Plymouth City Council (18 008 907)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 10 Jan 2020

The Ombudsman's final decision:

Summary: Ms B complains about the care provided to her father, Mr B, when he returned home from hospital and about the consideration of him for extra care housing. There was fault in the Council’s handling of care provision for Mr B, in its consideration of his suitability for extra care housing, the handling of a respite placement and in its complaint handling. In recognition of the injustice caused to Ms B and the family the Council should make a payment to her.

The complaint

  1. Ms B complains about the care provided to her father, Mr B, when he returned home from hospital. She says there was a delay in agreeing a proper support package and, before that was put in place, she, and other family members, were having to provide support to Mr B. She says the lack of proper support planning meant that an agreement to an extra care supported living place was delayed. This meant Mr B was living in an unsuitable house with inadequate support. It placed extra stress on the family and as Ms B lives abroad she had to take additional leave from work and flights to visit Mr B.

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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. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
  3. 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 complaint and documents provided by Ms B and spoke to her. I asked the Council to comment on the complaint and provide information. I sent a draft of this statement to Ms B and the Council and considered their comments.

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What I found

Summary of what happened

  1. Mr B was living at home. He suffered a stroke and was in hospital. He was discharged home in late December 2017. The reablement team provided care of three visits a day.
  2. The Council assessed his social care needs in January. It did not finalise a care and support plan as the family considered that Mr B needed more support than the Council was proposing. At the same time the family wanted Mr B to be considered for a place in extra care housing. That was considered at the decision making panel at the end of January. The panel deferred a decision asking for more information about Mr B’s needs.
  3. A different officer assessed Mr B in the middle of February. A care and support plan was drawn up. This was for three visits a day providing support with personal hygiene and support and prompting with eating and medication. Before this care package was put in place Mr B was admitted to hospital for a few days. When he came out the family requested some residential care.
  4. The Council arranged a care place but Mr B only stayed a couple of days as he was asked to leave because of smoking in his room. He did not go back home but stayed with his daughter, Ms B’s sister. The Council arranged for care at his home but this was lost as the family were not able to accept it quickly enough. Mr B returned home on 10 March and care was not in place until 15 March.
  5. At this time the panel considered Mr B’s application for extra care housing. It was approved and Mr B moved to an extra care place at the end of March.
  6. Ms B’s had made a complaint in January 2018. She chased this with the Council and then complained to us. We referred it back to the Council which responded in January 2019.

The response to the complaint

  1. The Council provides its adult social care responsibilities through Livewell South West (LWS). In responding to the complaint LWS accepted there were a number of faults. These can be summarised as:
    • Delay in carrying out an assessment of Mr B’s needs. It took three weeks when the target is to do so in 48 hours;
    • Delay in completing the assessment and referring it to the extra care panel;
    • Failures in communication and responses by the first social worker;
    • Failure to share the care plan with the family and Mr B;
    • Problems with carrying out the assessment for continuing health care funding;
    • Failure to make a referral for an advocate;
    • Sharing the care plan with the care home before the family; and,
    • Delay in responding to the complaint.
  2. LWS said it would offer financial redress. It asked Ms B to provide information about any payments made for absence from work and travel and it would consider reimbursements. Ms B submitted information. LWS said it would pay £500 for the faults but that she would need to take legal advice on any claim for financial redress as that would not be considered through the complaint process.
  3. LWS says it has made changes and improvements to the Discharge to Assess Service and people being discharged from hospital to their own home are now seen within 2 hours of discharge. The Council now gives twice weekly updates on delays for people waiting for packages of care so LWS can improve oversight of such delays and monitor the impact.

Analysis

Care and support to Mr B

  1. When Mr B was discharged from hospital he was receiving support at home from the reablement team. He also had support from family members in particular from his grandson who is referred to in the care planning notes as providing regular support to Mr B. But there was delay in the initial adult social care assessment of Mr B. And then following the disagreement between the family and the Council the reablement care continued rather than a transfer to social care.
  2. Where there has been fault I have to consider whether that has caused injustice to the complainant. Mr B was receiving support and that would still have been the same even if the assessment had been done more quickly. The key issue here for Ms B was the nature of the support being provided. She considered the support was inadequate and that as a result she had to visit often to provide extra support to the local family members. This was costly for her as she lives abroad and had to pay for flights to travel back and to buy extra leave from her employer.
  3. I have considered the records of care provided by the care provider over December to February. These show visits being made but they do not record a great deal of support being provided. Often there were members of Mr B’s family present and Mr B was not requesting support with personal care. The notes do not indicate that more support was needed. I understand the family wanting to be certain that the package of care proposed by the Council when it assessed would meet Mr B’s needs but I cannot say the care that was in place over that period fell significantly short of what Mr B required. This means I cannot say that some fault in the care provision and planning meant that Ms B incurred extra costs in providing support to her father. I fully understand that she would want to visit regularly and I accept that was expensive for her but I cannot say that was as a result of fault by the Council. I cannot, therefore, recommend that the Council should reimburse her costs.

Extra care housing

  1. This was considered by the panel in January. It was rejected as the panel considered it was not certain that Mr B’s needs were at such a level that he met the requirements for extra care housing. I can understand why that decision was made based on the information before the panel. But had there not been the initial delay in carrying out the first assessment I consider all the necessary information should have been before the panel by the February meeting. That means that Mr B would have been able to move a month sooner to extra care housing. That would have meant that he would have been in a place more suited to his needs.

Respite placement

  1. The Council has accepted there was some fault in how it arranged this – the care plan was shared with the care provider before it had been shown to the family. And there was a gap in the resumption of care when Mr B left the placement.
  2. I consider there was some fault in the arrangement of the care placement but I do not consider this is likely to have altered the outcome. This was an emergency, short-term placement and there was unlikely to be any alternative options available.
  3. The Council did arrange for a package of care to be resumed just after Mr B left the placement but that was lost when it was not immediately confirmed. There was then some delay in arranging more care which was fault

Complaint handling

  1. Ms B complained in February 2018 and the Council formally acknowledged it. It was allocated for investigation in September and a response sent in January 2019. The Council has accepted this was fault. It has commented that it had a significant backlog at that time but it has taken action to address that and new processes are in place.
  2. This was significant delay and I ask the Council to provide confirmation there is no backlog now in complaint consideration.

Other matters

  1. The Council has accepted fault in communication by the first social worker and in its handling of a request for an assessment for continuing health care funding and a request for an advocate. I have not referred to these matters in detail as I do not consider I can add anything to the responses already provided by the Council.

Agreed action

  1. Where there has been fault we consider what injustice that has caused to the complainant and ask the Council to provide an appropriate remedy. I explain above why I do not consider there are grounds for me to ask the Council to reimburse Ms B for the costs she incurred in her visits to her father. But I consider there should be a payment as the only way to remedy the injustice that has been caused to Mr B and the rest of the family as a result of the failings referred to above. The Council has offered £500. I consider the payment should reflect that Mr B’s move to extra care housing was delayed by a month, there was some upset to the family caused by the way the emergency care placement was arranged and in the provision of care after that. The delay in the complaint handling has also caused some injustice to Ms B. To recognise all of that, and the other issues referred to in paragraph 24, the Council should make a payment of £750 to Ms B.
  2. The Council should also confirm that there is no backlog in complaint consideration.
  3. Both these actions should be completed within a month of this decision statement.

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Final decision

  1. There was fault in the Council’s handling of care provision for Mr B, in its consideration of his suitability for extra care housing, the handling of a respite placement and in its complaint handling.

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Investigator's decision on behalf of the Ombudsman

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