Summary: The care provider failed to provide an adequate standard of care for Mr X. The care provider agrees to apologise for the failures of care and offer a sum to Mr X in recognition of the distress caused to him by its shortcomings and a further sum to Mr A and his family to recognise their time and trouble in pursuing the complaint. The care provider will also provide better training for staff and monitor the care it provides.

The complaint

1. Mr A (as I shall call him) complains the care provider failed to adhere to his father’s care plan, administer medication properly, prepare meals appropriately or attend to his personal hygiene. He says visits were often cut short or ill-timed. As a result there were times when Mr X was not given the right medication, could not eat the prepared food, and his home was left in an unhygienic and undignified state. Mr A, his sister and his aunt looked after his father on those occasions instead.

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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. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)

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How I considered this complaint

5. I considered all the information provided by the care provider and by Mr A: that includes video footage provided by Mr A as well as the provider’s daily care notes. Both parties had the opportunity to comment on a draft of this statement before I reached a final delusion.
6. 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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What I found

Relevant law and guidance

7. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 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.
8. Regulation 10 says that service users must be treated with dignity and respect.
9. Regulation 12 says that care must be provided in a safe way for service users, including the proper and safe management of medications.
10. Regulation 14 says the nutritional and hydration needs of service users must be met. It says “nutritious, appetising food should be available to meet people’s needs and be served at an appropriate temperature”.
11. Regulation 17 says the care provider must maintain securely an “accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment”.

What happened

12. Mr X has dementia and lives alone. Mr A and his sister arranged for Dunamis Care to provide care three times a day for 30 minutes, at 11am, 4pm and 7pm. The care provider says he told the family those times were not possible and agreed to 11am, 5pm and 7pm instead.
13. The care plan which Mr A prepared and agreed with the care provider, and placed prominently in Mr X’s home, was for carers to assist with a shower at the morning call, help Mr X dress, prepare breakfast, change Mr X’s stoma bag and (if it had leaked) put soiled garments in the washing machine, administer medication, encourage fluids and prepare a lunch sandwich. The teatime visit was to administer medication, check/change the stoma bag, prepare the evening meal from a selection of frozen meals which needed reheating, encourage fluids, remove washing from the machine. The evening call was to check/change the stoma bag, administer medication, find Mr X’s pyjamas, make sure teeth were cleaned, encourage fluids.
14. Mr A says he started to complain to the care provider when it became clear that the care staff were frequently arriving at unscheduled times, rarely staying the full amount of time, failing to reheat meals properly or administer the correct medication. On occasions the carers were not even in the house long enough to prepare the meals for the right length of time so Mr X would not eat them as they were still cold. He says inconsistent timekeeping meant that sometimes Mr X’s meals and medication were either too close together or too far apart: “not knowing when the carers would arrive caused him anxiety during the day because he would be constantly waiting for them and asking us when they would arrive.” He says some carers told him they were supposed to be at another call at the same time. Mr A points out that Mr X’s medication regime was time-specific and incidents when medication was missed affected his behaviour.
15. In December 2021 there was an incident when Mr X’s stoma bag leaked and although the carer assisted Mr X to shower and change, they did not clean up the mess from the leakage. Mr A has provided video footage showing there were faeces in the shower, sink, landing and bedroom. He says this was only noticed when his sister visited the following afternoon so other carers had attended in the meantime and failed to clear up as well. He says on another occasion the stoma bag had leaked while Mr X was being changed but the soiled clothes were just put in the laundry basket. The care provider says he knew about the first occasion and spoke to the carer concerned.
16. On 23 December 2021 the care provider wrote to Mr A’s sister giving notice on the contract. The care provider said it no longer covered the area where Mr X lived and “this has caused a lot of stress to both (Mr X) and the carers as they have to travel a long distance to meet the scheduled times leading to late calls and rushing around forgetting important things. It is also no longer financially viable as the travel distance and time has increased”.
17. Mr A says even during the notice period the carers continued to arrive late, miss medication and provide very short calls. He complained to the care provider. He received a response in March 2022 saying the care provider was concluding its investigation but did not receive a final response.
18. Mr A complained to the Ombudsman. He said the poor service from the care provider had a significant effect on his father’s wellbeing.
19. The care provider’s daily logs (which I have seen for the last 6 weeks of the contract) record electronically the duration of each call. I have only seen one example of a call which lasted the contracted 30 minutes. Most calls lasted less than 20 minutes. A number of care calls lasted 1 minute. There is an example of one call which lasted 4 minutes at which the carer said he had completed the following tasks:

“Dispose of PPE

Assist with daily living activities

Prompt to change into clean clothes

Prompt oral hygiene

Assist with light cleaning duties

Monitor behaviour / mood

Check communication book

Provide supervision during mealtime

Assist to prepare a meal with drinks

Prompt and assist (uid intake

Report any changes in behaviour

Oxer emotional support

Encourage independence

Developing coping strategies

Administer medication”.

20. The care provider’s MAR charts show frequent gaps in the administration of some drugs. The care provider says when errors in medication administration were brought to his attention, all the carers were retrained.
21. The care provider accepts the service was provided was poor. He says the number of calls being attended now is far fewer and so there is time to complete care plans as required.

Analysis

22. The care provider did not treat Mr X with respect and dignity. Failing to clear up leakage from a stoma bag and leaving soiled clothes in a laundry basket was very poor practice.
23. The care provider failed to administer medication as prescribed. The omission or late administration of some drugs affected Mr X adversely.
24. The care provider failed to ensure that Mr X received his meals properly prepared and on time. Some care calls were clearly far too short to reheat the frozen meals to the required temperature.
25. The length of the care calls and the tasks claimed to have been completed within them are incompatible. It is difficult to see how that met the standard of record- keeping required by the regulations. The care records were available to the care provider, but I cannot see it took any action to address the way the calls were undertaken.
26. The injustice caused to Mr X was the stress and anxiety caused by not knowing when the carers would arrive, and a loss of personal dignity. Mr X’s nutritional needs were not always met and his medical condition was adversely affected sometimes by the omission of his medication. Additional injustice was caused to Mr A and his sister in that they were called on to complete tasks which the carers omitted and spent time and effort trying to resolve the situation with the care provider.

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Agreed action

27. It is clear from the provider’s own records that the care fell far short of what was contracted for and reasonably expected. Within three months of my final decision the care provider should reimburse half the fees paid for care for the months July 2021 to January 2022. The care provider can make the reimbursement over three separate payments.
28. Within one month of my final decision the care provider should offer £1000 to Mr X in recognition of the distress and anxiety its poor care caused.
29. Within one month of my final decision the care provider should also offer £200 each to Mr A, his sister and his aunt in recognition of the distress they were caused and the additional tasks they had to carry out.
30. Within one month of my final decision the care provider should provide details of how it monitors completion of tasks by its staff; how it ensures they arrive on time at care calls; what action it takes when care falls short of the contracted tasks.
31. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

32. I have completed the investigation. I find that the actions of the care provider caused injustice to Mr X and his family which will be remedied by completion of the recommendations at paragraphs 27 – 30 above.

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Investigator's decision on behalf of the Ombudsman