Summary: We upheld Ms X’s complaints about a failure to arrange a timely assessment to enable Mrs Y to have an appropriate care package so she could go home from hospital and about poor care (missed medication). Mrs Y has passed away and so it is not appropriate to recommend a remedy for her. The Council will apologise to Ms X for her avoidable distress.

The complaint

1. Ms X complained about London Borough of Croydon (the Council). She said there was a failure to restart her late mother Mrs Y’s care after a hospital stay. And London Care (the Care Provider) provided poor care.
2. Ms X also complained the Council refused her request to care for Mrs Y in her home.
3. Ms X said the failings in her mother’s care meant she could not come home and she was exposed to pneumonia which shortened her life. This caused avoidable distress.

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The Ombudsman’s role and powers

4. 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)
5. The Care Provider acted for the Council because it provided a service to meet Mrs Y’s needs under the Council’s duties and powers in the Care Act 2014.
6. 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)
7. 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

8. I considered Ms X’s complaint, the Council and Care Provider’s responses to the complaint and documents later in this statement.
9. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance.

10. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. When investigating complaints about council-funded care, we consider the 2014 Regulations.
11. Regulation 9 of the 2014 Regulations requires care and treatment to be appropriate, to meet a person’s needs and to reflect their preferences. Care providers should carry out an assessment of needs and preferences and design a care plan to meet needs and preferences.
12. Regulation 12 of the 2014 Regulations says a care provider must provide care and treatment in a safe way including by working with health professionals to ensure the health and welfare of clients. Guidance on Regulation 12 explains medicines should be given accurately and in line with the prescriber’s instructions and at suitable times to ensure the person is not placed at risk.
13. Councils arrange and fund home care under powers and duties in the Care Act 2014. In summary, a council carries out a social care assessment, decides whether the person has eligible needs for care and support and if so, draws up a care plan explaining how to meet those needs and what this will cost.
14. Statutory Guidance explains a council should review a care and support plan at least every year, upon request or in response to a change in circumstances (Care and Support Statutory Guidance, Paragraph 13.32)
15. If a council has reasonable cause to suspect abuse of an adult who needs care and support, it must make whatever enquiries it thinks is necessary to decide whether any action should be taken to protect the adult. (Care Act 2014, section 42)
16. The Care Act sets out procedures to ensure the NHS and councils co-operate where patients may need social care services to be discharged from hospital safely. The Care Act says:
1. The NHS must give a council written notice in a specific form if it considers a patient may need care and support to be discharged safely. This is an ‘assessment notice’. The council must carry out an assessment within 2 days of the day after the assessment notice.
2. The NHS must then consult the council before deciding what it will do for the patient in order for discharge to be safe and notify the council the proposed date of discharge – this is a ‘discharge notice’
3. If the council does not carry out a needs assessment and the patient has not been discharged by the end of the relevant day (the date on the discharge notice) the NHS may charge the council. (Care Act 2014, Schedule 3)

What happened

17. Mrs Y had Parkinson’s disease and lived in a flat in a sheltered housing complex. The Council’s most recent social care assessment and care and support plans for Mrs Y were in 2017. The Council commissioned the Care Provider for care workers to provide five calls a day. Mrs Y also had a private arrangement where a friend lived with her and was on hand when the care workers were not there.
18. The Care Provider referred Mrs Y to the Council’s OT team in June 2019 because her ability to stand was deteriorating. The Care Provider asked for a reassessment and an increase to the care package.
19. An occupational therapist (OT) carried out a moving and handling assessment for Mrs Y. The OT visited Mrs Y again in June and July. The OT arranged for Mrs Y to trial a hoist, tilting shower chair and a recliner chair and observed care workers using the equipment to check for safe use. The OT also referred Mrs Y to the NHS wheelchair service and arranged for the care calls to be increased in length to allow for extra time needed for hoisting. The case notes indicate new equipment was delivered in the middle of July.
20. Ms X contacted the social care team to say she wanted Mrs Y to live with her. Ms X said her home would need adaptations.
21. Ms X contacted the safeguarding team in July to raise concerns about Mrs Y’s care. She said her mother was not able to have a bath and was being strip washed. She also said a carer had made an error giving Mrs Y her medicine.
22. Also in July, a social worker noted her view that Mrs Y’s condition may be declining such that nursing home care might be on the horizon, but Mrs Y did not want to move.
23. The Care Provider also contacted the social worker in July about a medication error Ms X had raised directly with it and said it was investigating this. The Care Provider confirmed several days later that Mrs Y had missed a dose of her medicine and the care worker had been sanctioned for this (received supervision and medication training). The records suggest that the care worker had left the Care Provider’s employment by September.
24. The Council considered Ms X’s concerns under safeguarding procedures. The safeguarding case records said:
• An OT assessed Mrs Y and ordered new equipment to help care workers transfer her – including a shower chair, recliner chair a hoist and slings. The care hours had been increased.
• In response to the medication incident, care workers had been told to ensure medicine was given at the correct time and the care worker involved had been sanctioned.
• Mrs Y’s family had arranged for a close family friend to move in with Mrs Y to provide additional help as well as the care package.
25. The Council decided the measures described in the last paragraph minimised any risks to Mrs Y and took no further action under safeguarding procedures.
26. An OT visited Ms X at her home in September. She said Ms X’s home would need major adaptations in order for Mrs Y to live there including a ramp to the front door, a through floor lift, hoist, widening of doors. The case was referred to a different team in the Council responsible for organising funding for major adaptations.
27. Mrs Y went into hospital at the start of December 2019 where she was diagnosed with cancer. Ms X’s complaint is about an alleged failure by the Council to make prompt care arrangements so Mrs Y could go home. Ms X said the Care Provider told the hospital it could not manage Mrs Y and she needed to be in a nursing home. The Council’s case records indicate it received an assessment notice from the hospital on 17 December with an expected date of discharge for the following day and requesting an increase in Mrs Y’s care package. A team manager from the Council spoke to the ward on the same day and was told Mrs Y required a soft diet and help with eating. The ward staff explained she had had a speech and language assessment and that they would forward a copy. The following day, a social worker spoke to the ward. The ward asked for a re-assessment of Mrs Y’s needs. There are no further entries about discharge and Mrs Y died a few days later in hospital. Ms X told us her mother caught pneumonia while in hospital.
28. Ms X complained to the Council and Care Provider. The Care Provider’s response to the complaint said its manager had followed correct procedures by asking for a review of Mrs Y’s needs which appeared to have changed since her admission to hospital.
29. Ms X was unhappy with the Care Provider’s response to her complaint and contacted the Council. The Council’s final response to the complaint said:
• It had been waiting for a speech and language assessment as Mrs Y’s ability to feed herself had declined. Mrs Y’s health deteriorated before this could be done. The Council could not confirm the care she required before the speech and language assessment was done
• Mrs Y then deteriorated and was not ready for discharge
• The safeguarding concerns she had previously raised were addressed by reviewing and increasing the care package by 15 minutes each visit and through an OT supporting Mrs Y including providing new equipment. There was an error with medication which was investigated. The care worker did not follow the specific instructions regarding administering the medication. It was a one-off error and the worker was sanctioned and received training.
• Professionals felt Mrs Y needed to be in a nursing home, but the family did not want this.
• An OT visited Ms X at the end of July 2019 and advised major adaptations would be needed to her home if Mrs Y was going to live with her. These adaptations would need to be done before Mrs Y moved in. Sadly, she died before this could be pursued.

Findings

Complaint: Failing to restart the care package

30. I do not consider the Care Provider was at fault because the evidence suggested Mrs Y’s needs may have changed and she may therefore need care over and above what the Care Provider was being commissioned to deliver. So there was no fault by the Care Provider in raising this. The Care Provider was required by Regulation 9 of the 2014 Regulations to provide tailored care to meet Mrs Y’s needs and as those needs might have changed, it was appropriate for it to raise the potential change in Mrs Y’s needs with the hospital.
31. However, the Council was at fault. It should have completed a social care assessment or a review of the care and support plan within two days of receiving the assessment notice from the hospital. The Council’s actions fell short of this. I note a team manager spoke to staff on the ward, but a conversation with the hospital was not sufficient. Further urgent attempts to get a copy of the speech and language assessment and to arrange a social care reassessment should have been made. The Council failed to act in line with the discharge provisions described in paragraph 16(a).
32. I note Mrs Y then became ill again and so she may not have been able to be discharged anyway. However, the Council did not know this at the time. There was no follow up liaison with the ward after the 18 December to set up a time for an assessment and there should have been as set out in the previous paragraph. I cannot say whether Ms X would have been well enough to come home had the assessment taken place within the required two-day timeframe. It was not the Council’s fault that Mrs Y developed pneumonia.

Complaint: The Care Provider provided poor care

33. The Care Provider accepted there was a missed dose of medication. This was poor care and was not in line with Regulation 12 of the 2014 Regulations and was fault. The Council dealt with the matter through safeguarding procedures and the care worker underwent training. This was an appropriate response to a safeguarding concern.
34. The records indicate there was a decline in Mrs Y’s abilities and she required new equipment for safe transfers to enable showering. There should have been a formal, documented review of Mrs Y’s care as there had not been one since 2017. This was not in line with paragraph 13.32 of Care and Support Statutory Guidance and was fault by the Council. Although there was no formal review of the care and support plan, I am satisfied the Council effectively completed a review of Mrs Y’s care arrangements through safeguarding processes and case management. The outcome was that Mrs Y had an increase in the duration of her care calls and received appropriate equipment to reflect the decline in her mobility and to enable her to shower safely and meet her increased mobility needs. So I do not consider the failure to complete a review caused any injustice.

Complaint: The Council refused Ms X’s request to care for Mrs Y at her home

35. I do not uphold this complaint. The records indicate an OT assessed Ms X’s home which needed major adaptations before Mrs Y could live there. Those adaptations would have taken months to organise and complete. Mrs Y’s health deteriorated meantime and she was diagnosed with cancer.

Agreed action

36. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the Care Provider’s service, I have made recommendations to the Council.
37. I upheld Ms X’s complaint about a failure to arrange a timely assessment to enable Mrs Y to have an appropriate care package so she could go home from hospital and about poor care (missed medication). Mrs Y has sadly passed away and so it is not appropriate for me to recommend a remedy for her.
38. The Council’s failings caused Ms X avoidable distress. It will apologise to her in writing within one month.

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Final decision

39. I upheld Ms X’s complaints about a failure to arrange a timely assessment to enable Mrs Y to have an appropriate care package so she could go home from hospital and about poor care (missed medication). Mrs Y has sadly passed away and so it is not appropriate for me to recommend a remedy for her. The Council will apologise to Ms X for her avoidable distress.
40. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman