Summary: The Care Provider adequately investigated Mrs X’s complaint about the quality of care provided by a live-in-carer to her husband, before the complaint came to this office. A suitable remedy was provided. There is no more this office could add to this.

The complaint

1. Mrs X complains about the live-in carer allocated to her husband, Mr X from Bluebird Care Taunton.

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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 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 a significant injustice or that could cause injustice to others in future we may suggest a remedy. (Local Government Act 1974, sections 34 B, 34C and 34 H(3 and 4) 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 complaint and the information provided by Mrs X;
• considered correspondence between Mrs X and the Care Provider, including the Care Provider’s responses to the complaint;
• made enquiries of the Care Provider and considered the responses;
• considered relevant legislation;
• offered Mrs X and the Care Provider an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

5. 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.
6. Regulation 18 - providers must tell the CQC of all incidents that affect the health, safety and welfare of people who use their services;
7. Regulation 20 - providers must be open and transparent with people using their services and their families and must notify them and apologise if something has gone wrong with the person’s care or treatment. Providers must tell the person or their representative if there has been a ‘notifiable safety incident’.
8. The Deprivation of Liberty Safeguards (DoLS) are an amendment to the Mental Capacity Act 2005. They provide legal protection for individuals who lack mental capacity to consent to care or treatment.
9. The DoLS protect people from being deprived of their liberty, unless it is in their best interests and there is no less restrictive alternative. The legislation sets out the procedure for getting authorisation to deprive an individual of their liberty.
10. Without authorisation, a deprivation of liberty is unlawful. It is the responsibility of the care home or hospital to apply for authorisation. The ‘managing authority’ of the care must request authorisation from the ‘supervisory body’ (the Council). There must be a request and an authorisation before a person is lawfully deprived of his or her liberty.
11. The Supreme Court decided on 19 March 2014, in the case of P v Cheshire West and Chester Council and another and P and Q v Surrey County Council, that deprivation of liberty occurs when: “The person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements”.

Background

12. As part of this investigation the Care Provider provided copies of all documentation relating to the care of Mr X, and correspondence with Mrs X before, during and after the events described below.
13. At the time of the events Mr X, was in his eighties, had memory impairment and lived at home with his wife, Mrs X.
14. Mrs X contacted the Care Provider in November 2023 to arrange care for Mr X whilst she travelled overseas to see family. Mrs X requested a live-in-carer from 27 January 2024 until 17 February 2024.
15. The Care Provider completed a pre-assessment of Mr X in November 2023, which was then sent to Mrs X in January 2024 for her approval. The document records Mr X to be “…very independent and says, “Please allow me to do as much for myself as I can”. It records Mr X to be mostly independent with personal hygiene/dressing and fully mobile; sometimes using a stick for support. Mr X required support with medication and to attend social occasions, such as coffee mornings. Under hydration, it records Mr X to be able to independently make himself drinks throughout the day, and requests a carer ensure he has plenty to drink. It records Mr X enjoyed getting out of the house every day and requested the carer take him out for coffee or a drive.
16. Mrs X said she was contactable during her break and provided a mobile contact number.
17. The dependence level for live-in-care was deemed to be ‘medium’. Under ‘carer break’, of the support plan, it records no preferred time when a carer could take a break and says “Carer can take some time to themselves whilst [Mr X] rests in an afternoon”. Under the section ‘home security’ it records the door key should be hung up in the kitchen on the key locks, and that security arrangements in place should not restrict a customer’s freedom to leave unless there was a Court of Protection Order in place. There was no such order in place. Mr X was recorded as having capacity to agree to care.
18. The care documents state care provision would be reassessed following any change or deterioration in a customer’s health and reviewed in response to specific situations.
19. The Care Provider provided a copy of the care plan to Mrs X by email on 10 January 2024, asking her to read through the document and let the office know if there was anything she wanted to add or remove. The Care Provider provided copies of emails exchanged with Mrs X about the care plan.
20. Mrs X met with the carer a few days before the care commenced to discuss Mr X’s needs, and Mrs X’s expectations of running the home.
21. The Care Provider says an experienced live-in-carer commenced work on 27 January 2024.
22. The records show the carer found Mr X to be unsettled, distressed and challenging in a way she had not expected. She (carer) contacted Mrs X by text about this numerous times. I have had sight of the messages exchanged between the carer and Mrs X. The carer asked if Mrs X could speak to Mr X. In one text, Mrs X asked the carer if Mr X was ‘still up’ and said she had tried ‘facetiming’ but the call had not been answered. She (Mrs X) said she thought Mr X “…may be difficult for a few days. Try and go with it”. The carer responded saying Mr X had been calmer after chatting to a person known to him. Mrs X responded saying “I think this was going to happen as I’ve never left him for more than two nights at once” The exchange of messages continued with the carer informing Mrs X that Mr X continued to be unsettled and was not sleeping through the night; and she (carer) was exhausted. Mrs X responded saying “I don’t know really what to do from here”. She later advised allowing Mr X a small glass of wine about 5pm.
23. Mrs X sent an email to the Care Provider on 1 February 2024 informing it of the emails from the carer and expressing concern. The Care Provider responded by email. She (staff member) apologised for the carer’s emails and explained she had been supporting the carer, but said ‘things’ were not settling, that she (staff member) would visit that day and consider swapping the care for another carer.
24. The carer sent a message to the Care Provider at 6.30am on 1 February 2024 saying Mr X had been awake all night confused and presenting as challenging. The carer said she had contacted Mrs X as she believed she may ‘know what’s going on’, and that she had also contacted Mrs X’s sister for advice. She said she was finding it very difficult to manage Mr X. She said Mr X was in the lounge and she [carer] was going to her room ‘for a bit’. The Care Provider responded to the carer saying “…take some time out as long as he is safe” and that the office was trying to source a replacement carer. The carer said she fell asleep and was woken by a neighbour who was angry. It was then explained Mr X had left the house and had been found in the road.
25. The care records show Mr X was very confused had accepted very little food and fluid that day.
26. The carer telephoned a senior staff member at the office, the call was unanswered, so she left a message to the office saying, “please help me”. The carer then telephoned another staff member, who alerted the senior staff member. The senior staff member went directly to Mr X’s home. On route she received a call to say Mr X had left the house and had been found in the road. An ambulance was called to attend Mr X.
27. Mrs X received a message from her neighbour asking her to call home immediately. Mrs X did so and was informed Mr X had been found in the road, and that a neighbour had returned him home, found the door open and the carer asleep in bed.
28. The attending paramedic spoke to Mrs X on the phone. The paramedic advised Mr X should go to hospital, where he was subsequently admitted. Mr X later passed away in hospital on 26 May 2024.
29. The Care Provider met with Mrs X on 7 March 2024 and confirmed it would be undertaking a formal investigation. In an email to Mrs X on 11 March 2024, the Care Provider confirmed the investigation was underway and said “…during our ongoing investigations, we have found that certain behaviours of the carer, meant that the service provided, was not of the normally very high standard that we would expect our customers to receive.”
30. The investigation report has been provided to this office. As it contains personal details about the carer, and her employment, I am unable to go into detail. Mrs X can be reassured that I have considered all the information objectively and given careful consideration to the issues she raised.
31. The Care Provider met with Mrs X and her friend May 2024 to discuss the outcome of its investigation. The Care Provider says it was at this meeting that Mrs X declared medical information about Mr X it had not previously known; that Mr X had previously experienced delirium whilst travelling with Mrs X and the episode was so severe that emergency travel contingency plans had to be implemented. Mrs X disputes this, saying she did provide this information. The investigating officer says there was no DoLS in place, so the carer could not prevent Mr X from leaving the house.
32. The Care Provider notified the Council’s safeguarding team and the Care Quality commission of the events. No further action was taken by either body.
33. The Care Provider’s investigation concluded the carer had not followed its correct procedure for reporting a change in Mr X’s condition. The investigating officer noted Mr X’s GP should also have been notified of his deteriorating condition.
34. Mrs X was dissatisfied with the outcome of the investigation and corresponded further with the Care Provider. In June 2024, the Care Provider wrote to Mrs X again reiterating its position and saying it believed Mrs X had not provided an accurate picture of Mr X’s needs at the outset, that Mrs X had made clear Mr X had the capacity to make his own decisions, and there was no DoLS in place restricting his freedom. Mrs X refuted this.
35. The Care Provider says it had no information to suggest Mr X could not be left alone. It says the carer had been awake since 1am trying to placate Mr X, and informed Mrs X’s sister and her manager she was taking a break. It was during this break Mr X left the house and was found in the road.
36. Mrs X told the Care Provider she believed she should not be charged for the care. As a gesture of goodwill, the Care Provider refunded the two days already paid and waived the remaining fees in full.
37. Mrs X believes the Care Provider failed in its duty of care to Mr X and failed to carry out a full investigation into the events. Mrs X wants an apology from the Care Provider and the carer to undergo re-training.

Analysis

38. I can see the circumstances of the above events must have been very difficult for Mrs X. Having given careful consideration to all the information from Mrs X, and the Care Provider, I find the Care Provider’s investigation into the events to be adequate.
39. Its investigation was fair, proportionate and thorough. I realise Mrs X believes it was not so because it did not interview the neighbour who discovered Mr X in the road; and who returned him home to find the carer asleep. I cannot fault the Care Provider for not including this person in its investigation because the facts of the incident are not in doubt; the carer did not dispute the turn of events or her part in it, so the witness could not add information not already known.
40. The investigation rightly focused on the days leading up to and including the day Mr X left the house. The investigating officer considered all relevant care records and interviewed the carer. From this it concluded some fault by the carer, in that she failed to formally escalate the deterioration in Mr X’s wellbeing as per the Care Provider’s procedure. In acknowledgement of this the Care Provider reimbursed fees paid and waived the outstanding fees. This office cannot add to this.
41. The Care Provider followed the correct procedure for reporting the incident to the local safeguarding team and the Care Quality Commission.

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Final Decision

42. The Care Provider adequately investigated Mrs X’s complaint about the quality of care provided by a live-in-carer to her husband, before the complaint came to this office. A suitable remedy was provided. There is no more this office could add to this.
43. It is on this basis; the complaint will be closed.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman