Summary: The Council failed to ensure the care home had necessary equipment in place before Ms X moved in. It also failed to ensure Ms X had access to an advocate. It offered her options to enable her to move but the evidence shows she declined. The Council has now agreed to apologise for the failings identified, actively pursue a referral for advocacy and consider options for door widening if Ms X remains in her current placement.

The complaint

1. Ms X complains the Council placed her in an unsuitable residential care placement, and, that she has been asked to pay for the accommodation.

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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. 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

• considered the complaint and discussed it with Ms X;
• considered the correspondence exchanged between Ms X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• considered relevant legislation.

Both Ms X and the Council had an opportunity to comment on a draft of this statement and I considered their comments before I reached a final decision.

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What I found

Relevant legislation

4. The Care Act 2014 require councils to assess a person’s care needs and how identified needs should be met. If it is found a person needs residential care, councils have a duty to arrange for the care. A council may arrange residential care in private care homes, but it remains responsible for the care arrangement, and ensuring the persons needs are met.
5. The Care and Support (Charging and Assessment of Resources Regulations 2014 requires councils to complete a financial assessment of a person’s circumstances when it is found a person has eligible care needs. This may mean the person cared for has to make payments towards their care.

Key Facts

6. This is not meant to be an account of everything that happened. I have focused only on the material issues in the complaint.
7. Ms X is in her forties. She has a progressive illness along with other complex physical and mental health issues. She requires support in all areas of daily living.
8. Ms X was admitted to a rehabilitation centre in November 2018, prior to this she lived in her own home. Whilst at home she had been immobile, bed bound and unable to stand unaided. She received home care services comprising of two carers visiting four times a day.
9. Ms X’s stay in the rehabilitation centre was fully funded by NHS Continuing Healthcare (CHC). Such care is arranged and funded solely by the NHS. To be eligible, a person’s care needs must be primarily 'healthcare needs' (and the responsibility of the NHS) and beyond the scope of local authority social care services. Eligibility is determined by assessment which is undertaken by healthcare professionals.
10. Ms X’s eligibility for CHC funding ceased and responsibility for her care transferred back to the Council.
11. In November 2019, the Council completed an assessment of Ms X’s needs. I have had sight of this document. It is comprehensive and details all Ms X’s needs and her wishes. The assessor recorded Ms X’s wish for further rehabilitation. A report by a physiotherapist concluded Ms X had reached her rehabilitation potential and further placement would not be beneficial.
12. The assessment concluded Ms X required a short-term residential care placement, with the long-term aim of returning to her own home or other independent living environment.

Ms X needed a placement that could accommodate her bariatric bed and wheelchair.

13. The Council’s brokerage team sent Ms X’s assessment to eleven potential care homes. The evidence shows only one was able to meet Ms X’s needs. A staff member from the care home visited Ms X to complete a pre-admission assessment on 12 December 2019. The records show Ms X also contacted the manager of the care home directly to ask questions on 16 December 2019.
14. Ms X did not visit the care home before moving in. The Council says it was not practical to do so because specialist transport arrangements were required, and the rehabilitation placement was soon coming to an end.
15. Ms X is unhappy she was not offered an opportunity to view the care home before moving in. She says when she did move in there were accessibility issues into the building and she was only able to gain entry after assistance from three men, who tipped her wheelchair backwards and moved her slowly up three concrete steps. The Council says there are ramps situated outside of the building that allow access into and out of the building. My investigation found there is a permanent ramp into the building which accommodates all types of wheelchairs, but Ms X says her self-propelled wheelchair was too wide for the ramp without an extra board. She now has an electric wheelchair with which she can use the ramp.
16. The Council says Ms X was allocated a room within the younger persons’ unit which already accommodated other residents in similar circumstances to Ms X. On admission it was discovered Ms X’s wheelchair would not fit through the bedroom door, so she was allocated another room on a different floor, not in the younger persons unit. The Council says Ms X has access to all the areas of the care home, including all communal areas. Ms X says her room is on the floor which mostly cares for patients with dementia and she is often disturbed by the noise. She says some of the keypads in the home are too high for her to reach other areas.
17. Ms X says there was no suitable bed or hoisting equipment in place, and this caused her significant discomfort. She says staff were not trained in using a standing hoist.
18. The Council says Ms X did not require a hoist when she arrived at the care home as she was weight bearing and suitable transfer equipment was provided and used to support her. However, the needs assessment completed by the Council prior to Ms X moving into the care home noted “[Ms X] continues to need the hoist to be transferred in and out of bed into her wheelchair and vice versa”.
19. Ms X says because of restrictions on visiting, and her inability to leave the building, she has been isolated from her family and her boyfriend. The Council says Ms X is free to leave the building as and when she chooses, and she is allowed visitors. The only restrictions in place were during lockdown.
20. Ms X says she expressed her dissatisfaction to the Council and made clear her wish to leave the care home. She says no alternative accommodation has been offered.
21. An Occupational Therapist (OT) and a surveyor visited Ms X’s home on 11 December 2020. Both the surveyor and OT concluded that the accommodation is not suitable to adapt and will not meet Ms X’s needs.
22. The Council’s case recordings from July 2021 show Ms X declined to pursue the offer of sheltered housing and declined the Council’s offer to purchase her home to allow her to buy another more suitable property.
23. Ms X is also unhappy that she is being asked to make a financial contribution towards a placement that is unsuitable, and that she has no desire to live in.
24. The Council told Ms X it intended to make her placement at the care home permanent, a financial assessment would be completed and she may be required to make a financial contribution. Ms X was also informed about other options, which included:

