St Helens Metropolitan Borough Council (18 003 276)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 02 Jan 2019

The Ombudsman's final decision:

Summary: The Ombudsman found fault on Mrs P’s complaint on behalf of her mother, Mrs Q, that the Council failed to provide fall monitors before her discharge from hospital. Mrs Q fell in her home and remained undiscovered for several hours. The Council also lost some of Mrs P’s appeal documents. The Council will send them an apology, pay Mrs P £150 and Mrs Q £500 for the distress caused, and review procedures.

The complaint

  1. Mrs P complains on behalf of her mother, Mrs Q, that the Council failed to:
      1. to explain the process properly during its involvement with a decision support tool (DST) assessment in 2015 which it failed to carry out properly and promptly;
      2. obtain evidence as staff claimed they would during that process;
      3. Promptly process her appeals against the DST decision;
      4. Provide her mother with monitors needed before her discharge home; and
      5. Ensure her appeal form and documents were not lost.
  2. As a result, Mrs Q suffered financially as she continued to pay for care herself, suffered physically from falls, and Mrs P was put to a great deal of time and trouble pursuing this complaint on her behalf.

What I have investigated

  1. The paragraph at the end of this draft decision explains why I did not investigate complaints a), b) and c).

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The Ombudsman’s role and powers

  1. 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)
  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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
  3. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

  1. I considered all the information provided by Mrs P, the notes I made of our telephone conversations, and the Council’s response to my enquiries, a copy of which I sent her. I sent a copy of my draft decision to Mrs P and the Council. I consider their responses.

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What I found

  1. There are two bodies responsible for providing care to meet a person’s needs:
  • The NHS: this provides healthcare and is free. The local clinical commissioning group (CCG) is responsible for providing services in an area; and
  • Local authority social services: this provides social and personal care but, a person may have to pay for it. This type of care includes help getting dressed or help at mealtimes, for example.
  1. In 2015, Mrs Q, aged 87 years old, lived in sheltered accommodation. She had a diagnosis of dementia. Following her admission to hospital, and during her stay there, a nurse and social worker visited to assess her needs. This in turn triggered an assessment for eligibility for NHS continuing healthcare.
  2. NHS continuing healthcare is free care for those with complex long-term health needs. It is funded by the NHS. The CCG is responsible for carrying out assessments and making decisions about NHS continuing healthcare. If awarded, it provides, and funds, the care needed.
  3. The NHS continuing healthcare checklist is used as a ‘light-touch’ assessment to help identify those who may qualify for a NHS continuing healthcare assessment who should go on to get a full assessment.
  4. Only those meeting the eligibility criteria qualify. The design support tool (DST) is used to see whether a person qualifies or not. It identifies 12 areas of needs which are in turn divided from ‘no need’, ‘low’, ‘moderate’, ‘high’, ‘severe’, and ‘priority’ need. It is carried out by a co-ordinator from a multi-disciplinary group and used by an assessor to reach a decision.

Complaint d): provision of monitors

  1. Following one hospital discharge, Mrs Q went in to a rehabilitation unit for about 6 weeks. While Mrs Q could return to her sheltered accommodation, she needed a care package. The social worker wanted door and floor monitors in the property. Mrs P was unhappy because when Mrs Q returned home, the monitors were not in place.
  2. Mrs Q had a fall and returned to hospital. When Mrs P complained to the Council about the failure to provide monitors, it partially upheld her complaint.
  3. In October 2017, Mrs Q moved in to a care home.


  1. The Council confirmed the following:
  • January 2015: Mrs Q was in hospital. The Council received a referral for her to have 2 care visits a day and a fall sensor (the sensor) from Provider A. This is a 24-hour response line. The Council found a care provider and made a request for the sensor. Her sheltered accommodation had its own internal intercom system but did not have fall sensor equipment in place. The sheltered accommodation intercom system was operated by Provider B.

Mrs P told me her mother received a care visit in the morning and one in the afternoon. The sheltered accommodation had pull cords in the property for emergency use.

The Council’s technology team visited her accommodation to see if the sensor would work with Provider B’s system. The Council says officers ordered the sensor for a compatible sensor with Provider B’s system but its delivery was delayed. When it arrived, it could not be programmed in to the accommodation’s system. Mrs Q had a fall before any sensors were fitted, resulting in her admission to hospital.

Mrs P explained when her mother fell, she was not near a pull cord. Nor could she manoeuvre towards one. Mrs P thought her mother was on the floor for about 4 hours before someone discovered her. During this time, she became a little dehydrated and stiff. Mrs Q was re-admitted to hospital.

The Council accepted Mrs Q had a fall before waist/wrist fall sensors from provider A were installed.

  1. The records show the following:
  • February: Mrs Q was fit for discharge from hospital but still needed the sensors. The Council waited for the delivery of Provider A’s system which should have arrived the previous month. An officer told Mrs P and discussed a temporary installation of a phone unit. Mrs P was unhappy but later changed her mind and would pay for the phone unit as her mother was due for discharge. Mrs P told me she did not refuse to pay.

The Council contacted Provider A about installing it. An installation date was agreed and the hospital told. The installation took place on 11 February before her discharge. Towards the end of the month, Provider A contacted the Council as Mrs Q now had choice of keeping the call system installed or changing it to the other system.

  • March: Provider A told the Council Mrs P did not want to change the system to avoid confusing her mother. Mrs P later confirmed this with the Council. A few days later, Mrs Q went to hospital following another fall. The Council waived Provider A’s costs.
  1. While I accept the Council took steps to arrange the sensors Mrs Q needed, they were not in place before her discharge in January. This is fault. The fault caused Mrs Q an injustice. This is because the evidence from Mrs P was her mother remained undiscovered following her fall for up to 4 hours. Had the Council installed the sensors, they would not have prevented Mrs Q from falling. What they would have done is allowed Mrs Q to raise the alarm promptly following her fall. On balance, I am satisfied the sensors would have meant her spending less time on the floor waiting for help. This would have reduced the distress caused to Mrs P and Mrs Q.

Complaint e): lost documents

  1. When Mrs P complained about lost appeal forms, and staff asking for documents they already had, the Council upheld the complaint. She was unhappy this delayed her appeal by about 12 months.
  2. In response to my enquiries, the Council accepted it could not locate some documents and emails about the appeals process. These included documents about Mrs Q’s discharge from hospital, for example, and a copy of her passport.


  1. Mrs P told the CCG in October 2015 she wanted to appeal its decision not to award Mrs Q funding.
  2. In January 2016, the CCG wrote and told her she needed to complete appeal forms. She sent the dispute notification form to the CCG in April.
  3. The Council accepted it lost some of her documents. This is fault. While this undoubtedly caused Mrs P a great deal of frustration and inconvenience, the funding decision was not altered. This means the injustice from the fault is limited.

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Agreed action

  1. I considered our guidance on remedies.
  2. The Council will, within 4 weeks of the final decision on this case, carry out the following:
      1. Send a written apology for the failure to provide the monitors before Mrs Q’s discharge in January 2015 and for losing some of Mrs P’s documents;
      2. Pay Mrs Q £500 for the distress she suffered because of the fault;
      3. Pay Mrs P £150 for the distress she suffered because of the fault; and
      4. Review procedures to ensure monitors assessed as needed, or a temporary suitable system if there are operational difficulties, are provided and installed promptly before a person’s discharge back home.

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Final decision

  1. The Ombudsman found fault on Mrs P’s complaint, sent on behalf of Mrs Q, against the Council. The agreed action remedies the injustice caused.

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Parts of the complaint that I did not investigate

  1. I did not investigate the following complaints:

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Investigator's decision on behalf of the Ombudsman

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