The Ombudsman's final decision:
Summary: The Council did not deal properly with Mr H’s transition from college to a permanent adult placement. It needs to remedy the injustice it has caused and prevent similar problems from happening again.
- The complainant, a Solicitor, complains the Council failed to deal properly with Mr H’s transition from college to a permanent adult placement, resulting in him spending months at his mother’s home.
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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)
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How I considered this complaint
- I have:
- considered the complaint and the documents provided by the Solicitor;
- discussed the complaint with the Solicitor;
- considered the comments and documents the Council has provided in response to my enquiries; and
- shared a draft of this statement with the Solicitor and the Council, and taken account of the comments received.
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What I found
- Mr H has a learning disability and uses a wheelchair. He communicates by signing. From 2013 until the end of July 2016 he attended a residential college for disabled students. He spent his vacations with his family (14 weeks a year plus some weekends and ad hoc visits). He received £4,071 in direct payments a year to pay for one-to-one care while at home:
On 19 March Mrs H asked the Council about the possibility of setting up a new supported living scheme so her son could live with some of his old school friends who would be in a similar position when he left college. When the Council replied on 1 April, it said with over 150 supported living places within its area it was not looking to commission more. On 10 June Mrs H told the Council they had visited many care homes looking for a post college placement for her son. She said his preference was for Care Home A, which is in another county, with Care Home B as a back-up. She asked the Council if it wanted to visit Care Home A but it said it could not do this until 2016. It told her decisions on future care would follow an assessment of her son’s needs. On 29 June the Council told Mrs H its Brokerage team would arrange a residential placement once its Learning Disability Panel had approved funding. On 3 September Mr H’s Progress & Transition Coordinator at the College wrote to the Council. She said she aimed to spend time with Mr H regularly and attend his multi-disciplinary team meetings and annual reviews. She asked the Council to keep her updated. On 14 December Mrs H asked the Council if it had heard from Care Home A about visiting. She also asked how things stood with her son’s decision to live at Care Home A and whether the Council’s Learning Disability Panel had been asked to approve funding. The Council told her Care Home A had not been in contact and it could not visit until its Brokerage team was involved. On 14 January 2016 the Council received a copy of the paperwork for Mr H’s annual review at the College. On 28 January Social Worker X started an assessment of Mr H’s needs by visiting him at his mother’s home. On 23 March Mrs H told the Council Care Home A would assess her son on 5-8 April and he hoped to secure a place there. She said he was on the waiting list for Care Home B as a back-up. She asked if the care homes had sent any paperwork and if the Council had sent the paperwork to its Learning Disability Panel. She noted her son would start his final term after Easter. She said she would start chasing up paperwork after Easter, as she did not want to run into any last minute problems. Social Worker X sent Mrs H’s e-mail to a Senior Practitioner. She noted she had not started writing up Mr H’s assessment but would do this as soon as possible. Social Worker X passed her assessment to the Senior Practitioner for approval on 29 March. The assessment says it took account of educational reviews from the College. It did not involve the College’s Progress & Transition Coordinator. Social Worker X noted she had completed the carer’s assessment but not the mental capacity assessment, as she had not visited Mr H at his college. The assessment says returning home when his college placement ended would put “immeasurable pressure on the family and it is something [Mrs H] can no longer cope with”. It says Mr H had an ulcer on his foot which had needed continuous treatment since 2009, including hospital stays, but it was difficult to keep it healed, impacting on his mobility. In January 2016 Mr H had a non-weight bearing plaster cast to aid healing. The assessment says Mrs H would not be able to meet these outcomes if her son returned home:
- £2,576 to pay for 16 hours a week during the 14 weeks;
- £1,495 for weekends and ad hoc visits.
The assessment recommended “that the home environment may not be the best one for [Mr H], given the impact caring has on [Mrs H] however she wants to be fully involved in his life”. It does not include an indicative personal budget but notes Mr H “is unable to return home and therefore the indicative estimated budget will be provided by the future allocated social worker”. The Senior Practitioner approved the assessment on 4 April. Social Worker Y arranged a meeting with Mrs H for 11 April to discuss her son’s care and support plan, as the Council needed to find a new placement for him before the end of the academic year. At the meeting Social Worker Y completed a mental capacity assessment for Mr H. This says Mr H did not have the capacity to decide where he should live and was unlikely to regain the capacity to do so. It says Mrs H would advocate on his behalf. On 22 April the Council’s Learning Disability Panel turned down an application for permission to find a residential placement for Mr H when his college placement ended in July 2016. The Panel referred the matter to a Manager who, on 26 April, approved it. However, on 1 July the Learning Disability Panel turned down an application to fund a £1,432 a week residential placement at Care Home A. The application noted two other placements would not meet Mr H’s needs as the other residents would be much older than him. Another placement had no wheelchair access. The Panel turned down the application saying:
- provide care to her other children;
- manage and maintain Mr H’s nutrition;
- maintain family relationships;
- engage in work, training, education or volunteering;
- make use of necessary facilities in the local community.
The Learning Disability Panel agreed an interim support package for Mr H to “remain at home” so the Care Manager could explore options for supported living. The Panel identified these actions for the Care Manager:
- transition planning needed to be more comprehensive and person-centred;
- Mr H’s views and aspirations needed exploring, although he does not have full capacity to decided where to live;
- he should be supported to maintain previous links and relationships with family and friends to promote his independence, confidence and wellbeing, and considering his access to continued education, vocational training, employment and social inclusion.
Mr H returned home on 20 July. Mrs H says it was not possible to prevent her son from weight bearing while at home, resulting in the wound on his heal returning. On 12 August the Learning Disability Panel met again to consider the application to fund a placement at Care Home A. The report to the Panel says:
- hold a family meeting to discuss care options;
- do a thorough carer assessment to identify interim support for Mrs H to continue in her caring role;
- consider an occupational therapy assessment of Mr H’s independent living skills and potential for development.
- a meeting had been held with Mrs H. Care Home C, identified by the Council’s Brokerage team, had assessed Mr H but could not meet his needs;
- Mrs H turned down a carers assessment as she was not prepared to have her son live at home permanently so did not need one;
- Mr H needs help with most of his daily activities, uses a wheelchair and has his food pureed;
- Brokerage had no further proposals to make other than those it had already made;
- Care Home A would be suitable for Mr H as:
The Panel agreed to fund the placement at Care Home A. Mr H moved to Care Home A on 5 September 2016. In 2017 the Council reviewed the terms of reference for its Adult Practice Review Group, which replaced the Learning Disability Panel. The terms of reference provide for frontline assessment and care management staff to attend meetings.
- it would meet his needs;
- he could access all the floors in his wheelchair;
- he had visited and wanted to go there;
- it is 30 minutes drive away from Bromley.
Is there evidence of fault by the Council which caused an injustice?
- Social Worker X took two months to complete Mr H’s assessment. There is no reason for it to have taken so long. That was fault. This would not have been a problem if the Panel had accepted the recommendation to fund a placement at Care Home A, but it did not.
- The Council found Mr H did not have the capacity to decide where he should live. Under the Mental Capacity act 2005 it should then have held a best interests meeting to decide where Mr H should live. It did not do that, which was also fault. Had it held a best interests meeting it would have had to explore all the options for meeting Mr H’s needs, and taken account of his wishes and feelings and the least restrictive option. If done properly, this could have streamlined the process of approving funding.
- Paragraph 10.85 of the Department of Health’s Care & Support Statutory Guidance provides guidance on the use of approval panels, such as the Council’s Learning Disability Panel. It says:
I cannot find fault with the Council for using a panel to approve Mr H’s placement and personal budget, as it is a large personal budget. However, it would have been helpful if someone directly involved in assessing Mr H had been part of the Panel, as recommended by the Statutory Guidance. This could have helped to prevent unnecessary requests being sent to the Care Manager. The Council has since reviewed the way such matters are dealt with and now involves the necessary frontline staff. The Council’s use of its Panel caused further delays in the process. The initial request was for approval to find a residential placement, despite the fact one had already been identified. When a request was made to approve funding for Care Home A, the Panel rejected it and said to consider supported living, which contradicted its initial decision to approve residential accommodation. The Panel’s decision put Mrs H in the position of having no choice but to have her son back home, when the assessment had already concluded this was not a realistic option for all concerned. That was fault. The Council’s delays and the decision to return Mr H to the family home caused injustice to Mrs H as she was wrongly put in the position of having to care for her son when she had made it clear she could not do this. This requires an apology and a financial remedy for Mrs H. The delays also caused injustice to Mr H, due to the distress and anxiety resulting from the failure to ensure a seamless transition from college to a long-term placement. The Council’s terms of reference for its Adult Practice Review Group should ensure the process works more efficiently in future, as frontline staff will be involved. However, the Council needs to ensure officers comply with the requirements of the Mental Capacity Act 2005 and hold best interests meetings when necessary. I note what Mrs H says about the sore on her son’s heel returning when he was back home. However, all the evidence indicates this was likely to happen whatever care setting he was in.
- “Due regard should be taken to the use of approval panels in both the timeliness and bureaucracy of the planning and sign-off process. In some cases, panels may be an appropriate governance mechanism to sign-off large or unique personal budget allocations and/or plans. Where used, panels should be appropriately skilled and trained, and local authorities should refrain from creating or using panels that seek to amend planning decisions, micro-manage the planning process or are in place purely for financial reasons. Local authorities should consider how to delegate responsibility to their staff to ensure sign-off takes place at the most appropriate level. In cases or circumstances where a panel is to be used, and where an expert assessor has been involved in the care and support journey, the same person or another person with similar expertise should be part of the panel to ensure decisions take into account complex or specialist issues”.
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- The Council has agreed to take action which will remedy the injustice it has caused. It will:
- within four weeks write to Mrs H apologising for failing to deal properly with the arrangements for her son’s care when he left college;
- within four weeks pay Mrs H £1,000 and Mr H £300;
- within eight weeks consider what action it needs to take to ensure officers arrange best interests meetings in line with the Mental Capacity Act 2005.
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- I have completed my investigation as the Council has agreed to take action which will remedy the injustice it has caused.
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Investigator's decision on behalf of the Ombudsman
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