Summary: Ms C complained she was unhappy with some of the aspects of the support she received at home from the care provider, which she said resulted in distress to her. We found there was no fault with the provider’s decision to give notice, but there was fault with two of the other issues Ms C complained about. The provider has agreed to apologise to Ms C and share the lessons learned with its staff.

The complaint

1. The complainant, whom I shall call Ms C, complained about the care provider who provided her care at home. Ms C complained:
• The care provider should not have decided to stop her care package.
• The care provider failed to tell her this information in an appropriate manner.
• The care worker regularly told her about her own personal problems and those of / with other service users. This was unprofessional and had a negative impact on her wellbeing.
• The care worker should not have left her alone on two occasions, when she mentioned plans to commit suicide that day.
• The care worker should not have given her advice about what medication she should take to make her sleep, as she is not medically qualified to do that. She did this, even though she was aware her doctor had told her not to take sleeping medication anymore.

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The Ombudsman’s role and powers

2. 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)
3. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
4. 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)
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission.

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How I considered this complaint

6. I considered the information I received from Ms C and the care provider. I also shared a copy of the draft decision statement with Ms C and the care provider and considered any comments I received, before I made my final decision.

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What I found

Ms C’s complaint about stopping her care package

7. Ms C received support at home from the care provider Helping Hands, which is part of Midshires Care ltd. Ms C’s care support included help with attending health appointments, collecting and organising medication, and having someone close by when Ms C was washing and dressing herself. The care worker would also help with shopping, going out for a walk or sitting with Ms C in her home.
8. Ms C said the care provider should not have decided to stop her care package, taking into account she had been with the same provider and care worker for three years and the impact this would have on her mental wellbeing.
9. Ms C added that, following the letter in which she received the notice, she contacted her social worker and asked her to support her with finding care support.
10. In the letter from the care provider to Ms C dated 30 September 2021, and headed “Notice to terminate care services”, the care provider gave the following reason: “covering the call and requirements is becoming increasingly challenging, as the care provider specialise in Elderly Care our workforce simply do not have the appropriate training to support your care needs”. The letter said it deeply regretted having to make this decision and gave Ms C 30 days-notice. It said this should give her enough time to find alternative arrangements.
11. In response to my enquiries, the care provider explained that it gave notice because it felt it was no longer able to safely provide the more specialist mental health support it felt Ms C needed now for her complex mental health conditions. The provider said it was only appointed to support and give her confidence while she undertook certain activities for herself. However, as time progressed, her main carer expressed concerns that Ms C now needed a care worker / provider who was more experienced in providing support to clients with complex mental health issues.

Analysis

12. The care provider considered that it felt no longer able / capable to safely provide the level of support Ms C needed during visits. As such, it decided to give notice so that Ms C could look for a care agency who had more experience and specialist expertise in supporting people with complex mental health conditions. A care agency is allowed to give notice when it no longer believes it can meet the needs of a client. As such, I did not find fault with this decision.

Ms C’s complaint about the way the care provider gave her notice

13. Ms C says the care provider was aware of her mental health conditions, including depression and anxiety, and should therefore have known how this news would impact her. As such, she said the care provider should have first explained its decision to quit to her in person, before it sent an official notice letter.
14. In response, the care provider said the team was unaware of the added anxiety it would cause to communicate the message by letter. It said that it would ask all branches and area teams to ensure that a client is first informed verbally, before sending a letter.

Analysis

15. Considering the records that I have seen, the care provider was aware that its decision to give notice would cause Ms C a significant amount of distress and anxiety. As such, the care provider should have explained its decision to her in person, before notifying her officially in writing. This was faut, which caused Ms C distress. Since then, the care provider has identified appropriate actions to try and prevent a similar incident from happening again.

Ms C’s complaint about the care worker sharing confidential information

16. Ms C complained her care worker regularly shared very personal information with her about the care worker’s family and other service users. She said this was unprofessional. Furthermore, Ms C said that, as the care worker was aware of her mental health conditions, she should have known the impact that hearing about the problems and stresses of the care worker and other service users, could have on her mental wellbeing, making her more worried about others, more (dis)tressed, more anxious, more sleepless etc.
17. In response, the care worker told me she only shared basic information about her personal life at the beginning of a visit to help make Ms C feel relaxed and comfortable. Ms C wanted more detailed information, but she never gave this. She never gave personal information about other service users.
18. In response to Ms C’s complaint, the care provider:
• Asked Ms C to provide additional information at the time of her complaint, to enable it to investigate this further. However, Ms C declined to do so.
• Told Ms C that, despite the care worker denying she provided such information to Ms C, it asked the branch to take this opportunity to re-address the importance of confidentiality in respect of customer and colleague information. Furthermore, all staff in the branch have since completed a GDPR refresher training.
19. As part of my enquiries, I sent the care provider some information I had received from Ms C that she had been told by the care worker about another service user. The information was about the support the other service users was receiving. There is no indication Ms C was aware of the other service user’s name. Ms C said she can provide more information about other service users and about the carer worker’s family as well.
20. A record from 3 September 2021 said that “We talked about what has been happening in our lives”.
21. The care provider carried out an annual care review call to Ms C on 11 August 2021. The record states Ms C was completely satisfied and said the provider had made a huge difference in her life. All care workers had been good and very professional, and she said she had a very good relationship with her main carer worker.

Analysis

22. I found that, on the balance of probabilities and considering the above record and fact that Ms C can provide personal information about the care worker’s family, as well as service users who her care worker supported, the care worker did share some personal information with Ms C during the two years she supported her. This is fault, which Ms C said resulted in distress to her.
23. However, Ms C did not raise this as a concern during her care review in August 2021, or before. During the review, she said she was very with the care worker and the support she provided. If she had done so, the care provider could have taken appropriate steps to address this at the time.
24. Since then, the care provider has identified appropriate steps to try and avoid a reoccurrence.

Ms C’s complaint about being left alone when suicidal

25. Ms C said that she would occasionally tell her care worker that she was feeling suicidal. However, Ms C told me that her care worker knew that, on days when she would say she was actually ‘making plans to commit suicide’, she was at an increased risk of actually doing this.
26. Ms C complained that, on two such days when she talked about plans to commit suicide that day, the care worker just left her, leaving her alone and unsupervised. Ms C says that, on both occasions, the care worker should have ensured that help was coming (an ambulance was called) and should have stayed with her until it arrived. Instead, Ms C said that:
• On one occasion the care worker told her to ‘stop ranting’ and only told her she should talk to a doctor and left. Ms C said she only called the Crisis Team after the care worker left. She was not ‘on the phone’ as claimed, when she left.
• On the second occasion, Ms C said she had to plead with the care worker to speak to the emergency services as she herself felt uncapable of doing this. The care worker subsequently left before the ambulance arrived.
27. In response, the care worker told me that she never spoke to Ms C in such a rude manner, and she never left her alone when there was a concern. She said she would ensure Ms C would press her lifeline and support her while she spoke to relevant services. She said she never left without knowing help was on the way.
28. The care provider only provided a response to Ms C about the first incident, which was on 30 August 2021. The records made that day did not mention that Ms C was suicidal, but said she was ‘very jittery’ that day. Furthermore, the records state:
• The care worker said Ms C should call 111 if she felt she couldn’t cope. She also asked Ms C if she would need an ambulance, to which Ms C said no. 
• Ms C said she did not want to go to hospital with regards to her mental health.
• Upon leaving, Ms C was speaking to the crisis team.
29. Ms C was unable to provide me with the date of the other incident. As such, I am unable to check the records for that specific date to see what the care worker recorded that day. I reviewed the care records from July to September 2021 and did not see a record that indicated ‘Ms C said she was suicidal that day but the care worker left’.
30. Ms C’s risk assessment states that:
• When Ms C had a bad episode, she did want to end her life and had had a history of taking an overdose of medication and needing the emergency services to come out and see her. There were also episodes when she needed to stay in hospital, until the hospital felt she was well enough to be able to go home.
• In relation to self-harm, it is important for the care workers to make sure that they keep an eye on Ms C and to report any changes in her behaviour and change in mood.
31. Records provided by the care provider showed that on two occasions in July and August 2021 Ms C was not feeling well. The care worker encouraged her to call 111 for advice and use her lifeline and updated the office after the visit.
32. Overall, the care records I have seen from July and August 2021 show the care worker was concerned about Ms C’s wellbeing, and encouraged her to contact 111 and / or her mental health support network when she was concerned about Ms C.

Analysis

33. I investigated the two incidents as described by Ms C. On one occasion Ms C was left alone, but the records do not indicate the level of risk as described by Ms C. I was unable to determine when the other incident happened and as such, what the records said about what happened.
34. Ms C’s risk assessment identified that she was at times at high risk of suicide and had in the past acted on this (taking an overdose). However, taking this risk into account, the risk assessment failed to sufficiently specify what a care worker should do if Ms C would be specific, during a visit, about having plans / going to kill herself. This is fault. With this being such a serious matter, I found the risk assessment failed to sufficiently state that on such occasions, a care worker should always contact the office and discuss whether the care worker should wait with Ms C until help arrives.

Ms C’s complaint about the care worker giving her medical advice

35. Ms C said her care worker gave her advice about what medication she should take to make her sleep, even though she should not do this as she is not medically qualified to provide that advice to clients. She said this was unprofessional and potentially dangerous. She told me the care worker also went with her to the supermarket to buy them. This was even though Ms C told the care worker her doctor(s) had told her not to take medication to help her to sleep and the risk of her using it to overdose herself.
36. In response, the care worker said she would never provide such advice as she is not medically qualified to do so. She never accompanied her to any supermarket to buy medication.
37. The care provider told Ms C in its response that it is unable to verify what was said in the conversation between the two parties.

Analysis

38. I found that any further investigation is unlikely to add to the response already provided. Furthermore, I have not seen evidence the events caused an injustice to Ms C. As such, I discontinued my investigation into this aspect of Ms C’s complaint.

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Agreed action

39. I recommended that, within four weeks of my final decision, the care provider should provide an apology to Ms C for the faults identified above and the distress these have cause her. It should also share the lessons learned from the fault identified in paragraph 34 with other relevant teams and branches.
40. The care provider has told me it has accepted my recommendations.

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Final decision

41. For reasons explained above, I found there has been fault, as a result of which I have upheld Ms C’s complaint.
42. I am satisfied with the actions the care provider will carry out to remedy this and have therefore decided to complete my investigation and close the case.
43. Under our information sharing agreement, I have shared this decision with the Care Quality Commission.

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Investigator's decision on behalf of the Ombudsman