Decision Date: 20 August 2024
Summary
Orchid Homecare Support Ltd failed to provide adequate home care and thereby were found to have caused distress to the family of the client. Bolton was responsible for the fault of its commissioned service in the usual way as the liability for the duty to meet the needs appropriately is non-delegable.
What happened
Ms Y was living with dementia and whilst she had an informal carer, Mr X, her son, her needs demanded the support of the Council (albeit she was a full cost payer due to her resources) which outsourced this responsibility to Orchid Homecare Support Ltd under its Care Plan.
The company was to deliver double handed house calls morning and evening for 45 minutes and at lunch and at teatime, for 30 minutes for personal care.
Mr X complained that staff neglected Ms Y’s hygiene as they frequently failed to change her incontinence pad and did not clean her nails. He also said that staff logged 30 minutes in their care records when in reality they only worked for 3 minutes and also often logged records retrospectively. To support this Mr X provided handwritten logs completed by carers which indeed showed on some occasions they failed to note the time of departure.
Additionally, he claimed that Ms Y was overcharged and that Orchid Ltd were unco-operative in refusing to provide any breakdown of charges.
He claimed that these failures caused him avoidable distress and confusion.
Orchid’s response was that Mr X often prevented carers from doing their job and denied falsifying records (although they admitted that one entry was due to a mistake). In support, they provided electronic records submitted by staff on entering and leaving Mr X’s property; in conflict with Mr X’s logs.
Orchid spoke to staff about record keeping and began a practice of spot checks and committed to coordinating care with informal carers, more effectively. Orchid recognised that it should have provided Mr X with a breakdown of charges when requested and had now done so. It stated it would credit invoices where Mr X had been overcharged.
Mr X was still displeased and extended his complaint to the Council. The result was that there were found inadequacies in the logs (some not in order, some visits missing) and in response to this the Council itself introduced books instead of sheets for record keeping and committed to making spot checks.
The issue was then brought to the attention of the Ombudsman.
What was found
The Ombudsman found fault regarding record-keeping. The available evidence showed logs to be inaccurate and insufficient and as such in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 17.
Although Mr X was not overcharged, he should have been provided with a breakdown of charges upon request and not made to wait. Whilst there should have been coordination of care between the parties such that Regulation 9 had been breached, Orchid had since recognised its failure and made changes to practise so that there was no longer injustice nor need for a further remedy.
Lastly, it was concluded the evidence available indicated both assertions of lack of care/negligence were undeserved.
The Ombudsman recommended that the Council reduce Mr X’s outstanding bill by £100 to offset confusion and distress caused by record failure and poor communication, and apologise to Mr X.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
When investigating complaints about Council-funded care placements, the Ombudsman considers the 2014 Regulations when determining complaints about poor standards of care.
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 sets out considerations care providers must take into account when administering their services.
Pertinently the care must reflect the service user’s preferences. As part of this an assessment of the needs and preferences for care of the recipient must be performed (3)(a), support must be provided to relevant persons to understand the care choices (3)(c) and the provider must arrange these persons’ input in decision making (3)(d),(e).
Additionally, systems must be in place to monitor and improve quality and safety of the care s17(2)(a); maintain accurate, complete and contemporaneous records of care (2(c)) and seek and act on feedback from relevant persons (2(e)).
The LGSCO said that it would not expect home carers to deliver personal care where the client’s informal carer (or the client him or herself, implicitly) does not want them to but commented further that the Care Provider would be entitled to charge for the full time commissioned on those occasions.
This is important as a principle because otherwise charging the Council for care not delivered could otherwise be characterised as fraud.
Some Councils’ contracts provide for this specifically, whilst others do not. Providers, be warned!!
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s Bolton Metropolitan Borough Council (22 016 488) report.
If you are affected by the issues in this report, please consider asking a free, one-off question, anonymously, at a level of principle, here. Our experts’ response will give you an opinion which may then help you and the broader community, when posted.
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