Summary: The Council delayed in confirming Mr Y’s need for permanent residential care. This caused his family unnecessary distress. It also failed to communicate effectively with Mr Y’s daughter. This caused further frustration and distress.

The complaint

1. Ms X complains about the Council’s actions during and after her father’s placement in a residential care home

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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)

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How I considered this complaint

4. I considered the complaint and discussed it with Ms X. I considered the correspondence between Ms X and the Council, including the Council’s response to the complaint. I have also taken account of relevant legislation. Mrs X and the Council have had the opportunity to comment on a draft of this document.

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What I found

Relevant legislation

5. A council must carry out an assessment of any adult who seems to need care and support. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9)
6. Having identified eligible needs through a needs’ assessment, the Council has a duty to meet those needs. (Care Act 2014, section 18)
7. If a council decides a person is eligible for care, it must prepare a care and support plan. This must set out the needs identified in the assessment. It must say whether, and to what extent, the needs meet the eligibility criteria. It must specify the needs the council intends to meet and how it intends to meet them. (Care Act 2014, ss 24 and 25)
8. A council should revise a care and support plan where circumstances have changed in a way that affects the care and support plan needs. Where there is a proposal to change how to meet eligible needs, a council should take all reasonable steps to reach agreement with the adult concerned about how to meet those needs. (Care Act 2014, s27(4) and (5))

What happened

9. Mr Y has Alzheimer’s disease. Prior to his placement in residential care he lived at home with his wife, Mrs Y, who was his main carer.
10. The Council assessed Mr Y’s care needs in January 2019 for residential respite care because his wife, Mrs Y, was due to have surgery at the end of February 2019 and needed time to recover.
11. The assessment concluded Mr Y needed nursing care and a temporary placement was secured.
12. Following Mrs Y’s surgery, it became apparent she could no longer care for Mr Y at home. The Council said it would consider the application for funding for a permanent placement at its ‘residential forum’.
13. The Council then told Ms X it would not confirm a permanent placement until an NHS Continuing Healthcare (CHC) had been completed. CHC is awarded depending on whether a person's primary need is a health need. It can be provided in a range of settings, including residential or nursing care or someone's own home.
14. The CHC assessment was completed on 23 April 2019, two months after Mr Y went into residential care. Ms X contacted the Council on numerous occasions to say the delay was causing her mother anxiety and distress. Ms X says she had to provide considerable support to Mrs Y.
15. Ms X, and Mrs Y were aware Mr Y would need to contribute towards his care if the CHC application was unsuccessful, and it was likely there would be a third-party top-up. Despite numerous telephone calls to the Council she was told the Council could not confirm the amount of contribution or top-up fee until after the CHC assessment. This added to Mrs Y’s anxiety.
16. The Council says the CHC assessment was delayed because of sickness of the nurse assessor. Ms X says she was not informed about this.
17. The CHC assessment concluded Mr Y was not eligible for CHC funding.
18. The Council confirmed Mr Y’s placement as permanent on 2 May 2019 and agreed funding.
19. In June 2019 the Council sent Mrs Y an invoice for £3,398.36 for backdated contributions for Mr Y’s care from March 2019. Mrs Y was distressed at receiving such a large bill. At the time she was undergoing treatment for a heart complaint. Ms X was on holiday so was unable to reassure Mrs Y. Ms X believes the Council should not backdate Mr Y’s contribution because of the delay in confirming his placement as permanent, and the delay in generating the invoice. She contacted the Council about the invoice and to clarify the amount of third-party top needed. She says she was passed from one officer to another without success.
20. Ms X submitted a formal complaint to the Council on 14 June 2019. The Council responded in writing on 29 August 2019. The officer apologised for time it had taken to respond to the complaint and said, “I acknowledge a lengthy delay in being able to arrange and undertake a DST (decision support tool) for your father… Whilst the backdating of the contribution has generated a large invoice given the time involved, this is something which regrettable, but necessary under finance charging policy. I acknowledge that this has been a lengthy process for you”. The officer said he intended to review the role and function of the residential forum. He went onto say “It is clear that at this time you did have great difficulty in trying to engage with our services and this is below the standard we always seek to achieve”.
21. Ms X was dissatisfied with the response and brought a complaint to the Ombudsman.

Analysis

22. The Council acknowledged the delay in confirming Mr Y’s permanent residential placement. It says it could not confirm a permanent placement because it needed to await the outcome of a CHC assessment. This is incorrect and fault by the Council. There was nothing that prevented the Council confirming Mr Y’s need for a permanent placement. The delay in confirming the placement caused Mrs Y and Ms X some injustice in that it led to continuing uncertainty about Mr Y’s situation and caused distress and anxiety at already difficult time.
23. The Council acknowledged Ms X had some “trouble engaging with the Council”. It did not offer an apology. This is not a satisfactory response. The lack of communication caused Ms X avoidable frustration and distress for which it should apologise.
24. In respect of the backdated invoice for care contributions. There was a delay in Mrs Y receiving an invoice for Mr Y’s contributions, and I appreciate this must have come a shock, however, there are no grounds on which to waive the bill. Mrs Y and Ms X were aware a contribution would need to be paid if the CHC assessment was unsuccessful.

Agreed action

25. To remedy the injustice caused the Council will within four weeks of the final decision:

• provide Mrs Y with a formal written apology and make a payment of £150 in acknowledgement distress caused
• provide Ms X with a formal written apology and make a payment of £150 to acknowledge the time and trouble she has been put to pursuing the complaint with the Council and the Ombudsman
• confirm a review of the role and function of the ‘residential forum’ has taken place and confirm the outcome.

26. Provide evidence of the above to this office.

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Final decision

27. There is evidence of fault in this complaint. The agreed action is a suitable way to settle the complaint.
28. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman