Summary: Mrs X complained CHJB Limited failed to provide the care it was contracted to provide to her mother, Mrs Y. The Care Provider is at fault because it did not properly record the care provided to Mrs Y on two occasions and did not provide her with a properly cooked meal on one occasion. This caused Mrs X uncertainty about the care received by Mrs Y and frustration. I am satisfied the Care Provider too appropriate action to deal with these matters before our investigation commenced. There is no outstanding injustice that requires remedy.

The complaint

1. Mrs X complained on behalf of her mother, Mrs Y, about domiciliary care provided by CHJB Limited (the Care Provider). Mrs X says the Care Provider failed to provide the care it was contracted to give to Mrs Y. She also states that reasonable care and skills were not always used when providing care for Mrs Y.
2. Mrs X states the Care Provider’s actions caused Mrs Y distress and left her without the agreed care. She also states the Care Provider’s actions caused her and her sister distress, negatively impacted their health and put them to the avoidable time and trouble of complaining.

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The Ombudsman’s role and powers

3. 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. (Local Government Act 1974, sections 34B and 34C)
4. If an adult social care provider’s actions have caused injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. 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. (Local Government Act 1974, section 26A or 34C)
6. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
7. We normally name care homes and other care providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
8. 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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What I have and have not investigated

9. I have investigated Mrs X’s concerns about matters that occurred from September 2022 onwards.
10. I have not investigated Mrs X’s concerns about matters that happened before September 2022. This is because we will not normally investigate complaints when someone takes longer than 12 months to complain to us about something a Care Provider has done. This applies to Mrs X’s concerns about things that happened before September 2022 and so these parts of her complaint are late and there is not enough reason to accept those parts of it for investigation now.

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How I considered this complaint

11. As part of my investigation I have:
• Discussed the complaint with Mrs X and her sister and considered the complaint;
• Made enquiries of the Care Provider and considered its response to my enquiries and;
• Set out my initial thoughts on the complaint in a draft decision statement and invited the Care Provider and Mrs X to comment. In response to comments from the Care Provider I amended my draft decision, and I invited both parties to comment.

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What I found

Fundamental Standards of Care

12. 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.

What happened

13. Mrs Y lives at home. She has a diagnosis of dementia, has arthritis in her hip and poor mobility. She takes medication to manage her health conditions and uses a pain relief patch.
14. Mrs X and her sister were Mrs Y’s main carers prior to them commissioning care from the Care Provider. Mrs X signed a care contract for Mrs Y’s care. The contract says the client must give the Care Provider 30 days’ notice in writing before terminating the service. It says the Care Provider will charge for scheduled services when a shorter notice period is given.
15. The Care Provider put in place a care plan for Mrs Y. The plan says it will provide three one-hour visits to Mrs Y per day. At the visits the carers will:
• Open or close the blinds and curtains;
• Prepare meals and leave them out for Mrs Y (a home cooked meal should be prepared at the teatime visit)
• Check the contents of the fridge, use food in date order to avoid waste, put opened food in a bag and during the morning visit carers should remove food from the freezer for Mrs Y’s dinner.
• Leave Mrs Y snacks and drinks;
• Ensure Mrs Y takes her medication and change her pain relief patch when required;
• Apply cream to Mrs Y’s legs;
• Let Mrs Y’s dog out and feed him;
• Check the property is secure and keys are put in the key safe;
• Check the thermostat and turn off Mrs Y’s electric blanket; and
• Provide companionship.
16. The care plan also states the following:
• Carers should turn Mrs Y’s cooker on and off at the mains and do so covertly so that she does not see. Mrs Y has left the oven on previously and this is a danger to her safety.
• Keys to Mrs Y’s home will be stored in two key safes. Carers should make sure Mrs Y does not see the keys because she will try and take them and become agitated.
• Carers should always leave Mrs Y with a warm evening meal even if she says she does not want anything.
17. The Care Provider asks carers to complete a task list following each visit to Mrs Y’s home.
18. In October 2022 Mrs X raised concerns about the food being provided for Mrs Y.
19. In November the Care Provider undertook a service review of Mrs Y’s care. Mrs X and her sister attended. Notes from the meeting show that Mrs X and her sister were happy with the service.
20. In March 2023 Mrs X told the Care Provider about problems with Mrs Y’s care. Her concerns included:
• meal preparation and quality of meals provided;
• how carers handled Mrs Y’s dementia;
• administering Mrs Y’s medication;
• securing Mrs Y’s home following visits;
• visits lasting less than the specified hour;
• changes in carers providing Mrs Y’s care; and
• failing to turn Mrs Y’s oven and hob off at the mains switch.

