Summary: Mr X complains that the Council failed to complete adaptations to his mother’s property before sending her home with a care package. We have found no fault by the Council.

The complaint

1. Mr X complains on behalf of his mother, Mrs Y. He says that the Council failed to complete adaptations to Mrs Y’s property before sending her home with a care package. Mr X says his mother is struggling to cope at home and this is affecting her health and wellbeing.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. 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)
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 information provided by Mr X and discussed the complaint with him. I made enquires of the Council and considered the comments and information it provided.
5. I provided Mr X and the Council with a copy of my draft decision and invited their comments.

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What I found

Legislation

6. The Care and Support Statutory Guidance says that:
• Councils must carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the outcomes they want to achieve. It must also involve the individual and where appropriate their carer or any other person they might want involved.
• If a person has eligible needs (needs which meet the eligibility criteria), a council can meet these by providing or arranging care and support at home, in a care or nursing home or in other ways.
• A council has to have ‘due regard’ to an adult’s wishes as a starting point, but social workers are entitled to exercise their professional skills and judgement in deciding how to meet eligible needs.

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What happened

7. Mrs Y is 89 years old. She lives alone in a first floor flat in a supported living complex. Mr X visits his mother regularly and provides support. Mr X and his wife hold a lasting power of attorney for Mrs Y.
8. On 29 February 2020 Mrs Y had a fall and broke her wrist. A week later she was discharged from hospital to a care home for rehabilitation. Her case was allocated to the Transfer to Assess Team and Mrs Y was supported by an occupational therapist (OT).
9. Mr X told the Council his mother required long term residential care. He explained Mrs Y had frequent falls, was not managing her personal care and there was a general decline in her health and memory. The Council said it would complete an assessment of Mrs Y’s care and support needs and consider all options for her future.
10. On 20 April 2020 a social worker discussed Mrs Y’s case with the OT. The OT said Mrs Y had made it very clear that she did not want to return home and wanted to go into residential care, closer to her son. The OT said it was unlikely Mrs Y would meet the criteria as she was quite capable and mentally alert to make her own decisions.
11. The social worker contacted Mr X about arrangements for Mrs Y to return home with a care and support package. Mr X said the Council had not assessed Mrs Y in her own home. He said she was at high risk of falling and her condition of Osteoporosis and brittle bones meant that the smallest of injuries could be fatal. The social worker agreed to an access visit to Mrs Y’s home before deciding her care and support needs.
12. The OT carried out the access visit on 11 May 2020. Mr X was also present. The OT said Mrs Y had a spacious flat and the only issue was the height of the kitchen worktops. Mr X said Mrs Y could not reach the worktops or open windows. He said Mrs Y should be in long term care. The OT explained that Mrs Y could return home with a care package as carers could provide meals, drinks, and support with Mrs Y’s care needs. The OT said Mrs Y did not have a previous care package and had no nighttime needs.
13. On 21 May 2020 the Council recorded that Mrs Y was “ready to return home. She is mobile, does not have any cognitive needs and is independent at night. “On the same day Mr X contacted the social worker. He said his mother had been advised by the care home that she would be going home. Mr X questioned the Council’s reasoning for its decision. He said due Covid-19 no face to face assessment had been carried out. The social worker explained she had gathered evidence from the Transfer to Assess Team and Mrs Y was managing well, mobilising, and mainly taking herself to the toilet. Mrs Y needed assistance with all aspect of drinks and meals because of her height and being extremely stooped. The social worker said Mrs Y’s needs could be met at home with a care package. Mr X’s wife said it was Mrs Y’s wish to go into a residential care home. Mr X also said he had been told the Council would carry out a home visit with Mrs Y before any decision was made. The social worker explained that the Care to Assess Team had been continually assessing Mrs Y but agreed to carrying out a home visit with Mrs Y. Later the same day a conference call was held with the social worker, OT, Mrs Y and Mr X. It was agreed a home visit with Mrs Y would be carried out the next day.
14. A home visit was carried out by the OT. Mrs Y and Mr X were also present. It was noted that Mrs Y mobilised independently with a rollator frame. She also had a four wheeled walker and a three wheeled walker. The OT reported that whilst Mrs Y was at risk of falling due to stoop and curvature she did have tolerance to mobilise safely over increased distance. The OT observed that Mrs Y was fully independent with chair and bed transfers. Mrs Y was able to use the toilet without assistance. The OT recognised Mrs Y would not be able to use the shower without support and Mrs Y confirmed that she had not used the shower for some time.
15. The assessment established Mrs Y’s greatest difficulty was in the kitchen. She struggled to lift the kettle to fill it with water due to not being able to lift her head to see what she was doing and with the weight of the kettle with the water in it. For the same reasons, Mrs Y struggled to lift meals in and out of the microwave. Mrs Y could not reach the wall cupboards and there was a risk of falling when bending down to access the base cupboards. Mrs Y was unable to reach switches on the wall that controlled her appliances and heating controls that operated her central heating. Mrs Y could not open the windows in her flat due to the positioning of the handles.
16. The OT recommended Mrs Y could return home with a package of care to support her with personal care to shower and supervision of dressing; prepare meals and hot drinks and prompting with daily medication.
17. Mr X complained to the Council. He said Mrs Y did not want to return home and required long term residential care. The Council delayed Mrs Y’s discharge until it had investigated and responded to the complaint. In its complaint response the Council explained how and why it decided Mrs Y could return home with a care and support package. The Council upheld its decision.
18. The Council confirmed the Short Term Assessment and Reablement Team would support Mrs Y on discharge, with four calls a day. It said that it had already contacted the District Council as it was responsible for carrying out the adaptations. It said the District Council would assess the adaptations further once Mrs Y was home.
19. Mrs Y was discharged on 9 July 2020 following liaison with Mr X.

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Analysis

20. It is not the Ombudsman’s role to say what a person’s needs are or what services they should receive. The Ombudsman’s role is to consider if the Council has followed the correct processes to assess a person’s needs.
21. I have considered the documents provided by the Council which included Mrs Y’s case notes and assessments. I find no fault in the completion of the assessments and the way the Council concluded that Mrs Y’s care needs could be met at home. The Council considered all the relevant factors including observations carried out whilst she was in rehabilitation and during the home visit. The Council engaged Mrs Y and Mr X throughout the process and considered their comments and the concerns they raised. The Council said the care and support package reflects the independence and confidence Mrs Y had before her fall and following her rehabilitation. This is a decision the Council is entitled to take.
22. The Ombudsman cannot question the merits of the decision itself without evidence of fault in the way it was made.
23. The Council delayed Mrs Y’s discharge until it had responded to the complaint and confirmed the specific details with Mr X. This is good practice.

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Final decision

24. For the reasons explained above I have found no fault by the Council and I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman