Summary: Mrs X complained that the Council communicated poorly with her and her family about paying for her mother’s care, finding and arranging assessments at care homes, and when her mother was in hospital. Mrs X said the delay arranging a residential care home placement resulted in her mother going missing. She said the family has had to pay for care fees they would not have had to pay if the Council had acted quicker to arrange the care home placement. She also said this caused anxiety and stress. We find the Council at fault for not covering the Social Care Practitioner’s work, meaning there was a lack of communication and a delay in arranging a care home placement. The Council will make a payment to Mrs X to reflect the uncertainty caused. Also, the Council will show us the arrangements it is making to cover unexpected staff leave in future.

The complaint

1. Mrs X complained on behalf of her mother, Mrs M, who has dementia. Mrs X complained that the Council communicated poorly with her and the family about Mrs M’s care. Specifically, Mrs X complained that the Council:
1. communicated poorly with her and the family when they told the Council Mrs M was running out of money to pay for her care;
2. failed to tell her or the family it had found residential care homes for Mrs M, and failed to arrange assessments at these homes; and,
3. failed to communicate with her or the family when Mrs M was in hospital.
2. Mrs X said the delay arranging a residential care home placement for Mrs M resulted in Mrs M going missing. Mrs X said the family has had to pay for care fees they would not have had to pay if the Council had acted quicker to arrange the care home placement. She also said this has caused anxiety and stress.

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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 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. 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)
6. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
7. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable.

(Local Government Act 1974, section 26A(2), as amended)

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How I considered this complaint

8. Mrs M has dementia so she is not able to give consent for her daughter, Mrs X, to represent this complaint on her behalf. Mrs X represented the complaint to the Council on behalf of Mrs M and is one of Mrs M’s next of kin. I consider that Mrs X is a suitable person to represent this complaint on Mrs M’s behalf.
9. I considered the information and documents provided by Mrs X and the Council. I spoke to Mrs X about her complaint. I also considered the Ombudsman’s published guidance on remedies. Mrs X and the Council had an opportunity to comment on an earlier draft of this statement. I considered all comments received before I reached a final decision.

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What I found

What happened

10. Mrs M lived at home with carers coming in daily to meet her care and support needs. The Council met some of the cost of the care package by way of a Direct Payment. Mrs M paid a top-up fee for the rest of the cost of the care package.
11. In August 2021, Mrs M’s son (Mr S) told Mrs M’s Social Care Practitioner that she no longer had sufficient funds to keep paying the top-up.
12. A few days later, the Social Care Practitioner told Mr S that Mrs M’s needs could be met in a residential care home, but the family had wanted her to remain at home because this is what she wanted. The Social Care Practitioner said there were options to allow Mrs M to remain at home: the family could pay the top-up, or they could consider changing to a better value care provider. The Social Care Practitioner also said the family could consider a residential care home. She asked the family to tell her which option they preferred, once they had decided. She told the family she would be on leave for a week.
13. In September, Mr S told the Social Care Practitioner again that Mrs M did not have the funds to pay for the care costs. The Social Care Practitioner replied, apologising if her last email was not clear. She repeated the options available to the family. She said if the family did not want to consider any of those options, they should tell her and she would arrange a formal review of Mrs M’s care package.
14. Shortly after this, Mrs X emailed the Social Care Practitioner saying the family were not in a position to help pay for the top-up. Mrs X said the family were considering a residential home.
15. Over the next two days, the Social Care Practitioner left voicemails for Mr S and emailed him. She said she would discuss Mrs M’s case with her manager and get back to them.
16. A few days later, the Social Care Practitioner emailed Mr S. She said the family had previously been clear that they did not want to consider residential care. She said if the care package for Mrs M at home was no longer sustainable, she needed to reassess Mrs M’s care and support needs to assess where her needs could be met. She said if a residential placement could meet Mrs M’s needs, she would work with the family to find the most suitable placement for her. She asked the family to let her know how they wanted to proceed, and she would arrange a reassessment if that was what they wanted.
17. The next day (mid-September), Mrs X told the Social Care Practitioner that residential care was the only option. She asked the Social Care Practitioner to go ahead with the reassessment.
18. The Social Care Practitioner did the reassessment in early October, with Mrs X present. The decision was that a residential care home was best placed to meet Mrs M’s needs. The Social Care Practitioner said the Council would identify residential homes that could meet Mrs M’s needs. She said she would share this information with the family. The family could then consider the available options.
19. In mid-October, the Social Care Practitioner went on unexpected compassionate leave.
20. A few days later, the Council identified four care homes that could meet Mrs M’s needs. The two that were the best value said they could assess Mrs M. A note was left on the system for the Social Care Practitioner to contact the homes to arrange assessments.
21. A week later, Mr S emailed the Social Care Practitioner twice, with no reply.
22. At the end of October, Mrs M was admitted to hospital after she was found by a member of the public wandering the streets in the early morning. Mrs M’s case was transferred from the Social Care Practitioner at the Council to the hospital social work team. Mrs X emailed the Social Care Practitioner that day to update her.
23. The same day, the care provider told the family they had spoken to the Council. They said the Council told them the Social Care Practitioner was on leave and her emails had not been looked at. They said the Council had found two care homes but had not told the family this.
24. Two days later, on a Friday, Mrs X left two voicemails for the Social Care Practitioner’s manager, asking for a call back. She also called the Adult Social Care team twice but got no answer.
25. On the following Monday, Mrs X called the manager again twice, leaving voicemails asking for a call back. The manager picked up the messages and ultimately asked the hospital social work team to call Mrs X back, because the Social Care Practitioner was not back at work.
26. That day the hospital social work team left a voicemail for Mrs X explaining that they were the point of contact for updates about Mrs M. The hospital social worker confirmed with the family that a care home had been found for Mrs M.
27. In Mid-November, Mrs M was discharged from the hospital to a care home.
28. Mrs X then complained to the Council.
29. In its response to the complaint, the Council said it was unfortunate that the Social Care Practitioner had to go on unexpected leave shortly after she had asked the Council to find care homes for Mrs M. The Council said the Social Care Practitioner did not contact the family when she was back from leave because Mrs M’s case had been transferred to the hospital social work team by that point. The Council apologised for the confusion caused by failing to explain to the family that the Social Care Practitioner was no longer Mrs M’s worker.
30. The Council said it did not put any cover in place, to cover the Social Care Practitioner’s work, until after Mrs M was admitted to hospital. And this is when Mrs M’s case was transferred to the hospital social work team. The Council apologised that it was not able to arrange any cover for the Social Care Practitioner’s work before this.
31. Mrs X then complained to the Ombudsman.

Analysis

Communication about paying for care

32. Mrs X complains that the Council communicated poorly with her and the family when they told the Council Mrs M was running out of money to pay for her care (part a of the complaint).
33. I find that the Council responded promptly to the family’s concerns. Within five working days from the family telling the Social Care Practitioner in August that Mrs M could no longer afford to pay the top-up, the Social Care Practitioner gave the family different options for Mrs M’s future care. She told the family to let her know their choice. She repeated these choices to the family in September.
34. I find the family first told the Social Care Practitioner their choice in mid-September. The Social Care Practitioner then arranged for the reassessment without delay.
35. I do not find that the Council communicated poorly with Mrs X and the family. I find that the Council clearly set out the options available to address the fact that Mrs M could no longer afford to pay the top-up for her care package.
36. For this reason, I do not find the Council at fault.

Communication about care homes, and assessments for care homes

37. Mrs X complains that the Council failed to tell her or the family it had found residential care homes for Mrs M, and failed to arrange assessments at these homes (part b of the complaint).
38. The Council found four residential care homes for Mrs M in mid-October. It was the Social Care Practitioner’s responsibility to tell Mrs X and the family about these placements. However, the Social Care Practitioner was off work on unexpected compassionate leave when these placements were found. This meant that not only did the Council not tell the family about the possible placements, but also the Council failed to arrange assessments at the two care homes.
39. This is fault. I find the Council should have told the family about the care home placements, and arranged assessments at the two care homes, as the Social Care Practitioner said. The Council should have a process in place to cover unexpected staff leave to make sure there are no gaps or delays in meeting someone’s care and support needs.
40. I find this fault caused Mrs X and the family injustice in that it caused uncertainty. The Council has apologised for failing to put arrangements in place to cover the Social Care Practitioner’s work.
41. The Council says that because the Social Care Practitioner’s absence was unexpected, it was not appropriate or possible to have done a suitable handover of her work to colleagues. This is the Council’s usual process for planned leave. The Council says that it reallocated the Social Care Practitioner’s cases once it knew she would be away for an extended period of time. During this time, Mrs M went into hospital and her case was transferred to the hospital social work team.
42. The Council says it currently does not have a process for covering staff’s work when they have to go on unexpected leave. To its credit, and in response to this complaint, the Council recognises the need to introduce an appropriate arrangement. The Council says the Adult Social Care director has asked that one is created. This is both proactive and positive, and should stop something similar happening in future.
43. Mrs X says the delay arranging a residential care home placement for Mrs M resulted in Mrs M going missing.
44. The Council found the placements in mid-October. Mrs M was hospitalised a week later. During this week, the Council did not act to arrange assessments at the two care homes. However, I cannot say that even if the Council had arranged assessments at these homes, that Mrs M would not have left her home and gone missing. The likelihood is that it would have taken more than one week to arrange the assessments and transfer Mrs M to a care home. I therefore cannot find that the Council’s delay in acting and Mrs M leaving her home are in any way linked.
45. For this reason, I do not agree with Mrs X that the delay arranging a residential care home placement for Mrs M resulted in her going missing.
46. Mrs X says the family has had to pay for care fees they would not have had to pay if the Council had acted quicker to arrange the care home placement.
47. As I have said above, the Social Care Practitioner told the family within five working days (in August) the options available to meet Mrs M’s needs, given that she could not afford to pay the top-up. The family did not tell the Social Care Practitioner their choice until mid-September. After this, the Social Care Practitioner acted without delay to arrange a placement at a care home.
48. As I have already found, there was a delay in arranging the care home placement because the Social Care Practitioner’s work was not covered in her unexpected absence. However, the care home placements were found one week before Mrs M went missing and was then in hospital. As I have already said, I find it unlikely that the Council would have been able to arrange assessments at the care homes and transfer Mrs M to a care home within one week.
49. I find that the family contributed to the length of time it took to arrange Mrs M’s care home placement. The Social Care Practitioner told the family in August what the options were. The family did not tell the Social Care Practitioner their choice until mid-September, at which point the Council acted without delay to arrange the placement.
50. I therefore do not agree that the Council could have acted quicker to arrange the care home placement. Also, I do not agree that the Council’s delay in arranging the care home placement caused any additional care fees. These are the care costs incurred while the Council was in the process of finding and arranging a placement.

Communication when Mrs M was in hospital

51. Mrs X complains that the Council failed to communicate with her or the family when Mrs M was in hospital (part c of the complaint). Mrs X says the hospital social work team called her saying the Council had passed Mrs M’s case to them. She says the family heard nothing from the Council.
52. Mrs M was hospitalised on a Wednesday. On the Friday and the Monday, Mrs X contacted the Council a number of times, leaving messages asking for a call back. On the Monday, the manager ultimately asked the hospital social work team to contact Mrs X, which they did on the Tuesday.
53. The Council says the reason it did not call Mrs X back was because the hospital social work team was better placed to inform the family of Mrs M’s current situation.
54. While I find that the hospital social work team was the best team for the family to speak to about Mrs M’s current situation, I find the Council could have responded to Mrs X’s requests for a call back. The Council knew the Social Care Practitioner was still off work. The family were going through a traumatic event. I find that the Council could have reassured the family and/or explained that the case had been transferred to the hospital social work team. I find the lack of response, despite Mrs X’s repeated attempts at contact, only added to the family’s distress.
55. While I do not find the Council’s failure to return Mrs X’s calls significant enough to constitute fault, the Council may wish to reflect on my findings here and decide to return a phone call, even if just to tell the person they will be contacted by someone better placed.
56. I find the Council’s action to put in place an arrangement to cover unexpected staff leave should address this in future.

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Agreed action

57. Within four weeks of this decision, the Council has agreed to make a payment to Mrs X of £200. This is to recognise the uncertainty caused by failing to cover the Social Care Practitioner’s work in her unexpected absence, which led to the Council taking no action to arrange a care home placement for Mrs M in October.
58. In arriving at this figure, I have considered the Ombudsman’s published guidance on remedies. I consider that a mid-range figure of £200 is appropriate, given the factors in this case.
59. Within three months of this decision, the Council has agreed to share with the Ombudsman its newly agreed process/arrangement which shows how the Council will cover staff’s work when an officer goes on unexpected leave.
60. The Ombudsman will need to see evidence that these actions have been completed.

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Final decision

61. I have completed my investigation and I uphold part b of the complaint. I find fault causing injustice. The Council has agreed to take action to remedy the injustice caused and prevent a future recurrence.
62. I do not uphold parts a or c of this complaint. This is because there is no fault.

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Investigator's decision on behalf of the Ombudsman