Summary: Mr C complained to us that the Council should have concluded, much earlier than it did, that his mother needed permanent residential care. He says this resulted in his mother having to contribute more towards the cost of her residential care during most of 2020. We did not find fault with the Council’s actions.

The complaint

1. The complainant, whom I sall call Mr C, complaind to us on behalf of his mother, whom I shall call Mrs M. Mr C complained that:
• He had to place his mother into a care home for respite care, because he was unable to speak to anyone within the Council’s Adult Social Care Department between 20 and 27 December 2019, when his mother faced a care emergency situation. As such, he says the Council should pay or contribute to what his mother had to pay to the care home between 17 December 2019 and 5 February 2020.
• The Council’s decision in February 2020, that his mother did not need residential care or 24/7 homecare, and instead only needed 3½ hours of homecare support a day, was wrong.
2. As such, Mr C says the Council should backdate the start of their funding from September 2020 to February 2020, which is when the Council’s needs assessment should have concluded that his mother needed residential care or 24/7 homecare.

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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. 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 considered the information I received from Mr C, the Council and the care home. I shared a copy of my draft decision statement with Mr C and the Council and considered any comments I received, before I made my final decision.

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What I found

Mr C’s claim the Council should pay for his mother’s respite care

7. According to a care review in September 2019, the Council was paying Mrs M to receive 2½ hours of support per day. Furthermore, it said:
• She needed support with getting dressed, eating and drinking, (un)dressing, personal hygiene, toileting and medication. She would sometimes prepare her own breakfast and go to bed independently.
• She advised she was very pleased with the support she received and liked to be as independent as possible. She said she would not want to move from her house.
• Mrs M was at risk of falls, care line and falls sensor in situ and she mobilised with a fame.
• Sleeps really well throughout the night.
8. Mr C told me he became increasingly concerned for his mother’s wellbeing in December 2019, and felt it was unsafe for her to continue living at home with a homecare package, due to her health, dementia, and an increase in the number of falls that led to her being admitted to hospital. Furthermore, she had a live-in care worker who left suddenly, and Mr C said he was unable to make alternative arrangements as he himself was about to go on a holiday.
9. Mr C said he tried to contact the Council between 20 and 27 December 2019 to ask if his mother should go into residential respite care while he was on holiday, or if the Council could help him arrange (temporary) homecare support at short notice. However, he says he could not speak to anyone and the messages he left were not answered. Mr C provided me with several telephone numbers that he said he tried to call.
10. The Council looked into this again and said it did not find any evidence in its record or on its system that Mr C tried to contact the Council between 20 and 27 December 2019.
11. The Council says that:
• The first evidence of any contact is an email from Mr C from 16 January 2020 to his mother’s social worker. The social worker responded the next day.
• Mr C, as his mother’s Power of Attorney, decided independently of the Council, to place his mother into a care home. This was therefore a private arrangement. As such, there is no requirement for the Council to pay for this.
• If Mr C had contacted the Council before moving his mother to the care home, it would have organised an urgent review and considered an urgent respite placement, if that was the best option.

Analysis

12. In the absence of any evidence to support Mr C’s claim that he tried to contact the Council before 27 December 2019, I did not find there was fault by the Council. As such, the Council did not need to contribute to the cost of Mrs M’s respite care, as this was a private placement.

Mr C’s complaint that his mother needed a care home as of February 2020

13. The Council arranged a meeting with Mr C on 5 February 2020. The Council said it agreed with Mr C that it would pay (contribute £586/week) for up to the next four weeks, to enable enough time to complete his mother’s needs assessment. As such, it paid for the period 20 February – 19 March 2020.
14. An assessment took place on 20 February 2020, with Mr C present. A follow-up Occupational Therapy (OT) assessment home visit happened on 26 February 2020, again with Mr C present. The Council completed the assessment in less than two weeks. The Council concluded Mrs M could return home safely with a care package of four visits per day, and assistive equipment and technology. Being at home was also what Mrs M had previously said she wanted. Mr C’s main concern was about the risk of falls and social interaction. However, the Council says it offered visits to a day centre, and her assessments showed that:
• Mrs M slept well and was able to get up at night by herself to go to the toilet. This was also confirmed by the care home who said she was able to use the toilet independently, using her frame.
• Mrs M was observed getting off the chair in the care home independently to go to the toilet. Staff reported no falls or near misses.
• Mrs M could eat and drink independently, as well as prepare snacks.
• In the unlikely event she would have a fall at night in her own home, a bed sensor could go off if she did not return from the toilet at night within a certain amount of time. In the care home staff were not physically supporting Mrs M with her mobility and transfers, and carers were advised not to stop someone falling.
15. I reviewed the care home’s care plans, which changed very little between February and September 2020. The care plan said that:
• Mrs M was at low risk of falls: Staff ensure she uses frame. Short distance with frame and independent. Can generally get up from chair and toilet. Independently mobile. Can alleviate pressure through mobilising. Mobility care plan does not report deterioration.
• Night: can reposition herself in bed to maintain skin integrity, able to use toilet at night, needs one carer to change pad if accident.
16. The Council proposed to increase Mrs M’s care package from 2½ to 3½ hours a day, in addition to a visit to a day center. However, Mr C said this amount of support would not have been sufficient for his mother because:
• She was at risk of severely injuring herself from falls and could have been at risk, especially at night, of having to wait a long time to be subsequently helped if this happened. A falls detector was not the solution, because on one occasion the falls detector did not work, and on another occasion it worked but it still took a long time for anyone to come and assist her. She had two falls in the six months before she went into the care home.
• She needed regular stimulation / human contact throughout the day as this had a positive impact on her mental state and ability to communicate.
17. Mr C told the Council he would only agree to his mother going home if she would have a live-in carer, which is what she needed to ensure her safety and sufficient social interaction. However, the Council said a live-in carer was not needed and Mr C would therefore have to pay for the additional cost if he wanted one.
18. The Council said it understood that Mr C would feel more assured and calmer if somebody would be with his mother all the time. It acknowledged to Mr C that his mother was at some risk of falls. However, it said that, based on her presentation, the lack of falls in the past months, the efficiency of her walking aids and both observations and assessment of the OT, the extent of this risk did not meet eligibility for placement in residential care. It also offered assistive technology solutions to reduce the risk of his mother having to wait, which Mr C refused. None of the falls she experienced happened during the night. The risk of falls was assessed as low by the OT, and the care home staff reported they were not physically supporting Mrs M with her mobility and transfers and there was no need to monitor for falls. It offered up to five visits a week to a day care centre.
19. The Council explained to Mr C on 4 March 2020 that it would pay £586/week towards the cost of the respite care. However, Mr C would have to pay a top up every week, because the private rate he agreed with the home was more than this.
20. Mr C continued to complain about the situation, as a result of which the Council offered to carry out a care review. However, there was a delay in carrying this out because some of the residents in the home had Covid-19. A different social worker eventually carried out Mrs M’s review in September 2020. The record of the review indicated that:
• Mrs M was not orientated to place and did not have capacity to engage with the review.
• Mrs M was unable to mobilise independently. She was unsteady on her feet and used a walking frame for short distances.
• She needed support with all daily living activities.
21. The social worker told Mr C on 2 October that her conclusion was that Mrs M would need 24-hour care.
22. The Council told me the care review concluded that Mrs M would need permanent residential care, because her needs had deteriorated. The assessor recorded:
• There had been recurring urinary tract infections, impacting on her overall physical health and increasing her weakness and risk of falls.
• This made her become more reliant on care staff, including at night.
23. In response to my enquiries, the care home told me that:
• Mrs M’s needs did not change between February and September 2020, and thus the care remained the same during that time period. Her care plan has remained unchanged until very recent.
• Her night-time needs were: support to mobilise and meet toileting needs with the assistance of one carer, at least twice per night. This support was needed due to her mobility needs and previous high risk of falls when mobilising independently.

Analysis

24. The Council carried out a needs assessment, OT assessment and obtained information from the care home. It considered all this information to come to its decision that Mrs M did not yet need residential care. We cannot question a decision the Council has made if it followed the right steps and considered all the relevant evidence to arrive at its decision (see paragraph 4 above).
25. Mr C’s main concern was that his mother was at risk of falls and needed social interaction. The Council explained that the OT assessed Mrs M as being at low risk of falls. She generally slept very well and was able to access the toilet independently at the time. This was confirmed by the information it obtained from the care home at the time. Furthermore, Mrs M would be visited by a care worker four times a day and the Council offered the option of visit a day centre.
26. It appears there was no major deterioration in Mrs M’s condition, between February and September 2020 and most of her care plans remained the same or changed slightly. However, the changes / concerns noted in the assessment in September 2020 were enough to now shift the balance in favour of residential care. The Council’s assessment did notice some increase in some support needs, including more support needs at night. The care home confirmed to me that Mrs M would get up around twice a night to access the toilet with the support of one care worker. This indicated she now did have 24/7 (night-time) needs.

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Final decision

27. For reasons explained above, I decided not to uphold Mr C’s complaint.

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Investigator's decision on behalf of the Ombudsman