Summary: Mrs X complains the Council and its care provider, MiHomecare Islington, failed to provide her late father with the support he needed. The Council accepts it failed to review her father’s needs for two and a half years. It also accepts MiHomecare was not cleaning the bathroom to the expected standard. MiHomecare’s care plan did not reflect all the needs the Council had identified. This put Mrs X’s father at risk of harm. The Council needs to apologise to Mrs X and provide evidence it and MiHomecare have improved their working practices.

The complaint

1. The complainant, Mrs X, complains the Council and its care provider, MiHomecare Islington, failed to provide her late father with the support he needed. She says this left him living in squalid conditions towards the end of his life.

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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)
4. 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, sections 24A(1)(A) and 25(7), as amended)

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How I considered this complaint

5. I have considered evidence provided by Mrs X and the Council, as well as relevant law, policy and guidance.
6. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

What happened

7. Ms X’s father, Mr Y, lived in his own home with support arranged by the Council. Since the end of 2018, MiHomecare was the care provider.
8. In June 2021, following a brief stay in hospital, after a fall, Mr Y confirmed he was happy for his existing care package to remain in place. MiHomecare’s care workers continued to visit Mr Y three times a week (two thirty-minute calls and one 60-minute call) to help him wash and dress his upper body, and to help with domestic tasks (changing sheets, vacuuming and cleaning the bathroom). An undated care plan said Mr Y was independent with medication. However, it said care workers were to check the blister pack to see if he was taking his medication regularly and to report any concerns to the Council. But this did not happen.
9. Mr Y died on 25 December 2023.
10. Mrs X complained to the Council in February 2024
11. When the Council replied to Mrs X’s complaint in April, it said:
• Between October 2021 and December 2023, there had been no communications from Mr Y’s GP or from MiHomecare, other than routine contact about cancelled calls (three in 2021 and three in 2023).
• A review of Mr Y’s needs did not take place in October 2022, because of the pressure on services following the COVID-19 pandemic, and apologised for this failure.
• No one reported a decline in Mr Y’s condition during the last six months of his life.
• MiHomecare accepted its care workers had not been cleaning Mr Y’s bathroom to the expected standard and apologised. In future, MiHomecare’s field supervisors would carry out regular spot checks to ensure cleaning was being done properly. The Council would monitor this going forward.
• MiHomecare had used an electronic system to record care plans and visits. Clients and their families could ask for copies of the information. This was why Mr Y did not have up-to-date logbooks in his home. There should however be a summary care plan in the home.
12. Mrs X was not satisfied with the Council’s response, so she raised further concerns later in April. She said:
• Mr Y and his family had not known about the change to electronic recording.
• There was no summary care plan in Mr Y’s home.
13. When the Council replied to Ms X in June, it said:
• MiHomecare last updated Mr Y’s care plan in March 2023, which Mr Y had signed. It had discussed the electronic recording process with Mr Y.
• MiHomecare said Mr Y sometimes asked its care workers to help with tasks outside his care plan.
• The Council last reviewed Mr Y’s care and support plan in June 2021 (during the COVID-19 lockdown) and he confirmed it was meeting his needs.
• MiHomecare said it had not removed the folder from Mr Y’s home which contained his summary care plan and other basic information.
• MiHomecare completed a telephone quality assurance check with Mr Y in September 2023 and he reported no issues.
• It apologised for the poor services provided to Mr Y.
• MiHomecare’s records from 4 to 22 December 2023 showed its care workers had completed all their duties. Mr Y had interacted with them, and they had no concerns about his wellbeing.
14. Mrs X says the problems were particularly bad in the months leading up to Mr Y’s death. She says there were buckets of urine in his home, soiled towels and the toilet would not flush properly. She says they had not realised how far things had declined, because her father preferred to visit family in their homes, rather than have them visit his home.
15. I have therefore reviewed MiHomecare’s records of its care workers’ visits from 20 October to 25 December 2023. They show care workers were due to visit for 30 minutes three times a week to help with personal care, and once a week for 60 minutes to help with domestic tasks. The records identified the need for support with these personal care tasks:
• dressing (if pain in his right hand prevented him from doing this)
• washing (as he could not reach his whole body)
• meal preparation
• drinks
• monitoring drinks
• monitoring meals
16. The records often describe Mr Y as independent with showering, but mostly needing help with dressing. They indicate that, while Mr Y would sometime accept help with meals and drinks, he was independent with such tasks. If he had not been, he would have needed more frequent visits than once a day.

Is there evidence of fault by the Council which caused injustice?

17. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.
18. The Council accepts it was at fault for not reviewing Mr Y’s needs in 2022. It last reviewed his needs in June 2021, which was two and half years before he died. The failure to review Mr Y’s needs at least every 12 months was fault by the Council. COVID-19 did not provide an excuse for not reviewing his needs in 2022, reflected in the fact it reviewed them in 2021. The fact that it failed to review Mr Y’s needs for over another year, is even less excusable. It suggests the Council has fallen into unacceptable working practices.
19. It appears MiHomecare made changes to its own care plans for Mr Y, as they identified the need for support with meals and drinks, as well as monitoring what Mr Y ate and drank. This was not reflected in the Council’s records and the evidence indicates he was independent with such tasks.
20. However, although the Council identified the need to monitor Mr Y’s medication and to report any concerns, this was not reflected in MiHomecare’s records. So this never happened, which put Mr Y at risk of harm. That was fault for which the Council is accountable. It is not clear why Mr Y was urinating in a bucket. It appears MiHomecare did not report this to the Council. If it had, this could have prompted a review of his needs.
21. There is nothing in either the Council’s or MiHomecare’s records to suggest Mr Y lacked the mental capacity to make decisions about his care needs. It appears he did not raise any concerns himself about the support he was receiving. Nevertheless, if the Council had taken the time to review his needs, it would have been able to address any concerns he may have kept to himself.
22. There is nothing to explain why Mr Y was urinating in a bucket. That he was should have prompted a review of his care needs. For instance, he may have benefited from a commode. Unfortunately we will never know.
23. There is no dispute over the fact that MiHomecare’s care workers were not cleaning Mr Y’s home to the right standard.
24. It is no longer possible to remedy the injustice to Mr Y, as he has died. However, the Council needs to send a further apology to Mrs X, addressing all the faults I have identified. It also needs to provide evidence that it and MiHomecare have improved their working practices.

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Action

25. When a council commissions or arranges for another organisation to provide services, we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions. Where we find fault with the actions of the service provider, we can make recommendations to the council alone. Here we have found fault with the actions of MiHomecare and the Council, but only make the following recommendations to the Council.
26. I recommended the Council:
• Within four weeks writes to Mrs X apologising for the failure to support her father properly, including the failure to review his needs every 12 months and the failure to ensure MiHomecare was meeting all the needs it had identified;
• Within eight weeks provides evidence to show:
1. it has a plan in place to make sure people receiving care and support have their needs reviewed at least every 12 months and it is monitoring compliance;
2. it has processes in place to ensure care providers are meeting all the care needs the Council has identified;
3. MiHomecare is doing regular spot checks to ensure its care workers are cleaning to the right standard.
27. The Council should provide us with evidence it has complied with the above actions.
28. Under the terms of our Memorandum of Understanding with the Care Quality Commission and information sharing protocol, I will send it a copy of this statement.

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Decision

29. I have found fault causing injustice, which requires a remedy. The Council has agreed to take action to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman