Middlesbrough Borough Council (18 003 767)

Category : Adult care services > Assessment and care plan

Decision : Not upheld

Decision date : 28 Mar 2019

The Ombudsman's final decision:

Summary: There is no evidence that the Council failed to arrange services which met the late Mr X’s needs.

The complaint

  1. Mrs P (as I shall call the complainant) complains that the Council failed to arrange residential care for her late father despite his poor mobility and increasing dependence.

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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. 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 written information provided by the Council and Mrs P, and spoke to Mrs P. Both the Council and Mrs P had the opportunity to comment on an earlier draft of this statement and I considered their comments before I reached a final decision.

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What I found

  1. The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs and their carers. The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. To have needs which are eligible for support, the following must apply:

1. The needs must arise from or be related to a physical or mental impairment or illness.

2. Because of the needs, the adult must be unable to achieve two or more of the following:

  • Managing and maintaining nutrition;
  • Maintaining personal hygiene;
  • Managing toilet needs;
  • Being appropriately clothed;
  • Being able to make use of the adult’s home safely;
  • Maintaining a habitable home environment;
  • Developing and maintaining family or other personal relationships;
  • Accessing and engaging in work, training, education or volunteering;
  • Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
  • Carrying out any caring responsibilities the adult has for a child.

Because of not achieving these outcomes, there is likely to be, a significant impact on the adult’s well-being.

Where local authorities have determined that a person has any eligible needs, they must meet these needs. When a local authority has decided a person is or is not eligible for support it must provide the person to whom the determination relates (the adult or carer) with a copy of its decision.

  1. The Care and Support Statutory guidance points out that “The concept of ‘meeting needs’ is intended to be broader than a duty to provide or arrange a particular service.” It goes on, “There are a number of broad options for how needs could be met, and the use of one or more of these will depend on the circumstances. Section 8(2) of the Act gives some examples of ways of meeting needs, and would cover:

the local authority directly providing some type of support, for example by providing a reablement or short-term respite service

making a direct payment, which allows the person to purchase their own care and support

some combination of the above, for example the local authority arranging a homecare service whilst also providing a direct payment to meet other needs….

  1. Where the local authority provides or arranges for care and support, the type of support may itself take many forms. These may include more traditional 'service' options, such as care homes or homecare, but may also include other types of support such as assistive technology in the home or equipment/adaptations, and approaches to meeting needs should be inclusive of less intensive or service-focused options.”

What happened

  1. Mr X was an elderly man who lived alone. His daughters, Mrs P and her sister, lived close enough to visit regularly. Mrs P acted as Mr X’s carer.
  2. Mr X’s mobility began to decrease and in May 2017, the Council arranged for a 2-week stay in its intermediate care unit. Mrs P says her father was in good spirits during his stay. As the boiler in Mr X’s home was faulty and not providing hot water, the Council arranged for his stay to be extended, and transferred him to care home A. Mrs P says she knew her father preferred a different care home (care home B) with which he was familiar from visits, and established there was a place there instead: the social worker arranged for a transfer.
  3. Mrs P says Mr X was very happy and settled at care home B, but lost some of the mobility he had regained at the intermediate care unit where he had been receiving physiotherapy exercises. The Council says an assessment at care home B described Mr X as independent with his care and mobility (with a walking stick). He did not require help with dressing in the morning and needed no attention during the night. Mr X fell on 5 July, however, and sustained some bruising to his leg.
  4. Mr X left the care home on 9 July. Mrs P says she was unable to wait for a meeting which the social worker had arranged prior to discharge as he was late. She says her father appeared quite disorientated when he arrived home.
  5. Mr X fell on 14 July at home. He had taken his alarm bracelet off to wash, was unable to summon help and lay on the floor for an hour. Mrs P contacted the Council and Mr X’s social worker arranged for a reablement care package for two weeks, with carers calling three times a day from 15 July to support Mr X with meal preparation and personal care, and to determine if ongoing support was needed. Carers were asked to report back on Mr X’s mobility.
  6. The carers’ notes for the daily calls evidenced that Mr X continued to be largely independent with dressing and meal preparation even when the carers were present. On occasions Mrs P had brought him a meal but there are also references to Mr X chopping vegetables to make his own dinner.
  7. The Council says the reablement service ended on 27 July as planned as Mr X was independent with his care. The Council closed his case the same day. Mrs P says she asked for respite care but was ignored.
  8. Mrs P says Mr X was low in spirits after the service finished because of the lack of social interaction. At his request she asked at care home B if Mr X could go there for lunch some days. Mr X started to attend care home B but Mrs P says he began to struggle getting out of the taxi. Mrs P contacted the social worker about residential care for her father after she asked if care home B had vacancies. She says the social worker said Mr X did not meet the criteria.
  9. Mrs P obtained a letter of support from Mr X’s GP to send to the Council to ask for residential care. The same evening Mr X fell again and Mrs P says she and her sister decided they would arrange for Mr X to enter residential care. Unfortunately Mr X was taken to hospital that night after he failed to respond to the alarm service, and died next morning from heart failure.

The complaint

  1. Mrs P complained to the Council that her requests for residential care and concerns about Mr X’s vulnerability had been ignored and she said if her father had been in care at the time of the falls, he would have received immediate attention. She said they had not been given an explanation of what the criteria for residential care were. She said her request for respite care had not been agreed.
  2. The Council investigated the complaint and responded. It did not uphold the elements of the complaint about the Council’s alleged failure to respond to Mr X’s vulnerability and detailed the services it had put in place to support him while he needed support. It did not uphold the complaint that respite care (requested for October 2017) had been refused, as it said the social worker had asked them to contact him in August to complete a carer’s assessment from which the need for respite could be determined. It partly upheld the complaint that the social worker had not properly explained the dependency levels for residential care, such as 24-hour care and overnight attention.
  3. Mrs P complained to the Ombudsman. She said she was sure if her father had been in residential care he would not have died when he did. She also said she later found out there was a night-sitting service available (which she says would have alleviated her own anxiety) but they were not given information about it.

Analysis

  1. The Council arranged care appropriately for Mr X in May 2017 when his mobility became a matter of concern. It then extended the care period to ensure he had proper facilities available when he returned home. There is no evidence of fault there.
  2. When Mr X fell in July, the Council arranged a reablement service to support Mr X and to observe his mobility and dependence levels. The carers’ notes show that Mr X was generally independent in his daily life. It was not fault on the part of the Council to complete the service and to close the case at that point. There was no evidence that Mr X was unsafe at home.
  3. The request for respite care was answered by the offer of a carer’s assessment for Mrs P to ascertain what her needs were and if they could be met by a period of respite care later in the year for Mr X. Sadly Mr X died before that could be arranged.
  4. The Council acknowledges it should have been more explicit in explaining the criteria for residential care, rather than simply telling Mrs P that her father did not meet the criteria. However, while that was frustrating for Mrs P, it did not cause Mr X any injustice as there was no evidence at that time that he needed or would have received Council funding for 24-hour residential care.

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Final decision

  1. There was no fault on the part of the Council in the way it considered Mr X’s needs.

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Investigator's decision on behalf of the Ombudsman

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