Summary: Ms B complained in her own right and on behalf of her late mother, Mrs C. She complained about the Council’s actions when her mother moved to a care home. She said the Council delayed in carrying out an assessment of her needs. That meant her mother did not receive the care she needed. She said the lack of appropriate care had a significant impact on her mother’s quality of life. It was also distressing for her and the rest of the family. She considered the Council did not respond appropriately to her complaints which added to her distress. There was fault by the Council which caused injustice to Ms B. The Council will apologise, make a payment and review its services.

The complaint

1. I refer to the complainant as Ms B. She complained in her own right and on behalf of her late mother, Mrs C. She complained about the Council’s actions when her mother moved to a care home. She said the Council delayed in carrying out an assessment of her needs. That meant her mother did not receive the care she needed. She said the lack of appropriate care had a significant impact on her mother’s quality of life. It was also distressing for her and the rest of the family. She considered the Council did not respond appropriately to her complaints which added to her distress.

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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. 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 considered the complaint and documents provided by Ms B and spoke to her I asked the Council to comment on the complaint and provide information. Ms B and the Council 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

5. The Care Act 2014 requires councils to carry out an assessment for any adult with an appearance of need for care and support. The person’s needs and how these will be met must be set out in a care and support plan.
6. Councils should keep care and support plans under review. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months.
7. It is not the Ombudsman's role to decide what, if any, care and support a person needs. That is the council's role. The Ombudsman's role is to consider if the council has followed the correct process for establishing a person's needs and if it acted correctly when this process was complete. In doing so we look at what information the council considered, and if it took account of the service user’s and carer’s wishes. If a council considers all this information properly the Ombudsman cannot find a council at fault just because a service user disagrees with its decision, or outcome of an assessment.
8. The Council uses a third-party to carry out its adult social care (ASC) responsibilities relevant to this complaint. 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. For clarity I have referred to the Council throughout even when the actions were by the third-party.

What happened

Summary of the key events

9. Mrs C was discharged from hospital in February 2021 to the care home. This was under the discharge to assess pathway where someone is well enough to leave hospital but not necessarily well enough to return to where they were previously living.
10. At first Mrs C was very frail and in an assessment of her needs in June 2021 she was considered to be on end-of-life care. But Mrs C’s health then started to improve and by July the family expressed concerns about the placement as they considered there was not sufficient stimulation for Mrs C.
11. Mrs C was under the Deprivation of Liberty Safeguards (DoLS) as she was not able to leave the care home. A DoLS review in August 2021 recommended the Council should appoint a social worker to conduct a review of Mrs C’s adult social care needs.
12. In February 2022 a new social worker took over and the family again raised their concerns about the care provided by the home. There were meetings with the home and the Council. The Council responded to the complaints in April and there was a further review of Mrs C’s care in May.
13. In September 2022 Ms B raised a formal complaint with the Council. This set out in detail her concerns and also suggestions for a way forward. There was no formal response to that complaint.
14. Mrs C went into hospital at the end of March 2023 and died in May.

Analysis

Mrs C’s placement in the care home

15. Mrs C moved to the care home after a spell in hospital. This was not initially on a permanent basis. The contract for the interim placement was between the Council and the home in February 2021. There were not arrangements in place for Mrs C to pay for her own care so the Council agreed to continue to fund the placement until the family could make the necessary arrangements. A further contract between the Council and the care provider in June 2021 confirms this. As I understand it Mrs C was able, at this point, to fund her own care. That meant she was a full-cost payer but the care was commissioned by the Council. In these cases, we treat the provider’s actions as if they were Council’s actions.

Meeting Mrs C’s needs

16. The issue at the heart of this complaint was summed up by the family in saying they accepted the home met Mrs C’s basic needs as they related to personal and nursing care but it did not maintain her well-being as it related to her social and psychological well-being.
17. These concerns were raised by the family over the summer of 2021 when Mrs C had begun to improve. The issues were clearly set out in the DoLS review in August. That recommended a social worker carry out a social care needs assessment. That did not happen until May 2022. That delay was unacceptable and is fault.
18. I am unclear from the documents provided by the Council as to the exact process of the assessment. There appears to have been assessments in May and September 2022.
19. Particular concerns for the family were about Mrs C’s diet and transfers from bed. Both assessment documents stated that referrals had been made for a Speech and Language Therapy (SALT) assessment and for a further assessment of moving and handling. I consider this is likely to stem from meetings in March and a later follow up meeting where the families concerns were discussed with the home. The Council has not provided any further information about the outcome of these referrals. As I say above, as the Council was commissioning the care, we consider the actions of the care provider as if they were the actions of the Council. It is unsatisfactory that the Council has not been able to provide more information about these referrals which were considered necessary to understand Mrs C’s needs. It suggests a failure by the Council to understand the role it had in ensuring Mrs C’s needs were met as the commissioner of her care.
20. In terms of the overarching issue of the social and psychological wellbeing the assessments and support plan stated that staff were to offer Mrs C stimulating activities, in her room, if she was unwilling or unable to leave her room. It was the case that Mrs C did not wish to leave her room. The plans do not specify the frequency or duration of the activities that should be offered to Mrs C. This is unsatisfactory. If something was considered to be necessary to meet needs there should be an appropriate degree of specificity in saying how those needs were to be met. The failure to be specific about the extent of the provision is fault.

Complaint handling

21. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. A single stage procedure should be enough. The council should include in its complaint response:
• how it considered the complaint;
• the conclusions reached about the complaint, including any required remedy; and
• whether it is satisfied all necessary action has been or will be taken by the organisations involved.
22. Ms B complained in late September 2022. The Council stated the complaint was forwarded to the third-party provider and ongoing support was provided to the family and the care home to resolve the issues. This included an offer of an alternative placement. The Council provided no detail or evidence of the action taken. There was not an adequate response to the complaint and that it fault.

Injustice

23. Ms B considered her mother did not receive the level and type of care and support she should in her time in the care home. I am finding fault as I detail above but I consider it is not possible for me to conclude that had those faults not occurred that it would have made a significant difference to Mrs C. In the DoLS review in August 2021 the reviewer stated they did not find there was any suggestion of failing to meet needs or provide a safe environment. In March 2022 the care home stated in a meeting with the family that it could not do more to support Mrs C. I do not, therefore, consider there is evidence to suggest there would have been any significant change to the care provided to Mrs C. But, the failure to respond to the complaint and delay in arranging the assessment has caused some injustice to Ms B and an apology and a symbolic payment is appropriate.

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Agreed action

24. The Council will:
• apologise to Ms B in accordance with our guidance on making an effective apology and pay her £300;
• review its complaint handling and guidance on the provision of services for people where the Council has commissioned the care but they are a full-cost payer.
25. The Council should provide us with evidence it has complied with the above actions. For the first bullet point within one month and for the second within two months of the final decision.

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Final decision

26. There was fault by the Council.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman