Reading Borough Council (19 005 250)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 18 Mar 2020

The Ombudsman's final decision:

Summary: Ms X complains the Council has failed to address her concerns properly about its handling of her care needs and failed to provide a satisfactory remedy for the injustice it has caused. The Council identified the need for help with medication seven days a week but only provided this five days a week. The Council needs to apologise and provide financial redress.

The complaint

  1. The complainant, whom I shall refer to as Ms X, complains the Council has failed to address her concerns properly about its handling of her care needs and failed to provide a satisfactory remedy for the injustice it has caused.

Back to top

What I have investigated

  1. I have investigated the actions of the Council and its care provider.

Back to top

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. 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, sections 30(1B) and 34H(i), as amended)
  3. 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)

Back to top

How I considered this complaint

  1. I have:
    • considered the complaint and the documents provided by Ms X’s Advocate;
    • discussed the complaint with the Advocate;
    • considered the comments and documents the Council has provided in response to my enquiries; and
    • shared a draft of this statement with the Advocate and the Council, and invited comments for me to consider before making my final decision.

Back to top

What I found

What happened

  1. Ms X is registered as blind and has mental health problems.
  2. In February 2018 the Council increased Ms X’s personal budget to pay for 10.5 hours of carer support a week:
    • 6 hours for two 30 minute calls six days a week (breakfast and lunch) to help with preparing food, cleaning, laundry, correspondence and reassurance over mental health;
    • 1.5 hours for shopping;
    • 1 hour to get to therapy sessions;
    • 1 hour for “home care support”;
    • 1 hour a month to get to medical appointments;
    • 2.5 hours a month to visit a music shop.
  3. Although not documented, the Council changed this to two 30-minute calls five days a week, leaving Ms X to self-care at weekends.
  4. The Council’s safeguarding team visited Ms X on 20 June after a neighbour reported her being very distressed. The record of the visit says:
    • Ms X agreed to move to supported accommodation;
    • Ms X had not been taking her medication since leaving hospital;
    • the NHS Crisis Resolution Home Treatment Team (CRHTT) would provide short-term medication supervision (morning and evening) until the carers took over or blister packs had been arranged;
    • until 26 June the carer provider would visit for two hours a day;
    • from 26 June the carer provider would visit twice a day (tea-time and lunchtime)
  5. On 21 June the Fire Brigade took Ms X to hospital after she reported a fire which was not there. On 25 June the Council agreed her care provider would continue visiting twice a day to help with meals, cleaning, personal care, supervising medication, monitoring mental health and reassurance. Another record says the NHS Crisis Team was visiting morning and evening to give Ms X her medication. The care provider confirmed Ms X had taken her medication that morning.
  6. On 28 June the Council visited Ms X with other professionals. She preferred to stay where she was but with more support, rather than move to supported accommodation. They agreed the care provider would visit twice a day for 45 minutes and include medication supervision. The Council agreed to consider proposals for more support in accessing the community. It left it to Ms X and a friend to send proposals.
  7. On 9 July the care provider told the Council Ms X took her own medication that morning and had been doing so over the weekend. The Council noted this meant it was doing the “usual 2 hours 5 days a week” and not the two 45-minute calls agreed on 28 June. The care provider told the Council it did not have the capacity to do weekends. The Council noted it would have to find another care provider, as Ms X needed three calls every day for medication and once a week for shopping. Ms X agreed to an increase in her care package.
  8. The Council contacted other care providers asking for carers fluent in British Sign Language. It corrected the mistake on 12 July.
  9. On 15 July, until it could find a care provider able to provide carers at weekends, the Council proposed delivering Ms X’s care package (10 ½ hours a week) through:
    • Monday – 30 minutes in the morning, 1 ½ hours in the afternoon
    • Tuesday – 30 minutes in the morning, 1 hour in the afternoon
    • Wednesday – 30 minutes in the morning, 2 ½ hours in the afternoon
    • Thursday – 30 minutes in the morning, 1 hour in the afternoon
    • Friday – 30 minutes in the morning, 2 hours in the afternoon
  10. The calls were to help with meals, medication, personal care, clothing and cleaning. The longer calls were to provide time for accessing the community, medical appointments, and shopping.
  11. On 17 July 2018 a carer reported a safeguarding concern to the Council. The records say Ms X made the disclosure after the carer commented on a “love mark” on her cheek. As this involved a criminal allegation, the Council referred it to the Police to investigate. The safeguarding records refer to a protection plan for Ms X. They say she was compliant with medication “with supervision from carers”.
  12. By 27 July Ms X was staying in temporary accommodation. A friend told the Council Ms X had been unable to attend a meeting and wanted to discuss her finances as some of her benefits had stopped.
  13. On 31 July the Council contacted the Department for Work and Pensions about her Personal Independence Payment which was going to stop.
  14. When the Council visited Ms X on 3 August with other professionals, she said she would consider moving to supported accommodation, using her current care provider until she moved.
  15. On Saturday 25 August the Ambulance Service reported a safeguarding concern to the Council, as Ms X had taken her medication “ever so slightly too early”. The main issue was Ms X’s increased anxiety. The Council’s records note Ms X was at risk as she did not have a braille dosette box for her medication and had no support at weekends. The Council referred Ms X to the NHS CRHTT. The Council’s records say CRHTT visited Ms X on 27 August and then referred her back to the NHS Community Mental Health Team.
  16. On 28 August the Council held a safeguarding strategy meeting with the Police, the care agency and Ms X’s housing provider. The record of the meeting says the Police would interview Ms X on 30 August “with appropriate support”.
  17. The Council reviewed Ms X’s needs on 30 August. It decided to increase her personal budget and updated her care and support plan, so carers could visit:
    • 14 hours a week, three visits a day to help with meals, personal hygiene, dressing, medication, and cleaning;
    • 4 hours a week to visit a café-bar.
  18. On 5 September the Council commissioned a package of care for Ms X based on 12 ½ hours a week:
    • Three 30-minute calls a day to help with meals, personal care, clothing, medication, cleaning and emotional support;
    • Two hours a week for shopping.
  19. The Council visited Ms X on 28 September, after she had moved to new permanent accommodation. Its record of the visit refers to someone helping Ms X familiarise herself with the local area and her friend contacting charities for other community support.
  20. In October and November Ms X received support in visiting her local area with a view to becoming independent with this.
  21. On 23 November, the Council noted Ms X’s personal independence payment had been reinstated from 1 August. Ms X’s financial representative told the Council he could no longer support her with finances. The Council told Ms X it would update her financial assessment to reflect the backdated benefits.
  22. On 26 November the Council reviewed Ms X’s needs. The record of the visit says:
    • the Council agreed to increase her care package, but it does not say by how much;
    • it would use charities to promote social inclusion;
    • the care provider would contact Ms X’s GP to check the availability of a braille dosette box.
  23. Ms X’s Advocate complained to the Council in December about:
    • the failure to adjust the administration of Ms X’s medication despite two safeguarding incidents about accidental overdoses due to her being unable to read the packaging;
    • because of this her care provider was using too much of her 10 hours of support to give Ms X her medication;
    • this left too little time to support Ms X to access the community;
    • failing to help Ms X understand the safeguarding enquires and using insensitive and inappropriate language in safeguarding and care planning documents;
    • inadequate communication between the Council and other bodies resulted in Ms X losing her Personal Independence Payment;
    • incorrect, misleading and prejudicial statements throughout Ms X’s 2017/18 care records.
  24. When the Council replied to the complaint in August 2019 it accepted:
    • it had delayed in responding and apologised;
    • it should have asked for a braille dosette box for medication before reviewing Ms X’s needs in November 2018;
    • the care provider had been spending too much time giving Ms X her medication and had therefore increased her support hours;
    • the increased demands on the care provider’s time would have affected the time to support Ms X with accessing the community, but equipment and the increased care package had resolved this problem;
    • Ms X’s experience of its safeguarding enquiries may not have been as good as it could have been, but the language used reflected what participants said at the time. It invited Ms X to identify specific statements which had caused concern;
    • it had not responded quickly enough to the request for increased support, but did not accept it had failed to communicate properly with other bodies
  25. The Council said it would need more information to consider the claim that Ms X’s records contained incorrect, misleading and prejudicial statements.
  26. The Council now says its earlier response to Ms X’s complaint was not correct. It says:
    • it did not commission the care provider to prompt Ms X with her medication;
    • Ms X can manage her own medication with the right dispenser;
    • following a review in November 2018 the care provider, via a pharmacist, bought a braille dosette box for Ms X;
    • any support the care provider gave Ms X with medication would have had a minimal impact on the support available to Ms X;
    • Ms X’s drug overdoses were purposeful rather than accidental;
    • the safeguarding enquiry Ms X had concerns about related to a criminal matter and was therefore a Police matter
  27. The Council says Ms X owes £4,411.27 after failing to pay 14 invoices. It says she agreed a payment plan but cancelled it in September 2019. Around that time she told her care provider she was moving to another part of the country and confirmed this to the Council in November.

Is there evidence of fault by the Council which caused injustice?

  1. The Council’s records are confusing and contradictory. This includes its handling of the complaint by first upholding it and now denying it did anything wrong. It is not clear what support it was providing for Ms X in 2018. This is because it made changes to her care package without always updating her care and support plan. Its records show the Council was wrong to say it did not commission the care provider to prompt Ms X with medication. However, it is right to say the support with medication would have had little impact on the other support available to her.
  2. The Council identified the need for help with medication but did not provide that help seven days a week. That was fault by the Council. It resulted in the incident on 25 August 2018. Although taking her medication too early did not cause physical harm to Ms X, it caused her much distress. That is an injustice which warrants an apology and financial redress.
  3. Under the Care Act, the Council has overall responsibility for safeguarding issues. While it can delegate responsibility for making enquiries into individual safeguarding concerns to other bodies, that does not remove its overall responsibility. Although the Council identified the need for a braille dosette box within the context of the 25 August 2018 safeguarding concern, it did not make sure this was followed up until November 2018. That was fault by the Council. It was in the Council’s interests to do this, as the failure to provide Ms X with a braille dosette box resulted in it providing more support for her. However, there is no evidence this caused Ms X injustice. This is because the Council asked the care provider to prompt Ms X with medication and there were no further incidents
  4. Ms X’s Advocate says she objected to the term “love mark” in the 17 July safeguarding document. The Council used this term within the context of the comment made by a carer which prompted Ms X to disclose the safeguarding issue. That does not amount to fault by the Council.
  5. I cannot find fault with the Council over the fact Ms X’s Personal Independence Payment stopped in August 2018. This is because Ms X had a financial representative to help with such matters until November 2018.

Back to top

Agreed action

  1. I recommended the Council:
    • within four weeks writes to Ms X apologising and waiving £200 of her outstanding charges;
    • within eight weeks, identifies the action it needs to take to make sure officers update care and support plans whenever they make changes to the care being delivered.

The Council has agreed to do this.

Back to top

Final decision

  1. I have completed my investigation as the Council has agreed to take the action I recommended.

Parts of the complaint I did not investigate

  1. I have not investigated events when Ms X was in hospital under Section 2 of the Mental Health Act 1983, or the actions of the NHS Crisis Resolution Home Treatment Team and Community Mental Health Team. They fall within the remit of the Parliamentary and Health Service Ombudsman.

Back to top

Investigator's decision on behalf of the Ombudsman

Print this page

Privacy settings

LGO logogram

Review your privacy settings

Required cookies

These cookies enable the website to function properly. You can only disable these by changing your browser preferences, but this will affect how the website performs.

View required cookies

Analytical cookies

Google Analytics cookies help us improve the performance of the website by understanding how visitors use the site.
We recommend you set these 'ON'.

View analytical cookies

In using Google Analytics, we do not collect or store personal information that could identify you (for example your name or address). We do not allow Google to use or share our analytics data. Google has developed a tool to help you opt out of Google Analytics cookies.