• privately placing her current property on the market and looking for suitable accommodation that will meet her requirements.
• selling the property through the Council’s buy back scheme, (Ms X owns 100% of the leasehold property and the Council is the leaseholder).
• deferred Payment Scheme
• moving to extra care supported living.

25. Ms X declined all the options, and her placement became permanent on 5 August 2021.
26. The Council sent Ms X a financial assessment form. It says to date, Ms X has not completed the form, so she is liable for the full cost of her placement from 5 August 2021.
27. I have seen the Council’s response to Ms X’s complaint. It sets out the matters complained about and confirms the options available, including those set out in paragraph 24 above. The author of the letter confirms the charging process had been explained and that explanatory literature had been provided. The author offered to provide this information again, and/or assign an officer from the Council’s financial assessment team to assist Ms X to complete the financial assessment.
28. To date Ms X has refused to pay for her care. She has accrued a debt in excess of £40,000. During this investigation Ms X received a letter from the Council threatening court action to recoup unpaid care fees. The Council agreed to suspend the action pending the outcome of this investigation.
29. The Council made referrals to Mind and an advocacy agency requesting an advocate for Ms X. It says both requests were refused because Ms X lives outside the catchment area. It says Ms X’s allocated worker advised her to contact the Citizens Advice Bureau. Following my enquires, the Council said Ms X’s allocated worker has made a new referral to a team covering the area Ms X lives.

Analysis

30. The Ombudsman’s role is to review how councils have made decisions. We may criticise a council if it has, for example, not followed an appropriate procedure, failed to take account of relevant evidence, or not properly explained the reason for its decision. But we do not make decisions on councils’ behalf or offer a right of appeal against their decisions. We cannot criticise a council’s decision where it has been made properly, and nor can we uphold a complaint simply because a person disagrees with what a council has done.
31. The evidence shows that overall, the Council assessed Ms X’s care needs properly. It took account of all relevant information and Mrs X’s wishes. I find no fault by the Council here.
32. I cannot criticise the choice of care home, as it was the only available option which met Ms X’s needs and would offer her a placement.
33. It is unfortunate Ms X was not offered an opportunity to visit the care home before moving in as this may have highlighted issues which could have been addressed - for example, the access into the allocated bedroom. It may be that alterations to the doorframe could have been considered. As it was, Ms X had reasonable expectations that were not met, through no fault of her own.
34. In relation to Ms X’s complaint about the lack of necessary equipment at the care home: I uphold this on the basis that Ms X’s assessment is clear she requires a hoist for transfers, and there was no hoist available. This must have added to Ms X’s frustration and distress.
35. I am not persuaded the Council did enough to source an advocate for Ms X. When a referral to an advocacy agency was refused because of boundary issues the Council should have contacted an advocacy agency in the area Ms X was living. It was wholly inadequate to advise Ms X, a vulnerable adult, to contact the citizens advice service. The Council says it has now made a referral to an advocacy agency in the area Ms X lives. There is no good reason for the delay in doing so.
36. There is no fault by the Council in respect of the financial assessment and the charging of care fees. Ms X declined to complete a financial assessment and is therefore responsible for the full cost of her care. There is no fault by the Council in its pursuit of outstanding care fees. However, the option to undergo a financial assessment remains open to Ms X. Any amendments could then be applied retrospectively.

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Agreed action

37. The Council will, within four weeks of the final decision:

• provide Ms X with a written apology for the failures set out in paragraphs 34 & 35 above;
• actively pursue a referral for an advocate for Ms X. When an advocate is allocated, the Council will arrange to meet with Ms X and the advocate to discuss all available accommodations options;
• should Ms X wish to remain in her current placement, the Council should explore the possibility of widening a doorframe in the younger persons unit.

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Final decision

38. I find there was fault by the Council as it failed to ensure the care home had necessary equipment in place before Ms X moved in. It also failed to ensure Ms X had access to an advocate.
39. Completion of the recommendations at paragraph 37 are a suitable way to settle the complaint.
40. I have therefore completed the investigation.

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Investigator's decision on behalf of the Ombudsman