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Essex County Council (17 009 380)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 01 May 2018

The Ombudsman's final decision:

Summary: The Ombudsman found there was fault with the way in which the Council carried out Mr F’s care review, while he was in temporary residential care. The financial remedy offered by the Council is sufficient to address any injustice caused.

The complaint

  1. The complainant, whom I shall call Ms C, complained to us on behalf of her father in law, whom I shall call Mr F. Ms C complained that due to fault by the Council, her father ended up staying in a care home longer than he should have had to.
  2. She says that, as a result, there was an unreasonable delay in him returning to his own home, which is what he wanted. He left the care home with a very large and unexpected bill for the cost of his stay.

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The Ombudsman’s role and powers

  1. 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)
  2. If we are satisfied with a council’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

  1. I considered the information I received from Ms C and the Council. I also interviewed two staff members from the Council who were involved with this case. I shared a copy of my draft decision statement with Ms C and the Council and considered any comments I received, before I made my final decision.

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What I found

  1. The Government’s “Care and support statutory guidance” says that:
    • 3.21: All reasonable efforts should be taken to ensure that information and advice provided meets the individual’s requirements, is comprehensive and is given at an early stage. Local authorities must seek to ensure that all relevant information is available to people for them to make the best-informed decision in their particular circumstances
    • 3.29: Advice and information content should, where possible, be provided in the manner preferred by the person and will therefore often need to be available in a number of different formats.

What happened?

  1. Mr F went into hospital in June 2016 for a blood transfusion. The hospital social worker spoke to Mr F, who agreed to a short free stay in a residential home while the Council would arrange a care package to enable him to go home. Mr F went into the care home on 26 July 2016.
  2. The Council found a care provider and arranged for homecare to start on 8 August 2016. The records show Ms C had a telephone conversation on 8 August 2016 with the hospital social worker. She said Mr F was due to have a hospital appointment later that day to discuss treatment. They discussed a return home later that day, but both agreed Mr F would benefit from staying a bit longer at the care home until his health needs were clearer. The record states Ms C felt Mr F was not medically ready to go home yet. As a result, the Council suspended the home care support. Ms C says the social worker failed to involve her father, who has capacity, in this decision.
  3. Ms C told me that she only supported the decision for her father to stay in the care home, because she did not know that her father would receive care support at home, if he was to decide to return home. Ms C says the social worker never told this to her on 8 August 2016, which is why she did not know.
  4. The Council subsequently planned to carry out a care review on 19 August 2016, which would have been before Mr F’s four weeks of free care would come to an end on 23 August 2016. However, Mr F went into hospital from 18 until 23 August. The Council told me there was a missed opportunity to discuss and re-evaluate the continued suitability of Mr F’s care home placement, with the hospital consultants as part of this discharge.
  5. The care home manager told the Council on 9 September 2016 that Mr F attended a hospital appointment the day before, at which his consultant asked him to stay at the home until his next appointment on 3 October. The consultant said Mr F was very ill and his condition could change rapidly. Mr F’s Haematologist also advised him not to go home as he needed to be monitored because his medication had been changed. Ms C told me the consultants only advised this because they believed there would not be a care package for Mr F at home.
  6. It took until 13 September 2016 before the social worker carried out the care review. This was three weeks after Mr F returned from hospital and four weeks after his four weeks of free residential care had ended. The Council told me it recognises there was a small gap between the end of the free interim placement, and the social worker’s visit to discuss the need for a financial assessment. In the light of this, the Council would like to offer £2,000 to remedy this.
  7. Mr F’s “Determination of Need” form, dated 13 September 2016, states that:
    • Mr F needs support with his medication, taking about 20 tablets a day.
    • His mobility has declined significantly since he was discharged from hospital. He needs to be monitored when using his Walker.
    • Mr F needs support with his nutrition, because he is unable to cook. He needs to eat regularly because he is Diabetic.
    • He also has eligible needs in the areas of: maintaining personal hygiene; managing toilet needs; and maintaining a habitable and safe home environment.
    • Mr F was eager to return home. He also confirmed he would use his car if returning home, which was against his doctor’s advice.
    • Ms C was concerned about Mr F’s health and that he would not receive the support he would need if he would go home. She said Mr F would need constant care, which he would not have at home. If he would take a turn for the worse there would be nobody to monitor him. Ms C was also worried that Mr F would use his care.
    • The care home said Mr F was settled and happy to share a double room at the home with his wife. Mr F had many health issues, but would often forget how serious they were.
  8. Based on the needs assessment and the concerns expressed by Mr F’s consultants, Ms C, and the care home manager, the social worker recommended that he should remain at the care home. Ms C supported this decision and Mr F agreed to stay.
  9. Ms C told me that she only supported the decision for her father to stay in the care home, because she did not know that her father would receive care support at home, if he was to decide to return home. Ms C says the social worker never told this to her on 13 September, which is why she did not know.
  10. At the review, the social worker explained there would be a financial assessment to determine what contribution Mr F would have to pay towards the cost of his residential care. The social worker told me she also explained that people with capital above £23,250 would have to pay for all their costs. However, she also said the Council does not have any leaflets or booklets about charging to give to its clients.
  11. According to the records, Mr F’s health subsequently deteriorated. Ms C told the Council:
    • On 30 September 2016, that Mr F’s health had deteriorated.
    • On 11 October, that Mr F has not been well. He had fallen twice and refused to go to the hospital. 
    • On 28 October, that Mr F was admitted to hospital.
  12. There was a delay in completing Mr F’s financial assessment. This was not due to fault by the Council. It was difficult for Mr F and his family to obtain the financial information the Council needed. In addition, one of the visits had to be rescheduled due to Mr F’s hospital admission.
  13. On 21 November 2016, the social worker had a discussion with Ms C about Mr F’s wish to go home. The social worker told Ms C she left the contact details of Essex Brokerage with the care home manager. This service could help Mr F and Ms C with finding carers privately to support Mr F at home. However, Ms C said Mr F could not go home until the family had fixed the heating in his house. In addition, Ms C continued to be concerned about Mr F driving his car, all the medication he has to take, and Mr F’s being at risk of falls when mobilising.
  14. The care home reported on 12 December 2016 that Mr F had decided to remain in the home until Christmas, because: the heating was not fixed yet and Ms C had not been able to find a care agency yet.
  15. Ms C says that Mr F had not been able to make an informed decision about his care, because he did not know he had to pay the full amount of his residential care. In addition, they were never told it would be possible for him to go home with a support package. They therefore believed that the alternative to ‘staying in the care home’ was to ‘go back home without support’. When her father went back home on 25 January 2017, he had to pay the home around £15,000.

Assessment

  1. There was fault with the way in which the Council dealt with this case, in addition to the delay already acknowledged by the Council in paragraph 12 above.
  2. I agree the social worker failed to involve Mr F in the decision she made with Ms C on 8 August 2016 to extend his stay. However, I am unable to conclude, on the balance of probabilities, that he would have decided to go home. Although it is known that Mr F wanted to go home, he has also been convinced to remain in the home, on several occasions.
  3. Ms C says she was not aware on 8 August 2016, that a return home would have been a return home ‘with a package of homecare support for her father at home’. She told me that, if she had known, she would have supported a return home. However, I found that, on the balance of probabilities, I do not support this claim. The records I have seen, state the Council told Ms C in July 2016 that it would source a care provider to ensure her father would receive homecare support to return home. The Council’s record does not state that/if the social worker mentioned a homecare support package on 8 August. However, the social worker made the call on 8 August, because the Council had sourced a homecare provider for Mr F. I would therefore have expected her to have mentioned it. The fact the social worker did not record this specifically, does not automatically proof that she did not mention it during this conversation. However, I acknowledge that Ms C says she did not. In addition, as Ms C had been informed in July 2016 that the Council would source a homecare package for her father, I do not know why Ms C would conclude that this would no longer be the case as of 8 August 2016. Furthermore, if Ms C had any doubts / questions with regards to this, she could have raised these with the social worker during the call, as Ms C had raised similar concerns previously. This similarly applied to the discussion on 13 September.
  4. Mr F had capacity to make decisions and said at his care review on 13 September 2016 that he wanted to return home. However, there is no evidence the social worker discussed this option with Mr F and explained why she believed that a care package at home, consisting of several visits throughout the day, would not be sufficient to meet his needs. This is fault. However, all agreed that it would be best for Mr F to remain in the care home, due to the risks involved and his fluctuating health, which needed close monitoring.
  5. The Care Act states a council needs to ensure it gives comprehensive information to people as early as possible, to enable them to make well-informed decisions. I found the Council failed to ensure Mr F had sufficient information about care charges, when he discussed his future care arrangements with the social worker in September 2016. This is fault. While I understand that it is not the role of the social worker to provide this financial information, the Council should have provided this by either giving him a leaflet/booklet about charging or information about where he could obtain this online etc.
  6. However, I am unable to conclude this would have resulted in a different outcome, meaning: Mr F moving back home following the care review in September 2016:
    • All agreed, including Ms C and Mr F, that it would be best for Mr F to remain in the care home, due to the risks involved and his fluctuating health, which needed close monitoring.
    • Mr F’s health deteriorated further following the care review, which would have further increased the risks of a return home.
    • Mr F was aware that people who have capital above £23,250 would have to pay the full costs of their care. Based on his knowledge of his financial situation, he could have been able to predict that he would be a full cost payer.
  7. In November 2016, the social worker provided Mr F and Ms C with the information they needed to arrange a move back to Mr F’s home. However, the record states Ms C had difficulties finding a suitable care provider and the heating in the property needed to be fixed. The delays that occurred due to this were not because of fault by the Council.
  8. The remedy offered by the Council in paragraph 12 above, is sufficient to remedy any injustice caused by the faults identified above.

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Agreed action

  1. I recommended that the Council, within six weeks of this decision:
    • Pays Mr F the £2,000 mentioned above.
    • Review what information it should provide to people about financial assessments and charging (at the time it decides that a financial assessment needs to take place) to ensure people have access to comprehensive information, at an early stage, that is available in a number of different formats.
    • Produce an action plan to address any gaps and actions identified as a result of this review.
    • Share the faults identified above with regards to the care assessment in September and record-keeping (see paragraph 24 and 25), with staff involved with care assessments.
  2. The Council has agreed to implement my recommendations.

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Final decision

  1. For reasons explained above, I found there was fault by the Council. I am satisfied with the actions the Council will take and I have therefore completed my investigation.

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Investigator's decision on behalf of the Ombudsman

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