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 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.
What I have investigated
- I have investigated the actions of the Council and its care provider.
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, sections 30(1B) and 34H(i), 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)
How I considered this complaint
- 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.
What I found
- Ms X is registered as blind and has mental health problems.
- 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.
- 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)
- 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
- 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.
- Three 30-minute calls a day to help with meals, personal care, clothing, medication, cleaning and emotional support;
- Two hours a week for shopping.
- 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.
- 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.
- 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
- 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
Is there evidence of fault by the Council which caused injustice?
- 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.
- 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.
- 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
- 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.
- 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.
- 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.
- I have completed my investigation as the Council has agreed to take the action I recommended.
- 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.
Investigator's decision on behalf of the Ombudsman