London Borough of Harrow (21 003 547)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 07 Apr 2022

The Ombudsman's final decision:

Summary: Mr X complained the Council did not appropriately safeguard his father Mr D and failed to involve him and his sister Ms Y in its decisions regarding Mr D’s social care needs. He also complained the Council did not properly respond to complaints he made about this. He said this matter caused him and his family distress. The Council was at fault when it delayed arranging a capacity and needs assessment for Mr D. The Council has agreed to do so now and provide evidence it has reminded its staff of the importance of arranging timely assessments when necessary.

The complaint

  1. Mr X complained the Council:
    • failed to arrange a needs assessment for Mr D after he was discharged from hospital;
    • did not involve him or his sister Ms Y in its decision-making regarding Mr D’s care package; and
    • did not investigate or address his complaints fully.
  2. He said this matter has caused him and his family distress and upset.

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The Ombudsman’s role and powers

  1. 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)
  2. 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

  1. I made enquiries of the Council and considered the information it provided. This included a chronology its contact with Mr X, Mr D’s care and support plans and social care assessments, telephone notes, emails shared between Mr X and the Council, Mr D’s risk assessment and action plan.
  2. I wrote to the Council and Mr X with the draft decision. I considered Mr X’s comments before I made the final decision.

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What I found

Law

  1. The Care and Support Regulations 2014 sets out the eligibility threshold for adults with care and support needs. Where local authorities have determined a person has any eligible needs, they must meet these needs.
  2. Sections 9 and 10 of the Care Act 2014 requires local authorities to carry out an assessment for any adult with an appearance of need for care and support.
  3. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
  4. The Council must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs.
  5. Once a council has arranged support to meet a person’s needs it must keep those arrangements under review. The review process is about making sure the support is working and, if not, what should change to help avoid any crisis situations.
  6. Regardless of whether a person is assessed as having any needs at all or any needs which are to be met by the local authority, the authority must provide information and advice in an accessible form, about what can be done to prevent, delay, or reduce development of their needs.
  7. If a local authority considers a person may lack capacity to understand and carry out a self-assessment, they must carry out a capacity assessment. If this shows that the person lacks the capacity to carry out a self-assessment, then the self-assessment should not be offered.
  8. Where local authorities have established the adult has capacity to undertake a self-assessment but experiences substantial difficulty in understanding or retaining the relevant information in relation to their self-assessment, they may wish to involve their carer or any other member of their family in their self-assessment.
  9. During the assessment the local authority must consider the impact of the person’s needs for care and support on family members or other people the authority may feel appropriate. This will require the authority to identify anyone who may be part of the person’s wider network of care and support.
  10. In considering the impact of the person’s needs on those around them, the local authority must consider whether the provision of any information and advice would be beneficial to those people they have identified. For example, this may include signposting to any support services in the local community.

The Council’s complaints policy

  1. Someone who is unhappy with the service they have received from the Council can make a complaint over the phone or in writing.
  2. Complaints should be acknowledged within 3 working days and a full written reply issued within 15 working days. The Council will nominate an appropriate officer to respond to the complaint at Stage 1.
  3. If the complainant remains unhappy following the Stage 1 investigation, the Council will arrange for the complaint to be reviewed at Stage 2 by a senior manager. The reply should be sent within 20 working days of receiving the escalation request.

What happened

  1. Mr X’s elderly father Mr D suffers with dementia, severe hearing loss and poor mobility. Mr X and his sister Ms Y support Mr D with household and finance management but Mr D has capacity to make decisions about his care.
  2. On 4 February 2020 Mr D fell over at his home. The Council received a referral from the police and ambulance crew who helped Mr D as they were concerned about his home environment. At the time, Mr D was receiving 1 visit a day from a private carer to help with his daily activities.
  3. A Council officer visited Mr D on 18 February 2020 with Mr X present. Mr D told the officer he did not want more personal care support but admitted he struggled to climb the stairs. Mr X says the social worker did not fully assess Mr D or his living environment and failed to notice that Mr D was repeating himself and showing signs of dementia. He also says the worker told him there was nothing further the Council could do apart from provide equipment to assist with his mobility.
  4. Following the visit, the Council arranged for Mr D to receive equipment to assist with his mobility and instructed Mr X to declutter Mr D’s home.
  5. On 17 August 2020 the Council and Mr X discussed the decline in Mr D’s health. Mr X told the Council Mr D was experiencing memory problems and difficulty walking. The Council told Mr X it was arranging an occupational therapy (OT) assessment for Mr D.
  6. On 28 September 2020 a Council officer visited Mr D and noticed his condition had worsened. The officer asked the Council to prioritise Mr D’s for a OT assessment before his mobility and memory loss worsened. They also recommended Mr D move to the lower floor of his property considering his mobility issues. The officer told the Council they had left voice messages for Mr X to discuss the situation and had spoken to him to advise they had concerns for Mr D’s housing. Mr X explained he would be visiting the house to deal with the concerns raised. Mr X told the Council it needed to review Mr X’s care package as he needed more support.
  7. In response to the OT’s email, the Council said, “Mr D is able to manage the majority of his daily living activities independently and does not meet the criteria for placement. He is not compliant with care at present as he feels he can manage without support.” The Council reiterated this to Mr X and said it would arrange an assessment due to health and safety concerns noted at Mr X’s home. The Council told Mr X it would also arrange a review of his care package once Mr D moved to a lower floor of his property.
  8. The Council arranged a social care assessment on 11 September 2020. The assessment found Mr D was struggling with his mobility and needed an OT assessment.
  9. A further visit to Mr D took place in October 2020. It was again noted that Mr D was in poor health and required a mobility assessment. It was further noted Mr D would not allow Mr X to arrange repairs at the property.
  10. Environmental health assessed Mr D’s home and confirmed Mr D’s health and safety was at risk due to asbestos at the property. The Council contacted Mr X on 6 October 2020 to update him on the outcome of the assessment and explained it was his responsibility to arrange and pay for the necessary work as Mr D owned the home.
  11. The Council contacted Mr X in November 2020 to discuss Mr D’s care package. Mr X told the Council Mr D should receive 2 care visits per day as he had recently suffered another fall on 16 November 2020 and been admitted to hospital whilst under the supervision of a carer. Mr X asked the Council to investigate why neither the Council or care provider had let him know Mr D had fallen or been admitted to the hospital for several days. Mr X also said he was unhappy the OT assessment had still not taken place.
  12. The Council told Mr X it received an email from the care agency informing them of the fall on 18 November 2020. The Council confirmed a hospital OT had recommended that Mr D’s care visits increase from 1 to 4 times a day and advised that it was unsafe for Mr D to return home. An audiology assessment was carried out on 30 November 2020 and it was confirmed Mr D needed a hearing aid, which would take 4 weeks to receive.
  13. The Council arranged for Mr D to be temporarily discharged to a residential home and told Mr X it would arrange an assessment to determine whether it was safe for Mr D to return home.
  14. On 22 December 2020 a Council worker contacted Mr D to review his needs and discuss the situation. Mr D told the Council he did not have his hearing aid and had great difficulty hearing what was being said. Mr D asked to go home and the Council said it would arrange a meeting in January 2022 to discuss the next steps once Mr D’s audiology assessment had taken place and he had received his hearing aids.
  15. The Council decided to extend Mr D’s temporary placement until his home was safe and he had received his hearing aid. The Council contacted Mr X to discuss Mr D’s comments and Mr X again raised concerns that Mr D did not have the capacity to understand the risks of living independently.
  16. In January 2021 the Council said it could not force Mr D to stay in the care home as he had mental capacity and Mr X would need to support Mr D in carrying out repairs needed for him to be safe. At this time, Mr D was repeatedly asking to go home.
  17. On 20 January 2021 Mr X contacted the Council and said he was not happy for Mr D to return home as his dementia had worsened. The Council said it would arrange a capacity assessment as soon as Mr D received his hearing aid.
  18. The Council held a discussion on 30 January 2021 with Mr D and Mr X. The Council noted that Mr D’s home was unsafe, and he needed a more intensive care package. The Council also noted that Mr X and Ms Y felt Mr D should be placed in a care home and Mr D disagreed with this. The Council told Mr X that as Mr D still had capacity to make decisions the Council would need to facilitate his return home.
  19. A Council social worker visited Mr D on 1 February 2021 at the care home to discuss where Mr D would like to live. Mr D again expressed his wish to return home. Mr X complained to the Council that he was unhappy with this because Mr D did not have capacity to make this decision and the Council should have assessed this before speaking to him. He was also unhappy the Council had led him to believe a meeting would take place with him and Ms Y before the Council decided to return Mr D to his home.
  20. The Council attempted to relay Mr D’s comments to Mr X but this was unsuccessful and Mr X remained unhappy. The Council also explained the social worker assigned to Mr D’s case was shortly due to go on annual leave and this was the reason for the meeting taking place earlier than expected. The Council said it could not deprive Mr D of his liberties as he was still deemed to have capacity and a capacity assessment would need to be carried out over several visits.
  21. Mr X formally complained to the Council on 12 February 2021. He asked the Council to investigate its failure to contact Mr D’s GP or to arrange a needs assessment despite showing signs of being vulnerable. He said he had been requesting help for Mr D since August 2020 and the Council did not act on this for several months. He also complained the Council spoke to Mr D to gage his mental capacity without involving him or Ms Y. He said the Council’s intentions to return Mr D home did not consider the risk to his safety.
  22. Mr X chased the Council for a response on 1 March 2021. The Council spoke to Mr X and discussed the situation with him and its position that Mr D should be supported to return home as per his wishes.
  23. Mr X complained again on 8 April 2021 because he felt the Council failed to properly respond to the concerns he had raised. He was unhappy the Council did not provide him with Mr D’s file and did not keep him or Ms Y updated on Mr D’s wellbeing. He stated the Council should have assessed Mr D after his fall and failed to investigate his concerns or respond to his emails.
  24. The Council issued its complaints response on 13 May 2021. The Council said:
    • it did not ignore any specific requests made by Mr X or tell him it could not assist him beyond the mobility aids it had supplied
    • it could not update Mr X on Mr D’s hospital visit until it had been made aware of it by the care provider
    • it had updated Mr X on Mr D’s progress at the care home as necessary
    • COVID 19 had impacted the Council’s resources.
    • a doctor would be carrying out a mental capacity assessment for Mr D
  25. The Council concluded its letter stating it had tried to address Mr D’s care needs whilst staying in contact with Mr X and Ms Y but it acknowledged it could have signposted Mr X to its service better.
  26. Mr X referred the complaint to the Ombudsman in June 2021 as he remained unhappy with the Council’s actions. He has recently confirmed that Mr D has suffered further falls since returning home which he has had to be hospitalised for.

Findings

  1. The crux of Mr X’s complaint is his belief the Council has not done enough to assess Mr D’s needs since his fall in February 2020. The guidance requires the Council to carry out a capacity assessment for a resident under its care with the appearance of need within a timely manner. Having reviewed all available evidence, I am not persuaded the Council has met this objective. It took several months to refer Mr D for an OT assessment and neither this or the capacity assessment had been carried out at the point Mr X brought the complaint to the Ombudsman’s attention. The notes provided by the Council indicate Mr D was having trouble understanding the questions posed to him and I cannot see that the Council acted on this. This is fault. Mr X has experienced worry and frustration due to the delay and it is likely Mr D has missed out on support he could have been entitled to earlier.
  2. Mr X says the Council has not involved him or Ms Y in its decision making or kept him updated on developments with Mr D’s care. The guidance requires the Council to consider the needs of family members in managing care. Having reviewed the correspondence shared between Mr X and the Council during the concerned period, I can see the Council has consistently called Mr X to discuss Mr D’s condition and generally responded to his emails promptly. There has been delay on the Council’s part in arranging Mr D’s assessments, but it has not made unilateral decisions regarding Mr X’s care without consulting with Mr D. I can appreciate Mr X’s frustrations, but I have not found evidence of fault on this point.
  3. Mr X has complained that the Council failed to investigate the complaints he has raised. The Council is required to formally respond to complaints within designated timescales. I can see Mr X raised concerns about his father’s care many times throughout the concerned period and the Council has sought to deal with these concerns through ongoing conversation rather than formal investigation. I can also see the Council issued its complaints response slightly outside of the required timescales. I can appreciate why Mr X found this frustrating but I stop short of calling this fault. Even if I were to call this fault, I cannot see that this part of the complaint caused a significant injustice to Mr X or Mr D.

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Agreed action

  1. Within three months of the date of my final decision the Council has agreed to arrange a needs and capacity assessment for Mr D.
  2. Within three months of the date of my final decision the Council has agreed to issue a reminder to its staff to act within a timely manner when a resident with the appearance of need requires an assessment.

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Final decision

  1. There was fault on the Council’s part. I have suggested remedies to address this and the Council has agreed to them. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman

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