Summary: Mr X complains the care provided to his Mother Mrs Y, was unsatisfactory. We find fault with the Care Provider for falling below the expected standards of service. We have recommended a financial remedy for the distress and frustration caused as a result.

The complaint

1. Mr X complains about the way the Care Provider went about arranging care for his mother, Mrs Y, for 22 days over the Summer while he was away.
2. He says the Care Provider did not arrange a carer until the last minute, when it had seven months’ notice, and the carer provided did not have experience the Care Provider represented.
3. Mr X would like to be refunded for the extra care he had to source as the Care Provider did not provide the service expected. He would also like an apology, compensation and for the carer to be dismissed.

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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. If they have caused an injustice we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) as amended)
5. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
6. 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)
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission.

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How I considered this complaint

8. I have considered:
• The information provided by Mr X and discussed the complaint with him;
• The Care Provider’s comments on the complaint and the supporting information it provided; and
• Relevant law and guidance.
9. Mr X and the Care Provider 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

Law and guidance

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. The standards include:
• Person-centred care (Regulation 9): The service user must have care or treatment that is tailored and meets their needs and preferences. Providers must involve a person acting on the service user’s behalf in the planning of their care and treatment.
• Dignity and respect (Regulation 10): Service users must be treated with dignity and respect and in a caring and compassionate way.
• Safeguarding from abuse (Regulation 13): Service users must be protected from abuse and improper treatment, this includes neglect.

What happened

11. Mr X arranged for a live-in carer to look after his Mother, Mrs Y, while he was away for just over three weeks. Mr X’s son and girlfriend stayed at the house for the first week, and his cousins stayed for the weekend.
12. Mrs Y usually has three to four visits a day by a different care provider (CP2). As Mr X was away, he wanted a live-in carer to support Mrs Y.
13. Mr X did not want to lose the slots he already had with CP2 so the plan was for CP2 to cover the live-in carer’s daily two-hour break while he was away.
14. Mr X arranged the care seven months before his holiday. The week before he was about to leave, the Care Provider contacted him to say the carer they were going to provide was no longer available so they were looking for alternatives.
15. Mr X says this caused him stress and chaos a week before his holiday.
16. The Care Provider did provide a carer who arrived on 4 August. Mr X said he immediately had concerns she was unsuitable for the job.
17. The Care Provider had promised the carer would provide:
• 1:1 personalised support to meet Mrs Y’s individual needs;
• Companionship to prevent isolation and loneliness;
• Support for medication, hydration and nutrition;
• Domestic chores such as laundry, cooking and cleaning;
• Managing continence, medication and mobility;
• Personal care and bathing, and
• Support to attend social events.
18. Mr X says the carer was a slight lady who used a walking stick and told him she couldn’t bend down. Mrs Y needs help with mobility and needs to be taken to the toilet every 90 minutes.
19. When Mr X and his fiancé were home, he says the carer did not take Mrs Y to the toilet once. She also failed to engage or talk with Mrs Y before Mr X left for his holiday.
20. Mr X left for his holiday on 5 August. His fiancé wrote notes for the carer and they both gave her instructions on how to care for Mrs Y. Mr X says he felt the carer was not paying attention and was always on her phone.
21. Mr X arranged for extra care to come in from CP2 to help care for Mrs Y in the morning, as well as an hour in the afternoon to cover the live-in carer’s breaks.
22. Mr X returned from his holiday at midday on the 26 August. The carer was not due to leave until 5pm.
23. Mr X’s son advised him that when he was at home with Mrs Y the carer didn’t engage with Mrs Y at all. She sat in her room or in the kitchen on her phone.
24. The carers from CP2 reported to Mr X the carer asked them to put the washing out, and she left Mrs Y wet in bed in the morning.
25. Mr X said the carer missed giving some medication to Mrs Y, and on arrival to the house she had promised to make homemade meals but Mr X says on their return there was ready meal packaging left all over the kitchen. He says he returned home to a terrible smell in the kitchen and overflowing bins.
26. The Care Provider made a care plan dated 6 July. Mrs Y regularly attends a singing group one afternoon a week and the care plan said the carer would escort her to this, and play card games with her.
27. Mrs Y said she did not go to her singing group and the carer did not play cards with her.
28. The care plan also stated the carer must wash Mrs Y, help with the toilet and change her pads, prepare all meals, encourage fluids, socialise at mealtimes, ensure the kitchen is tidy after meals, buy fresh food items, ensure all medication is taken at correct times and with the correct dosage filling in the medication charts. The carer must clean and tidy, change bed sheets, do laundry, take out rubbish and feed the cat.
29. The care plan says Mrs Y usually wakes around 7am and likes to be taken to the toilet and then have a cup of tea in her chair before she gets washed and dressed.
30. The care records show there were days when the carer did not go to Mrs Y until 9 or 10am, once the carers from CP2 arrived.
31. Mr X complained to the Care Provider on 16 September and said the carer was:
• Unable to bend down or support Mrs Y who has reduced mobility;
• Inexperienced – she said this was her first assignment;
• Neglectful – she left Mrs Y on her own for long periods of time, she didn’t engage or converse with her, left her in soiled clothes and didn’t take her to the toilet every 90 minutes as she was supposed to;
• Non companionable – did not take Mrs Y on any excursions and stayed in her own room;
• Forgetful – unable to remember simple instructions and got Mrs Y’s medication wrong, failed to give her the lunch time medication and told the other carers it wasn’t required;
• Disorganised – food left in fridge was past its use by date, and the bin was infested with maggots.
32. Mr X said he had to pay over £1000 for extra care and sought a refund.
33. The Care Provider’s response addressed Mr X’s points:
• Disabled: Unsubstantiated. The Deputy Manager trained the carer on 8 July and witnessed her moving and handling abilities, which raised no concerns. The Deputy Manager also visited the carer at work on 16 August where she saw her carry out daily tasks for Mrs Y without struggle.
• Inexperienced: Unsubstantiated. During the investigation the carer said she had said this was her first assignment. The Care Provider apologises for this miscommunication. It was in fact her first assignment with the Care Provider. She has over three years professional and personal caring experience.
• Neglectful and Non-Companionable: Partly substantiated. The carer said that she often engaged with Mrs Y, and she did take her to the toilet every 90 minutes although this is not reflected in the care records. She said during the investigation she did not play cards with Mrs Y, and did not take her to singing group but this was because the carers from CP2 came at different times each day. CP2 could not confirm their arrival times in advance so she could not plan excursions.
• Forgetful: Substantiated. It is evident looking at the medication charts that some medication was not given to Mrs Y on 24 August, with no reason given in the chart. The Care Provider apologises that this happened and was not noticed sooner for it to action.
• Disorganised: Partly substantiated. During the investigation the carer said she only cooked two meals, the rest were ready meals. She said on arrival the bins were full, so she had to leave the black bin bags on the side in the kitchen.
• She let the supplementary carers do her work and asked them to do the domestic chores: Partially substantiated. During the investigation the carer said she asked CP2 to hang out the washing as the wash had just finished when CP2 had arrived to cover her break. Her domestic tasks were documented every day in the care records.
34. The Care Provider apologised for the distress caused and confirmed the carer was subject to their disciplinary policies and procedures. It gave Mr X a credit of £300 for the substantiated complaints.
35. It also said “further actions are being implemented to prevent further concerns”.
36. Mr X was not happy with the response or credit so he brought a further complaint on 8 November, and the Area Manager responded on 23 November saying:
• The assessment was Mrs Y did not need waking night care. If Mrs Y had nighttime needs, it would have put in a second carer (to cover night duty);
• He was sorry about the change of staff, there was an unexpected emergency;
• If family who were staying with Mrs Y had raised concerns at the time, they could have provided a replacement carer;
• The deputy manager had observed the carer and did not have concerns about her moving and handling; and
• Mr X paid for an additional hour (on top of the existing two hours already in place with CP2).
37. The Care Provider offered £500 to Mr X as a gesture of goodwill. Mr X did not accept the offer and brought his complaint to the Ombudsman.

