Summary: Mrs C complained about two Occupational Therapy assessments she received to determine if she needed support with getting out of bed and using her bath. She said this resulted in her getting the equipment she needed. We found fault with the way in which the Council responded when Mrs C told OT1 that the bed lever was not suitable. There was also fault in referring Mrs C to the incorrect Ombudsman. The Council has agreed to apologise to Mrs C for any distress this caused her.

The complaint

1. The complainant, whom I shall call Mrs C, complained that:
• The Council failed to carry out an appropriate Occupational Therapy (OT) assessment on two occasions. As a result, there was a delay in receiving the equipment she needed, namely a bath lift and an easy bed rise. This resulted in distress and several falls.
• The Council failed to properly investigate the complaints she made about the two assessments, and the complaint she made about the manager’s complaint investigation / response.
• The rail installed on her stairs is not at the correct height.
2. As an outcome, Mrs C says she wants the Council to acknowledge there were faults in the way the first two OTs assessed her. While she understands the argument of professional judgements, she says it was these faults in the assessments that resulted in incorrect conclusions. Mrs C says she wants an apology and a financial remedy for the injustice she experienced. She also wants the lesson to be learned that OT assessments need to be more thorough and that complaint investigations should be more critical (where needed). Mrs C said sometimes an OT can do somethings wrong and this should then be simply acknowledged.

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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. 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)
5. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
6. 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

7. I considered the information Mrs C and the Council provided to me. I shared a copy of my draft decision statement with Mrs C and the Council and considered any comments I received, before I made my final decision.

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What I found

8. Mrs C says she is unhappy with the way an OT carried out her assessment for adaptations in November 2018, and the way another OT carried out her reassessment in March 2019. She says that, as a result, there was a delay in receiving the correct bath and bed transfer equipment which left her in a dangerous situation and caused three falls.
9. The OTs were part of the Redbridge Community Health and Social Care Service (HASS). This is a team providing integrated health and social care services on behalf of North East London NHS Foundation Trust (NELFT) and London Borough of Redbridge (the Council). The OT assessments were done on behalf of the Council. As such, any injustice cause by them should be remedies by the Council.
10. The complaint was dealt with by NELFT on behalf of the joint integrated service. However, the issues being responded to related to a Council function. As such, the Trust was acting on behalf of the Council in terms of responding to the complaint.

The OT bath assessments

11. A record from the Council from 2018 (Wellbeing assessment) says “Why I would like an assessment: I become extremely short of breath talking and with physical exertion. I can lift my leg over the side of the bath but struggle to wash using the bath-board and need a seat to go down into the bath”. As she was able to continue to have a strip wash in the interim, her case was allocated as ‘low priority’.
12. Mrs C made a self-referral to the Community Treatment team on 27 September 2018 as she struggled to get in/out of the bath. The record shows the team did not accept the referral, as she was not in crisis. However, it did send a brochure for her with possible equipment she could explore and possibly buy privately. Mrs C says she did not get a brochure.
13. Mrs C said at a visit by OT1 on 22 October 2018 that her first main issue was that she had difficulty to get in and out of the bath. The records state that she said on 2 November, during a call, that she was struggling to have a bath as she cannot get in and out of bath.
14. Mrs C told me that, while she was able to get her legs in and out of the bath, she explained to OT 1 she was worried about the risk of falling over when she would try to get in and out of the bath. She said she was so nervous about this, that she avoided using the bath at home for two years. Even so, she said OT 1 did not go into the bathroom to assess her needs, did not take this risk / fear into account and did not recommend any equipment in the end that would have resolved this fear and risk. As a result of this, her situation remained unchanged following the assessment and she had no option but to continue to do a strip wash only.
15. OT1 visited again on 14 November 2018. The record said: Bath - independent with bath board.
16. OT 1 recorded on 6 December 2018: Bath transfer: practiced transferring in and out of bath with bath board with handle X3. Mrs C was able to bring legs in and out of bath independently.
17. A record dated 27 December 2018, from a visit by OT1 to review previously recommended equipment, said:
• Bath transfer- independent with bath board and handle. Current bath board with handle will meet her needs to transfer in and out of the bath for personal care.
• Mrs C said she fell forward in the bath when she tried bending forward to wash her legs about two years ago and had not used the bath since then.
• Mrs C said she was willing to purchase equipment that can assist with bathing. She has received an equipment catalogue.
• Advised to continue with strip wash. If she is to access bath to purchase long handled brush to reach legs during personal care to minimise risk of falling forward.
18. Mrs C told me she never said she had fallen forward in the bath or received an equipment catalogue. She also told me she had a fall in her bath two days later following this advice from the OT. She said there was no harm, but she had a bruised knee, hips and arm.
19. Mrs C was seen in February 2019 by the rehabilitation team. It states that Mrs C was able to bring her legs in and out of the bath independently.
20. OT1 wrote a letter to Mrs C on 22 February 2019. It said:
• Her bath board with handle currently meets her needs as she is able to lift leg over bath to sit on it.
• Recommendation: Advised to continue with strip wash. Use bath board to access bath and buy long handled brush to reach legs to min risk of falling forward.
21. Mrs C made a complaint on 14 March 2019. She said the OT assessed her bath transfers and stated the bath board she had in place was acceptable for her. Mrs C disputes this, stating she falls backwards into the bath when using the bath board. She has had to strip wash for the last 2 years as she cannot access the bath. She wanted another OT to assess her bath needs and felt there were bath options in the catalogue she received that she thought would work for her.
22. In response, the Council agreed that an OT manager (OT2) would do a second assessment of Mrs C. The assessment took place on 29 March 2019. The records of this assessment said that:
• Joint visit by OT2 and a Rehabilitation support worker.
• The OT offered to liaise with a Physiotherapist so Mrs C could receive strengthening exercises to improve her strength when lifting her legs into her bath. However, Mrs C explained she did not need this, as the strength in her legs was fine. She explained she walks to the bus and has always used hotel baths (which have handles) without any issues.
• Based on this statement from Mrs C, the OT identified that Mrs C has managed bath transfer using handles in the bath. As such, OT2 recommended to instal a grab rail. Mrs C declined, insisting she would only accept a bath-lift she had seen in her catalogue.
• The OT recorded that Mrs C refused to do a bath assessment. Transfers: in/out of bath and shower “not assessed”.
23. Mrs C says that OT2 did not offer a grab rail. She also says that both OTs failed to do the most important bit of the assessment, which was to go into the bathroom and ask her to demonstrate how she would try to go into the bath, and out of the bath, and to observe and ask her about what she felt she needed support with.
24. Mrs C made a complaint to the Council. The Council’s complaint response of 2 July 2019 said that:
• Both assessments were based on observation of Mrs C’s functional abilities in performing key tasks.
• Both OTs were in agreement to the level of her abilities.
• Mrs C declined the recommendations OT2 suggested for the bathroom, because Mrs C did not want alterations to her bath.
25. In response to her complaint, a third OT assessment took place in July 2019 by a different assessor (OT3). It said:
• Mrs C showed she sits on the edge of the bath board to use the sink. However, this is precarious. She does not feel safe doing this, as she sits on the board and cannot effectively wash herself.
• Considered a bath seat, so she could transfer from the bath board to the bath seat. However, thought Mrs C would be unable to complete this transfer because she has a large frame, reported joint pain and appeared short of breath following exertion.
26. The bath lift and bed aid were delivered on 8 August 2019.

Analysis

27. Mrs C said OT1 failed to actually observe her doing a bath transfer and failed to consider she was worried about the risk of falling backwards. However, the records only refer to her saying she fell over two years ago when she bent forwards trying to wash her legs and had been scared to use the bath as a result ever since. As such, the OT recommended a long-handled brush so she would not have to lean forward. According to the records, OT1 visited Mrs C several times and did observe and practice bath transfers with her. We cannot question the merits of a decision if the Council has made it after following the right steps and considering relevant information (see paragraph 4).
28. Mrs C said OT2 failed to actually observe her doing a bath transfer and disagreed with OT1 who correctly concluded she was able to lift her legs into the bath. However, according to the records, Mrs C refused to take part in a bath assessment when OT2 visited her. Furthermore, the records indicate that, after Mrs C explained what she could do, OT2 accepted she could lift her legs in and out of her bath and recommended to instal a grab rail. Mrs C declined this, but I did not see evidence in the records that she subsequently explained why she believed this would not be suitable for her. We cannot question the merits of a decision if the Council has made it after following the right steps and considering relevant information (see paragraph 4).
29. Although OT3 recommended something different, this does not automatically mean that the recommendations by OT1 and OT2, based on Mrs C’s presentation and the information she provided at the time, was fault.

The OT bed assessment

30. In May 2018, Mrs C said she needed a bed stick as she was struggling to get in and out of her bed. Mrs C says that, while she was able to get in and out of her bed independently, she explained to both OTs she was sometimes more unsteady (when she needs to use the toilet during the night) and worried about the risk of falling over.
31. Mrs C said on 22 October 2018, during a visit by OT1, that her second main issue was about getting up from her bed at night-time. She reported that in the last 12 months she fell once (in February 2018) when she slipped out of bed and wasn’t able to get up alone.
32. The records state that, during a phone call on 2 November 2018, Mrs C said that she needs a bed stick, as she was struggling to get in and out of bed. This is similar to a bed rail / lever.
33. OT1 visited Mrs C several times, between November 2018 and February 2019. The records state that:
• Mrs C had a mattress topper. OT1 recommended that Mrs C should remove the topper to lower the height of the bed. This would minimise her risk of falling, as the bed was high and could become slippery when she tried to get out of her bed. Mrs C declined this, saying the mattress was preventing bed sores. However, the Council says it has not seen evidence that Mrs C is at risk of bed sores. In response to my draft decision, Mrs C has told me the District Nurse had recommended it.
• The OT also recommended that Mrs C should not get out of bed too fast. Mrs C has told me she never did that anyway.
• The OT provided a bed lever to assist with safer transfers. When the OT returned to review Mrs C’s use of this equipment, Mrs C said she removed it because it would pull the mattress when in use. The OT was unable to verify this, because Mrs C had already removed it and taken it away.
• The OT concluded she was independent with bed transfers and did not recommend using any other equipment.
34. Mrs C was unhappy, because she felt the OT had left her without the equipment she needed to feel more secure / safe when transferring out of bed during the night. Mrs C made a complaint saying there were other options for bed rails to consider, which she had seen in a catalogue. As such, she wanted to have one of those options instead, and would like an assessment for this.
35. As a result of Mrs C’s complaint, she received another assessment from a different OT (OT2) in March 2019. The records of this assessment said that:
• Joint visit with Rehabilitation support worker.
• The OT observed Mrs C getting in and out of her bed independently. At present Mrs C has improved and recovered from her recent operation so no longer needs any equipment to assist getting out of bed.
• Mrs C pointed to a bed lever in a catalogue and said she wanted it.
• The OT concluded a bed lever was not required anymore. However, the OT was willing to compromise by providing a bed lever that could be strapped to her mattress. Mrs C declined this.
36. Mrs C told me that she did not have any recent operation, as recorded by the OT. She also said she did not point out a bed lever and was not offered one.
37. Mrs C was unhappy with the outcome of the second assessment and made a complaint. In response, Mrs C received a third OT assessment by a different assessor (OT3) in July 2019. It said:
• Mrs C said she would like to transfer in and out of her bed independently and safely without the fear of falling, especially at night when going to the toilet. She said she had a bed lever in the past, but this was too loose and not secured, so she did not feel confident using it.
• The bed transfer was independent but effortful.
• Mrs C said her main issue was standing up from bed and feeling confident to take the first steps, feeling supported. As such, the OT issued an easy bed rise.
38. Mrs C said that OT3 had access to exactly the same information as the previous OTs. The difference was that she felt listened to, the OT asked her to demonstrate what she could do and why she felt anxious about certain transfers. As such, when OT3 initially proposed a single bed lever with straps, but Mrs C advised that her main issue was standing up from bed and feeling confident to take the first steps feeling supported, the OT correctly realised she needed an easy bed rise instead.
39. The Council said OT2 offered to have straps added to the bed lever provided by OT1. However, Mrs C was asking for a bed lever from her own catalogue. We understand that the product from her catalogue was the same design as the product proposed by the OTs.

Analysis

40. Mrs C said in November 2018 that she wanted a bed stick to get in and out of bed. The OT assessed Mrs C’s needs and concluded she would benefit from equipment. As such, OT1 recommended a bed lever, which was similar to the bed stick Mrs C said she wanted at the time. However, during an equipment review visit, Mrs C said the bed lever was not suitable for her. As such, I would have expected the OT to subsequently consider / discuss if there would be any other equipment that may work, or at least discuss / explain if/why he felt there was no need to try any other equipment. This did not happen, which is fault. However, I am unable to come to a view what the outcome of such a discussion would have been.
41. OT2 observed Mrs C getting in and out of bed independently and concluded she no longer needed any equipment to assist her with this. As such, the Council carried out an assessment, considered all the information and came to a reasoned decision which we cannot criticise (see paragraph 4). However, the OT was willing to provide a bed lever that could be strapped / secured to Mrs C’s mattress, which she declined. I did not see evidence in the records that Mrs C subsequently explained why she believed this would not be suitable for her. I have also not seen evidence that shows this option would clearly not have been suitable for Mrs C.
42. The Council says the equipment OT3 recommended, and which Mrs C accepted, was similar to the equipment offered by the first two OTs. However, Mrs C says they are different. Again, although it may be different in design, this does not automatically mean the equipment offered by OT1 and OT2 was wrong.

The way the complaint was dealt with:

43. The complaint was about the actions of two OTs. However, the complaints handling was carried out by the NHS Trust, as the complaint relates to an integrated health and social care team. As such, as the NHS Trust was acting obo the Council in this context, in terms of responding to the complaint, the Council remains responsible for the way the complaint was dealt with.
44. Whenever Mrs C made a complaint about an OT assessment, she immediately received a reassessment by a different OT.
45. The Council did not agree that “the assessments undertaken by the two OTs were faulty and contradictory”. It said that both OTs were in agreement about her abilities, and the OT’s recommendations were based on their clinical and professional judgement following their assessment visit(s).
46. The complaints were responded to by the Integrated Care Director. It was explained to Mrs C that, if she was unhappy with the way her complaint was dealt with, she should refer this to the Health Service Ombudsman.

Analysis

47. Mrs C says she felt the complaints responses were dismissive. I have reviewed the responses and did not find them dismissive.
48. However, when she was unhappy with the complaint response she had received, she should have been advised to go to the Local Government and Social Care Ombudsman, for reasons explained in paragraph 10 above. This was fault.

The issue around adjusting the height of the stair rails

49. I decided not to investigate why/how the stair rail was installed at this particular height, as this happened too long ago. The Ombudsman can usually only investigate things that have happened in the last 12 months, unless there is a good reason why the complainant could not make this complaint to the Ombudsman sooner.
50. However, once Mrs C complained about the height of the rail:
• The records state on 22 February 2019: “offered to readjust height of rail to her request despite rail being at an acceptable height. Person declined”.
• The Council offered (again) to adjust the height of the rails in its complaint response of July 2019, which has since been done.

Analysis

51. I did not find fault with the way the Council responded once Mrs C made a complaint about the stair rails.

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Agreed action

52. I recommended that, within four weeks of my decision, the Council:
• Apologises for any faults identified above.
• Shares the lesson learned with relevant staff.
53. The Council has told me it has accepted my recommendations.

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Final decision

54. I found there was some fault by the Council. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case

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Investigator's decision on behalf of the Ombudsman