Summary: Mr C complained about the way the Council assessed and supported his mother when she went into a care home to be assessed. We upheld the complaint as there was some fault with the way the Council involved Mr C and his brother, and with the information (not) included in the assessment report. The Council has agreed to apologise and share the lessons learned with relevant adult social care staff.

The complaint

1. The complainant, whom I shall call Mr C, complained to us on behalf of his (late) mother, whom I shall call Ms M. Mr C is unhappy with the way the Council acted as part of his mother’s discharge process from hospital. He said:
• The Council failed to ensure that it had completed a comprehensive needs assessment of his mother by the time the NHS Clinical Commissioning Group (CCG) made a decision as to whether she would be eligible for free NHS CHC.
• The Council failed to appropriately involve Ms M and both her sons in decisions.
• The quality of his mother’s care assessment document was unsatisfactory.
• The Council failed to provide the support needed to move his mother to another nursing home.

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The Ombudsman’s role and powers

2. 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

3. I considered the information I received from Mr C and the Council. I shared a copy of my draft decision statement with Mr C and the Council and considered any comments I received, before I made my final decision.

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What I found

Relevant legislation and guidance

4. The National Framework for NHS Continuing Healthcare (CHC) from 2018, states there are specific requirements for councils to cooperate and work in partnership with CCGs in a number of key areas. It says that: councils must, as far as is reasonably practicable, provide advice and assistance when consulted by the NHS in relation to an assessment of eligibility for NHS Continuing Healthcare. This duty applies regardless of whether an assessment of needs for care and support under section 9 of the Care Act 2014 is required. Where the council has carried out such an assessment of needs it must (as far as it is relevant) use information from this assessment to assist the NHS in carrying out its responsibilities.
5. The assessment for Eligibility for NHS Continuing Healthcare involves a multidisciplinary team (MDT) undertaking a comprehensive assessment and evaluation of an individual's health and social care needs and reviewing evidence to make an eligibility assessment for CHC using a standardised tool called a ‘Decision Support Tool’ to help inform the decision.
6. The CCG has responsibility for coordinating the process until the decision on funding has been made.
7. As far as is reasonably practicable, the CCG must consult with the relevant council before making any decision about an individual’s eligibility for NHS Continuing Healthcare. If a council is consulted, there is a requirement for it to provide advice and assistance to the CCG, as far as is reasonably practicable.

The complaint about the assessment process

8. Mr C complained the Council failed to:
• Ensure it had completed a comprehensive needs assessment of his mother by the time the CCG decided if she would be eligible for free NHS CHC.
• Appropriately involve Ms M and both sons in her assessment and decisions.
9. Ms M went into hospital in November 2020 after taking an overdose. The records state the mental health team advised on 30 November that Ms M should go into a care home. The Council notified the family of this the same day. However, the family was concerned about this.
10. A social worker had a conversation with Ms M on 2 December, during which Ms M said she wanted to go home. It had been determined that Ms M had capacity to make decisions about her discharge (destination) and the social worker agreed this could be done with a care package and support from the Community Mental Health Team.
11. However, Ms M’s Mental Health Team was very concerned about her going home and carried out a review with Ms M on 7 December. The review concluded Ms M needed 24-hour support to manage her physical health and mental health risks, which could not be done at home. As such, they discussed this with Ms M and reported that Ms M had agreed to go into a care home instead.
12. Ms M’s social worker spoke to Ms M on 9 December. The records state he asked her if she would like to go into a care home for further review, to which she said yes. The social worker updated her family the same day. He:
• Explained Ms M initially expressed a wish to return home. However, she was then convinced and agreed to go into a care home on discharge.
• Asked Mr C if the family had a preference for a particular care home that they would like his mother to move into. It later explained it is very common to ask the family if they have a preference for a care home, along discussing this with the client (in this case Ms M).
13. Ms M’s case was discussed at a Mental Health Complex case meeting on 10 December 2020, who concluded her needs should be met in a 24-hours general nursing home placement. The social worker told the family the same day. He said that, as such, it would be the responsibility of the NHS to discharge her into a home, where her needs would be assessed during a period of up to six weeks. He also said there would be an assessment to determine if his mother would meet the criteria for free NHS Continuing Healthcare (CHC). The decision would be made at an MDT meeting. Mr C said the social worker said the Council would complete a social care assessment before the MDT meeting. However, I have not seen reference to that promise in the records.
14. Mr C said on 15 December 2020 that he did not feel comfortable making decisions on behalf of his mother, when his mother has capacity to make these decisions herself. He also said that he would like an advocate to be present whenever his mother has to make a decision. He wanted to ensure his mother was fully aware of the options, that she is mentally capable to make that decision and that she is not pressured and wants it to be an informed decision. The record states that Mr C agreed with the plan to discharge his mother into a care home so she could be assessed. The social worker contacted Walton House (Ms M’s preferred option) but it did not have a vacancy. It was the NHS hospital trust who subsequently decided to which care home Ms M should be discharged to.
15. The Council appointed a new social worker to Ms M on 29 December 2020 to carry out an assessment of Ms M’s needs. The Council says she commenced her assessment the next day by having a very detailed conversation with Mr C. The social worker recorded on the case notes that:
• She told him that she was contacting him in relation to the assessment that she would be doing to determine his mother’s future social care needs.
• She said she would read the 24-page document he had sent with all his mother’s health appointments
• Mr C said again that he wanted Advocacy Focus to be involved, and said the social worker needed to contact them to get this sorted. The social worker said that a previous assessment undertaken with a colleague in the hospital concluded his mother had capacity to make decisions.
16. As part of the assessment, the social worker:
• Had various telephone conversations with the care home to determine the home’s views (based on their actual experience) of Ms M’s needs in areas such as washing, dressing, mobility, eating, medication and mood.
• Spoke to two staff members from the Mental health Team who were involved in Ms M’s care.
• She also contacted Advocacy Focus. However, they said on 5 January 2021 that they closed the case, but they would call Mr C to ask what support he needs.
17. Mr C sent an email to the CCG and the social worker on 4 January 2021, to say he and his brother: “would (…) like to attend assessments as we have our mother's best interests at heart”.
18. The care home told the social worker as early as 5 January 2021 that they did not think Ms M’s placement was appropriate. The social worker also tried to talk to Ms M that day, as part of her assessment. However, the records state that Ms M did not understand who the social worker was and why she was phoning her. Ms M did not say where she would like to go and did also not reply to other questions.
19. The MDT meeting happened on 22 January 2011 and was attended by the CCG Nurse assessor, the social worker, the care home and Ms M’s sons. Mr C complained the Council failed to ensure it had completed a comprehensive needs assessment of his mother by the time the CCG made a decision as to whether she would be eligible for NHS CHC. He said this fault contributed to the CCG deciding at the meeting that his mother was not eligible for free NHS CHC (a decision that was later overturned). By that time, the social worker had not yet completed her needs assessment. However, she had obtained information about Ms M’s social care needs at that stage from the care home, who had the most up to date information in that area.
20. The Council said that
• Normal practice is for social workers to gather all relevant information before the MDT meeting, so they can have a constructive discussion about health and care domains with nurse assessors and families. Although the social worker had not completed her assessment yet on the Council’s social care records system, she had gathered comprehensive information about Ms M’s social care needs since 30 December 2020 through discussions with staff at the home, Ms M’s family and other professionals.
• The social care assessment was recorded in draft by 22 January. The social worker said the CHC meeting went on for many hours and she was able to constructively contribute to discussions around the domains within the DST.
• As such, the social worker was engaged in the process, had a good understanding of the CHC process, took part in the proceedings and critically looked at whether care needs were on a level with or over and above what the Care Act says.
• The social worker completed a FACE Screening Tool which is still classed as a statutory social care assessment. This document has been accepted by the CSU as sufficient to pass audit for CHC National Framework purposes. The outcome of the assessment would not have been different if the assessment had been completed on an overview assessment document.
21. The Council has said that:
• “It has been evident throughout the process that both social workers had difficulty with helping Ms M to engage in the assessment process and she always maintained that she wanted workers to liaise with both of you”.
• Ms M has consistently said that she did not want to engage in discussions, and she asked for her sons to be consulted with regards to decisions relating to care and support. Apart from the discharge process from hospital, the Council made sufficient attempts to involve family members.

Analysis

22. The CHC National Framework requires a council to provide relevant information for the purposes of a CHC assessment. However, it doesn’t say what form this should be in or require a specific document to be completed. The Framework says a council should, as far as is reasonably practicable, provide advice and assistance, which they did. As such, I found the Council met the requirements as laid out in the National Framework. Furthermore, in the end, it was the NHS / CCG who were responsible for ensuring the required decision-making process was adhered to and make a determination that it had all the information needed to make a well-informed decision.
23. It is clear from the records that Ms M and her sons wanted someone to be with her to support her when discussing her needs and making decisions. In addition, they mentioned this specifically on 4 January 2021. The records also showed the difficulties the social worker had in involving Ms M in her assessment (without support). I found the Council failed to ensure this happened. Although it tried to involve an advocacy agency, it should have done more to ensure Ms M was sufficiently supported in the assessment and decision process and was given all possible support to be involved and express her views.
24. The Council had various conversations with Mr C about Ms M’s needs during the above assessment process. As such, Mr C had sufficient opportunities to be involved and tell the social worker what his view was with regards to his mother’s current needs. The feedback from these conversations were that Mr C felt it was up to the professionals involved in his mother’s care to assess her needs and find a care home that the professionals deemed suitable to meet those. He said he would support such a process as much as he could.

The complaint about the Council’s lack of support to find another home

25. Mr C complained the Council failed to provide the support needed to move his mother to another nursing home.
26. Mr C contacted the social worker on 25 January 2021 to ask for an update and say his mother was unhappy at the home and wanted to move. In response, the social worker said the MDT meeting concluded that his mother did not have nursing needs and she could therefore be cared for in a residential care home.
27. The social worker told Mr C that:
• As his mother had family to help her to find such a home, there was no requirement for the Council to find a care home for her. As such, the Council’s care navigation team would send out a list of homes to the family, so the family could call them to see if they have any vacancies and can meet his mother’s needs.
• If he did not feel that he could support his mother with choosing a home, the Council could do this for him
28. It was subsequently difficult for the family to proceed because:
• The social worker had not yet finished Ms M’s needs assessment. As such, the family was unable to answer the initial questions care homes had about her needs. The care homes asked for this information (a completed needs assessment) to get an initial indication if Ms M could potentially be suitable for the home. For instance, such an assessment would include vital information about her (mental) health conditions.
• The Council failed to send the list of care homes to the family.
29. Mr C told the social worker on 27 January 2021 that: whilst we will obviously give as much assistance as possible as our mothers wellbeing is our priority, we are unable at this time to choose and apply to a home on our mum's behalf.
30. The social worker told Mr C on 28 January 2021 that she would have a Zoom meeting the next day with his mother. She said she would finalise her assessment after this and stop her involvement. She did not ask Mr C to support his mother during this meeting which (in light of her communication difficulties etc) was likely to be difficult for Ms M to participate in. Mr C asked the social worker to ask his mother for her consent to share a copy of her needs assessment with him. The records show the social worker did not ask this.
31. The Council said that, at the Zoom meeting on 29 January 2021, Ms M chose not to engage in discussions and asked the social worker to liaise directly with her sons. The Council closed the case to the social worker on 1 February 2021. On the same day, it was decided that Ms M would actually need a nursing care home, not a residential care placement.
32. The Council’s Care Navigation Team did not subsequently send out a list of nursing homes to the family. It also took until 11 February 2021 before it sent a copy of Ms M’s needs assessment to Mr C.
33. Mr C asked for a new care needs assessment on 3 February 2021, after which the Council allocated his mother’s case to a new social worker who carried out a new assessment.

Analysis

34. Ms M was discharged to the care home for six weeks to enable the Council to complete an assessment of her needs. The Council completed Ms M’s needs assessment within six weeks.
35. However, once the Council completed the assessment, it failed to share it immediately with the family. This is fault.
36. The Council also failed to share a list of care homes the family could contact, despite this having been promised. This is fault.
37. The above was distressing and frustrating as it made it more difficult for the family to find a care home for Ms M.
38. The Council told Mr C that if the family did not feel they could support Ms M with choosing a home, it could do this for him. Despite Mr C telling the Council on 27 January 2021 that they were unable to choose a care home and saying they would want the Council to do this, the Council failed to take over the process. This was distressing and frustrating for Mr C and his brother. However, I am unable to determine to what extent this resulted in a delay in Ms M finding another home, at that specific point in time.

The complaint about the quality of the Assessment report

39. Mr C complained that the quality of the FACE assessment document he received on 11 February 2021 was unsatisfactory. He said the assessment was wrong, which hindered the family’s attempts to find another care home. He said that:
• The GP surgery was wrong, as the GP had changed when his mother moved into the Beeches Care Home
• The social worker failed to update the section “Your personal and family background including recent events or changes in your life”, with events that happened since October 2020. He said his mother’s circumstances changed massively after October 2020.
• It did not have up to date views of the family
40. I reviewed the FACE Assessment and found that, in addition to the above:
• It did not specify on page 9 if Ms M had mental capacity
• It did not mention the mental health professionals involved with Ms M in the section “Professional Involvements”
• It said that Ms M was able to communicate over the phone as part of the assessment, even though the records state she was hardly able to engage.
• The social worker had not obtained information about Ms M’s view on what changes would most improve her wellbeing, what she wanted to achieve in terms of relationships, what activities were important to her etc. The social worker may have been able to get this information if she had ensured Ms M was supported during the assessment.
• Family views: it said the family was aware but does not list their views.
41. The needs assessment highlighted the importance of the Council involving her family (sons) in meetings as it said that: “Ms M can struggle to communicate she is hard of hearing has bad eyesight and struggles to converse or make decisions, is quite reliant of her sons to communicate for her as she can get very overwhelmed”.

Analysis

42. I am unable to explain why the social worker decided to use a FACE assessment form rather than the normal care act needs assessment form that includes more information and detail with regards to (for instance) eligibility criteria.
43. There were a range of short comings with regards to the assessment, as set out in paragraph 39 and 40 above. However, I found there is insufficient evidence to conclude they had an impact on finding a care home for Ms M, at that particular time.

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Agreed action

44. I recommended that, within four weeks of my decision, the Council should:
• Apologise to Mr C and his brother the faults above and the distress these have caused them. It should also pay £200 to each of them
• Share the lessons learned above with its adult social care workers / assessors.
45. The Council has told me it has accepted my recommendations.

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Draft decision

46. For reasons explained above, I found there has been fault as a result of which I have upheld the complaint.
47. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case

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Investigator's decision on behalf of the Ombudsman