Summary: There is fault by the Council in this complaint. It cancelled Mr Y’s day service at short notice, failed to provide alternative support, and failed to respond to a crisis situation whilst Mr Y was in residential respite care. Consequently, the placement broke down. The impact on Mr Y’s wife was significant.

The complaint

1. Mrs X complains the Council cancelled her father, Mr Y’s, day care service with very little notice. The Council withdrew the service with immediate effect on Sunday 7 July 2019 saying Mr Y’s behaviour was becoming increasingly challenging. No other day service has since been offered.

Back to top

The Ombudsman’s role and powers

2. 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)
3. 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)

Back to top

How I considered this complaint

4. I have:

• considered the complaint and discussed it with Mrs X;
• considered the correspondence between Mrs X and Mrs Y and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mrs X and the Council an opportunity to comment on a draft of this document.

Back to top

What I found

Relevant legislation

5. The Care Act 2014 sets out local authorities’ duties in relation to assessing people’s needs and their eligibility for publicly funded care and support. Under the Care Act 2014, local authorities must:

• carry out an assessment of anyone who appears to require care and support, regardless of their likely eligibility for state-funded care
• focus the assessment on the person’s needs and how they impact on their wellbeing, and the outcomes they want to achieve
• involve the person in the assessment and, where appropriate, their carer or someone else they nominate
• provide access to an independent advocate to support the person’s involvement in the assessment if required
• consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support)

6. Eligibility determination must be made after the needs assessment.
7. Councils still have the power to meet needs that are not considered eligible in order to help maintain wellbeing and independence. Councils should consider risk factors which can include physical safety.
8. The Act gives local authorities a legal responsibility to provide a care and support plan. When preparing a care and support plan the local authority must involve any carer the adult has. The support plan may include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
9. Direct payments are monetary payments made to individuals who ask for one to meet some or all of their eligible care and support needs. They provide independence, choice and control by enabling people to commission their own care and support to meet their eligible needs.
10. The personal budget must always be an amount enough to meet the person’s eligible care and support needs. It can be administered by the Council, by a third party, or as a direct payment.
11. The council should carry out a carer’s assessment where a person with care needs is also caring for another person with care needs. This follows a similar approach to the need’s assessment discussed above.

What happened

12. Mr Y is elderly. He has Alzheimer’s disease. He is reported to be demanding and can at times be very challenging. He lives at home with his wife, Mrs Y, who is his main carer.
13. Mr Y used to attend a day centre. This provided with Mrs Y with relief from her caring role during the day. The records show Mr Y was often challenging and he needed significant support to ensure his safety and the safety of other services users.
14. On 12 October 2018, during a discussion with a social worker Mrs Y expressed her fears that day service provision may be removed because of Mr Y’s behaviour. The social worker said she would ‘look into’ 1-1 support’.
15. In August 2018 the day centre contacted the Council to say Mr Y needed 1-1 support. The Council agreed. It says the day centre had been providing 1-1 support informally since September 2017, but it had become unsustainable due to staff resources. Formal 1-1 support started on 18 October 2018.
16. Mrs X says the day centre did contact her to say Mr Y needed 1-1 support, and she agreed, but she was not told it would come at a cost. She had no idea there was a cost until she later received a bill.
17. On 22 January 2019, Mrs Y received an invoice for £800 for the 1-1 support provided by the day service. She contacted the day centre to query it. The day centre said Mrs Y had been informed. Mrs Y initially refused to pay the invoice, but later paid in full.
18. The Council completed a review of Mr Y’s care on 19 February 2019. Mrs Y was present. I have seen a copy of the review document. It sets out the 1-1 support provided. Support staff reported Mr Y was difficult to manage at times, and it was getting more difficult to distract him. At times Mr Y had to be removed for the safety of other service users. Staff would take him for a walk.
19. At that time Mr Y had 28 nights residential respite allocation, used throughout the year. The reviewing officer noted Mrs Y to be at risk of carer breakdown, and if Mr Y did not attend the day centre the risk would increase because she would not have a break from her caring role.
20. The reviewing officer noted Mr Y had not been ‘screened’ for NHS Continuing Healthcare funding (CHC), “he was screened in for a DST” during the review. A DST is a document which helps to record evidence of an individual's care needs to determine if they qualify for CHC. CHC is a package of care arranged and funded solely by the NHS.
21. The Council says a decision about CHC was made on 3 April 2019, he was not deemed to be eligible.
22. Mrs X says whilst Mr Y was in residential respite care she received a telephone call on a Sunday afternoon from the day centre manager to say Mr Y could no longer attend the day service. Mrs X says Mrs Y was offered no alternative support and this caused her significant stress and distress.
23. The Council says Mr Y’s behaviour became increasingly challenging at the day service and it was unable to manage him. Consequently, it withdrew the provision with immediate effect on Sunday 7 July 2019. This increased Mrs Y’s caring role significantly. She was caring for Mr Y full time without support.
24. Mrs X says Mr Y is becoming increasingly demanding and challenging.
25. The Council reassessed Mr Y’s care needs on 15 July 2019. The day care aspect of the care package was removed, and this left 28 nights of respite. I have seen a copy of this document. It does not record what, if any, alternative service was offered to Mr Y. Respite allocation was increased from 28 nights to 35 nights. The assessor did not record if Mrs Y was offered services to support her to manage the additional demands of caring for Mr Y on a day to day basis.
26. The Council says officers from its social services were in regular contact with Mrs Y after the cessation of the day service. The records show officers contacted Mrs Y three times in July 2019, twice in August 2019, twice in September 2019 and twice in January 2020. I have seen the notes of the discussion on each date. This shows Mrs Y often told officers she “was managing fine”. When there was an issue with Mr Y’s behaviour or health, Mrs Y often said she wanted to wait and see if things improved.
27. Mrs Y’s daughter began providing some care for Mr Y at home. The Council agreed this “to be a suitable outcome for the family, the service discussed with them how this could proceed. The response from the family has consistently been that they are coping well (apart from some short term health issues) and no further support was needed”.
28. In August 2019 Mrs Y became unwell, at the time Mr Y was in residential respite care. The Council extended his stay until September 2019 to allow Mrs Y to recover.
29. A further Carers Assessment review was offered to Mrs Y on 25 September 2019, but she declined.
30. On 20 December 2019 the residential respite care facility contacted Mrs Y to say they could not cope with Mr Y’s behaviour; he was reported to be agitated and violent. Mrs Y was asked to collect him. Mrs Y says the care home asked her to fund 1-1 care at £14 per hour, and she felt under pressure to agree. Mrs Y telephoned the Council’s social services duty team to say she was afraid she would not be able to cope with Mr Y if he became violent towards her. The duty team advised Mrs Y not to collect Mr Y. It recorded “The home appeared to have not followed this process and had gone straight to her for 1 to 1 agreement. [Mrs Y] is reluctant to pay this as she felt under pressure to pay it or have her husband home early from respite. I advised for her to put a complaint into writing to the head office of [care home] as we were not involved in this discussion”.
31. On 23 December 2019 Mrs X contacted the Council to express her concern that Mrs Y was distressed. She said Mrs Y “felt pressured” to pay for 1-1 care. The Council “Advised that unless we have evidence from [respite care home] that the 1 to 1 was needed it is doubtful that Kirklees will fund it”. The Council contacted the care home to ask for behaviour charts to support the request for 1-1 care.
32. The records show Mr Y’s condition was deteriorating. An officer telephoned Mrs Y on 15 January 2020 to check ‘how things were going’. Mrs Y updated the officer and said she did not want Mr Y to return to the residential home for respite care. The officer gave Mrs Y information about three other residential respite care homes. The officer asked if Mrs Y wanted Mr Y to go into permanent residential care, Mrs Y said she was “not ready for that, but it may be getting close”. Mrs Y’s daughter was still providing some support. The officer advised Mrs Y to contact her if ‘things deteriorate’.
33. Mrs X telephoned the Council again on Friday 24 January 2020 to express her concern about Mrs Y. She said Mr Y had a urine infection and the “last week had been bad”. The officer offered to review both Mr & Mrs Y’s needs and suggested possible respite options. Mrs X said Mrs Y wanted to ‘carry on and see how things are over the weekend’. The officer provided Mrs X with the contact details for the Council’s emergency duty team and explained its emergency support services. The officer then contacted Mrs Y. Mrs Y said Mr Y was argumentative and angry, but she did not feel at risk. She confirmed she wanted to ‘see how she got on over the weekend’. The officer advised Mrs Y to contact the Council immediately if she felt unable to cope. The officer discussed the option of respite and Mrs Y said she would consider this. She asked the officer ‘to find him somewhere'. The officer “agreed we could and review earlier to look at ongoing support”.
34. The officer contacted numerous residential care homes to enquire about vacancies. She contacted Mrs Y again on the Monday for an update. Mrs Y said Mr Y was much calmer and ‘100% better’. Mrs Y said she needed no further assistance at that time.
35. The officer had ongoing contact with Mrs Y over the course of the following days. On 4 February 2020 Mrs Y contacted the Council’s duty team to say Mr Y was becoming more difficult sand she may need to consider permanent residential care. An officer contacted Mrs Y and her daughter the same day to arrange to review Mr Y’s care. The officer expressed concerns to Mrs Y’s daughter that “crisis episodes are increasing and when things plateau [Mrs Y] says she can cope again”. Mrs Y’s daughter agreed.
36. Mr Y went into residential respite care on 20 February 2020 with a view to a permanent placement.

What the Council says

37. “The Council accepts that unfortunately, the notes do not demonstrate clearly whether the potential cost was discussed clearly or not at the time. Therefore, the service are willing to refund these costs to [Mrs Y]. This has been calculated as follows:

• Initially the charge was £100 per week; 2 days at the Homestead at £50 per day.
• The additional 1-1 support increased the total substantially more than Mr Y’s maximum weekly contribution of £123.41 per week, so the charge was capped at that value when the 1-1 support was added.
• This additional £23.41 per week was charged for a total of 28 weeks.
• Therefore, the total to refund is £23.41 x 28 weeks = £493.64

38. With regard to the lack of notice when terminating [Mr Y’s] day care service, the Council would like to make amends for this and have considered a financial remedy. We acknowledge the family were left in a difficult situation, especially [Mrs Y]. Therefore, as an apology for the upset this caused, we would like to £200 to the family” This does not go far enough.

Analysis

39. The Council acknowledges it is unable to demonstrate that the cost of 1-1 care was explained to Mrs Y. Consequently, it has agreed to reimburse her the amount set out above.
40. Withdrawing the service without a review was unacceptable, particularly as there was already clear evidence that carer breakdown was likely as a result. Given the information known about Mr Y’s condition and behaviour the Council should have monitored the situation more closely than it did.
41. Although the Council reviewed Mr Y’s care needs shortly after the cessation of the day service, and increased the respite allocation, it appears not to have offered an alternative service, or in the absence of this, support for Mrs Y to meet the additional demand of caring for Mr Y on day to day basis. This is fault. Consequently, Mrs Y’s caring responsibility increased significantly which caused her increased stress and compounded an already difficult situation within the home.

After the cessation of the day service respite care stays were crucial to Mrs Y. During the last stay at the regular facility the care home found Mr Y increasingly difficult to manage. It contacted Mrs Y to ask her to collect Mr Y. It should not have done so; it should have directed concerns to the Council’s social services. Mrs Y alerted social services the same day. It advised her not collect Mr Y. The Council should have considered this a crisis situation and acted immediately. It should have contacted the care home directly in an attempt to avert the breakdown of the service. It did not, it contacted the care home three days later to ask for behaviour charts for Mr Y.

42. The Council was aware Mr Y had very challenging behaviour and that he had 1-1 support at the day service. It should not have had to ask for behaviour charts or suggest it would not fund 1:1 care. It should have responded to the request immediately. Had it done so; it may have prevented the breakdown of the placement.
43. A council officer told Mrs X to complain directly to the care home about its request for 1-1 funding because “we were not involved in this discussion”. This was wholly inadequate. The Council should have addressed the situation directly with the care home.
44. Mr Y’s health and behaviour was changeable, when Mrs X contacted the Council for support, officers did respond, but this was too little too late. By this point Mrs Y was a carer under stress because of loss of services which provided much needed relief from her caring role.

Agreed action

45. The Council will, as soon as reasonably practicable:

• reimburse Mrs Y the cost of 1-1 care
• provide Mrs Y with a formal written apology for the failures identified above
• pay Mrs Y £500 in acknowledgement of the lack of notice in terminating Mr Y’s day services
• pay Mrs Y £500 for loss of day service and respite service
• confirm the current care arrangements for Mr Y. If he is not in permanent residential care, explain how his care needs are being met.
• undertake a carers assessment of Mrs Y (if Mr Y remains living at home)
• reviews its response to crisis situations

46. Provide evidence of the above to this office.

Back to top

Final decision

47. There is evidence of fault by the Council in this complaint. It cancelled Mr Y’s day service at short notice, failed to provide alternative support, and failed to respond to a crisis situation whilst Mr Y was in residential respite care. Consequently, the placement broke down. The impact on Mr Y’s wife was significant.
48. The recommendation above is a suitable way to remedy the injustice caused.
49. It is on this basis; the complaint will be closed.

Back to top

Investigator's decision on behalf of the Ombudsman