Summary: The ProMedica24 carer failed to seek medical attention promptly which caused Mr X to suffer more pain and distress than necessary; she also failed to communicate properly with his family about the wound. The care provider agrees the carer failed to report the injury and record it properly and offers to waive the charges for the days the carer did not work and offer £350 in recognition of the distress caused. It has also undertaken retraining as appropriate.

The complaint

1. Mrs A (the complainant) complains about the action of the care provider ProMedica24. In particular she complains the carer failed to seek medical attention when her father injured his arm or let the care provider or the family know soon enough. As a result the injury took longer to heal and was more painful than it would otherwise have been. The family had to suddenly find a new care provider as it did not trust staff offered by ProMedica24 as replacements.

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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. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

5. I considered all the information provided by the care provider and by Mrs A. Both parties had the opportunity to comment on an earlier draft of this statement before I reach a final decision.

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What I found

Relevant law and guidance

6. 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.
7. Regulation 12 says that care providers must ensure “that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely”.
8. Regulation 17 says that “Records relating to the care and treatment of each person using the service must be kept and be fit for purpose. Fit for purpose means they must: Be complete, legible, indelible, accurate and up to date, with no undue delays in adding and filing information, as far as is reasonable.”
9. In February 2023 we published guidance for care providers on good record keeping. We said, “We are likely to find a care provider at fault where records are illegible or have clearly been changed after the event, where they are inadequate for their purpose, or where they omit essential information or include misleading information.”

What happened

10. Mr X has dementia and needed a live-in carer. Mrs A says she stressed the importance to the care provider of engaging the right person as this was the first experience her father had of care in the home.
11. Within the first week, Mr X injured his arm while the carer was pushing him in his wheelchair. Mrs A says that instead of getting medical help, the carer ran some cold water over the wound and dabbed it with tissue paper. She told Mrs A next day that Mr X had a ‘small scratch” on his arm but was fine. Two days later a friend called on Mr X and found the wound was significantly worse than imagined.
12. Mrs A says she drove three hours to take Mr X to hospital where the wound had to be washed out, the skin flap removed, and a dressing applied. She says she was told at the hospital that if the wound had been attended promptly it would have healed much more quickly with the skin flap in place. She had to take him back to the hospital every three days for the wound to be re-dressed. Mrs A also says she was shocked at the state of her father’s flat when she saw it.
13. Mrs A complained to ProMedica24 about the carer’s actions. She cancelled the care and the direct debit. She also complained the carer had left out of date food in the fridge, had overreacted when Mr X had gone out with friends and she could not find him (without trying to call him), left the flat in a poor state and also taken with her food that had been purchased for her.
14. The care provider responded that the carer had said Mr X did not want medical help when he injured his arm: however, it agreed she had not followed the correct processes. It had contacted the safeguarding team about the matter. It said there was conflicting information from the carer about many points of concern but in general terms it upheld Mrs A’s complaints and offered £350 in recognition of the distress caused and the cost of the food taken by the carer.
15. Mrs A complained to the Ombudsman. She said she believed ProMedica24 had sent a carer who was not able to carry out her role competently. She says she did not see why the family should pay for the days they had been invoiced for when the carer did not work.
16. ProMedica24 says the carer was fully trained before she started working with Mr X. It agrees however she did not follow the reporting and recording procedures: “Failed to report a skin tear on the client’s arm to the emergency line- Plus her notes that she made are minimal and not to the standard we would expect no body map completed either. No mention of the skin tear in the report books.” The care provider says the carer has received refresher training and been reminded that when a service user declines medical help she should still seek medical advice.
17. The care provider has offered to waive the amount of £858,57 for the notice days not worked by the carer.

Analysis

18. The carer showed a failure of competence and skills in the way she treated Mr X when he injured his arm. That was fault which caused him injustice, as well as a potential breach of regulation 12.
19. The carer also failed to disclose the nature of the injury to Mr X’s family and to the care provider, or to keep proper records of what had happened. That was also fault which caused injustice and a potential breach of regulation 17.

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Agreed action

20. In addition to the offer to waive the fees (paragraph 16) and the refresher training completed (paragraph 16), within one month of my final decision the care provider will ensure it reviews the way in which staff are reminded of the importance of keeping proper records in line with the regulations and let me know how that has been done.
21. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

22. I find there was fault in the actions of the care provider which caused injustice to Mr X. Completion of the recommendations at paragraph 20 will remedy the injustice caused.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman