London Borough of Hillingdon (18 012 812)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 12 Sep 2019

The Ombudsman's final decision:

Summary: Ms D complains the Council forced a homecare package on her parents, that her parents did not want. She says there was subsequently also a delay in responding to their request to cancel the package. The Ombudsman found fault with the Council’s failure to ask Mr F whether he agreed to receive the proposed care support package and explain to him there could be a charge. If it had done, Mr F would have refused the care support. As such, the Council will waive the cost of the care package he received between April and July 2018.

The complaint

  1. The complainant, whom I shall call Ms D, complained to us on behalf of her (late) father, whom I shall call Mr F. Ms D complained that:
    • The Council forced Mr F to accept a care package that he did not want or need. They only ‘accepted’ the care package, because they were told that her father would not be allowed to leave the hospital and return home without one.
    • When the family told the care provider they wanted to reduce/stop the care package, there was an unreasonable delay in the care package being reduced, and subsequently stopped.

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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 investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
  3. When a council commissions another organisation to provide services on its behalf, it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions/service of the care home, I have made recommendations to the Council.
  4. 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 D and the Council. I shared a copy of my draft decision statement with Ms D and the Council, and considered any comments I received before I made my final decision.

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What I found

  1. Mr F went into hospital in March 2018 as he was confused and had fallen out of bed. Ms D told me she was the main carer for her parents and her father did not have capacity to make decisions. However, she was out of the country at the time, so her brother was looking after them. Ms D says:
    • The Council did not allow her father to return to his home, unless there was a care package in place.
    • Her father and mother did not want any care support, nor did they believe this was needed. They simply accepted what the hospital told them and did not raise any objections with the Council at the time.
  2. The Council said the hospital's social worker liaised with Ms D’s brother, who agreed to care services being put in place to support his mother in her role as Mr F’s informal carer. The social worker also made Ms D’s brother aware of the Council’s charging policy and the Council sent the financial assessment documents, a few days after the care services started. The Council told me that Mr F had capacity to make decisions according to the records.
  3. On 23 March 2018, the hospital asked the Council to carry out an assessment of Mr F’s needs. The social worker said the section 5 notification dated 27 March from the hospital said Mr F would need a package of care, consisting of four care calls by two carers.
  4. The Council allocated the case to a social worker on 27 March 2018. The social said the information she received indicated that contact should be with Mr F’s son. Furthermore, Mr F’s English language was limited and his preferred language for communication was Greek. This is also why all communication went through Mr F’s son.
  5. A report by the Occupational Therapist, recommended that Mr F would need a double handed care package providing assistance with all transfers and activities of daily living, including personal care.
  6. The social worker carried out Mr F’s social care assessment on 29 March 2018. The assessment, which included information obtained from Mr F’s son, said that:
    • Mr F’s wife was in poor health and had been struggling to care for her husband for the past few months.
    • Mr F would need help from two carers with all his transfers and activities of daily living, including personal care. He was double incontinent and would need his pads changed in bed by two carers.
    • Mr F was often unable to leave his bed due to dizziness. He was unable to use the stairs and would need to be nursed in bed.
    • Mr F’s son believed his mother would even struggle at home with the support of carers. But the Council should try this first before considering other options.
    • Support with toileting, continence management (x2 four times a day) and washing in bed + (un) dressing in bed (x2 once a day) and mobility.
    • Mr F will have no support from his family with preparing food and helping to eat and drink / medication.
    • Financial assessment document and financial assessment information booklet given to family.
  7. Ms D told me the Council did not share a copy of the assessment with the family. I shared a copy of the assessment with Ms D who pointed out several inaccuracies. For instance, the assessment said that Mr F would have no support from his family with preparing food or help with eating, drinking and medication, even though his wife would do this.
  8. The Council did not carry out a carer’s assessment with Mrs F, and acknowledged to me that this was fault. it should have done this, as Mrs F would have been able to provide some informal support (ensuring safety).
  9. The care provider carried out a pre-service visit on 3 April 2018. It says:
    • His wife maintained the home, managed his medication and provided all meals.
    • Mr F would need two carers to support him with personal care needs. Nursing staff were changing his pads with the support of two carers.
    • Two carers would need to assist him with all his personal care
    • The care plan was unsigned
    • Care Plan:
        1. 8am: personal care and strip wash in bed; change pad; cream body; dress me.
        2. Change pad and empty catheter at 1pm, 5pm and 8pm.
    • The assessment and proposed support plan were both unsigned
  10. The Council sent a letter on 10 April 2018. It also included a financial assessment form and a booklet. The letter explained that Mr F was receiving a chargeable service.
  11. Ms D told me her mother could have provided all the support that was provided by the carers. She said that neither her mother, nor her father, wanted care support in place. However, the records do not show the family indicated, before the package started, that Mrs F could manage all the support tasks, nor that Mr and Mrs F would not allow care workers to do this. However, the records do indicate Mr F’s family were concerned that Mrs F would not be able to cope without support.
  12. The care package started on 5 April 2018 and the social worker said she would review the care support after four to six weeks. The social worker told me:
    • This review was not carried out after six weeks, as Mr F went back into hospital at the time (mid May 2018). In the interim, the care provider did not raise concerns about care support being refused.
    • Once a patient has been readmitted to hospital, the package of care they are discharged with will be reviewed again within a 6 weeks period, to ensure that the package of care is appropriate.
  13. Ms D told me her mother and father never allowed the carers to provide personal care support to her father. Her mother changed and fed Mr F before the carers arrived. This meant carers were often not doing anything at all during visits. I asked the Council to look at the daily care records, to determine what care was provided during visits. However, the care provider said it accidentally shredded these records. As such, there is no evidence of the support the carers provided.
  14. Ms D told me she regularly asked the care provider to stop the care package. When the care provider said this would not be possible, because her father needed support, she asked the care provider to reduce it. The care provider explained to Ms D that it needs to inform the Council of her request, who will then have to agree and send a revised care plan to the provider. I have not seen any records to evidence the care provider discussed this with the Council. However, I have received evidence that showed the care provider acknowledged that Ms D had regularly discussed her request with the care provider. The care provider also acknowledged that Ms F had refused entry into the property on several occasions.
  15. Due to the care provider’s lack of record keeping, I have not been able to determine when Ms D first asked the care provider to stop / reduce the care package. The care agency did not report a concern to the social worker about the package in April. On 17 April 2018, the care provider sent an email to the Council which said that: “Everything is fine Mr F happy with the carers and our services”. The care provider told the social worker on 20 April that they would let social services know if there are any concerns. The social worker spoke again to the care provider on 4 May 2018 to obtain an update about the care. According to the records, the care provider did not say the family wanted to reduce the package.
  16. Ms D told me her mother eventually took it into her own hands and barred the entrance to her home when the carers came. She said the care provider told her it would talk to the Council and reduce the visits to twice a day.
  17. The care agency informed the Council on 19 June 2018, that Mrs F reduced the care visits to twice a day (morning and evening). She refused the carers to come for the lunch and tea call. The care provider said it was concerned that Mrs F felt under pressure to take care of her husband. The manager said that Ms D had also told her she was worried about her mother and the manager asked the social worker to call Ms D to discuss this.
  18. An internal email from the Council dated 20 June 2018, said the social worker subsequently:
    • Spoke to Mr F’s son who confirmed the carers were not doing much. He said his mother had to do most things, because his father did not want the carers to wash him. He said he did not think his parents would want to pay for the service and asked what would happen if the service would stop.
    • Spoke to Ms D who advised that her mother “is very stubborn and so is her father”. Ms D was concerned this was making her mother ill. Ms D asked if the Council could talk to her mother but she would probably not change her mind.
    • Spoke to Mrs F who advised the package had been reduced to two visits a day since about a month. Mrs F became tearful and said she promised her husband she would take care of him, because her husband did not want anyone else helping him. That is why she requested the change.
    • Passed the case to triage team for reassessment
  19. The above shows that Ms D and her brother were expressing concerns that their parents needed help from carers, but carers were not allowed and able to provide this.
  20. Mr F’s son called again on 6 July 2018 to say his father refused to complete the financial assessment documents and did not want his care package anymore. He said that, even in hospital, his father never wanted his care package. However, he was told he could not go home without one. He wanted the Council to end it today. However, he also said his father had dementia and did not have the capacity to cancel his package. In response, the council allocated the case to a new social worker to carry out a review.
  21. The care agency told the council on 12 July that the care package had stopped because Mrs F refused the support. The council spoke to Ms D who said her mother had been forced into having a package. She said her parents were very independent and her mother was adamant she could manage on her own. Furthermore, her father did not want carers to change his pads, which was a key aspect of the care package. Ms D said she told this to the care provider on several occasions and believed this was the way to request this. Ms D told the Council she would be willing to pay half of the bill.
  22. The Council told me that:
    • All requests to cancel care must be made to the Council’s Social Care Direct team, and not to the care agency. Clients should be told about this during the assessment and support planning stage. This has not been a formally documented process as a result of this enquiry this is under review.
    • However, the family had many opportunities to cancel the service. Mr F’s son knew it was a chargeable service and he could have contacted the Council to stop it.
    • Despite several requests, it has not received the information it needed to complete a financial assessment. As such, Mr and Mrs F have to pay for the full cost of the care (£5,896.80).
    • It has offered Ms D to contact the financial assessment team and provide the documents it has requested to complete an accurate financial assessment to determine what, if anything, Mr F has to contribute. However, Ms D has not provided this.
    • If Ms D believes she told the care agency that care was not needed, but the care provider ignored this, she should submit a complaint to the care agency.
  23. Ms D has told me the Council needs to ensure that clients and the care agencies know what the process is, when a client wants to ask to reduce, increase or stop their package. Further, her mother will not cooperate with a financial assessment and she will not let her mother go through that.

Assessment

  1. The Council discussed the care support with Mr F’s son, who was aware there would be a financial assessment to assess whether his father would have to pay a contribution. Mr F’s son agreed there was a need to put a support package in place. I did not find evidence the Council ‘forced the care package’.
  2. The Council has said that Mr F had capacity at the time of discharge. The Council also said the care support was put in place to ensure Mr F received the support he needed, and his wife was supported in her role as his carer. However:
    • The Council did not ask Mr and Mrs F if they agreed to having support in place and (if so) if they agreed to the proposed care support plan, which focussed on personal care support.
    • The Council failed to carry out a carer assessment to determine what support Mrs F would be able and willing to continue to provide, so as to inform its care support plan.
    • The Council did not inform Mr and Mrs F, the people who would be asked to pay for it, that there would be a financial assessment to determine if there would be a charge for the care package.
  3. This was fault. Instead, the Council carried out all key discussions about care support and how to pay for this with their son. The records indicate that Mr F’s son agreed his mother should receive support in her role as his father’s carer, and he accepted there would be a charge. However, there is no evidence this was shared and discussed with Mr and Mrs F.
  4. When the Ombudsman has found fault, he will seek a remedy for that injustice which aims to put the complainant back in the position they would have been in if nothing had gone wrong. On the balance of probabilities, I found that: if Mr F had known about the proposed care plan, the type of care (personal care) that would be provided by outside carers, and the possible costs for him involved, he would have refused the care package. The Council said Mr F had capacity to make such a decision.
  5. I also found there has been fault with regards to the following:
    • The Council failed to share a copy of the needs assessment with the family to enable them to provide comments to ensure it was accurate.
    • The pre-service assessment and care plan from the care provider were not signed by Mr F or his wife to indicate they agreed with it.
    • The Council failed to make clear to Mr F and his family who they should contact if they wanted to reduce or stop the care package. The Council has told me it is working to address this.
    • There were clearly issues, early on, with regards to carers not being allowed / able to carry out all of the tasks included in the care plan and which the Council had commissioned the care agency to provide. However, the care provider failed to raise this immediately with the Council.
    • The care provider failed to inform the Council, in a timely manner, that there were issues with regards to the delivery of the care package.
    • The care provider destroyed all the records related to Mr F’s care, including his daily care records and records of communication with the family.
  6. The Council received information on 20 June 2018, which showed Ms D and her brother were concerned their parents needed help from carers, but their parents did not allow and able the carers to provide this. In addition, Mr F’s son indicated his parents would not be willing to pay for the care. However, while the Council carried out a telephone conversation with Mrs F, it did not result in the Council urgently carrying out a / the care review visit to discuss these matters with both Mr and Mrs F. This was fault.
  7. Mrs F told the Council on 20 June 2018 that the care package reduced to twice a day about a month ago. However, the care provider only told the Council there had been a reduction on 19 June. The Council never looked into this discrepancy. Furthermore, I have not received supporting evidence from the care provider to conclude that Mrs F continued to receive four visits a day between 19 May and 19 June 2018.
  8. The Council told Ms D that, if she believes the care agency failed to pass on her mother’s request to stop the care package, she could make a complaint to the care provider. However, as the care provider was commissioned by the Council, the Council should have dealt with this as part of its complaint investigation (see paragraph four above). This was a key aspect of Ms D’s complaint. This was fault.

Agreed action

  1. I recommended that, within four weeks of my decision, the Council should:
    • Apologise to Ms D and her mother for the faults identified above and the distress this has caused them.
    • Write off the cost of Mr F’s care package.
    • Develop and agree an action plan with the care provider to address the above shortcomings and monitor this through its contract and commissioning team.
    • Share the lessons learned from this case with staff involved in carrying out need assessment.

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Final decision

  1. For reasons explained above, I have upheld Ms D’s complaint. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case

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Investigator's decision on behalf of the Ombudsman

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