Summary: Mr C complains his mother did not receive the right support, after she was discharged from hospital and completed six weeks of rehabilitation at a residential centre. Mr C says the Council should have agreed to a further period of interim residential care with physiotherapy support, before trying to move his mother back into her own home. The Ombudsman found fault with the way the Council dealt with Mr C’s complaint, for which the Council has agreed to apologise and pay a financial remedy.

The complaint

1. The complainant, whom I shall call Mr C, complains to us on behalf of his mother, whom I shall call Mrs M. Mr C complains the Council failed to:
• Agree to place his mother temporarily into a care home, with physiotherapy support. Instead, it wanted to discharge his mother back to her own home. If she had received the interim support, she would have become more mobile.
• Explain its decisions to him and provide a copy of the reports the Council had used to arrive at its decision.
2. As a result of the above, he had to place his mother in a care home privately, and also pay for her physiotherapy support privately.

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The Ombudsman’s role and powers

3. 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)
4. We cannot question whether a council’s decision is right or wrong, simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
5. 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

6. I considered the information I received from Mr C and the Council. I also carried out an interview with the Council. I shared a copy of my draft decision statement with Mr C and the Council and considered any comments I received, before I made my final decision.

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What I found

7. Mrs M was independent and managed without a care support package, before she went into hospital. She had sustained a neck femur fracture and went into hospital for a hip replacement. The Council says the plan was always for her to return home after receiving rehabilitation support for two to six weeks. Mr C told me that:
• After his mother’s stay in hospital, his mother spent six weeks in a rehabilitation centre, where she received regular physiotherapy support to improve her mobility and strength.
• At the end of the six weeks, an Occupational Therapist (OT) came to assess his mother. The OT said that, after the six weeks rehabilitation support would end, he could apply to the Council to continue physiotherapy for his mother. Mr C asked the OT to include this in his report.
8. The records say the Council visited Mrs M in hospital in August 2018. The record states that:
• Mrs M, who was over 90 years old, was able to verbally communicate her views and wanted to be discharged back to her house.
• Mrs M said she lives alone and her son Mr C supports her. Mrs M would now need support to meet all her needs for personal care, nutrition, safety and medication.
• Mrs M could fully weight bear but was not able to mobilise. She was recommended to use a rota stand.
• It was agreed at the hospital discharge meeting that Mrs M was eligible for a period of residential rehabilitation, to build more strengths in her muscles.
9. Mrs M went into a specialist rehabilitation centre at the end of August 2018, and the community team would complete her care review when needed. Mrs M had regular Physiotherapy sessions to try and improve her mobility and functions. Mrs M could mobilise using a gutter frame and support from two therapists.
10. On 28 September 2018, the Physiotherapist requested input from an OT to start planning Mrs M’s discharge from the rehabilitation centre. The OT from the centre arranged a visit with Mr C to Mrs M’s home on 2 October 2018. During the site visit, the OT made several recommendations. The OT report states that, for Mrs M to be able to return home, the following would need to happen:
• Bed to go against the wall nearside of the window to create more room for a Rotunda (equipment to transfer a person from seat to seat).
• Move furniture in / from the lounge to create more room for a Rotunda and a commode.
• Double handed care support to assist with everyday activities etc.
• District nurses to monitor pressure areas.
11. The OT said Mrs M would need community physiotherapy input (from the Community Physiotherapy Team) for her ongoing therapy needs, to maximise her potential. This can be requested via the GP. The Centre made a referral on 11 October 2018. The Council explained in the interview that it has no role to play with regards to such referrals and the provision of physiotherapy support in the community, which is the responsibility of the NHS to assess and provide, if needed.
12. The OT also recorded that Mr C did not feel that his mother would be safe in-between care visits and feared she may have a fall and/or may end up back in hospital. Mr C said he wanted his mother to transfer to a safe interim place of care, while she further regained her strength. Mr C wanted to know if the Council would fund this. If not, Mr C told the OT he would try and fund this privately for a short term.
13. The Centre contacted Mrs M’s social worker on 3 October 2018, attaching the OT report. The social worker responded the same day and said that, at the moment, he did not believe an interim place would be needed. In response, the deputy manager of the Centre said she ‘totally agreed’.
14. The social worker completed his assessment and had a conversation with Mrs M on 5 October 2018 to discuss her concerns about returning home. Mr C was not present at this. The record of the meeting states that:
• The social worker explained that Mrs M did not need 24/7 care and support. Mrs M confirmed she would not be mobilising independently between care calls, as she feared she may end back up in hospital if she was to fall again.
• Mrs M was concerned that carers may not turn up and she would be unable to meet her care needs herself if that happened, due to her reduced mobility. The social worker assured Mrs M that if this would happen, she could contact social care and the care agency. This would then be a safeguarding concern, because she would have been neglected. Mrs M felt reassured.
• The social worker said it may take some time to get her back to her baseline of mobilising independently. The social worker suggested to have a careline, so she could notify someone if she was to fall. Mrs M agreed to this.
• Mrs M confirmed she did not wake up throughout the night to go to the toilet. There were therefore no concerns about night-time care needs not being met.
• The Centre would make a referral for district nurses to attend to her property in the community to support her in changing her bandages on her left foot.
15. The social worker spoke to Mr C later that same day. The record states that:
• Mr C was unhappy with the assessment and believed his mother would need a further short-term placement to get back walking and to have intensive physiotherapy.
• Mr C said he wanted a copy of the social worker’s needs assessment and appeal the outcome of the assessment. The social worker suggested Mr C could speak to his manager or make a complaint.
• Mr C said he would make private arrangements and would deal with the assessment outcome later. The social worker provided the contact details of the Council’s brokerage team where Mr C could go for information and advice on placements.
16. The social worker summarised the Council’s view in a letter. It said it offered:
• A non-chargeable short-term reablement support care package for up to 6 weeks, pending a community review. This care package would consist of four visits per day, by two carers:
1. A 45 minutes morning-time visit.
2. A 30 minutes lunch-time visit.
3. A 30 minutes tea-time visit.
4. A 30 minutes bed-time visit.
• A referral to have a Careline button installed.
17. Mr C wrote to the Council in October 2018, expressing his unhappiness with the Council’s decision and asking for a copy of all relevant assessments and reports. The Council called Mr C on 2 November to confirm it had received his complaint letter. The Council also agreed to send Mr C a copy of any OT reports, assessment and support plan.
18. Mr C did not receive a response to his complaint, nor a copy of the documents he asked for. As such, he chased the Council on 4 March 2019. The Council eventually responded to Mr C on 20 May 2019. It apologised for its failure to provide a response and explained this was because the officers involved in investigating it had since left.
19. Mr C told the Council on 3 June 2019, that he was unhappy with its response, because:
• He had still not received any of the documents he asked for on 25 October 2018.
• He had to spend £2,000 on private physiotherapy, which he said could have been avoided if the Council had agreed to an interim placement.

Analysis

20. I found there was no fault with the way through which the Council decided that Mrs M’s needs could be met in her own home. The Council carried out a review of Mrs M’s care needs and considered any concerns Mr C and his mother had about his mother’s return home. The Council explained to Mr C and his mother, amongst others during a meeting in October 2018 and a subsequent letter, why it believed Mrs M could return home and would not be at risk. The decision, not to provide interim support, was supported at the time by the centre where Mrs M had stayed for six weeks. Without fault, I will not question the merits of the Council’s decision (see paragraph 4 above).
21. I also found the Council was not at fault for Mrs M not receiving free physiotherapy after she left the Centre. Community physiotherapy provision is a matter for the NHS. If Mr C wanted this at the time, it was up to him to pursue this for his mother through her GP.
22. However, I did find the Council failed to provide a response to Mr C’s complaint in a timely manner, which took seven months. This is fault. Although the Council told me it gave a copy of the needs assessment to Mrs M in October 2018, it failed to provide Mr C with a copy of the reports he asked for in October 2018. This is fault. This resulted in distress and frustration for Mr C that should have been avoided.

Agreed action

23. I recommended that, within four weeks of my decision, the Council should:
• Apologise to Mr C for the faults identified in paragraph 22 and pay him a financial remedy of £100.
• Provide a copy to Mr C of the documents he asked for in October 2018.

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Final decision

24. For reasons explained above, while there was no fault with the way in which it made its decision about Mrs M’s care, I found fault with the way the Council dealt with Mr 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.

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Investigator's decision on behalf of the Ombudsman