Summary: Ms X complained about the Council’s handling of her disabled son, Mr F’s care between 2020 and 2022 following a safeguarding investigation. There was fault identified by a safeguarding investigation around the care Mr F received at a care home commissioned by the Council. There was then poor communication and delay in putting funding in place when Mr F moved into a temporary care home. The Council agreed to apologise and pay Ms X a total of £600 to remedy the distress and uncertainty caused by the faults. There was no fault in the Council issuing Ms X with an invoice for outstanding care fee contributions or with how it managed Mr F’s move to a permanent supported living placement.

The complaint

1. Ms X complains about the Council’s handling of her disabled adult son, Mr F’s care between 2020 and 2022. Specifically, she complains:
• A safeguarding investigation found failings in the standard of care provided to F at care home 1 which caused him serious ill health and to be admitted to hospital, but did not offer a remedy.
• Due to the failings Mr F was forced to move to a nursing home (care home 2) in another council area.
• The Council issued her with a debt for Mr F’s outstanding care contributions while he lived at care home 2 which she says she should not have to pay.
• The Council failed to follow up on her request to move Mr F in with her.
• The Council delayed moving Mr F to care home 3.
2. Ms X says the poor care at care home 1 caused Mr F significant distress. She said the Mr F has also been caused upset, uncertainty and potential financial loss should he have to pay the debt. She said the matter has caused her distress, uncertainty and time and trouble.

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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 of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
5. 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)
6. 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)
7. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

8. I spoke to Ms X about her complaint and considered information she provided.
9. I considered the Council’s response to my enquiry letter.
10. Ms X and the Council had the opportunity to comment on the draft decision. I considered comments before I made a final decision.

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What I found

Relevant law

11. Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions.

Safeguarding

12. A council must make enquiries if it has reason to think a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themself. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

Residential care

13. The Care and Support and Aftercare (Choice of Accommodation) Regulations 2014 set out what people should expect from a council when it provides or arranges a particular type of accommodation for them. Where the care planning process has determined a person’s needs are best met in a care home, the council must provide for the person’s preferred choice of accommodation, subject to certain conditions. This also extends to shared lives, supported living and extra care housing settings.

Charging

14. The Care Act 2014 provides a single legal framework for charging for care and support under sections 14 and 17. It enables a council to decide whether to charge a person when it is arranging to meet a person’s care and support needs, or a carer’s support needs. The charging rules for residential care are set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and councils should have regard to the Care and Support Statutory Guidance.
15. When the Council arranges a care home placement, it must follow the regulations when undertaking a financial assessment to decide how much a person has to pay towards the cost of their residential care.
16. The financial limit, known as the ‘upper capital limit’, exists for the purposes of the financial assessment. This sets out at what point a person is entitled to access council support to meet their eligible needs. People who have over the upper capital limit are expected to pay the full cost of their residential care home fees. Once their capital has reduced to less than the upper capital limit, they only have to pay an assessed contribution towards their fees. Where a person’s resources are below the lower capital limit they will not need to contribute to the cost of their care and support from their capital.

What happened

17. Ms X has an adult son, Mr F, who has severe learning disabilities and does not have mental capacity. In 2020 Mr F lived in a supported living residential home (care home 1) which was arranged and commissioned by the Council. Ms X lived in another council area (Council B). Ms X is Mr F’s appointee and therefore responsible for ensuring he pays his assessed contribution towards his fees. Mr F’s assessed contribution at care home 1 was £74.49 per week.
18. In mid-2020 Mr F was admitted to hospital after falling ill at care home 1. Ms X raised a safeguarding concern that poor care at care home 1 led to Mr F’s admission. The Council held an enquiry meeting and began an investigation.
19. The Council’s safeguarding investigation identified various issues with Mr F’s care including, poor record keeping, lack of evidence showing how Mr F received personal care and missed opportunities to refer him to clinicians in the run up to his hospital admission. The Council said was satisfied that care home 1 had taken measures to prevent recurrence of these issues and had removed any safeguarding risk.
20. Ms F told the Council she did not want Mr F to return to care home 1 when he left hospital and asked it to look for another placement which it agreed to do.
21. Following a best interest meeting in September 2020 Mr F went to live in a nursing care home (care home 2) in Council B’s area which was closer to Mrs X. The hospital discharged Mr F to care home 2. The Council took over Mr F’s contract with care home 2 after six weeks.
22. Following his move into care home 2 the Council carried out a financial assessment. It assessed Mr F could contribute £102.85 towards the cost of his care.
23. Case records show that in October 2020 Ms X suggested to the social worker that Mr F could go and live with her. There is no evidence the Council progressed this and no evidence of Ms X raising this again.
24. In November 2020 Mr F’s social worker confirmed that his placement at care home 2 was not permanent and the Council said it would commission the placement once his initial six weeks had ended.
25. Records show Ms X said she was happy for Mr F to remain at care home 2 until he was fully recovered. In December 2020 Ms X said she had found an assisted living placement (care home 3) for Mr F to move into and had asked it to assess him. Care home 3 was a brand new home and at this point was not yet complete and ready to move into.
26. In mid-December 2020 care home 2 sent Ms X an invoice for Mr F’s care fees. Ms X sent it to the Council and asked it to look into it. Records show the Council had not put in place funding for Mr F.
27. Mr F remained at care home 2 during the first part of 2021. In March 2021 the Council carried out a re-assessment of Mr F’s finances. This resulted in his care contributions rising to £103.48 per week. The Council wrote to Ms X explaining this.
28. In April 2021 care home 2 threatened to serve notice on Mr F as no fees had been paid. The balance at this point stood at over £45,000. Records show the Council had still not approved funding by July 2021. Ms X said she was receiving invoices for care fees but was unsure why. Ms X raised concerns around whether care home 2 was appropriate for Mr F. She was frustrated that he still had not moved into care home 3.
29. Records show the Council held a best interest meeting in September 2021 which proposed Mr F moved into care home 3 as soon as possible. The Council explained the invoices Ms X received were for unpaid care contributions since Mr F moved into care home 2. It referred Ms X to the financial assessment letters it sent her in October 2020 and March 2021.
30. The Council approved Mr F’s move to care home 3 in November 2021. However, the home was still not complete for Mr F to move into so he remained at care home 2.
31. Records show Ms X discussed the outstanding care fee contributions with the Council in November. Ms X said she was aware of the financial assessments but said Mr F should not be required to pay anything because it was the poor care at care home 1 which resulted in a forced move to care home 2.
32. Mr F was due to move into care home 3 in December 2021. However, delays in finishing the building and then a COVID-19 outbreak at care home 2 caused further delays. Mr F moved into care home 3 in February 2022 and remains living there to date.
33. Ms X complained to the Council. She complained that she and Mr F were not informed about the cost of Mr F’s care when he moved into care home 2 or told about what fees Mr F would need to contribute. Ms X was unhappy Mr F remained at care home 2 for so long which was a nursing home and therefore no appropriate. Ms X said the Council failed to make arrangements for Mr F to move into her home. Ms X was unhappy with the invoice she received for Mr F’s care contributions which was more than he was required to pay at care home 1.
34. The Council provided Ms X with its final response in February 2022. It said following Mr F’s move to care home 2 it reassessed his finances and sent her a letter setting out his contributions. The Council said it was satisfied Ms X was fully informed and aware of the requirement to pay contributions. It said it would not waive the contributions.
35. The Council said it was a best interest decision to move Mr F to care home 2 which Ms X agreed to. It said although Ms X raised the possibility of Mr F moving in with her, she later expressed he should stay at care home 2 to fully recover. The Council said it was agreed Mr F should move to care home 3 permanently in line with Ms X’s wishes. Therefore, it did not look to source other alternatives. The Council accepted care home 2 was not a long term option however delays moving to care home 3 were out of its control.
36. Ms X remained unhappy and complained to us. She reiterated that the plan was for Mr F to move to care home 2 and then live with her until he could move to care home 3.

The Council’s response to our enquiries

37. The Council accepted the safeguarding investigation found instances of ‘neglectful care’ of Mr F including missed opportunities to highlight Mr F’s health to doctors in the build up to his hospital admission. It said it has ensured care home 1 carried out staff training, daily record checks and it completed a 12 week action plan to improve various aspects of record keeping.
38. The Council said it accepts care home 2 was never a long term placement for Mr F but his care and needs were met at all times. It said Mr F’s preferred long term placement at care home 3 was delayed due to various factors outside its control.
39. With regards to Mr F’s care fee contributions, records show Ms X has made various ad-hoc payments on behalf of Mr F between 2020 and present; however, there remains an outstanding debt of over £3,500.

My findings

40. Ms X reported safeguarding concerns about Mr F’s care at care home 1 following Mr F’s admission to hospital. The Council appropriately carried out a safeguarding investigation and identified areas of poor care which was fault. The safeguarding report recommended various actions for care home 1 to carry out to improve its service and remove the safeguarding risk. I am satisfied it has carried out service improvements appropriately. However, the faults caused Mr F an injustice and caused Ms X distress and uncertainty. I have therefore made a recommendation below to remedy that injustice.
41. Ms X was resistant to Mr F moving back into care home 1 after he left hospital. Records show Mr F required nursing care initially and a best interest meeting showed both the Council and Ms X agreed for his move to care home 2. There is no evidence this was forced upon Mr F or Ms X. Throughout Mr F’s stay his care needs were met and there is no evidence of any complaint made to the contrary. The best interest meeting considered the circumstances and Ms X’s wishes at the time. There was no fault by the Council around Mr F’s move to care home 2.
42. However, following Mr F’s move to care home 2, there was poor communication and confusion around payment of his fees. The Council delayed commissioning the placement and putting funding in place which caused care home 2 to threaten notice. The delays and poor communication were fault and it caused Ms X distress and uncertainty. However, it did not cause Mr F an injustice because he remained living at care home 2 which fully met his needs.
43. However, Ms X is Mr F’s appointee and was aware of the requirement for him to pay his assessed care contributions. The Council wrote to Ms X informing of the assessed contributions following his placement at care home 2 and records show she was aware of those letters. Mr F was required to pay his assessed contribution regardless of which care home he lived in. There is no fault in the Council invoicing Ms X for any arrears.
44. Ms X says there was an agreement for Mr F to live with her once he was well enough at care home 2. There is one reference in the records of Ms X raising the possibility of him moving in with her. However, subsequent records show she was happy for him to remain at care home 2 because of continuing health needs. Other than that one reference Ms X did not raise the prospect again and there is no evidence of any other formal agreement. The Council was not at fault.
45. The records show that care home 3 was Ms X’s preferred choice of placement for Mr X having first proposed it in December 2020. For various reasons care home 3 was not ready to accept residents until early 2022. The delays were outside of Council control and therefore it was not at fault any delays in Mr F moving in.

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Agreed action

46. 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. The Council funded and commissioned Mr F’s placement at care home 1. So, although I found fault with the service of care home 1, I made recommendations to the Council.
47. Within one month of the final decision the Council agreed to:
• apologise to Ms X for the uncertainty and distress caused to her and Mr F because of the poor record keeping and missed opportunities to identify medical concerns as identified in the safeguarding investigation at care home 1. It agreed to pay Ms X a total of £600 to remedy the injustice caused to both her and Mr F.
• apologise to Ms X for the distress and uncertainty caused to her by its poor communication and the delay in commissioning and funding Mr F’s placement at care home 2.

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Final decision

48. I completed my investigation. I found fault and the Council agreed to my recommendations to remedy the injustice caused by that fault.

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Investigator's decision on behalf of the Ombudsman