Summary: Mrs X complained the Council and its commissioned care provider failed to deliver proper care and support for her relative’s needs or finances before they passed away, affecting their wellbeing. The Council accepted fault and waived half of the outstanding care fees. The Council agreed to our additional recommendations to apologise to Mrs X and make a symbolic payment to recognise her outstanding injustice of frustration and uncertainty.

The complaint

1. Mrs X complains the Council failed to properly support her relative and failed to review their care and support needs for a few years when it should have. This resulted in concerns their needs were not being adequately met by its commissioned care agency, poor living conditions, financial abuse and the build-up of a significant debt of care fees up until their death. This has caused significant distress and frustration for the family.

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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. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by someone we consider to be suitable. (section 26A or 34C, Local Government Act 1974)
4. 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)
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I have and have not investigated

6. Mrs X said she evidenced unauthorised transactions and withdrawals from her relative’s bank account. I am not investigating this as this has been looked into the Police as the appropriate body. We cannot add further to this. I have referenced this for relevant context, but for this reason, I have not gone into the specific details of the concerns.

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How I considered this complaint

7. I discussed the complaint with Mrs X and considered her views.
8. I made enquiries of the Council and considered its written responses and information it provided.
9. Mrs X, the Council and the Care Agency had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Law and administrative background

10. 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.
11. Regulation 17 says care providers must “maintain securely an accurate, complete and contemporaneous records in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided”.
12. 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 where they are inadequate for their purpose, or where they omit essential information or include misleading information”.

Reviews

13. 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.

Background

14. At the time of events in 2023, Mrs X’s relative (“Y”) was in their nineties and lived alone. Y had disabilities and communication difficulties. Y had a care package commissioned by the Council through the Care Agency for several years. Y funded this. Y lived many miles away from Mrs X.
15. In 2021, the Care Agency made a safeguarding referral about alleged financial abuse of Y (not part of this investigation). At the end of this enquiry, the Council made recommendations. During 2021, the Council had chased payment from Y for their care bills a number of times.

What happened – summary of key relevant events

16. At the end of 2023, Mrs X became aware Y was in hospital. Y presented as weak and malnourished. It was noted Y did not have a formal dementia diagnosis but had a high degree of cognitive impairment. She visited Y’s home and said she found evidence of financial abuse, and the property was in a filthy condition.
17. In early 2024, Mrs X made a formal complaint to the Care Agency raising several concerns. She said its carers had neglected Y, not ensured their wellbeing and failed to provide a satisfactory service which resulted in a decline to Y’s health.
18. The Care Agency responded. It said carers gave specific foods to Y on their request and preferences. It outlined its reporting of disrepair issues in Y’s home. It accepted it was not of an acceptable standard at the end of 2023 and agreed the carers could have done more. It disputed the severity of it. This was not the normal condition, but a few cleaning visits had been missed as Y had been in hospital. It was co-operating with an ongoing enquiry about the financial abuse concerns. The Care Agency did not accept it caused Y’s declining health.
19. Mrs X forwarded her complaint to the Council. She said it had failed to review Y’s home care, and she discovered a significant amount of debt had built up with Y’s unpaid care bills. Mrs X said she had evidence the Care Agency had agreed to help Y with paying these but did not do so.
20. A Hospital Officer carried out an enquiry into Y’s living conditions. The Care Agency maintained its position about the cleanliness. The Hospital Officer spoke to Y. Y had no concerns about the Care Agency, and said they had always lived untidily. The Hospital Officer concluded the enquiry as partially substantiated. They noted the separate ongoing investigation of the financial abuse concerns. The Hospital Officer decided it was Y’s best interest to be discharged to a care home. Shortly after, Y passed away.

Outcome

21. The Council gave updates to Mrs X about her complaint. In spring 2024, it sent a final response. The next month, the Council shared the outcome of the safeguarding with Mrs X. It made the following findings:
• Financial abuse concerns: The Care Agency denied the allegations of financial abuse. It said Y took responsibility for their own finances and it was also not in the care plan or its remit to assist Y with payments. The Police confirmed it did not have sufficient evidence to take further action.
• Capacity: The Council completed a capacity assessment for Y managing their finances in 2021. But it had not carried one out since so Y was always assumed to have capacity in that regard.
• Care review: an annual care review did not happen. This was a failing by the Council and the Care Agency. This would have been the opportunity to discuss Y’s finances and to re-assess their capacity.
• The 2021 safeguarding: it found the Council did not action the recommendations from this enquiry.
• Care Agency: The Care Agency said it was not policy for its staff to take a client’s card to withdraw cash or pay for goods. But a carer had followed Y’s instructions to do this. The Council found the Care Agency went against its own policy which was in place to prevent accusations of theft. It made a recommendation to the Care Agency.
• Outstanding care bill: The Council said it should have been aware of this and made arrangements to recover this sooner. While Y was recorded to have capacity, there were concerns about this due to some of their actions with their finances. But Y had declined offers of professional help in the past.
22. In summary, the Council decided the concerns were substantiated against the Council and the Care Agency who held joint responsibility. It did not uphold the standards of scrutiny expected in this case.
23. It made a recommendations to the Care Agency to review its policy about the management of service user’s financial transactions. I have seen evidence the Care Agency has done this. The Council itself now had a process to ensure recommendations from safeguarding enquiries are monitored with review dates.
24. In response to my enquiries, the Council sent me some copies of Y’s daily care logs and records from 2023. It said it carried out a care review in August 2022 for Y and an Occupational Therapist visited for unrelated matters in March 2023. It said these did not discuss capacity issues. It missed a 2023 care review for Y.

Care bills follow up

25. In light of the Council’s findings, the Council agreed to Mrs X’s request to pay half of the outstanding debt of Y’s unpaid care bills.

Analysis

The Council’s findings

26. The Council accepted shortcomings and faults in the case, which I agree with. I welcome this acknowledgement. It was possible Y could have lost capacity to deal with their finances since 2021 but not picked up with lack of a reassessment in that regard. This was not discussed in their August 2022 care review and the Council missed the review in 2023. Given Y’s age and history, these were lost chances to do this. The Care Agency also went against its own policy around the handling of a service user’s bank card. The concerns were substantiated. I am satisfied the Council has appropriately followed up the recommended action it made to the Care Agency and the Council has improved its own service for the future. I consider what injustice this caused later.

The care bills

27. The Council had historical issues with Y paying for their care from 2021. It appears the Council and Care Agency did not take substantive action to resolve this or could not overcome certain barriers for this. But Y would still be responsible for the bills at that point. The Council said to me since 2021, it is possible Y had fallen under the threshold for having to pay full cost for their care. But it could not establish this as a review was not completed in the meantime. This is fault. The injustice was the missed opportunity and uncertainty about whether Y’s financial circumstances may have led to lower care costs for them.

Care logs and records

28. Our investigations are proportionate, so I have looked at a sample of the Care Agency’s records and log sheets. I note many entries are illegible. From those I can read, they suggested carers largely visited four times a day and completed tasks in line with Y’s care plan. However, the records appeared to show visits generally lasted between 10 and 15 minutes, when the plan said calls should be 30 minutes minimum. This does raise some uncertainty around the standards of care given in the short visits.
29. I have also seen some electronic call monitoring records which did not match the times set out in handwritten care logs of the same dates. This casts some doubt on the accuracy of these. This is poor record keeping. This is fault. This falls below the standard we would expect and is a potential breach of care standards (Paragraph 11). This is another area for improvement.

Injustice

30. There was injustice to Y with the missed opportunities and substantiated concerns against the Care Agency about their care and condition of their home at the end of 2023. Y’s bills covered a few years, but the Council’s agreement to waive half the outstanding debt is satisfactory and proportionate to acknowledge this. As Y has died, we cannot made recommendations to remedy injustice to them.
31. Mrs X had to handle the outstanding debt herself, and the above waiving of fees goes towards some of the inconvenience caused here. However, there is remaining injustice to Mrs X that should be remedied. She has been impacted by significant uncertainty and distress caused by the faults identified about the care Y received, including the concerns with the Care Agency’s records.

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Agreed action

32. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I have found fault with the actions of the Care Agency, I have made recommendations to the Council.
33. To remedy the injustice set out above, the Council has agreed to carry out the following actions:
34. Within one month of the final decision:
• Apologise in writing to Mrs X for the injustice caused to her by the faults identified (in line with our guidance on making an effective apology) and pay Mrs X a symbolic payment of £200 to recognise this.
35. Within two months of the final decision:
• The Council should ensure the Care Agency sends written reminders to its staff about the standards expected for record keeping and proper documentation procedures.
36. The Council should provide us with evidence it has complied with the above actions.
37. In my draft decision, I made a recommendation for the Council to send a copy of our Good Practice Guide - Good Record Keeping to the Care Agency for its consideration and to reflect my findings. The Council provided evidence it has done this, so I have removed this recommendation.
38. The Care Agency said it will be taking a number of actions on this front as it had introduced a new system for care notes to be written digitally so care can be monitored more efficiently. This is positive action to recognise its previous shortcomings.

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Final decision

39. I found fault with the Council which caused injustice to Y and Mrs X. The Council has agreed with my recommendations to remedy this, and I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman