Summary: Ms X complains about the Council’s handling of her mother’s care and support needs. She complains the Council did not reassess her mother’s care and support needs in October 2020, failed to provide her mother with 24 hour care, and only gave her a few days to find her mother a care home. She says this caused her distress. We find fault with some of the Council’s actions. We have made recommendations for the Council to apologise, to reimburse Ms X, and to pay a financial remedy.

The complaint

1. Ms X complains about the Council’s handling of her mother’s care and support needs. She complains:
• The Council did not reassess her mother’s care and support needs in October 2020 when she asked it to do so.
• The Council failed to provide her mother with 24 hour care, which she needed.
• The Council only gave her a few days to find her mother a care home before funding for night support ended.

Ms X says the Council’s actions meant her mother had to privately fund her night support between February and March 2021. Ms X also says the Council’s failures caused her stress, anxiety, and upset.

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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. 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)
4. 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

5. I spoke with Ms X and considered the information she provided.
6. I made enquiries with the Council and considered the information it provided.
7. I sent two draft decisions to Ms X and the Council and considered their comments.

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What I found

Care and support statutory guidance

8. The guidance sets out when Council’s should review a care and support plan. The review is to help identify if the person’s needs have changed and can lead to a reassessment.
9. Paragraph 13.13 of the guidance notes there are several different routes to reviewing a care and support or support plan including:
• An unplanned review, which results from a change in needs or circumstance that the local authority becomes aware of, for example, a fall or hospital admission.
• A requested review, where the person with the care and support or support plan, or their carer, family member, advocate or other interested party makes a request that a review is conducted. This may also be as the result of a change in needs or circumstances.
10. Paragraph 13.19 also notes that if there is any information or evidence that suggests circumstances have changed in a way that may affect the efficacy, appropriateness, or content of the plan, then the local authority should immediately conduct a review to ascertain whether the plan requires revision. For example, this could be where there is evidence of a deterioration of the person’s physical or mental wellbeing.

What happened

11. Ms X’s mother, Mrs A, received a package of care and support from the Council for several years. A care provider provided Mrs A with care in her home. Mrs A received 4.5 hours a week of outreach support to help with social activities.
12. In September 2020, Mrs A’s care provider asked the Council to increase her outreach support hours. The care provider told the Council her current hours were not enough, and that Mrs A was not enjoying the social interactions she should.
13. The Council reassessed Mrs A on 23 September 2020. The Council did not increase Mrs A’s outreach support hours.
14. In October 2020, Mrs A’s care provider again contacted the Council asking it to increase Mrs A’s outreach support hours. The care provider told the Council it had previously asked for an increase in hours. The Council said it completed an assessment for Mrs A on 12 October 2020. The Council did not provide evidence of an assessment with this date.
15. At the end of October 2020, the Council’s records note it was asked to increase Mrs A’s outreach support hours. The records also noted Mrs A’s family had asked for an increase in social stimulation for Mrs A as they could not visit as regularly because of the lockdown.
16. In November 2020, the Council told Mrs A’s care provider no new support plan had yet been agreed. It confirmed Mrs A’s outreach support hours would remain at 4.5 hours a week.
17. Mrs A’s care provider again contacted the Council to discuss her outreach support hours in mid-November and December 2020.
18. At the end of December 2020, the Council agreed to an extra four hours of outreach support for Mrs A.
19. At the end of February 2021, Mrs A was seen by her doctor. The doctor told Ms X her mother could pass away at any time and needed palliative care. Ms X asked the Council to complete a care assessment to identify Mrs A’s needs and to set up a package of care. Ms X also told the Council she wanted a live in carer for Mrs A and did not want her to go to a care home.
20. In March 2021, Ms X continued to tell the Council of her preference for Mrs A to have a live in carer. Ms X said if she was forced to place Mrs A in a care home, she wanted it to be a home near to where she lived. Ms X also told the Council she was paying for night support for her mother as she was at risk if left alone.
21. The Council completed Mrs A’s care assessment on 23 March 2021. The assessment noted Mrs A needed 24 hour care to meet her assessed needs and to manage risks.
22. On 25 March 2021, Mrs A’s doctor told the Council Mrs A had a medical condition that could end her life suddenly. However, Mrs A was not end of life and did not need 24 hour care. On the same day, Mrs A was admitted to hospital.
23. Mrs A was discharged from hospital four days later. Mrs A had two discharge summaries, each recommending a different care package. One discharge summary recommended a step down bed and assessment. A step down bed is usually in a care home and is used for when people are ready to be discharged from hospital but are not ready to return to their former home or level of independence.
24. The second discharge summary recommended a restart of Mrs A’s care package and that the Council’s discharge team had agreed to source night support for 3-6 weeks to keep Mrs A in her own home.
25. The Council’s records noted the Council’s preference was for residential placement to ensure Mrs A’s holistic and long term care needs are assessed appropriately. The clinical commissioning group (CCG) agreed with a residential placement. The CCG agreed to fund night support for 3 nights while a residential placement was secured.
26. Ms X told the Council the CCG had agreed to fund the night support for six weeks. In April 2021, the CCG confirmed it advised Ms X it would fund care for up to six weeks. While a residential placement was secured, the CCG told Ms X it would pay for three nights of night support. However, once a residential placement was secured, the CCG would then fund that placement for up to six weeks.
27. On 16 April 2021, the Council emailed Ms X to confirm Mrs A’s funding from the CCG would end on 11 May 2021. The Council said it would work with Ms X to identify an appropriate care package for Mrs A after 11 May.
28. The Council offered Ms X direct payments of just under £630 per week. The Council said this was the amount it would pay for a residential placement. The Council said Ms X could use the direct payment to commission a live in carer or a care home near to where Ms X lived. The Council confirmed any cost difference, for either option, would need to be privately funded.
29. On 21 April 2021, Ms X received a call from the CCG telling her funding for night care ended on 6 April. Ms X contacted the Council to find out what was happening as she was concerned about whether her mother would continue to receive her night support.
30. On 30 April 2021, the Council emailed Ms X to confirm the CCG funding for night support would end on 11 May.
31. Ms X found a care home for Mrs A near to where she lived which accepted the Council’s rates. Mrs A moved into the care home on 12 May.
32. In response to our draft decision, the Council explained the process of assessing Mrs A started near the end of September 2020. The Council said the assessment process concluded in October 2020.
33. The Council also explained the increased outreach support started in November 2020. The Council provided a screenshot of its system records which showed an increased package of outreach support was implemented in November 2020.

Analysis

Reassessment of support and care needs in October 2020

34. There is clear evidence Mrs A’s care provider had asked the Council to review her care package in September and October 2020. This was due to the view Mrs A’s outreach support hours were not enough to meet her needs. There is also evidence Mrs A’s family asked the Council to increase her outreach support hours in October 2020.
35. The Council explained it started the process of reassessing Mrs A at the end of September 2020 and that it finished the assessment process in October 2020. We consider the documentation provided by the Council is confusing as it does not suggest the assessment was finalised in October 2020. However, we accept the Council’s comments. Therefore, we do not consider the Council was at fault as it did assess Mrs A’s care needs in October 2020.
36. The Council has provided evidence it increased Mrs A’s outreach support hours in November 2020. Therefore, we are satisfied there was no delay in the Council increasing Mrs A’s outreach support hours that she was assessed as needing.

Council failed to provide her mother with 24 hour care

37. The records show it was not until near the end of February 2021 when the Council was first given evidence Mrs A might need 24 hour care.
38. In line with the statutory guidance, the Council should have immediately considered whether to review Mrs A’s care and support plan when it received the information from Ms X that Mrs A needed 24 hour care. This is because this was new information to suggest Mrs A’s needs or circumstances had changed in a way that may affect the appropriateness of her care plan.
39. The Council did not review and reassess Mrs A’s care needs until 23 March 2021. This was around one month after Ms X first told the Council Mrs A needed 24 hour care. This is delay and is fault.
40. We consider the fault has caused an injustice. This is because we consider it is likely, on balance, the Council would have assessed Mrs A as needing 24 hour care if it had assessed her at the beginning of March 2021. This is supported by the fact the Council had assessed Mrs A as needing 24 hour care in its 23 March assessment and there is no evidence to suggest Mrs A’s needs or circumstances were different.
41. Therefore, we also consider it is likely the Council would have either funded night support or found Mrs A a residential placement in March 2021. We are satisfied Ms X has suffered a direct financial loss because of fault identified. This is because Ms X had to pay for night support for the whole of March 2021.

Night support funding

42. There is clear evidence the Council told Ms X twice in April 2021 that funding for Mrs A’s night support would end on 11 May 2021. Therefore, we do not consider the Council was at fault as Ms X was given reasonable notice of when funding would end.
43. However, it is clear there was some confusion regarding the length of funding for Mrs A’s night support. This is because of the confusing discharge planning which resulted in two recommendations for Mrs A. We accept the Council had made efforts to resolve the care planning as it was liaising regularly with the CCG regarding what information it provided to Ms X. However, the Council also accepted the confused discharge planning at put Mrs A at risk. This is fault.
44. We do not consider the fault caused any injustice to Mrs A. This is because the evidence suggest she did receive night support from end of March to May 2021. We do consider the fault identified caused Ms X some distress caused by not knowing exactly what was happening with her mother’s night support. We also consider it likely caused her some anxiety at not knowing whether the support might be removed suddenly.

Agreed action

45. To remedy the injustice caused by the faults identified, the Council has agreed to complete the following:
• Apologise to Ms X for the distress, anxiety and financial loss caused by the faults identified.
• Reimburse Ms X for the cost she incurred paying for night support in March 2021. Ms X should provide the Council with evidence of the costs, such as an invoice.
• Pay Ms X £300 to recognise the distress and anxiety caused by the faults identified.
46. The Council should complete the above within four weeks of the final decision.

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Final decision

47. I find fault with the Council for the delay in reviewing Mrs A’s care plan in March 2021 and for its confused discharge planning. The Council has accepted my recommendations. Therefore, I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman