Summary: The care provider did not always provide a good and safe standard of treatment to Mrs X. Although some concerns were addressed after Mrs A’s complaint, the care provider will now acknowledge the outstanding injustice.

The complaint

1. Mrs A (as I shall call her) complains about the standard of care provided to her mother Mrs X at home. She complains about late and rearranged care calls, some poor standards of cleanliness and unsafe care, and inadequate notice about timings of care calls. She says on one occasion a manager acted as a carer but under a different name. She says as a result of the poor responses she had to her complaints she suffered stress and anxiety.

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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))

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How I considered this complaint

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. I considered the information provided by Mrs A and by the care provider. This includes photographic evidence provided by Mrs A. Both parties had an opportunity to comment on an earlier draft of this statement and I considered their comments before I reached a final decision.
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 9 says the care and treatment of service users must be appropriate, meet their needs and reflect their preferences.
9. Regulation 12 says care and treatment must be carried out in a safe way.
10. The care provider’s complaints procedure says it will acknowledge a complaint within three working days and provide the name and contact details of the person dealing with it.

What happened

11. Mrs X lives with her daughter Mrs A. Mrs X began to receive care from the care provider in May 2021. The contract was for three calls a day at 08.40, 13.30 and 19.30. It was agreed there was a 30-minute window of variability about the call times.
12. Mrs A says because she works part-time it was important she knew the carers’ rota. She says at the start of the contract everything went well. She says however that she constantly had to ask for the rota to be sent to her despite the agreement this would be done.
13. Mrs A says as the familiar carers changed, the standard of care and time-keeping deteriorated. She says carers told her they were late for the morning call because another call had now been arranged to precede it. She says that standards of cleanliness also deteriorated and she found the waste bins overflowing and the toilet not cleaned properly. She says that she came home on one occasion to find the carer in the bathroom, and her mother facing downstairs attempting to get into the stairlift on her own, without the stairlift chair being turned round for her to access.

The complaint

14. Mrs A provided photographic evidence to the care provider of her concerns in August 2022. She complained about the change in the care call times without agreement, the unsafe practices and poor standards of cleanliness, and the lack of confidentiality evidenced by some staff. She queried whether the proper employment checks had been undertaken with one member of staff whom she believed to have been found guilty of fraud. She also complained that on one occasion a new carer had introduced herself under a false name and Mrs A later discovered she was a manager shadowing care staff.
15. The contract was terminated by the care provider on 02 September.
16. The care provider responded to the complaint in October 2022. She said where concerns had been raised by Mrs A she had responded at the time. She referred to a review in August 2022 where Mrs A had said she was satisfied with the service, had no concerns to raise and was generally happy with the staff – although Mrs A had also commented that some staff were better than others.
17. The care provider said breaches of confidentiality had been addressed with all staff and they had been reminded in supervision not to discuss details of other clients. She said in respect of the carer about whose employment history Mrs A had raised concerns, that matter was confidential, but she confirmed all appropriate checks had been completed.
18. In response to the attendance of a manager under a different name, the care provider said that manager did sometimes act as a carer so she could get real-life experience of how other carers behaved. The care provider said it was an audit tool it had found useful.
19. Mrs A complained to the Ombudsman. She commented on the care provider’s response. She said in respect of the photographs of her mother leaning over the stairs, she believed there was an urgent need for staff training but had been told by the local branch manager that staff did not receive training in the use of stairlifts. She said she did not object to the manager facilitating a care call, she objected to her introduction of herself with a false name.
20. The care provider says the rota was not rearranged to accommodate another client, as Mrs A was told. She says there was a cyber-attack on the agency’s system (and has provided evidence) which affected the way calls were arranged. The care provider issued a credit note to Mrs A for calls reduced to 30 minutes (from 45 minutes) during the relevant period, although she says frequently calls exceeded this.
21. The care provider says where concerns were raised about (for example) failure to clean the commode, this had been discussed with the relevant staff who accepted it was poor performance on their part. She says unfortunately some staff no longer wanted to work with Mrs X while Mrs A was present as they felt she was unduly critical. She points out that on occasions Mrs A asked for staff to be withdrawn from the care package then rescinded the request the following day (and has provided the email trail as evidence).
22. In response to Mrs A ‘s complaint about the manager attending care calls, the care provider says, “It is not unreasonable to expect this [the attendance of a manager] to be undertaken particularly with service users where previous complaints have been lodged to ensure that they have been resolved to everyone`s satisfaction, and to assess if she feels further improvements can be made to the care delivery service we provide.” The care provider says this practice has been praised by the local council’s quality assurance officer.

Analysis

23. There were occasions (as shown in the photographs) where standards of cleanliness and care were not acceptable, and the care provider accepted that. In particular it was poor and unsafe practice for care staff to fail to attend Mrs X while she was attempting to access the stairlift. That caused uncertainty and anxiety to Mrs A about what might happen when she was not there to witness it.
24. Although Mrs A had agreed some variability about the times of the care calls, they became unacceptable when a morning call scheduled for 0840, for example, was not attended until 0950.
25. It appeared to be poor practice that the care provider’s response to the complaint in August 2022 was to terminate the contract. That was not in line with its procedure.

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Agreed action

26. In response to my draft decision, the care provider has reviewed its training needs for staff around the safe use of stairlifts, introduced this into its moving and handling training, and carries out spot checks;
27. Within one month of my final decision the care provider has reviewed the way it implements its complaints procedure to ensure compliance;
28. Within one month of my final decision the care provider agrees to offer the sum of £250 to Mrs A in recognition of the anxiety caused by potentially unsafe practices and the frustration of not knowing which carers would attend.
29. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

30. I have completed the investigation. I find the actions of the care provider caused injustice to Mrs A and Mrs X which the completion of the recommendations in paragraphs 26 – 28 will remedy.

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Investigator's decision on behalf of the Ombudsman