Decision : Upheld
Decision date : 27 Aug 2019
The Ombudsman's final decision:
Summary: Ms C complains about the Council’s decision that her elderly mother should move from the care home where she was settled, into Flexicare Housing. The Ombudsman has decided to uphold Ms C’s complaint. The Council has agreed to provide an apology to Ms C and pay a financial remedy for the distress she experienced.
- The complainant, whom I shall call Ms C, complained to us on behalf of her (late) mother, whom I shall call Mrs M. Ms C complained the Council failed to carry out a needs assessment / care review, to determine where her mother’s needs could best be met. When the Council finally carried out the assessment, it failed to obtain and consider some information, which resulted in the incorrect recommendation that her needs could be met in the community.
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)
- 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 C and the Council. I also made enquiries with the care home Mrs M had stayed and interviewed a manager of the Council who had been involved in reviewing Mr M’s case. I shared a copy of my draft decision statement with Ms C and the Council, and considered any comments I received before I reached my final decision.
What I found
- Mrs M lived with her daughter, at her daughter’s property. This enabled Mrs M to get an income from renting out her property.
- Mrs M went into hospital in July 2017 with sepsis. Ms C had a conversation with the hospital social worker on 19 August 2017. The social worker said that:
- Mrs M would receive a four-week reablement support package, as she had specific enablement goals. During this period, the Council would work closely with Ms C to ensure there would be a long-term plan in place at the end of this period.
- If Ms C could no longer cope with her mother’s night-time needs, her mother would have to go into a care home.
- Acknowledged that it should have offered an assessment of Mrs M’s needs. It has told Ms C that it should have given her further information and advice before her mother moved into the care home. This would have enabled her to make an informed decision about possible care arrangements for her mother.
- Concluded this fault did not result in an injustice. It said it only resulted in a delay of Mrs M being assessed; the outcome of the assessment would still have been a recommendation for Flexicare.
- The Council failed to carry out a review / assessment of Mrs M’s needs, to determine how her needs should best be met after her four weeks reablement support would end. As a result of this, and the advice the hospital social worker provided to Ms C (see paragraph six point two), she decided to move her mother into a care home on a trial basis.
Ms C’s disagreement with the Council’s recommendation that her mother’s needs should be met within Flexicare Accommodation
- Ms C says she became aware on 20 November 2017 that her mother’s savings were far less than she had initially thought. As such, she contacted the Council’s finance team, after which she received a letter on 29 November 2017. The letter said the Council had to carry out a financial assessment and a needs assessment. The Council allocated a social worker, who arranged a visit for 5 December 2017. Ms C says that, during the visit:
- They briefly spoke about her care needs and her mother said she wanted to stay at the home.
- The social worker said he would review the care home’s care plans and speak to the care home staff.
- Falls risk: Mrs M’s mobility has improved since she arrived at the home. She is now able to transfer and walk with a frame and support of one carer. She needs prompting and supervision when walking to reduce the risk of falls. Mrs M’s cognitive impairment means she does not always recognise that her mobility has declined and can try to mobilise without proper support, putting her at risk.
- Skin breakdown: Mrs M continues to be at high risk of pressure areas developing and had a recent pressure sore. Carers need to apply regular cream and pad changes to maintain hygiene and therefore skin integrity.
- There was no need for a formal mental capacity assessment (MCA), as there would not be a formal decision at the moment. She has cognitive impairment and difficulty engaging in the assessment process.
- Her mother was at risk of falls, because she would try to mobilise on her own, which put her at risk of falling. However, in response, the manager told her that her mother could have a falls pedant alarm, which would alert staff if she had a fall.
- Her mother had night-time needs. However, in response, the manager told her the social worker had spoken to the care home and the Council had evidence Mrs M did not currently have night needs.
- Her mother would be socially isolated if she would leave her care home. However, in response, the manager told her that her mother would have the opportunity to meet with other clients and socialise.
- Staying safe from harm section:
- Mrs M does not recognise her limited mobility and will try to mobilise independently without appropriate support. This happened on one occasion when care home staff left her alone briefly. Mrs M cannot remember that she cannot mobilise very well, putting her at high risk of falls. Care home staff do not leave Mrs M on her own throughout the day.
- Staff check on her two-hourly overnight in case of any concerns. However, she routinely sleeps well overnight without any support needed.
- The social worker explained he had spoken to the care home manager, who said Mrs M sleeps well overnight. However, Ms C said the care home had shown her night care records that indicated her mother was receiving support at night. Staff had to turn her every four hours while she was in bed, to reduce the risk of pressure sores.
- The assessment did also not say anything about her mother's inability to use of a call bell to call for help. This is why staff would check her at night every two hours.
- Her inability to use a bell would be a risk to her safety and wellbeing if left alone in her own flat within a Flexicare environment. This was clearly not factored into the decision.
- Telecare falls sensors would not be able to prevent her mother from falling; it would only alert staff after she had a fall. Her mother needed constant monitoring to ensure she would not try to mobilise independently, something which could not happen if she was left alone in her Flexicare flat.
- Although the records showed Mrs M was awake at times, and that she would have a pad change at 5.30am most days, the Council did not consider this significant night needs. A worker would be on site at the Flexicare scheme during the night in case of an emergency.
- A sensor mat and falls detector would be provided with regards to her risk of falls.
- There are numerous voluntary resources within the community that than can provide social support.
- At the time of the assessment, Mrs M was on 4 hourly repositioning and pad checks at night. Her pads would be changed in bed when needed by two carer workers. The charts showed she was changed at least once most nights.
- It is not correct to say that: Mrs M was checked at 530am, because this was the end of the night shift. The end of the night shift was at 730am.
- It believes Flexicare would have been unsuitable for Mrs M.
- It has delegated the decision whether a person should go into a care home. This decision is made by managers, not a panel. However, if a manager recommends Flexicare, a panel decides in the end if this is suitable.
- It is very significant that Mrs M was unable to use a call bell system. If she was unable to call for help when needed, this would her at risk and make her vulnerable.
- While the social worker and the manager provided some information about Flexicare, and how it could work for Mrs M, it was not specific or comprehensive enough to reassure her daughter and address her concerns. He agreed that, in these specific circumstances, a meeting would have been better to discuss Ms C’s concerns, to enable her to come to a view if she would like to consider Flexicare.
- The Council’s fault (identified in paragraph 11) had contributed to Mrs M moving into the care home.
- Ms C had raised some serious concerns about the suitability of Flexicare, particularly in relation to: preventing her mother from falls (when she is alone in the flat and tries to mobilise), and her mother’s need to be checked / repositioned / changed at night by two carers.
- Mrs M’s inability to call for help if she needed (urgent) help, during the day and at night.
- She was vulnerable, had settled in the care home, and it would likely have a significant impact on her mental / emotional wellbeing if it would move her to a completely different and unfamiliar environment.
- The Council failed to establish if Mrs M was able to make decisions about her care and/or where she wanted to live. This is fault. As such, it failed to establish who the decision maker was and only discussed with Ms C whether she wanted to consider Flexicare for her mother:
- If Mrs M had capacity to decide where she wanted to live, the Council should have involved her mother in these discussions and ask her if she wanted to move into Flexicare.
- If Mrs M did not have capacity to make this decision, the Council could have reassured Ms C that it would organise a best interest meeting with all stakeholders involved (including the care home), at which Ms C could raise her concerns. Based on the information I have seen, it appears Mrs M did not have capacity to decide where she wanted to live.
- I recommended that the Council should, within four weeks of my decision:
- Provide an apology to Ms C for the faults identified above, the distress this has caused her and for the time and trouble she experienced in bringing the complaint. It should also pay her £200.
- Share the lessons learned above with staff within adult social care who are involved with carrying out needs assessments.
- For reasons explained above, I have upheld Ms C’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