Mrs X told the care provider she has installed CCTV because Mrs Y should not leave home alone. She said footage from the CCTV at Mrs Y’s home supported her concerns about the care she was receiving.

21. In May 2023 the Care Provider held a team meeting with the carers providing care for Mrs Y. The meeting discussed meal preparation for Mrs Y and noted this can sometimes be difficult because of Mrs Y’s behaviour. The meeting resulted in reminders for carers working with Mrs Y and some changes from Mrs X, such as separating frozen foods into portion sizes.
22. In June 2023 the Care Provider undertook another service review of Mrs Y’s care. Mrs X and her sister attended. Notes from the meeting detail that Mrs X was happy with the care being provided.
23. However, following the review Mrs X felt unhappy with the care and in August she ended the service. Mrs X did not give the required notice and refused to pay the notice period charges.
24. The Care Provider offered to reduce the notice period charges, as an act of goodwill and to end the service on good terms. The reduction amounted to a 50% discount. Mrs X accepted the offer and paid the remaining 50% of the fees owed.
25. In August Mrs X made a complaint to the Care Quality Commission (CQC) about the care Mrs Y received. Mrs X complained:
• Mrs Y was not given assistance with meals and missed them on three consecutive nights;
• A carer left a pork pie and crumpet for dinner on one occasion;
• A carer cooked a microwave meal for 10 minutes instead of the 25 minutes it needed and left the call early;
• Carers offered Mrs Y the same sandwich for lunch on three consecutive days;
• Mrs Y’s daily records said a carer made her lunch but there was no evidence she had done so;
• A carer told Mrs Y where the mains switch for the cooker was and, consequently, she started to use cooker again which put her at risk;
• Carers did not witness Mrs Y take her medication as requested;
• A carer did not replace Mrs Y’s pain relief patch as required and said she would not let her do so;
• Carers are not hiding the house keys when they go into Mrs Y’s home which has led to her becoming distressed and upset with carers as she tries to get the keys back.
• Carers have left Mrs Y’s home unlocked;
• Calls are meant to last one hour but some carers have left after 20 minutes;
• The carers caring for Mrs Y are constantly changing with up to 10 carers caring for her per week and a new carer joining her care team every fortnight; and
• Staff do not appear to be adequately trained to care for clients with dementia.
26. The Care Provider responded to CQC. It said:
• Mrs Y’s behaviour is challenging, and she follows carers around when they are preparing food which makes it difficult for them to do so. The carers try to distract her but are not always successful.
• The carer who provided Mrs Y with a pork pie and crumpet for dinner found Mrs Y’s behaviour challenging. She visited Mrs Y three times before she was reassigned to a different client.
• It accepts a carer did not cook a meal for long enough. The carer was new to caring for Mrs Y when the incident happened, and she misread the label when cooking the meal. An apology was offered at the time.
• A carer prepared Mrs Y a sandwich which she did not eat and which was put away in the fridge. The carer left the sandwich out again the following day for Mrs Y as she felt it was safe to do so. The sandwich was still not eaten the next day and the carer threw it away. It said food was a big issue for Mrs Y’s family and carers were mindful of not wasting food and preparing food Mrs Y would eat.
• It accepted a carer said she made lunch for Mrs Y in a daily record but did not do so. The carer was reprimanded. Mrs X was advised of the action taken at the time and was happy with this.
• The carer denies telling Mrs Y where the mains switch for the cooker was. Nevertheless, it apologised to Mrs X and held a meeting reminding carers not to tell Mrs Y where the switch is.
• All carers know the importance of making sure clients take their medication and receive training about this. It noted that Mrs X has asked for Mrs Y’s medication to be left on her coffee table and she had also thanked carers for their detailed notes about Mrs Y taking her medication.
• It accepts a carer did not replace Mrs Y’s pain relief patch but says this was because Mrs Y would let her do so. It says the carer should have reported this but did not do so. It has addressed this with the carer.
• The key safe at Mrs Y’s home has been found to be unlocked on several occasions but it is not clear if carers or others visiting Mrs Y are responsible. Carers know not to show Mrs Y the keys to her home but occasionally this does happen. If Mrs Y sees the keys she can become verbally and physically aggressive prompting carers to leave early so that she can calm down.
• If a carer leaves the call early, they record the reasons why. Mrs Y’s behaviour towards her carers varies from day to day and sometimes she would be unhappy and challenging requiring the carer to leave.
• It acknowledged that carers visiting Mrs Y did change more than it would have liked but this was due to staff turnover, sickness and leave. It also said some carers asked to be assigned to other clients because of Mrs Y’s behaviour.
• All staff receive dementia training.
• It said that perhaps in hindsight it should have suggested to Mrs Y’s family that two carers attend visits or perhaps accepted their service was no longer right for Mrs Y. It said that it had tried to work with Mrs Y’s family to support her and had changed her care plan, sent updates to carers and made changes to the team to help do so.
27. The CQC was satisfied with the care provider’s response, and it took no further action.
28. In September 2023 Mrs X and her sister made a complaint to the Care Provider that it had breached the contract for Mrs Y’s care. It reiterated the matters raised in their complaint to the CQC.
29. The Care Provider replied to the complaint the same day. It acknowledged the matters raised had arisen throughout the period it provided care for Mrs Y. It said that it had apologised and acted where appropriate. It said it did not agree it had breached its contract with Mrs Y. The response did not tell Mrs X she could complain to the Ombudsman if she remained unhappy.
30. Unhappy with the Care Provider’s response Mrs X complained to the Ombudsman. Her complaint reiterated the concerns raised in her complaint to the CQC.
31. In response to our enquiries the Care Provider said:
• It told carers on Mrs Y’s care team about changes in her care via memo, emails, updating care plans and updating the daily task list.
• It held meetings with Mrs Y’s daughters to understand and address their concerns. It updated carers on Mrs Y’s care team following the meetings.
• It only used its own carers to provide care for Mrs Y and all carers had access to her care plan and the task list.
• It said 31 carers provided care for Mrs Y during the time it provided her care. It said that carers often leave or have annual leave, and this accounts for the number of carers. It also noted it had to remove some carers from Mrs Y’s care team because of her behaviour towards them.
• Dementia training is mandatory for all its staff.
• It followed its complaints procedure when investigating Mrs X’s complaint to CQC. It used the information it gathered when responding to Mrs X’s complaint to CQC when considering her complaint to it, and so it was able to answer the same day.

The care provider included evidence supporting its response to us.

32. In response to our draft decision the care provider explained that from now on complaint responses will advise complainants they can complain to the Ombudsman if they remain unhappy.

Finding

33. Evidence from the Care Provider shows that it broadly provided care in line with Mrs Y’s care plan over the period we investigated. It has demonstrated that it acted to address concerns raised by Mrs X, held review meetings, and made changes to the care it provided.
34. I note Mrs X told the Care Provider she was happy with the service being provided at the review meetings held in October 2022, May 2023 and June 2023. The notes of the review meetings express the service provided to Mrs Y had improved.
35. Additionally, the CQC did not consider it necessary to take further action against the Care Provider following Mrs X’s complaint nor did it raise concerns that its fundamental standards had been breached.
36. The Care Provider’s response to Mrs X’s CQC complaint contained details about incidents where carers did not properly record the details of the care provided, such as when a carer said she had provided a meal but had not done so or when another carer did not record that she was unable to replace Mrs Y’s pain relief patch. I understand that Mrs Y refused care during these incidents and that it would have been inappropriate for the carer to make Mrs Y receive care she was refusing to have. However, the carers should have accurately recorded they were unable to do so. Without accurate records others will not know what care Mrs Y has accepted and what care may still need to be provided, such as changing her pain relief patch. The Care Provider’s response to CQC also identified an occasion where Mrs Y’s carer did not cook a meal for her properly. These actions amount to fault. I note the Care Provider acted once aware of the incidents and that Mrs X was happy with its response. However cumulatively the incidents reduced Mrs X’s confidence in the service. This caused her avoidable worry, which is an injustice.
37. The Care Provider has explained what action it took in response to each of the incidents in its response to the CQC. It also apologised to Mrs X and spoke with them about the incidents when first reported. The records of the service review meetings show Mrs X was happy with the action being taken. Additionally, I note the Care Provider amended Mrs Y’s final bill by 50% as an act of good will. I consider the Care Provider’s actions provides suitable redress for the injustice caused.
38. Mrs X raised concerns about the speed with which the Care Provider replied to her complaint. Mrs X’s complaint to the Care Provider reiterated the same concerns as her complaint to the CQC. Therefore, the Care Provider had already investigated the matters complained about and had the information it needed to address the complaint.
39. However, the complaint response did not address each ground of complaint and gave a general overview. The complaint response should give a more substantive response. I also note the reply did not tell Mrs X she could complain to the Ombudsman. We consider it good practice to do so. The Care Provider has said it will do so in future and so I do not consider it is necessary to make a service recommendation in this regard.

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Final decision

40. I have completed my investigation. I found fault leading to injustice. The Care Provider took appropriate action to deal with the matter before we began our investigation and so, there is no outstanding injustice.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman