Decision : Upheld
Decision date : 14 Aug 2020
The Ombudsman's final decision:
Summary: The Council is at fault as it delayed in completing a Care Act assessment and care and support planning for Mr X. As a result, Mr X had to live in a care home for six months longer than necessary which caused significant distress to Mr and Mrs X. The Council has agreed to remedy this injustice by making a payment of £1000 to Mr and Mrs X to acknowledge the distress caused to them.
- Mrs X complains that the Council lost paperwork and delayed in carrying out an assessment of Mr X’s care and support needs. As a result, Mr X had to stay in residential care for 15 months when he had only been placed there for one week of respite care which caused significant distress to Mr and Mrs X.
What I have investigated
- I have investigated the Council’s assessment of Mr X’s care and support needs.
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 have:
- Considered the complaint and the information provided by Mrs X;
- Discussed the issues with Mrs X;
- Made enquiries of the Council and considered the information provided;
- Invited Mrs X and the Council to comment on the draft decision.
What I found
- Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved. The Council must carry out the assessment over a suitable and reasonable timescale.
Care Act assessment
- Mr X has dementia. In January 2018 Mr X’s family contacted the Council for a Care Act assessment as Mr X had wandered from home and Mrs X needed support in caring for him. The Council arranged a short stay for Mr X in a care home. Mr X had to pay a contribution towards his care fees.
- The Council allocated a social worker to Mr X, Officer A. Officer A visited Mr X in February 2018 and completed a checklist for continuing health care (CHC) to see if he was eligible for a full assessment. CHC is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’.
- Mr X’s family were concerned that the care home could not meet his needs. So, in February 2018, Mr X moved to another care home.
- Officer A visited Mr X to complete consent for the CHC checklist assessment and sent it to North Lincolnshire Clinical Commissioning Group (CCG). The Council’s records show the checklist triggered a decision support tool (DST) for full assessment of Mr X’s eligibility for CHC funding.
- In May 2018 the Council updated Mr X’s care and support needs assessment. The assessment notes Mr X liked his placement but his personal goal was to return home. The assessment recommended Mr X remain in the care home.
- Mrs X contacted the Council in July 2018 to report Mr X was unhappy with the care home and that he had been formally diagnosed with dementia. The Council transferred Mr X’s case to another social work team due to his memory impairment in July 2018. Mr X did not have a social worker at this time. The Council has said there were a number of staff vacancies in the team at this time. The Council has also acknowledged the transfer of Mr X’s case to another team was not robust and there was some confusion between 31 July and 21 August 2018 which caused some delay.
- Mrs X then contacted the Council to report the CCG had not received the CHC checklist. The Council established the CCG had not progressed the checklist as the wrong consent was completed.
- In August 2018 Mr X and his family contacted the Council to request a care package to allow Mr X to return home and for an update on the CHC checklist. The Council’s records note an officer informed the family that Mr X’s case was waiting for the allocation of a social worker to carry out a care needs assessment. The Council’s records show Mrs X chased for an update on the CHC checklist. In September 2018, Mr X also contacted the Council about returning home.
- The Council allocated a social worker, Officer B, to Mr X in late September 2018. The Council’s records note Officer B met with Mr and Mrs X in early October 2018 and advised a significant support plan would be needed to ensure Mr X’s safety and that returning home may not be possible.
- The Council’s records note a meeting was held to complete the DST in mid October 2018 to see if Mr X was eligible for CHC funding. The Council has said it could not carry out a care and support needs assessment at this meeting as Mr X was tired due to completing the DST. Mrs X contacted the Council shortly after the meeting to find out the outcome of the DST. There is no record Officer B contacted Mrs X to advise her of the outcome.
- The Council has said a mental health assessment was due to be carried out for Mr X in December 2018 but this did not proceed due to Mr X’s emotional state.
- On 30 January 2019 the Council held a meeting with Mr and Mrs X. The Council has said Mr and Mrs X agreed to have a personal assistant to enable him to access the community safely and Mrs X agreed to support Mr X with his personal care. They agreed to a referral to Penderel’s Trust who could assist with employing a personal assistant. The Council has said this was the first time Mr and Mrs X agreed to the referrals and a personal assistant as part of a home care package.
- In February 2019 the Council had a meeting with Mr and Mrs X to discuss care and support planning for Mr X. The Council agreed to contact Penderel’s Trust to consider a personal budget and agree a care and support plan. Mr and Mrs X met with Penderel’s Trust for support with the process of employing a personal assistant. The Council met with Mr X in early April 2019 to complete the assessment and support plan.
- Mrs X raised on a number of occasions her concerns that she could not afford to pay Mr X’s contribution towards his care costs and had taken two jobs to pay for this.
- The CCG decided Mr X was not eligible for CHC funding in May 2019.
- Mr X returned home with a care package in June 2019. Mr X’s care and support plan shows he pays a contribution of £57.28 per week towards his personal budget.
- Mrs X submitted a financial assessment form to the Council shortly after Mr X was admitted to the care home. The Council decided Mr X would need to make a contribution of £113.75 to his care fees. The Council’s records note Mr X’s family contacted the Council as they were concerned they could not pay the contribution as Mr X’s DLA had been stopped. They asked if they should pay the charges or wait until the outcome of the DST was known. Mrs X was also unsure as to whether she had provided all the financial information required. The Council advised Mrs X to contact Finance.
- Following further contact from Mrs X the Council reviewed the financial information in January 2019 and realised Mrs X had not provided all the financial information which could be taken into account when calculating Mr X’s contribution. The Council reviewed the additional financial information provided by Mrs X and Mr X’s contribution for the period 22 January 2018 to 30 May 2019. The Council refunded £2221.82 to Mrs X for overpaid contributions.
- Mrs X made a complaint to the Council in June 2019 about the time taken to assess Mr X’s care and support needs which she considered caused Mr X to stay in the care home for a year longer than necessary. The Council responded to Mrs X’s complaint in August 2019. The Council apologised for the length of time it had taken to deal with her complaint but it did not address Mrs X’s complaint about the time take to assess Mr X’s care and support needs.
- In response to a further complaint from Mrs X, the Council offered a payment of £50 for the anxiety and worry caused by its delay in dealing with her complaint and for the delay in reimbursing the overpaid contribution.
- In response to my enquiries the Council has acknowledged the transfer of Mr X’s case was not robust and there was some confusion between 31 July and 21 August 2018 which caused delay. The Council has reviewed the transfer process for cases to ensure such delays do not recur. The Council has said it was experiencing staff shortages at this time. The Council has also acknowledged it did not proactively deal with Mr X’s case between October and December 2018. It has offered to apologise to Mr and Mrs X.
- Mrs X considers the Council delayed in assessing Mr X’s needs and putting a care package in place to allow him to return home. Mrs X has said it was only intended for Mr X to stay in the care home for one week. She could not afford Mr X’s contribution towards his care fees and visit him every day. Mrs X has said she had to take two jobs but she has not been able to pay Mr X’s contribution in full. Mrs X says the delay in assessing Mr X caused significant distress to him as he wanted to live at home.
Care Act Assessment
- There is no evidence Mr and Mrs X told the Council that Mr X wanted to return home between January 2018 and August 2018. The assessment carried out in May 2018 records Mr X stating he liked his placement at the care home. So the Council is not at fault for not assessing whether Mr X could return home between January and August 2018.
- Mr X and his family made a clear request for him to return home with a care package in August 2018. On balance, I consider the Council delayed in carrying out a Care Act assessment to determine if and how Mr X could return home following this request. The Council has acknowledged there were delays in transferring Mr X’s case. It is also not clear why Officer B did not start a Care Act assessment with Mr X in early October when meeting with Mr X and his family to discuss him returning home. The assessment would inform the decision as to whether Mr X could return home.
- The Council has said it could not complete a Care Act assessment when it met with Mr X on 16 October as he was tired from completing the DST. There is no evidence to show the Council rearranged the meeting with Mr X to carry out the Care Act assessment or mental health assessment. The Council has acknowledged it was not proactive during this time.
- The next meeting did not take place until 30 January 2019, some six months after Mr X had asked to return home. The Council has said that Mr and Mrs X only agreed to a personal assistant and referrals at this meeting. But there is no evidence a personal assistant was previously discussed or that the Council started a Care Act assessment before this time.
- The Council then took a further four months to complete the Care Act assessment and care and support planning and to put the support in place to allow Mr X to return home. The Council carried out care and support planning in mid February 2019 and Mr and Mrs X met with Penderel’s Trust in early March 2019 to discuss the management of their direct payments and the personal assistant. I have not seen any evidence to account for why the Council took a further three months to put the care package in place.
- Overall, the Council took 10 months to assess and put a care package in place for Mr X to return home. It is inevitable it will take time for a council to complete an assessment, care and support planning and put the care package in place. But 10 months would be excessive in most circumstances and particularly as Mr X was unhappy in the care home and wanted to return home. In the circumstances, I consider it would have been appropriate for the Council to have taken no longer than four months to allocate to a social worker, complete the assessment, care and support planning and put the care package in place.
- As a result of the delay Mr X had to stay in the care home for six months longer than necessary. This caused significant distress to Mr and Mrs X.
- Mrs X would like the Council to write off Mr X’s contribution to his care charges. This would not be appropriate or proportionate as Mr X received care in the care home. Furthermore, I note Mr X is required to pay a contribution towards his care package so he would not have avoided charges even if he had been able to return home sooner. However, I note Mr X’s contribution to his care package is lower than his contribution to his care home fees. The Council should therefore review Mr X’s contribution from December 2018 to June 2019 when he returned home to ensure he has not paid increased contributions as a result of having to remain in the care home for six months longer than necessary.
- The Council first completed the checklist for CHC funding in February 2018 but did not receive a decision on Mr X’s eligibility until May 2019. I do not know if the delay in progressing the CHC application was caused by the Council. But I will not investigate this matter further as any delay by the Council will not have caused significant injustice to Mr and Mrs X. This is because Mr X was not eligible for CHC funding so the outcome would not have been any different for him.
- The Council has acknowledged it delayed in dealing with Mrs X’s complaint and offered £50 for the anxiety and worry this caused. The Council is also at fault as it did not address the substance of Mrs X’s complaint of delay in carrying out care and support needs assessments and agreeing a care package to allow Mr X to return home. This is poor complaint handling and is fault. As a result Mrs X was caused avoidable time and trouble in having to make a complaint to the Ombudsman as the Council had not addressed her complaint.
- That the Council will:
- Send a written apology and make a payment of £1,000 to Mr and Mrs X for the distress caused to them as a result of the Council’s delay in carrying out Mr X’s Care Act assessment and putting into place his care package which caused him to stay in a care home for six months longer than necessary.
- Make an additional payment of £150 to Mrs X to acknowledge the avoidable time and trouble caused to her by the Council’s failure to address her complaint.
- Review Mr X’s client contribution from December 2018 to June 2019 when he returned home to ensure he has not paid increased contributions as a result of having to remain in the care home for six months longer than necessary. The Council should carry out the actions at a) b) and c) within one month of my final decision.
- Review its procedures for carrying out Care Act assessments and care and support planning to ensure the delays experienced by Mr and Mrs X do not recur. The Council should carry out this action within three months of my final decision and explain to the Ombudsman how it has improved its performance in this area.
- The Council is at fault as it delayed in completing a Care Act assessment and care and support planning for Mr X. As a result Mr X had to live in a care home for six months longer than necessary which caused significant distress to Mr and Mrs X.
Parts of the complaint that I did not investigate
- Mrs X has also complained about the care home not properly dealing with a health issue with Mr X’s finger which was subsequently diagnosed as cancer. Before we investigate a complaint we have to be satisfied the Council is aware of the complaint and has had the opportunity to investigate it. I have not investigated this complaint as Mrs X has not made a complaint about the matter to the Council.
Investigator's decision on behalf of the Ombudsman