Summary: There was fault by the Council in complaint handling, poor feedback about safeguarding concerns and a failure to respond promptly to a request for a change in care provider. This caused Ms Y avoidable distress. The Council will apologise and pay Ms Y £500.

The complaint

1. Mr X, a representative, complained for Ms Y about London Borough of Southwark (the Council). He said:
1. The arrangements for Ms Y’s care and support were poorly planned
2. The Council did not act on concerns about Hope Care (a care provider)
3. Complaint responses had inappropriate language.
2. Mr X said the Council caused Ms Y a financial loss in hotel and taxi costs. And, Mrs Y had to endure care from a provider about whom she had made allegations of neglect and abuse. This caused her avoidable distress. She said she felt unsafe and lost trust in the Council.

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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 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 Council commissioned Hope Care to provide Ms Y’s care to fulfil its duties and powers under the Care Act 2014. We can investigate Hope Care’s service to Ms Y.
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:
• The complaint to us
• The complaints to the Council and the responses
• Documents set out later in this statement.
9. Mr 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 Care Act 2014 begins with the duty on local authorities to promote a person’s well-being, when exercising functions under the Care Act. Well-being includes:
• Personal dignity
• Protection from abuse and neglect
• Control over daily life. (Care Act 2014, section 1)
11. If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
12. Statutory Guidance explains a council should review a care and support plan at least every year, on request or in response to a change in circumstances. The purpose of a review is to see how a care and support plan has been working and to decide if any revisions need to be made to it. The council should act promptly after receiving a request for a review. (Care and Support Statutory Guidance, Paragraphs 13.19-21 and 13.32)
13. A council should revise a care and support plan where circumstances have changed in a way that affects the plan. Where there is a proposal to change how to meet eligible needs, a council should take all reasonable steps to reach agreement with the adult. (Care Act 2014, sections 27(4) and (5))
14. 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 or safeguard the adult. (Care Act 2014, section 42)

What happened

Background

15. Ms Y has physical disabilities and mental health problems and uses a wheelchair. She is eligible for care and support from the Council which commissioned a care package with the Care Provider to deliver the care and support.
16. Ms Y’s flat needed adaptations and so in January 2021, her landlord (a housing association) arranged for her to stay in a hotel in a different borough temporarily while these were being done. The housing association also made payments to Ms Y which covered Ms Y’s essential living costs while she was not living in her flat and funding to cover removal and some transport costs connected to her having to be away from her home. The work to do the adaptations took far longer than expected. Eventually, Ms Y moved back to her flat at the start of September 2021 when her care provider changed back to the usual provider (There are no complaints about the usual provider).

Ms Y’s care and support plan and case notes

17. Ms Y’s care and support plan review of March 2021 noted Ms Y needed support to change soiled sheets and with catheter care, continence pad changes, showering, dressing, applying cream, transfers, meal preparation, feeding, taking medicine and housework. The Council funded four care calls a day with two carers. The NHS physiotherapist would review her hand function. The Council agreed a large increase to the care package at the end of March to provide more support around feeding among other tasks. The Council commissioned Hope Care (the Care Provider) to provide the calls.
18. I have looked at the social worker’s case notes between January and November 2021. These show Ms X (either directly or through her representatives) raised issues regularly about the Care Provider’s care workers including:
• lateness
• non-attendance
• moving and handling errors causing bruising, pressure sores,
• theft of belongings and unauthorised use of her bank card,
• care workers eating her food and bringing their children to visits,
• removing her catheter
• refusing to do laundry or change soiled sheets.

The case notes show the social worker considered the concerns and checked to see if there was evidence to confirm them including by seeking evidence from the Care Provider and third parties such as the police, district nurses and hospital and by listening to audio recordings by Ms Y. Most concerns had conflicting evidence or could not be substantiated. Sometimes, Ms Y gave conflicting accounts about what happened when asked on different occasions. Having considered each of the concerns, the Council took no further action under safeguarding procedures (see paragraph 14).

