Summary: Miss X complains the Council has prolonged her stay in residential care, but the evidence shows the Council has made every time to enable a supported return home. Miss X has so far chosen not to pay for the renovations her house requires to be habitable.

The complaint

1. Miss X (as I shall call her) complains the Council placed her in residential accommodation on a temporary basis but will not let her return home unless she pays for deep cleaning and renovations to her home.

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The Ombudsman’s role and powers

2. 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)
3. If we are satisfied with an organisation’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 the Council and by Miss X. We spoke to Miss X. Both Miss X and the Council had an opportunity to comment on a draft statement before I reached this final decision.

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What I found

Relevant law and guidance – mental capacity and compulsory detention in hospital

5. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The Act (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so.
6. The Deprivation of Liberty Safeguards provide legal protection for individuals who lack mental capacity to consent to care or treatment and live in a care home, hospital or supported living accommodation. The DoLS protect people from being deprived of their liberty, unless it is in their best interests and there is no less restrictive alternative.
7. The Mental Health Act 1983 sets out when a person can by law be admitted, detained and treated in hospital against their wishes.
8. A person can be detained in hospital under section 2 of the Act for assessment and for treatment after the assessment. A person can be kept in hospital under section 2 for a maximum of 28 days.
9. A person can be detained under section 3 of the Act for treatment and kept in hospital for up to six months. The detention under section 3 can be renewed for another six months.

Relevant law and guidance – housing improvement

10. The Regulatory Reform (Housing Assistance) (England and Wales) Order 2002 gives councils the discretionary power to provide financial and practical help for repair, improvement and adaptation of homes.

Councils have the power to improve people’s living conditions by helping to:

• adapt, improve or repair existing accommodation
• demolish accommodation
• replace accommodation that has been demolished
• acquire living accommodation for someone, in certain circumstances.

The help can be provided in any form and can include loans, grants (with or without a means-tested contribution from the applicant), equipment, materials and advice.

11. Councils must also:

Before help is provided, give the prospective recipient a written statement of the terms and conditions under which any help will be given

Ensure the recipient has received appropriate advice and information about any obligations they will have to fulfil if they receive help from the council

Consider the recipient’s financial circumstances before imposing any repayment arrangements or charges. The council should not offer a loan if it is clear the recipient would not be able to repay it.

Get consent from the owner before doing any work to the property

What happened

12. Miss X was admitted to hospital in October 2018 with sepsis and acute kidney damage due to poor nutrition and hydration. The fire officers who had accessed her house to assist Miss X raised concerns about severe hoarding. The assessment of Miss X while in hospital concluded she could not return home safely until the hoarding was resolved. The Council funded a short-term placement in a residential care home in the interim. It assessed that she needed “advocacy support with finances, clean of the home, collection and removal of personal items, family photos, paintings, drawings, other personal items.”
13. The decision for Miss X to remain in a care home was supported by an Independent Mental Capacity Assessor. The Council’s records say, “IMCA decision, (Miss X) agreed to go temporarily into a care home close to where she lives while her home is being cleaned, doesn't have insight into the risks around the need for her home to be cleaned however (Miss X) would like to be involved in the clean as much as possible. To make a list of the items not to be thrown away (also IMCA said she would not disagree if (Miss X) made the decision not to return home and to remain living in a care home).”
14. The Council obtained a quote of £4250 for the necessary work to the property (“deep clean as well as subsequent gas, electricity, pest control (rats), water and heating checks subsequent to the deep clean to allow technical access”). The Council said it would arrange for the work to be carried out and a charge put on the property to secure the loan, but Miss X refused. She said she would make the arrangements with her bank instead. She said she wanted to be involved in the clearance work so she could ensure personal items were not discarded.
15. Miss X was detained in hospital at various times on a section of the Mental Health Act: in between she was placed in residential care homes under a DoLS authorisation. The Council says that some care homes refused to offer her another placement because of the state of her room when she left: others refused a placement outright because of the history of hoarding.
16. The Council made arrangements to have some clearance works undertaken in two rooms of Miss X’s house, as well as some necessary electrical work which Miss X agreed. The company employed to do the work then refused any further work as Miss X did not pay for the electrical work which she had commissioned as she said she had been tricked into agreeing it.

The complaint

17. In March 2021 Miss X complained to the Council. She said she wanted help to bring her home up to a habitable standard so she could return. She said the care home environment was not suitable for her. She also said she had been tricked into privately arranging a contractor for the electrical works which she could not afford.
18. The Council responded to the complaint. It said although the loan process had begun it was paused to enable the house to be cleared so the surveyor could assess accurately the works required. That had not happened due to Miss X’s personal “complex situation” and in the meantime the Council had frozen its Home Improvements Loans because of financial constraints. The Council said a social worker would ask the funding panel what assistance might be given to carry out the work, as the Council was currently funding Miss X’s residential care placement.
19. The Council also pointed out that Miss X had seen and agreed the estimate for the electrical work. It said the final bill was the same as the estimate. It said, “We cannot see evidence of being misled over the cost of work, as these were transparent, and dependent upon your agreement which you provided ahead of the work.”
20. In respect of Miss X’s assertion that the care home environment was not suitable for her, the social worker commented “this is why we are working so hard to get the lady home to a safe warm environment. We are looking to provide basic needs to ensure her safety.”
21. The Council’s funding panel met later in March to discuss Miss X’s case. The Council says it agreed to pay “whatever the cost to make the property liveable (estimated at £10,000/15,000) putting a charge on the property with her agreement to raise the funds to get the home into a habitable condition so that she can return. (Miss X) did not agree to a charge being put on the property.” Miss X was admitted to hospital again under a section of the Mental Health Act.
22. Miss X complained to the Ombudsman in March 2022. She said she was ‘at stalemate’ with the Council.
23. The Council says it had no further contact from Miss X about her complaint after its response of March 2021. It says she manages her own finances, and it is aware that bank officials have visited her in different care homes to discuss her accounts. However, it says its Home Improvement Loans have now been reinstated and could be used to fund the works if Miss X cannot afford to pay for the works herself. It says, “However the team would need to do a financial assessment to see whether she is eligible for a loan or not. If a loan is granted, the Council puts a lifetime charge on the property for the loan to be repaid, when the property is sold or transferred, and again (Ms X) would have to agree to this if the loan were to go ahead.”
24. The Council visited Miss X (who is now residing in a care home again) on 4 October and reviewed her wishes for returning home. It arranged for her to visit her home address on the day her belongings would be transported from the care home. On 11 October, Miss X’s belongings were transported from the care home to her home address. Miss X and a social worker attended to receive her belongings which will be stored there. The Council’s commissioned contractor, an electrician and a builder also attended to look at the work outstanding and provide quotes.
25. The Council says it will take a request for funding to its panel in due course.

Analysis

26. Miss X cannot return to her home safely until it is made habitable. The Council has offered to do so but so far Miss X has refused. There is no evidence of fault there.
27. The Council pays for Miss X’s care in a care home. Although the Council would enable Miss X’s return home, it is notable the IMCA who assessed her said she would not oppose a decision for Miss X to remain in residential care. There is no evidence the care home environment of itself is unsuitable for Miss X.
28. The situation has been made more complex by the number of occasions on which Miss X has been detained under section. That is exceptionally unfortunate but is not the fault of the Council.

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Final decision

29. I have completed this investigation on the basis there is no fault on the part of the Council in the way it has responded to Miss X’s circumstances.

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Investigator's decision on behalf of the Ombudsman