Analysis

38. The Care Provider was right to inform Mr X the original carer was no longer available. This is not fault. It found an alternative carer before he went away.
39. The use of a walking stick does not prohibit the carer providing the care needed. The Care Provider says she completed all the training given and it had no concerns about her ability to carry out the job. And the evidence indicates a manager provided moving and handling training before the carer started work. So there is no fault.
40. However there was fault in the care which the Care Provider has acknowledged in the complaint response. Medication was missed, the carer failed to engage with Mrs Y as stated in the care plan, she was left in bed a lot later than stated on the care plan, and there is no record of her being taken to the toilet every 90 minutes so there is no evidence this was done. Care was not in line with the Regulations set out in paragraph 10.
41. This was distressing for Mrs Y, and frustrating for Mr X. I therefore recommend a distress payment for Mrs Y along with a symbolic payment for the faults identified.
42. In response to the draft decision, the Care Provider said it has introduced an electric recording system where the care workers record the daily notes and medication. It warns when medication has not been given and is accessible to the family of the person receiving care.

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Agreed action

43. The Ombudsman’s role is to provide a solution or remedy to the problem, not to hold bodies to account or provide compensation. That is for the Courts. We identify fault causing injustice that we can remedy.
44. The Ombudsman cannot instruct the Care Provider to take disciplinary action against specific employees. This is because the Ombudsman does not employ them.
45. It was Mr X’s choice to book the extra care. He did not tell the Care Provider who may have been able to relieve his concerns or instruct another carer. I therefore do not think it is a suitable remedy to refund the money paid for the extra care.
46. Within one month of the Ombudsman’s final decision, the Care Provider should:
• Write a personalised apology to Mrs Y for the distress caused;
• Pay £250 to Mr X for the frustration identified above;
• Pay £250 to Mrs Y for the distress caused.
47. Within three months of the Ombudsman’s final decision the Care Provider should arrange training for the carer involved. This should focus on the importance of providing personalised care, medication administration, and accurate record keeping.
48. The Care Provider should provide us with evidence it has complied with the above actions.

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Investigator's decision on behalf of the Ombudsman