19. When speaking with the social worker, Ms Y repeatedly asked for a change of care provider from March onwards and was refused. The Council did not agree to change the provider until the end of May and a new provider started delivering Ms Y’s care in June.
20. The Council, housing association and Ms Y’s representatives met weekly to discuss issues relating to adaptations and how these were progressing. The minutes of a meeting in August noted:
• The adult social care team had previously paid for taxis when attempts at removals did not go to plan.
• There were also some hotel costs from a previous move when Ms Y remained in the hotel as her mobility scooter would not fit into the council transport. (Responsibility for those costs was not stated in the meeting)
• The housing association was to arrange transport for Ms Y and her belongings at the end of the stay in the hotel
• Adult social care could fund carers to support packing. More time might be needed for unpacking and cleaning in the flat.

The complaint to the Council and its responses

21. Mr X complained to the Council and emailed concerns about Ms Y’s care between February and May including safeguarding concerns about the Care Provider as I have summarised in paragraph 18.
22. The Council’s first complaint response in March 2021 did not uphold Ms Y’s complaints saying.
• There was a recent increase to the care package set out in an updated care and support plan.
• Incontinence pads were the NHS’s responsibility and she needed to discuss continence issues with the district nurse
• Staff had given her money several times and paid for food and given her food bank vouchers. Social care would not give her more money because it was not a benefits service
• Times of visits had been adjusted in line with her preferences. Her current plan had evenly spaced calls. The agency had not reported pressure sores and the district nurses, who visited regularly did not know about any concerns of pressure sores. The Council would follow this up with the district nurses
• She had a history of refusing care visits, not answering the door and there had been breakdowns in relationships with care providers, with eight providers since 2018. Care records showed care workers stayed the assigned time
• There were no concerns about Ms Y’s ability to clean herself after soiling. The care plan included support with eating and drinking, and other tasks requiring fine motor skills
• The records showed Ms Y was often rude, abusive and challenging to work with. Council staff should be treated with respect and should not receive abuse.
• As soon as the Council became aware the hotel room was not big enough, it arranged for her to move to a different room where there was enough space for hoisting
• The Council would develop a behavioural contract with her. It would also assign a new social worker because the current social worker ‘had put up with a lot of abuse from her’ and needed a break to reduce his stress levels and the Council had a duty to protect the health and safety of its staff.
23. Ms Y was unhappy with the Council’s responses and so escalated her complaint. The Council’s final response to the complaint in July 2021 said:
• The first response should have mentioned evidence from the care provider (it said it wanted to withdraw the service because care workers did not have enough time to complete tasks). It should not have said she needed to contact the care provider herself to discuss matters
• It was wrong to suggest Ms Y’s hand function had not declined by referring to her other abilities. The Council was sorry for this and for the delay in setting up extra support
• All the safeguarding concerns she raised had been considered and the outcomes recorded were there was not enough, inconsistent or conflicting evidence
• There was a delay in sourcing a care provider following a breakdown in relationship with one provider and because she was not living in Southwark
• There had been an assessment to address potential night-time care needs and the findings would be reviewed and discussed with her as well as a review of the care and support plan once she returned to her flat
• It was sorry the previous response caused offence. It focused on the social worker’s feelings and not hers and the letter did not get the right balance. The Council was sorry for this. The letter should have used different wording.
• The new social worker spoke with Ms Y most days and rebuilding her trust needed to be a priority. There was also a weekly meeting to discuss progress on returning to her flat and Mr X attended that meeting and fed back to Ms Y
• In summary: the Council upheld the complaints about her care package and inappropriate comments and partly upheld complaints about delay and inadequate care. It would pay Ms Y £100 to reflect the distress it caused.
24. Ms Y moved back to her flat in September. The Council emailed Mr X about Ms Y’s request for repayment of costs. It said it would not repay costs because:
• Ms Y said she had to stay in a hotel because the social worker had arranged transport which could not accommodate her. The social worker and Ms Y spoke, she said she was unhappy about moving back to flat on 3 July. Transport for 15 boxes was arranged, this changed at short notice because Ms Y said she had 6 boxes, 6 cases and 2 dogs. The social worker arranged for the Council’s day centre transport to move said items. The driver arrived and was told Ms Y was not there and had not been seen since previous day. There were many attempts to contact her. She decided she would stay in the hotel, the Council did not agree to fund the costs and so there would be no repayment.
• Ms X sought taxi costs from the Council because she could not pack her belongings to be ready in time for moving. The social worker advised her to arrange support from hotel staff or relatives and she did not tell him there was a problem with this. When transport arrived, many of the belongings were not packed. The social worker packed items, Ms Y booked taxis without the social worker saying funding was approved. She had since sent him receipts.

Was there fault?

The arrangements for Ms Y’s care and support were poorly planned

25. The Council acted in line with the Care Act 2014 and with Care and Support Statutory Guidance by completing a review of Ms Y’s care and support plan in March 2021, including an OT assessment for equipment and moving and handling. The outcome was an increase to the care package. There was no fault in the way the Council planned Ms Y’s care. The Council and the housing association also met regular with Ms Y’s representative to discuss issues. This was good practice and evidence of collaborative working and not fault.

The Council did not act on concerns about care providers

26. I have considered almost 500 pages of case notes and although I have not referenced every single allegation because there are multiple concerns raised almost daily, overall I am satisfied the social worker acted appropriately by looking into the issues Ms Y or her representatives raised. In each case there was conflicting evidence about what happened or not enough evidence of any fault by the Care Provider to warrant further action under the Council’s safeguarding responsibilities in section 42 of the Care Act 2014.
27. Although I consider the social worker investigated the issues Ms Y raised in an appropriate and proportionate way, my view is there could have been a fuller written response to her through her representative Mr X as and when she raised issues. I appreciate the contact was almost daily, but the issues were serious and she should have had some feedback in writing to say how the conclusions had been reached. As Ms Y remained unhappy with the Care Provider and was asking for a change in agency repeatedly from March, I consider the Council should have considered commissioning another agency in line with her request. This is in line with the principle of well-being and client choice and control set out in Section 1 of the Care Act 2014. I also consider there was a failure by the Council to evidence it had taken reasonable steps to respond to Ms Y’s request for a revision to her care and support plan (the request for a change in provider was potentially a revision to the plan) The failure to respond promptly to a request for a change in provider was not in line with section 27 of the Care Act 2014 and this caused Ms Y avoidable distress.

The complaint responses had inappropriate language.

28. The Council already accepted its first complaint response was inappropriate in parts. I agree this was fault. However, the Council’s second response apologised and clarified parts of the first response which it considered flawed. I consider this a partial remedy for the avoidable distress this caused Ms Y.

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Agreed action

29. I found fault by the Council in its first complaint response and in the failure to give Ms Y detailed feedback in response to concerns she raised which were potential safeguarding issues and the failure to respond to her request to change care provider in a timely manner. This caused her avoidable distress. The Council apologised and offered a payment of £100 for the failure in complaint handling. This is a partial remedy for the fault and injustice. Within one month of my final decision, the Council will:
1. Apologise again for the fault in complaint handling and the additional fault I have identified in the failure to give Ms Y feedback about her safeguarding concerns and to respond promptly to her request for a change in care provider
2. Pay her £500 to reflect her avoidable distress. I have taken account he allegations and the uncertainty caused by the lack of detailed written feedback, would have caused Ms Y anxiety about receiving care from a provider she no longer had any faith in.
30. Ms Y seeks repayment for taxi and hotel costs, but there are no grounds for me to recommend repayment because there is no evidence the Council ever agreed to fund them. The taxi costs were for a previous decant (move from the flat into temporary accommodation) not covered by this investigation. In any event, costs associated with the current decant (removal costs and temporary accommodation) were to be covered by the housing association and not the Council.

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Final decision

31. There was fault by the Council in complaint handling, poor feedback about safeguarding concerns and a failure to respond promptly to a request for a change in care provider. This caused Ms Y avoidable distress. Provisionally, the Council needs to apologise and pay Ms Y £500.
32. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman