Summary: Mrs D complains the Council failed to provide timely and appropriate support when her family sought an assessment for her late father and in response to their requests for emergency respite and night sitting services. Mrs D says her late father did not receive the support he needed and her mother took on the responsibility of main carer without adequate support. We have found fault by the Council but consider the agreed action of an apology and payment in addition to the actions it has already taken provides a suitable remedy.

The complaint

1. The complainant, whom I shall refer to as Mrs D, complains the Council failed to provide timely and appropriate support when her family sought an assessment for her late father and in response to their subsequent requests for emergency respite and night sitting services when his condition deteriorated. Mrs D also complains the Council provided information about funding in a telephone message which it subsequently denied.
2. Mrs D says because of the Council’s fault, her late father did not receive the support he needed and this may have contributed to his unexpected death and left her mother as the main carer without adequate support which also affected Mrs D and her brother.

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The Ombudsman’s role and powers

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. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
5. 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

6. I read the papers provided by Mrs D and discussed the complaint with her. I have also considered the Council’s complaint response and supporting documents. I have explained my draft decision to Mrs D and the Council and considered the comments received before reaching my final decision.

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What I found

Key events

7. Mrs D contacted the Council in early October 2019 about help for her parents. The Council completed an assessment in early November. The outcome of the assessment was to provide care at home through the use of direct payments so care could be provided by carers known to Mrs D’s father as this was his preference.
8. The Council completed a carers assessment for Mrs D’s mother on 12 November. Mrs D’s mother was not provided with a copy of this assessment and it was wrongly placed on her father’s record. This constitutes fault.
9. Mrs D contacted the Council on 17 November to say residential care was now the family’s preferred option due to the deterioration in her father’s mental health. Mrs D identified a preferred care home but sought some evening support until the placement could be confirmed.
10. The support plan to set up direct payments was placed on hold while efforts were made to secure emergency respite/night sitting services from the Emergency Response Team (ERT) which is an NHS service. The Council contacted ERT on 18 November. ERT was not able to offer support until 20 November.
11. The Council also contacted the family’s GP about the possibility of an urgent mental health assessment with an approved mental health professional. The family did not wish to pursue such an assessment at this time.
12. A consultant psychiatrist reviewed Mrs D’s father on 20 November and changed his medication and suggested a community psychiatric nurse visit and monitor the situation to see if this change resulted in an improvement. It was suggested that residential care be put on hold until the impact of the change in medication could be assessed.
13. Mrs D contacted the Council on 20 November to say ERT had not visited as agreed and her family still needed support. The Council offered an evening carer support visit but Mrs D’s mother was concerned about her husband’s response to strangers. The Council agreed on 21 November to pursue the direct payment option instead. The Council submitted a support plan for direct payments on 22 November. The Council also confirmed ERT would attend. No such visit took place. ERT had no capacity for a personal care service to help Mrs D’s father in the evening and during the night time which was the family’s main concern.
14. Mrs D contacted the Council on 22 November to say the family could no longer cope and asked for an emergency respite placement in a care home. Mrs D also sought a night sitting service and explained their preferred care home could not currently provide a place.
15. 
    The Council contacted an alternative care home suggested by Mrs D. This home advised the Council it did not accept respite referrals and was mainly used as a short term reablement hub and did not consider it was an appropriate placement for Mrs D’s father. The Council also contacted other care homes and found an available place subject to an assessment. Mrs D noted the poor CQC rating and did not wish to pursue this option.
16. Mrs D contacted the Council and asked it to facilitate a placement for her father at the reablement hub. The Council agreed to do so and confirmed it would obtain the necessary approval. However, the care home confirmed its earlier position that it could not accept Mrs D’s father. The Council contacted other care homes but none were able to accept Mrs D’s father.
17. Mrs D asked for a night sitting service on 23 November. A provider was identified on 24 November which could offer this service from 25 November subject to a risk assessment. The Council was asked to call that day to arrange such an assessment but did not do so.
18. Mrs D identified a different care home on 25 November which required an assessment and mental health diagnosis from the consultant psychiatrist. The consultant psychiatrist suggested care homes that provided Elderly Mentally Impaired (EMI) residential care would be the best option. The care home completed an assessment on 26 November which confirmed Mrs D’s father needed EMI care which they did not provide. Mrs D contacted the Council for ERT help for that night.
19. The Council contacted the consultant psychiatrist to explain all the care homes contacted could not accept Mrs D’s father. The consultant psychiatrist advised a mental health assessment with an approved mental health professional was now required. This was arranged for 27 November.
20. Another care home completed an assessment on 27 November and agreed to accept Mrs D’s father for a couple of days respite as long as one to one care was provided. Mrs D complains about the content of a telephone message which she says suggested the family would have to fund the placement. The Council has no record of the telephone message. The Council says there were internal discussions about the costs and practicalities of the placement but this would not have had a financial impact on the family if Mrs D’s father had moved there for respite. In the event, a mental health assessment was completed the same day and Mrs D’s father was detained under section 2 of the Mental Health Act and admitted to hospital.

Council’s response to complaint

21. The Council provided a detailed response in March 2020 to Mrs D’s complaint which accepted some fault. The Council accepted it should have managed and better communicated the reasons why the reablement hub was not a suitable placement for Mrs D’s father. The Council also accepted it advised approval for the reablement hub would be obtained when this was not the case. The Council accepted these failings raised Mrs D’s expectations of a placement when efforts should have been focused on exploring other options.
22. The Council also identified two missed opportunities to secure support for Mrs D’s father between 20 and 25 November. The Council did not follow up the failure of ERT to visit on 20 November. The Council also did not ensure an urgent follow up action was subsequently completed for a night sitting service. It is not known if this service could have been provided.
23. The Council also found it had not followed the correct procedure for the carers assessment for Mrs D’s mother and there had been poor communication between two services involved. As the carers assessment set out the impact on Mrs D’s mother of caring for her father, the Council accepted it was likely Mrs D's mother would have been offered services to support her better with her caring responsibilities and this would also have added weight to the requests for ERT and night sitting services.
24. The Council also accepted an issue with an old ‘out of office’ return date meant Mrs D did not know when the case worker would be available to respond to some of her emails.
25. As a result, the Council confirmed the Director of Adult Services and Health would write to Mrs D to apologise. The Council also confirmed it would take the following action:

• review its notification procedures ensuring that follow up actions were made clearer and brought to the attention of the relevant social worker with a timescale;
• put steps in place to ensure all staff and partners worked collaboratively and were aware of the correct procedures when carrying out carers assessments to ensure the most appropriate services are offered to meet the carer’s needs;
• brief staff to ensure they take ownership and follow up the outcome of any support services they have put in place and to chase up and challenge in instances when support promised was not provided;
• remind all staff to have correct out of office details with clear instructions who should be contacted in their absence;
• put Mrs D in contact with her mother’s carer development worker to discuss carer options and benefits which are still available twelve months after her father’s death; and
• pay £350 to Mrs D’s mother to reflect the missed services as a carer calculated by working out the weekly cost had the assessment been completed correctly.

My assessment

26. I have reviewed the Council’s response to Mrs D’s complaint and the evidence that was considered during its investigation. I am satisfied the Council has completed a thorough review of events and welcome the Council’s actions as set out above. These go a considerable way in providing a suitable remedy.
27. There remains a dispute about the content of a telephone message about the funding of the potential respite placement identified on 27 November. In the circumstances of Mrs D’s father being admitted to hospital later the same day I do not consider further investigation on this point would achieve any benefit for Mrs D or her family.
28. I have gone on to consider if the Council’s recommended actions as set out above provide an appropriate and proportionate remedy.
29. Mrs D says the promised letter of apology from the Council’s Director of Adult Services and Health was not received. I highlighted this to the Council and it provided the Ombudsman with a copy of an apology letter dated 17 April addressed to Mrs D. The Council has also confirmed it has recently provided a copy to Mrs D after being made aware she had not received the letter in April.
30. Mrs D has told me that a similar apology letter to her mother would go some way to providing reassurance the complaint had been taken seriously. I consider this to be a reasonable suggestion.
31. I also consider the Council should provide a written update to Mrs D on its progress for each of its recommended actions above which would provide her with reassurance the Council has learned lessons from her family’s experience.
32. I should explain the Ombudsman does not calculate a financial remedy based on what the cost of the service would have been to the provider. We may recommend a financial payment to reimburse a person who has suffered a quantifiable financial loss or it may be a symbolic payment to serve as an acknowledgement of the distress or difficulties a person may have suffered.
33. On balance, in the absence of the fault identified above, I am satisfied some support would have been put in place which would have reduced the stress Mrs D’s mother and the wider family suffered during an intensely difficult time. Although the Council’s payment of £350 goes some way to providing a remedy for Mrs D’s mother I do not consider it fully reflects the risk of harm posed or her distress. I would suggest a further payment of £150 to make a total payment of £500 to Mrs D’s mother. I would also suggest a payment of £200 to Mrs D to acknowledge the impact on the wider family and her time and trouble in making the complaint.

Agreed action

34. The Council has agreed to:
1. ensure its Director of Adult Services and Health writes to Mrs D’s mother to apologise within one month of my final decision;
2. write to Mrs D with an update on its progress for each of its own recommendations set out above within two months of my final decision;
3. pay Mrs D’s mother an additional £150 to provide a total payment of £500 within one month of my final decision; and
4. pay Mrs D £200 to acknowledge the impact on the wider family and her time and trouble in making the complaint within one month of my final decision.

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Final decision

35. I have completed my investigation as I have found fault by the Council but consider the agreed action above with the actions already taken by the Council are enough to provide a suitable remedy.

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Investigator's decision on behalf of the Ombudsman