The Ombudsman's final decision
Summary: Mr F complains about the domiciliary care his wife received from Cera Homecare Ltd, commissioned by the Council. There was fault in record-keeping but this has not caused significant injustice. There was no fault in the care provided.
The complaint
Mr F complains on behalf of his wife about the domiciliary care she received from Cera Homecare Ltd, commissioned by the Council. In particular he complains about carers leaving calls early, inconsistent visit times, and inadequate management of Mrs F’s medications, which caused distress.
The Ombudsman’s role and powers
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) Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the care provider’s actions as if they were council actions. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act) We may investigate complaints from the person affected by the complaint issues, or from someone they authorise in writing to act for them. If the person affected cannot give their authority, we may investigate a complaint from a person we consider to be a suitable representative. (section 26A or 34C, Local Government Act 1974) We normally expect someone to notify the Care Quality Commission about possible breaches of standards. However, we may decide to investigate if we think there are good reasons to do so. (Local Government Act 1974, section 34B(8), as amended) 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) 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) Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).
How I considered this complaint
I spoke to Mr F about his complaint and considered the information he sent, the Council’s response to my enquiries, and: The Care Act 2014 (“the Act”) The Care and Support Statutory Guidance 2014 (“the Guidance”) Mr F and the Council now have an opportunity to comment on my draft decision. I will consider their comments before making a final decision.
What I found
Relevant law and guidance Care and support The Care Act 2014 requires local authorities to carry out an assessment for any adult with an appearance of need for care and support. The assessment determines what the person's needs are and whether the person has any needs which are eligible for support from the council.
Where councils have determined that a person has any eligible needs, they must meet those needs. The person's needs and how they will be met must be set out in a care and support plan.
Fundamental Standards of Care 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. The standards include: Person-centred care (Regulation 9): The service user must have care or treatment that is tailored and meets their needs and preferences. Providers must involve a person acting on the service user’s behalf in the planning of their care and treatment.
Complaints (Regulation 16): The provider must have a system in place to handle and respond to complaints.
Good governance (Regulation 17): Providers must maintain securely an accurate, complete and contemporaneous record in respect of each service user.
Council’s contract with care providers The Council’s contract with its homecare providers says they can provide care flexibly over a four-week period. This means providers can have different length visits as long as the person receives in total the number of hours care required over a four-week period.
Complaint procedure Councils should have clear procedures for dealing with social care complaints. Regulations and guidance say they should investigate a complaint in a way which will resolve it speedily and efficiently. A single stage procedure should be enough. (Local Authority Social Services and National Health Service Complaints (England) Regulations 2009) What happened Mr F’s wife has dementia and some health conditions including a heart condition. In late 2022 she had a stroke. She was discharged from hospital to a rehabilitation unit. In February 2023 she went home and received six weeks of reablement care, with four care visits a day.
The Council assessed Mrs F’s care and support needs on 6 April 2023. Mr F was present at the assessment. The social worker found that although Mrs F had memory issues, she was able to express her views about her care. Mr F would support his wife with medication, meals, shopping, laundry and finances.
Mrs F needed help from carers with personal and continence care and with getting dressed and undressed. The assessment determined that Mrs F required three visits a day: 30 minutes in the morning to help her out of bed, 15 minutes “at around 3pm”, and 30 minutes at bedtime.
The Council’s care and support plan does not specify the times of the visits.
The Council commissioned Cera Homecare (“the care provider”) to deliver this package, to start on 18 April.
The care provider visited Mrs F on 18 April and drew up its own care plan with her and Mr F. This said carers would help Mrs F with showering, changing of continence wear, assisting to the bathroom, applying creams morning and nighttime to prevent pressure sores, and getting dressed.
The Council posted its care and support plan to Mrs F on 19 April.
Over the next month there were in total 83 visits. The care provider uses an electronic care recording system; carers log in and out of the visit using a mobile phone. These records show that: Ten of the visits were not recorded at all.
In one visit there is no record of creams being applied.
Four of the 15-minute teatime visits were less than 10 minutes.
Seven evening visits were less than 20 minutes.
Two morning visits were after 10am; two teatime visits were after 4pm; 14 bedtime visits were before 8pm.
In two visits the log out time was recorded 6km away from Mrs F’s home (i.e. the actual visit was about five minutes less than the recorded time).
Carers noted on two occasions that Mr F was not happy about the visit times and was abusive. Mr F says he is partially deaf so sometimes speaks loudly or shouts.
On 11 May two carers arrived for the bedtime visit. Mr F says they arrived at 6.40pm; the log is at 19.01. Mr F was concerned this was too early and raised this with the carer, who then left. The care provider says its supervisor visited later in the evening, although this is not recorded in the log.
Mr F called the care provider the next day. He says the manager said she was not happy with his attitude and accused him of being argumentative and unpleasant with carers, which Mr F denies. The care provider then gave notice to terminate the service.
On 14 May the morning carer said she was not feeling well. She tested positive for COVID-19 the next day. Mrs F, who was also being treated for a urinary tract infection, then started to feel ill and was admitted to hospital on 16 May. She tested positive for COVID-19.
Mr F’s complaint Mr F contacted the CQC. He said he was concerned about the visit times as if carers arrived too late in the morning or too early in the evening, it would mean Mrs F’s continence wear would not be changed for up to 16 hours. He noted there was no schedule of visits, so times were inconsistent.
Mr F was also concerned that there had been no care plan in place before the care provider started and Mrs F had not received a care plan. He said carers were unaware who the care provider manager was and did not know what care they were meant to be providing.
He said carers were not trained to deal with medication, so he had to administer it and they sometimes did not apply the creams. The CQC contacted the care provider and the Council. The care provider responded to the CQC and completed a Council contract concern form.
Mr F complained to the care provider on 3 July. It responded on 7 July that: The Council should have advised Mr F the care package was starting.
Its records were digital so hard copies of care plans and risk assessments had not been provided.
It had not been commissioned to administer medication so there was no medication chart.
Its contract with the Council allowed it to visit within two hours, although there were no specific visit times. There was one occasion where the call was very late due to an emergency. Carers should not leave the visit until all tasks were completed.
All staff had the branch phone number and met the branch manager, with supervisions.
Staff wore PPE.
Its relationship with Mr F had broken down. It apologised if Mr F felt he had not received a good service.
It signposted Mr F to the Ombudsman.
My findings
There was no fault in the way the Council assessed Mrs F’s care and support needs or drew up her care and support plan. The Council did not send the plan to Mrs F until after the care package had started, but this is not fault. In any case, Mr F had been present at the assessment so was aware what had been agreed.
It was not fault for the care provider to draw up its own care plan and to do this at the first visit. Whilst I appreciate why Mr F was concerned about this, it is normal practice as the care provider is putting in place the council care and support plan which had already been agreed.
The care and support plan says Mr F would be responsible for administering medication, so there was no fault by the care provider in not doing so and not keeping a medication record.
Ten of the visits were not recorded. This is fault and a possible breach of Regulation 16 in relation to record-keeping. But I do not consider this caused injustice to Mrs F.
Having reviewed the daily care logs I find no fault in the care that was provided. There is one visit where it is not recorded if creams were applied, so it is unclear if there were not applied or just not recorded. But even if this was not done this has not caused significant injustice to Mrs F as I have seen no evidence that her skin was breaking down.
As described in paragraph 23 above, some of the visits were shorter than planned. However, this was not fault due to the Council’s flexible hours contract with the provider. It would be fault if care was insufficient or not all care was provided when required. But I have not seen evidence of that.
In relation to the times of visits, it is normal practice to not specify exact times. The Council and care provider must ensure that Mrs F’s needs are met and her views should be considered. So, for example, if she wished to have a later bedtime this should be accommodated as far as possible. But it is not fault for there to be no set schedule.
Mr F raises concerns about the length of time Mrs F was left overnight with her continence wear left unchanged. This must have been considered by the Council when it drew up the care and support plan for three visits a day. It was therefore not fault by the care provider to have the visits spaced as they were. The Council should review whether Mrs F’s continence needs are being met if there are concerns about this.
It is unfortunate that Mrs F contracted COVID-19 but I cannot say, even on the balance of probabilities, that she caught it from the carer and I have not seen evidence that the care provider failed to comply with infection and prevention controls. So I do not find fault.
Final decision
There was fault but this did not cause injustice. I have completed my investigation.
Investigator’s decision on behalf of the Ombudsman
Investigator's decision on behalf of the Ombudsman