Summary: Mrs X complained about the quality of care provided by the Council commissioned care provider Routes Healthcare DCA. Mrs X received care in line with her care package. However, the care provider’s lack of records leaves Mrs X with a sense of frustration and uncertainty over whether her complaints were fully responded to. The Council has agreed to apologise for this. It has already taken action to prevent recurrence of the fault.

The complaint

1. Mrs X complained about the quality of care provided by the Council commissioned care provider, Routes Healthcare DCA, between June 2022 and June 2023. In particular, Mrs X said care workers failed to support her fully with her personal hygiene and meals. She said care workers also damaged her clothing, bed sheets, broke her boiler and tumble dryer and cut their visits short. Mrs X said this caused her distress and meant her care needs were not met and she was paying for care she did not receive. Mrs X would like a refund of some of her care charges and action taken against the care provider.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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)

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How I considered this complaint

4. I have considered the information provided by Mrs X and discussed the complaint with her on the telephone. I have considered the Council’s response to my enquiries and the relevant law and guidance.
5. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
6. In this case the Council commissioned the care provider to support Mrs X so we consider the Council is responsible for its actions.
7. 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.
8. I gave Mrs X and the Council the opportunity to comment on a draft of this decision. I considered any comments I received before reaching a final decision.
9. Under our information sharing agreement, we will share the final decision with the Care Quality Commission (CQC).

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What I found

Relevant law and guidance

10. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
11. 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 CQC has issued guidance on how to meet the fundamental standards below which care must never fall. This includes:
• that the care and treatment of service users must be appropriate, meet their needs and reflect their preferences (regulation 9);
• providers must make sure that people have enough to eat and drink to meet their nutrition and hydration needs and receive the support they need to do so (regulation 14).
• providers must have an effective and accessible system for identifying, receiving, handling and responding to complaints (regulation 16).
• providers must securely maintain accurate, complete and detailed records in respect of each person using the service. (regulation 17)

What happened

12. Mrs X has physical health conditions which affect her mobility. Following a hospital admission, Mrs X stayed in a care home before being discharged home in late June 2022 with a package of care. This consisted of 30 minute visits four times a day by two care workers. Mrs X manages her own finances and pays for the full cost of her care package which was commissioned for her by the Council.
13. The care package consisted of support with personal care and repositioning, help with dressing and undressing, laundry, support with continence and the preparation of meals, snacks and drinks.
14. In early July the social worker contacted Mrs X. They noted Mrs X loved being at home but did not think the care package was very good with care workers not turning up when they were supposed to and not always offering her a wash. They noted Mrs X did not want the social worker to take any action as Mrs X said she had already complained to the Care Provider’s head office.
15. The social worker visited Mrs X in mid-July. They noted Mrs X was eating a lot of snack food. She declined the suggestion of meals on wheels but was given information about local cafes that provided deliveries. She reported certain staff moved things around and she was unhappy with this and having to pay for her care. At a further home visit in mid-August, Mrs X was concerned if her regular care workers were not available, it meant the morning visit was very late which impacted on her health conditions and meant her continence pad was not changed for a long period.
16. In early September, Mrs X complained to the Council that her morning visit had been at 11.15am and then care workers arrived for the lunch visit at 12.30pm. She said she had rung the head office who had hung up on her. Mrs X confirmed she had raised her voice. She said this was the fifth time she had to ring head office as care workers were late. The social worker contacted the care provider who confirmed the late visit was due to last minute staff sickness. It said Mrs X had originally requested a 10am morning visit and had now requested this to be at 9am. It did not have availability at that time but would put her in an earlier slot when it had availability.
17. In mid-October, Mrs X contacted the Council. She said the care workers regularly arrived late and did not know what they were doing. She said they would walk out without giving her food. She thought this was because she annoyed them as she spoke her mind. Mrs X said she had made four complaints in four months to the care provider. The care provider confirmed to the social worker it had moved Mrs X’s visit to 9am from the following week. It said Mrs X was very abusive to staff. When she rang the office, she shouted and called staff stupid and would put the phone down. It said it was having difficulty finding staff to visit Mrs X because of the way she spoke to them. The social worker phoned Mrs X who said the care provider’s staff were stupid and were useless. They noted Mrs X refused to give any specific information and Mrs X put the phone down.
18. In late February 2023, the social worker visited Mrs X with a nurse to assess whether Mrs X was eligible for health funding. This concluded Mrs X’s care needs should continue to be met by adult social care. The social worker reviewed Mrs X’s needs assessment. During the assessment Mrs X raised concerns about the care provider. The social worker suggested a meeting with the care provider which Mrs X initially declined. They suggested they look for an alternative provider but Mrs X said there was no point.
19. The social worker spoke to the care provider which said Mrs X was very abusive to staff calling them stupid and idiots and would ask them to leave the property. It had tried to resolve issues with Mrs X without success. Mrs X later agreed to a meeting. At the meeting in mid-March they discussed:
• Food – Mrs X said she wanted care workers to cook ‘proper meals’. The social worker noted they suggested Mrs X buy food care workers can prepare in the allocated time such as microwave rice, mashed potato and steamed vegetables. Mrs X said she did not like any of this. The social worker suggested care workers put meat in the oven on a low heat during the morning visit to cook through the day but Mrs X did not agree. She did not give an example of the food she wanted, did not want to create a weekly meal plan, order meals for delivery or increase the visit time so she could prepare food with the care workers.
• Personal care – Mrs X said care workers did not know how to change a pad, wash her properly or help with oral hygiene. The care provider assured her staff were trained in delivering personal care. It agreed to update the care plan to include oral hygiene.
• care workers were late and did not always stay for 30 minutes. The social worker asked Mrs X if all tasks were complete during the visit and she confirmed they were. The social worker suggested care workers could complete light household tasks if there was time remaining and agreed to add this to the care plan.
• care workers broke and ruined things. Mrs X reported they broke her boiler but it had been fixed. The care provider suggested care workers had tried to assist in turning the heating on. It agreed to talk to the carer workers and ask them not to touch the heating.
• The attitude of care workers who she said argued with her and over-reacted. Mrs X did not name particular care workers who had a bad attitude. The care provider explained care workers had a duty of care to report any concerns about Mrs X’s health to head office.
• Not sending regular care workers – Mrs X liked her regular care workers and was unhappy sometimes when they were not sent. The care provider explained this could not always be helped due to sickness and leave but said it would call Mrs X to inform her when her regular care workers were not available.
20. The social worker spoke with Mrs X in early April and she was happy with her care at that time.
21. In early May 2023, Mrs X complained to the Council about the care provided.
22. In mid-May, the care provider contacted the Council. It said there were ongoing concerns about Mrs X’s attitude to care workers. She had barred certain care workers and would not let them visit but the care provider had to send them back as there were no others available. She would sometimes accept the support and refuse on other occasions.
23. In late May 2023, the care provider gave two weeks’ notice to the Council. It said it could not provide adequate numbers of care workers to safely maintain the package of care. It said Mrs X was rude and argumentative towards staff and multiple care workers declined to visit Mrs X. A new care provider started supporting Mrs X in June 2023.
24. In early July, the Council responded to Mrs X’s complaint. It said the social worker had tried to resolve Mrs X’s concerns. They had arranged a meeting, spoken with the care provider and had offered to change care providers. It noted:
• Mrs X would send care workers away without letting them support her with personal care. The care provider had attempted to reassure Mrs X all staff had undergone the required training to provide appropriate support. However, Mrs X developed a moisture lesion which would not have been helped by not having regular pad changes.
• Care workers were not supporting Mrs X with oral care and this was added to the care plan as it was not on it originally.
• Mrs X had refused suggestions to try and support her with meals.
• Mrs X felt some care workers were disrespectful but without more details of specific names it could not take action.
• There was an issue with the boiler pressure which carers had tried to fix. The boiler was repaired and care workers were advised not to touch it.
• It was unclear how carers may have damaged clothes or bedding and if so it would have been accidental.
25. Mrs X remained unhappy and complained to us.

Response to our enquiries

26. I requested a copy of all issues and complaints raised by Mrs X directly with the care provider. Due to a change in staffing the care provider said it could not retrieve some of the information relating to Mrs X’s case and could not locate any records of complaints or issues logged by Mrs X. I also requested the daily care records for four different months and the care provider has only provided these for two. The Council advised it had passed this information on to the Council’s quality monitoring team to address this with the provider.
27. The handwritten daily care records for February 2023 show most visits lasted between 20 and 30 minutes. Of the 112 visits, there were seven occasions when the visits were only 10 or 11 minutes long. During these visits, the notes show Mrs X was changed, repositioned and offered or provided with food. On one visit Mrs X did not want continence care or food. On five visits staff recorded Mrs X was unhappy/frustrated/angry. Two visits were after 10am (10.30 and 10.50).
28. The daily care records for May 2023 show most visits were 20 to 30 minutes long. Mrs X often ate cereal/snacks/sandwiches. On one occasion, staff recorded Mrs X was upset and refused to be changed. She declined offers of food and Mrs X was quite rude and intimidating.

Findings

29. From the start of the care package, Mrs X raised concerns about the care provided. She sought to address this first with the care provider and then with the Council. The social worker spoke with the care provider and Mrs X and sought to address her concerns. They arranged a meeting and offered to find an alternative care provider. There is no evidence of fault in the way the Council sought to address her concerns. Mrs X was dissatisfied with the quality of care provided but the records I have seen, show Mrs X received care in line with her care plan and her wishes.
30. Of the care records I have seen, there were two occasions when care workers arrived later than planned. There may be occasions, due to the needs of other service users or because of sickness that care workers do not attend at the agreed times. The frequency of late visits was not so significant I would say it constituted service failure.
31. A small number of visits were much shorter than scheduled. However, the records show care was provided in line with the care plan and Mrs X’s wishes. The number of occasions was not so significant that I would have expected the Council or care provider to consider reducing the length of visits. The Council was not at fault.
32. Mrs X raised issues around not being provided hot meals. The records show Mrs X generally ate snacks and cereal. The Council suggested a range of options to address this including microwave meals, meal deliveries, extending the call time and purchasing easily prepared foods but Mrs X did not agree to the suggestions made. The notes I have seen show Mrs X was given the food she asked for and there was no evidence of fault in the way the Council and care provider sought to meet Mrs X’s nutrition needs.
33. Mrs X complained about the attitude of staff. However, she did not name individuals or give specific examples and without such information the care provider could not address her concerns. It was not at fault. The records note occasions when Mrs X was rude or unpleasant to staff and the care provider had raised its concerns with the Council about Mrs X’s behaviour to staff. Mrs X considered she spoke her mind. However, that is not how her actions were perceived by the care provider.
34. Mrs X said the care workers broke her boiler and tumble dryer and damaged clothes and sheets. I cannot reach a finding on these issues. The records show the care workers did attempt to turn on the heating. However, I cannot say their actions specifically led to the boiler breaking. The care workers carried out Mrs X's laundry. I would not be able to establish whether the tumble dryer broke because of their actions or due to general wear and tear. Similarly, even on the balance of probabilities I could not say whether clothes/bedding was damaged through wear and tear or carelessness by staff. I will not investigate these issues further.
35. Due to staff changes, the care provider says it was unable to provide any records of the issues raised by Mrs X or the actions it took to address these. It has also been unable to provide all the care records I requested. This is fault and is not in line with the CQC fundamental standards regarding record keeping and complaint handling. It leaves a sense of frustration and uncertainty over whether the care provider responded appropriately to Mrs X’s complaints and took all the action it could to address her concerns and also whether Mrs X received all the care she should have. The Council has already raised this with its quality monitoring team to address with the care provider. This is an appropriate way to prevent a recurrence of the fault.
36. The care provider explained why it could no longer fulfil the care package and provided appropriate notice. The Council arranged an alternative care package so Mrs X was not left without care. The Council was not at fault.

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Agreed action

37. Within one month of the final decision the Council has agreed to apologise to Mrs X for the frustration and uncertainty caused by the care provider’s lack of records.
38. The Council should provide us with evidence it has complied with the above actions.

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Final decision

39. I have completed my investigation. On the evidence considered, there was fault leading to injustice which the Council has agreed to remedy.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman