The Ombudsman's final decision
Summary: The Council acknowledges more carers than expected visited Ms Y during reablement services but says this was due to access issues. Given the lack of records about such instances I am unable to come to a definitive finding about this. I find the Council at fault for the omission of this information in its records.
The complaint
Mrs X complains about the reablement services provided to her adult daughter, Ms Y.
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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), 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)
How I considered this complaint
I have: considered the complaint and discussed it with Mrs X; considered the correspondence between Mrs X and the Council, including the Council’s response to the complaint; made enquiries of the Council and considered the responses; taken account of relevant legislation; offered Mrs X and the Council an opportunity to comment on a draft of this document.
What I found
Relevant legislation 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 Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
Regulation 9 Person Centred Care says Care Provider must do everything reasonably practicable to make sure that people who use the service receive person-centred care and treatment that is appropriate and meets their needs. Each person, and/or person lawfully acting on their behalf, must have all the necessary information about their care and treatment.
Background
Ms Y is in her thirties. She has a learning disability and epilepsy. The frequency of seizures increases if she experiences stress/distress.
Ms Y and her family moved into the Council’s area in early 2021.
In May 2021, Ms Y had a stay in hospital. On discharge she received reablement care, provided by the Council. Two visits a day (morning and evening) were arranged to support with administering medication.
Mrs X says Ms Y becomes stressed when she is faced with a large number of strangers and that she made this clear to the Council before reablement commenced. She said Ms Y needed a core group (no more than eight) of regular carers. This is not what happened. More than thirty-one carers attended and there were issues with timekeeping. This caused issues with medication, which need to be taken at specific times.
Mrs X complained to the Council. She received a formal written response dated 16 November 2021. The author of the letter acknowledged there had been a large number of carers visiting Ms Y but said this was in part due to the fact some carers had been turned away.
During its investigation into the complaint the Council contacted the reablement service, who reported that Mrs X would on occasions ask carers to wait outside the house because Ms Y was ‘not ready’. This meant carers sometimes had to go to their next call, which may have been time critical, or to meet another carer for double up visits. As a result, different carers attended at a time different to the planned visit.
Mrs X refutes carers were turned away and she is angry the Council is ‘using this’ to defend the number of different carers attending. She provided this office with a list of all carers that attended, including dates and times. She says Ms Y only started refusing to see carers after a large number of carers had attended and she became stressed and anxious about who would be visiting. Ms Y did not want carers unknown to her to see her in nightwear. Once familiar with carers, this is not an issue.
As part of this investigation, I requested the records of the visits. These show the times of visits and the different carers that visited. Between 20 September 2021 and April 2022, there were 16 occasions where a carer was recorded to have been declined entry, and either the same carer or a different carer returned later. A total of 22 carers that visited during the above period.
The Council says carers record the duration of visits and information pertinent to the care of Ms Y, but they do not record any issues accessing the property, or the time spent waiting outside.
Mrs X would like the Council to ensure a core group of regular carers attend Ms Y. The Council acknowledges that the number of carers needs to be kept to a minimum and says this is achievable if carers are allowed to carry out the requirements of the visit at the time they arrive. It says despite not upholding Mrs X’s complaint it took action to reinforce the importance of maintaining continuity of carers as far as possible.
Analysis The Council acknowledges more carers than expected visited Ms Y. Given the lack of records about access issues I am unable to come to a definitive finding about the reasons for this, or whether this amounts to fault.
I find the Council is at fault for the omission of this information in its records. Carers should record if/when they are refused entry and/or kept waiting, and the reasons why.
In respect of timings of visits, the Ombudsman considers it acceptable for visits to vary by 30 minutes either side of a planned visit. Because of the lack of records relating to access/carer wait times, I am unable to come to a definitive decision about the timings of visits.
The Ombudsman would not consider the Council at fault if a carer arrived within 30 minutes either side of the planned visit and was kept waiting, and/or had to leave and return because of this.
Ms Y experiences stress and distress when faced with a large number of strangers. To mitigate this, and to meet Ms Y’s specific needs, it would be good practice for Council to ensure the number of carers attending is kept to a minimum. It could also consider providing Ms Y with a weekly rota of proposed carers to reduce her anxiety about who will be visiting.
Agreed action
The Council should within four weeks of the final decision: ensure the number of carers attending is kept to a minimum wherever possible, and consider providing Ms Y with a weekly rota of proposed carers clearly record all instances where there are access issues visiting Ms Y, and/or the time spent waiting outside.
Final decision
The Council acknowledges more carers than expected visited Ms Y during reablement services but says this was due to access issues. Given the lack of records about such instances I am unable to come to a definitive finding about this.
I find the Council at fault for the omission of this information in its records.
It is on this basis; the complaint will be closed.
Investigator's decision on behalf of the Ombudsman