Summary: Miss B complained the Council insisted her mother, Mrs C, returned home following a stroke and ignored her concerns. She also complained the Council delayed resolving who owned their home. She said this caused her distress and affected her relationship with her mother. During the Council’s complaint procedure, it recognised it did not take enough account of Miss B’s circumstances and apologised. The Council’s apology was a suitable remedy for the injustice caused to Miss B. In addition, the Council will provide staff training.

The complaint

1. Miss B complained the Council insisted her mother, Mrs C, returned home when it was unsafe and ignored her safeguarding concerns. She also complained the Council delayed resolving who owned their home.
2. She said this caused her distress and affected her relationship with her mother.

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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. 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

5. I considered:
• Miss B’s complaint and the information she provided;
• documents supplied by the Council;
• relevant legislation and guidelines; and
• the Council’s policies and procedures.
6. Miss B and the Council had the opportunity to comment on a draft decision. I considered their comments before making a final decision.

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What I found

Legislation and guidance

7. The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life. Underpinning all of council’s individual ‘care and support functions’ (that is, any process, activity or broader responsibility that the council performs) is the need to ensure that doing so focuses on the needs and goals of the person concerned. (Department of Health and Social Care, Care and support statutory guidance)
8. Councils must undertake an assessment for any adult with an appearance of need for care and support, regardless of whether the council thinks the individual has eligible needs or their financial situation. Councils must consider all the adult’s care and support needs, regardless of any support provided by a carer. (Department of Health and Social Care, Care and support statutory guidance)
9. Section 1 of the Care Act 2014 states councils must promote wellbeing when carrying out any of their care and support functions in respect of a person. This is referred to as ‘the wellbeing principle’. It applies equally to adults with care and support needs and their carers.
10. In addition to the general principle of promoting wellbeing, there are other key principles and standards which councils must have regard to including:
• The importance of beginning with the assumption the individual is best placed to judge their wellbeing. 
• The individual’s views, wishes, feelings and beliefs. 
• The importance of achieving a balance between the individual’s wellbeing and that of any friends or relatives who are involved in caring for the individual. (Department of Health and Social Care, Care and support statutory guidance)
11. Where it appears to the council that a carer may have needs for support (whether currently or in the future), it must offer a carer’s assessment. Carers’ assessments must seek to establish not only the carer’s needs for support, but also the sustainability of the caring role itself, which includes both the practical and emotional support the carer provides to the adult. Factored into this must be a consideration of whether the carer is, and will continue to be, able and willing to care for the adult needing care.

What happened

12. Miss B lived with her mother, Mrs C, and was her main carer. Miss B has physical and mental health difficulties. Mrs C’s brother, Mr D, holds Lasting Power of Attorney for Mrs C’s health and wellbeing.
13. In March 2021, Mrs C was admitted to hospital following a stroke. The hospital’s occupational therapy team visited Mrs C’s home to assess whether domiciliary care could be provided. It referred her to the Council for a Care Act assessment. Mrs C was allocated to the integrated community service (ICS).
14. ICS started a hospital discharge assessment in April 2021. It spoke to Miss B and Mr D about the plan for Mrs C. Miss B said because of her deteriorating health she could not care for her mother at home. Miss B confirmed she owned the property they lived in. ICS said it could consider a short-term residential placement to assess how her care and support needs could be met long-term. ICS asked Miss B if Mrs C knew she felt she could not care for her at home. Miss B said she did not. ICS asked Miss B to tell Mrs C before its spoke to her about her care plan.
15. Mrs C was discharged from hospital and admitted to a care home in April 2021.
16. ICS spoke to Mrs C about where she wanted to live. Mrs C said she wanted to return home. She said she gifted her property to Miss B on the understanding she could live there until she passed away. ICS told Mrs C she could not return home to live with her daughter. This upset Mrs C.
17. ICS told Miss B about its discussion with Mrs C. Miss B said she had not told her mother that she did not want her to return home because it would be too upsetting. Miss B confirmed she did not want Mrs C to return home. She told ICS she had become unwell because of the pressures of caring for her mother and had been referred to the mental health team. ICS asked Miss B for evidence she owned the property.
18. ICS told Mrs C Miss B did not want her to return to their home because she felt it would be too much pressure for her to cope with. Mrs C told ICS she wanted to return home and to reduce the pressure on Miss B, she would accept a package of care. ICS told Mrs C it would arrange a meeting to discuss her support plan and invite Miss B and Mr D.
19. Miss B reported a safeguarding concern to the Council. Miss B did not have concerns about Mrs C being abused or neglected. Her concern was that she would not be able to care for her mother if she returned home. The Council closed the safeguarding case and told ICS about Miss B’s concerns.
20. Miss B shared her concerns with her mental health social worker. She said she felt Mrs C’s needs were too high to be met at home. She was worried she would be pulled into caring for Mrs C, and this would impact her physical and mental well-being. She said she could not be the main point of contact for ICS and Mr D would take over. With Miss B’s consent, her social worker referred her for a carers assessment. Because of Miss B’s distress, her social worker also referred her to the crisis team and for respite.
21. In May 2021, the early supported discharge team undertook a stair assessment with Mrs C at the care home. It found Mrs C could walk up and down stairs. It decided Mrs C was independent and there were no issues with her returning home.
22. Miss B went for a week’s respite at a mental health service that provides short-term mental health crisis intervention and a place of safety.
23. ICS held a meeting to discuss Mrs C’s care. Miss B’s mental health social worker attended on her behalf. Mrs C said she wanted to return home. She said she understood Miss B was struggling but did not think she would need any help from her if she went home. ICS confirmed Mrs C’s care could be managed at home. Mr D raised concerns about Mrs C using the stairs. ICS agreed to assess Mrs C at home. Miss B’s social worker updated her.
24. ICS completed a home assessment for Mrs C. The occupational therapist raised concerns with ICS. They said Mrs C did not accept safety advice they gave and would not accept meals unless they were cooked fresh which carers would not have time to do. They said Mrs C’s non-compliance with safety advice would negatively impact on Miss B and she would not be able to cope. The therapist said Mrs C took medication three times a day and she could not do this without support. They said district nurses would not be able to visit Mrs C at the times she normally took her medication to support her.
25. The Council completed a Care Act assessment for Mrs C in May 2021. The Council recorded concerns about Mrs C returning home and that Miss B could not continue to care for her. The Council extended the funding for Mrs C’s care home placement while it explored her housing options.
26. The Council completed Miss B’s carers assessment. The assessment concluded that if Mrs C returned home, it would have a severe detrimental impact on Miss B’s health and well-being.
27. Miss B gave ICS evidence she owned the property.
28. ICS explained to Mrs C that it was Miss B’s decision, as the legal owner of the property, whether she could return to live there. ICS told her it could not insist that Miss B allow her to return.
29. ICS held a meeting in June 2021 to discuss Mrs C’s support plan. Mrs C said she wanted to return home. ICS explained the concerns raised by the occupational therapist. Mrs C said she knew her limits and would say if she thought she was unsafe. The Council updated her support plan that conversations about where she would live would be ongoing.
30. Miss B told her social worker she felt she needed talking therapy to manage the fallout from this situation and the impact it had on her relationship with her mother, Mrs C. Her social worker referred her to IAPT (Improving Access to Psychological Therapy).
31. In August 2021, ICS told Mr D it had arranged for Mrs C to stay at the care home long-term. The Council asked Mr D if he wanted it to tell Mrs C. He said he would do this.
32. ICS wrote to Miss B. It said Mrs C had accepted a place at the care home as a permanent resident.
33. ICS started Mrs C’s Care Act reassessment and twelve-week review in October 2021. Mrs C told ICS she wanted to return home. ICS spoke to Mr D about Mrs C’s request. He said Miss B was recovering from an operation and could not care for Mrs C. ICS said it could put in a package of care to support Mrs C and it would not expect Miss B to care for her. Mr D told ICS Mrs C could not return to the property.
34. ICS held a meeting in December 2021 to discuss Mrs C’s support plan. Mrs C said she wanted to return home and she would accept a package of care. ICS told her she would need to be able to administer her medication independently. The care home said it would monitor whether Mrs C could do this. Attendees, including Mrs C, agreed she should remain at the care home.

Complaint

35. Miss B complained to the Council in November 2021. She said the Council overlooked her welfare and damaged her relationship with her mother by telling her she did not want her to return home. She said the Council failed to help, aid or support Mrs C or her. She also complained the Council asked her to evidence she owned the house rather than contacting Land Registry itself.
36. In December 2021, the Council responded at stage one of its complaint procedure. It recognised:
• The social worker told Mrs C that Miss B did not want her to return to live with her. The Council apologised for the distress this caused and said it would deliver staff training on communication and difficult conversations.
• The social worker did not take into full consideration Miss B’s personal circumstances, and the impact on her of caring for her mother. The Council apologised and said it would provide staff training and ensure the service promotes continuous professional development.
37. The Council responded at stage two of its complaint procedure in January 2022. It confirmed the member of staff involved had reflected on the case. It said it was working with its training department to put in place training around communication and difficult conversations. It apologised for the distress caused by asking Miss B for information about Mrs C’s house sale rather than contacting its own finance department or land registry.

Analysis

38. Before being admitted to hospital Mrs C lived with her daughter Miss B. On discharge from hospital, Mrs C wanted to return to her home and kept this position throughout the Council’s care planning discussions. The Care Act requires Council’s to consider the individual’s views and wishes, feelings. It was therefore necessary for the Council to explore this option with both Mrs C and Miss B.
39. When Miss B told the Council she did not want Mrs C discharged to the home they shared, the Council arranged for Mrs C to move into a care home. While Mrs C was living in the care home, the Council engaged with Mrs C, Miss B, Mr D and relevant professionals in assessing and care planning for Mrs C. Although Mrs C wanted to return home, Miss B said she could not, and the Council found she did not have the independence needed to enable this. Consequently, Mrs C remained living at the care home. The Council explored but did not insist that Mrs C return home to live with Miss B.
40. It was necessary for the Council to tell Mrs C she could not return to her home so other options could be explored. The Council gave Miss B the opportunity to tell Mrs C herself, but she could not. Sharing this information caused both Mrs C and Miss B distress and impacted their relationship, however, I consider this was unavoidable. Mrs C needed to know Miss B did not want her to return because she felt she could not cope so other options could be considered. It was not fault for the Council to tell her.
41. Miss B complained the Council did not offer her enough support at the time. ICS and the mental health team had different roles. ICS worked with Mrs C to find her a suitable place to live when she was discharged from hospital. The role of the mental health team was to support Miss B. The mental health team supported Miss B throughout this period and facilitated her access to respite, a carer's assessment and IAPT.
42. The Council accepted during its complaint procedure that ICS did not take into full consideration Miss B’s personal circumstances, and the impact on her of caring for her mother. It apologised to Miss B. I consider this a suitable remedy given Miss B was supported by the mental health team and Mr D, both who advocated for her. The Council will provide the ICS team with training around managing difficult conversations and I consider this a suitable service improvement.

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Final decision

43. I have completed my investigation and uphold Miss B's complaint. There was fault by the Council which caused injustice to Miss B. I am satisfied the Council has taken action to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman