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 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.
The Ombudsman’s role and powers
- 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)
- 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)
- 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.
- 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)
How I considered this complaint
- 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.
What I found
- 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.
- 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.
- 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:
- 8am: personal care and strip wash in bed; change pad; cream body; dress me.
- Change pad and empty catheter at 1pm, 5pm and 8pm.
- 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.
- 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
- 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.
- 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’.
- 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.
- 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.
- 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.
- 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
Investigator's decision on behalf of the Ombudsman