to Mr P’s complaint in August 2020. The care provider did not tell Mr P he had 10 working days to comment on the complaint response. The care provider also did not advise Mr P of his right to bring his complaint to the Ombudsman. This was not in line with its policy and this is fault.
52. Mr P provided a copy of his email communications with the director of the care provider. I have reviewed the correspondence and I am of the view the responses by the care provider were not professional or appropriate in the circumstances. I also do not consider the care provider treated Mr P with respect and courtesy in its responses.
53. I appreciate the care provider’s position that it had found no fault during its complaint investigation. I also acknowledge its position that it was entitled to chase Mr P for the outstanding payments. However, it should have remained objective and impartial when communicating with Mr P. Its comment that it would contact Mr P’s employer was inappropriate in the circumstances as it was not relevant to dealing with Mr P’s complaint.
54. Therefore, I find fault with the care provider’s complaint responses to Mr P as I do not consider the responses to be in line with our fourth principle of good administrative practice.
55. I consider the faults identified caused Mr P an injustice. This is because he was caused distress by the care provider’s response.

Agreed action

56. To remedy the injustice caused by the faults identified, I recommend the care provider complete the following:
• Apologise to Mr P for the injustice caused by the faults identified.
• Pay Mr P £100 to recognise the distress caused by the faults identified. The care provider may offset this amount against any outstanding debt.
57. The care provider should complete the above within four weeks of the final decision.
58. Develop a policy or operational guidance to ensure:
• records of any verbal conversations with staff regarding concerns or complaints raised by service users are accurately kept and retained.
• detailed risk assessments are completed for all service users, including around the use of PPE during the Covid-19 pandemic.
59. Remind relevant staff of the importance of keeping accurate records of actions taken during care visits. This includes accurately recording the time spent at the visit.
60. Remind relevant staff of its complaints policy to ensure complainants are referred to the Ombudsman at the end of the process.
61. The care provider should provide the Ombudsman with an update on the above within two months of the final decision.

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Final decision

62. I find fault with care provider for not taking all reasonable steps to manage the risks that may arise during care and treatment during the Covid-19 pandemic. I also find fault with the care provider’s record keeping. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman