London Borough of Haringey (19 014 205)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 22 Sep 2020

The Ombudsman's final decision:

Summary: The Council delayed assessing Mrs B’s mobility needs. Following the assessment, the Council caused delay in providing the required aids and equipment, and ramp to the property. Mrs B struggled at home and felt isolated, she felt no choice but to move out to improve the mental wellbeing of her and her husband. Mrs B feels frustrated at the length of time it took to get the necessary assistance. The Council has accepted the Ombudsman’s recommendations; it will apologise, pay £250 and consider how to improve its service for future users.

The complaint

  1. The complainant, who I will call Mrs B, says following her leg amputation in May 2018, an Occupational Therapist and District Nurse assessed she needed adaptations and equipment. The Council has not arranged this, despite Mrs B chasing it since March 2019. The Council does not follow up on promises made. Because her property is not suitable to meet her needs, Mrs B stays at her caravan which has a ramp to access and is all on one level. However, she cannot stay there in winter so feels trapped in the house. Mrs B’s husband has problems with both his hands, so it is dangerous for him to attempt to help her out of the property. Mr and Mrs B are depressed because of the situation and feel the Council does not care or wish to help them.

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What I have investigated

  1. I have investigated the issues from March 2019. I am investigating the delay in the Council providing the ramp, and any failure to chase up other services as promised.

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The Ombudsman’s role and powers

  1. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended). Issues before March 2019 are a late complaint.
  2. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended). Mrs B has given consent for an advocate to act on her behalf.
  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. 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

  1. I considered information provided by Mrs B and the Council.
  2. Mrs B and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

  1. In February 2019 Mrs B’s landlord contacted the Council to say Mrs B struggled with mobility; she needed a ramp to her front door, and support bars in the toilet. Almost four months later the Council contacted Mrs B. The Council’s notes show Mrs B was on holiday at her caravan and would contact the Council on her return home. Mrs B says she moved to the caravan in June because she was struggling at home and had heard nothing from the Council.
  2. Mrs B says she went to her caravan because it has ramp access and is all on one level, so it was better for her to be there as she could not manage at home. Also, when at home Mrs B was confined to the upstairs and could not easily see out of windows, it felt claustrophobic. Mrs B did not tell the Council this directly, but around a week later her representative contacted the Council to explain the situation. The representative told the Council if it could make an appointment then Mrs B would return to her home.
  3. Five months after the original referral, the Council completed an Occupational Therapist (OT) assessment with Mrs B at her home. The OT recommended the following:
  • raised toilet seat and rails in the toilet to reduce falls risk during toilet transfers.
  • bed lever to support bed mobility.
  • couch raiser to enable independence with wheelchair to chair transfers
  • Adaption to front entrance to enable ramp access for wheelchair, as footpath in front of the main door is too narrow to use portable ramp.
  • Recommended that client spend time lying flat on her back or stomach when on the bed to stretch her hips and reduce risk of contracture.
  • Advised client to contact Wheelchair services re: wheelchair repairs.
  1. The OT ordered the equipment and a funding panel approved the ramp. Mrs B must have told the OT that she was also awaiting pressure care equipment. The OT chased this up with the District Nurses and GP.
  2. The Council provided the toilet seat and bed lever promptly after the OT assessment.
  3. The equipment provider attended Mrs B’s property but could not fit the bathroom grab rail or raise the sofa. Mrs B says the worker told her they would order alternative fittings. The Council’s notes show Mrs B said she would need notice for a revisit as she was living away from home, so the Council was aware a further visit was needed.
  4. The grab rail and chair risers were fitted seven months later following a further OT assessment. The Council’s records show no evidence of the Council chasing up these items, or trying to arrange a revisit with Mrs B.
  5. There is no evidence of anything happening regarding the ramp between the Council approving the work in July and then reviewing the case in September after the OT left its employment. The Council noted the proposed ramp was not suitable for the property and would need to re-visit and assess. The Council did not have capacity to allocate an OT at the time, so put Mrs B’s case on its waiting list.
  6. Mrs B’s representative chased the Council in September who explained the current situation regarding the ramp. The Council contacted Mrs B who said she would not be returning home until November. They agreed the Council would visit and review the outside of the property to decide what ramp would be suitable for the space.
  7. The Council visited Mrs B’s property as agreed and contacted her landlord for permission to do the work. The landlord promptly gave consent. This was in November, by which time Mrs B was back at the property.
  8. There was delay in getting the quote from the ramp company because it had not included internal works. There was a one-month delay because Mrs B was away from her property over the Christmas period. The ramp was fitted nine months after the OT assessed Mrs B needed it.
  9. By the end of April 2020, the Council had provided all aids and equipment it assessed Mrs B needs. It closed the case in June 2020 following a telephone review with Mrs B.

Was there fault causing injustice?

  1. It took four months for the Council to make first contact following the referral. The Council has not provided any policy to show its intended timescales. In the absence of any policy to the contrary I find that four months is too long to make first contact in a situation where people are struggling with day to day living and need assistance. There is no evidence the Council was repeatedly trying Mrs B’s landline over this period, and even if there was, it could have used her mobile telephone number much sooner, which is what it eventually contacted her on.
  2. Mrs B did not tell the Council how much she was struggling, and that because of that she was moving to her caravan where she can move around more easily. The Council says some of the delay was because Mrs B was at her caravan, but I do not find that added delay. Mrs B was clear she would return home for appointments, she just needed some notice to plan her return. The first OT assessment was completed shortly after first contact.
  3. After the OT assessment the Council promptly took action to arrange aids and adaptations. However, when the worker came to fit them, they were unsuitable. This was not then followed up for seven months, which is fault of the Council. There is no evidence the Council chased this equipment or attempted to arrange a revisit with Mrs B. It therefore cannot say this delay was because Mrs B was living away from home. Because of this Mrs B could not easily manage transfers to the toilet, and on and off the chair/sofa.
  4. There is no evidence the Council took action to progress the ramp works between July and September, a delay of two months. The case was only assessed when the OT left its employment. It is possible the Council should have identified the problem with the proposed ramp sooner which also added to the delay.
  5. The Council says some delay was caused by the quote from the ramp company not including internal works. There is no evidence the Council or ramp company contacted Mrs B to arrange to visit the property to see the internal threshold. So, any delay is caused by the Council, or contractor acting on its behalf, rather than because Mrs B was away from home.
  6. The only time that Mrs B’s actions impacted on the timeline was when the Council contacted her in December to assess her toileting and seat transfers and she said she was away for Christmas and would return in one month. However, the toileting and seat transfers should have been resolved following the OT assessment in July, so it is the Council’s fault these issues were still outstanding five months later.
  7. Mrs B raised concerns that the Council promised help with getting required items from the District Nurses. I have seen evidence the Council contacted the District Nurses and GP, and appropriately chased this up. I find no fault with the Council’s actions here, as it did what it promised. It is possible it did not properly communicate this to Mrs B or her representative, or signpost her to the relevant professional bodies involved in sorting that equipment and how to complain about any delay.
  8. Mrs B’s representative was chasing the Council for updates over this period and made a formal complaint about delay. Mrs B felt isolated at home; her husband struggled to get her in and out of the property, so they were mostly spending time indoors. Mrs B was confined to the upstairs where she could not really see out of the windows. Mrs B did not have the required equipment to help her with transfers within the property, so was struggling to manage. Mrs B felt no choice but to stay at her caravan for extended periods of time, where she did have ramp access, and everything is on one level. Mrs B developed depression, and Mr B’s depression worsened. Spending time at the caravan helped their mental wellbeing. Mrs B is frustrated by the Council’s lack of action and care.

Agreed action

  1. To acknowledge the impact on Mr and Mrs B caused by the Council’s faults in this case, the Council will:
      1. Apologise to Mr and Mrs B for its delays in this case.
      2. Pay Mr & Mrs B £250 to recognise their frustration and the impact on their mental wellbeing.
      3. The Council has not given satisfactory reasons for the delays. To make sure significant delays do not happen again the Council should review the case, including how it monitors progress (such as from date of referral to assessment, and following up items that could not be fitted and needed re-ordering), and establish any learning. The Council should implement any identified improvements and update the Ombudsman accordingly.
  2. The Council should provide the apology and payment within one month of the Ombudsman’s final decision and complete its review within three months. It should evidence its compliance to the Ombudsman.

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Final decision

  1. I have completed my investigation on the basis the agreed actions are sufficient to acknowledge the impact on Mr and Mrs B, and to prevent future problems.

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Parts of the complaint that I did not investigate

  1. I have not considered issues before March 2019 as that is a late complaint. I have not considered concerns about the actions of the GP and District Nurses. Mrs B should make a complaint to the appropriate bodies, and if they cannot satisfy her concerns, she can make a complaint to the Parliamentary and Health Service Ombudsman.

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Investigator's decision on behalf of the Ombudsman

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