Summary: Mrs X complains the Council delayed assessing her care needs. This meant she was denied the opportunity to return home and became eligible for charges. The Ombudsman finds fault with the Council for unreasonably delaying assessing Mrs X’s care needs. The Council has agreed to pay a financial remedy, refund of care payments, and implement service improvements.

The complaint

1. The Council failed to follow the COVID-19 discharge to assessment policy. This meant the Council did not assess Mrs X’s needs properly, which resulted in delays to the assessment and the Council not considering her wishes.
2. The Council has not suitably communicated with Mrs X’s representatives and professional agencies about her care. This caused further delay and meant her care needs were not properly communicated.
3. Mrs X complains the Council’s delay meant she could not return home and was moved to a permanent care placement.

Back to top

The Ombudsman’s role and powers

4. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
5. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether an organisation’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), 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)

Back to top

How I considered this complaint

7. I considered Mrs X’s complaint and information from Mrs X’s representatives. I also considered information from the Council.
8. I considered comments from Mrs X’s representatives and the Council on a draft of my decision.

Back to top

What I found

Relevant guidance

Assessment

9. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
10. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Promoting wellbeing

11. The Government’s Care and Support statutory guidance highlights the importance of councils supporting individuals to achieve the outcomes that matter to their life and promoting wellbeing. Principles that underpin promoting wellbeing are:

• The importance of beginning with the assumption the individual is best placed to judge the individual’s wellbeing. Building on the principles of the Mental Capacity Act, the council should assume the person themselves knows best their own outcomes, goals and wellbeing. Councils should not assume what matters most to the person.
• The individual’s views, wishes, feelings and beliefs. Considering the person’s views and wishes is critical to a person-centred system. Councils should not ignore or downplay the importance of a person’s own opinions about their life and their care. Where particular views, feelings or beliefs (including religious beliefs) impact on the choices that a person may wish to make about their care, these should be taken into account. This is especially important where a person has expressed views in the past, but no longer has capacity to make decisions themselves.
• The importance of the individual taking part as fully as possible in decisions about them and being provided with the information and support necessary to enable the individual to take part. Care and support should be personal, and councils should not make decisions from which the person is excluded.

What happened

12. Mrs X was discharged from hospital in December 2021. She was discharged under the COVID-19 Discharge to Assess policy.
13. Mrs X was discharged to a funded placement while the Council carried out an assessment of her needs.
14. The Council contacted Mrs X nearly three weeks after she was discharged to arrange a visit, however the placement Mrs X was temporarily in was closed to visitors due to COVID-19.
15. The Council carried out a Care Act Assessment in January 2021 and said Mrs X was to remain at the placement under a short-term agreement, and her care from this point would be chargeable.
16. The Council spoke to Mrs X’s representatives and the staff at the placement, and further decided that her case needed to remain at the placement as Mrs X remained too unwell to move home.
17. The Council sent correspondence to Mrs X’s representatives in February to advise how to pay the charges for Mrs X’s stay at the placement.
18. Mrs X’s representatives raised concerns with the Council that they were unhappy with the Council’s decision that Mrs X needed to remain at the placement and would be charged for it. This correspondence continued for several weeks as Mrs X’s representatives felt the Council had not completed a needs assessment and therefore could not say what Mrs X needed. They also felt that by delaying the assessment, the Council was removing Mrs X’s wishes of returning to her home.
19. The placement for Mrs X contacted the Council in February 2022 and advised that it felt Mrs X needed a residential care home instead of the interim nursery placement.
20. Mrs X’s representatives continued to contact the Council and ask for an update on Mrs X’s assessment. The Council told the representatives that Mrs X’s social worker was now off sick. The Council reassigned Mrs X’s case in March 2022.
21. The new social worker completed a full assessment of Mrs X’s care needs in March 2022, three months after Mrs X had been discharged to the temporary placement.
22. The needs assessment advised that Mrs X needed 24-hour care and a residential care home would be most suited to her needs. Mrs X then moved to a residential care home.
23. The Council wrote to Mrs X’s representatives and advised it would be charging her for the care she received in the temporary placement.
24. Mrs X’s representatives complained to the Council about the charges for the residential placement. They felt the Council should not have charged Mrs X as it delayed carrying out the assessment and this meant her wishes could not be carried out.
25. In its complaint response, the Council explained that Mrs X’s bed was initially funded by the government under the discharge to assess scheme. The purpose of the scheme was to free up beds in hospitals and allow for a full assessment of the person’s needs. The Council explained that Mrs X had become eligible for charging for her care a month after being discharged, as it was agreed Mrs X was not ready to return home.
26. The Council recognised that Mrs X’s assessment had been delayed because of staff sickness.
27. Mrs X’s representatives remained unhappy with the Council’s response and bought her complaint to the Ombudsman.

Analysis

28. As part of my investigation, I asked the Council to provide a chronology of the events from Mrs X’s discharge, and all case notes related to this period of time.
29. The Council provided the requested information. It advised that “The assessment for Mrs X longer term care needs was not completed until the 4th March 2022; the Covid-19 funded period of the stay at temporary placement ended on the 10th January 2022. Therefore, the assessment was not completed in a timely way. There had been some difficulties due to covid outbreaks in the home and the social worker being unexpectedly absent from work, but the assessment still should have been completed at a much earlier stage and before 10th January 2022.”
30. The shows the Council has accepted that it did not carry out the assessment in a timely manner and delayed fully assessing Mrs X’s needs.
31. The Council has also accepted the social worker responsible for carrying out the assessment had not completed the assessment. It also recognised it had decided to extend the care without speaking to Mrs X’s representatives.
32. During my investigation, the Council has accepted that it did not follow its own policy when assessing Mrs X’s care needs following her discharge from hospital in December 2021. The Council recognises it delayed assessing Mrs X’s long-term needs unnecessarily. The Council understands that her family believe that this meant she missed her opportunity to return home to her flat, which was her wish. However, it cannot say this would have happened if it had completed the assessment sooner.
33. However, the Council has also accepted “we do know is that the longer a person spends in residential / nursing care, the harder it is for them to regain their independence sufficiently to be able to return home. As a local authority, we are very sorry for the delay in the assessment being carried out”.
34. In recognition of the fault caused by the Council’s maladministration, the Council has agreed to waive the costs for Mrs X’s stay at the temporary placement. This also means any payment that Mrs X or her family have made will be refunded to her.
35. The Council has also proposed to make a financial payment of £100 in recognition of the distress caused to Mrs X.
36. The Ombudsman usually recommends between £100 and £300, and sometimes can recommend higher where fault by Council’s has caused distress. The amount is dependent on the levels of distress and the vulnerability of the complainant.
37. In this case, the Council’s fault has caused Mrs X’s significant distress. The Councils actions meant Mrs X was unsure about her care and if she would ever be able to return home, which she had previously expressed was her wish. Therefore, I recommend the Council pay Mrs X a higher remedy for the distress caused.
38. The Councils actions also meant Mrs X’s family were uncertain about her care and spent significant time trying to resolve the issues with the Council.
39. The Council has also proposed to carry out the following service improvements

• Escalation of requests for Complaints Reviews to Senior Managers in both Health and Adult Services and Social Complaints.
• Remind Care and Support workers of the need for timely assessments for long term care following a person’s discharge from hospital, particularly where there is an expressed desire and expectation that they will return home.
• Ensure that Team Managers are aware of the need to reallocate cases in a timely way when workers are absent from work.
• Remind Care and Support workers of the need for regular and consistent communication with people and their families so they do not need to chase for information / updates.

40. It is my view that since the Ombudsman has started its investigation, the Council has been proactive in identifying fault and proposing suitable remedies to address the impact caused to Mrs X.

Back to top

Agreed action

41. Within 4 weeks of the final decision, the Council has agreed to

• Write to Mrs X and her representatives and apologise for the fault identified.
• Refund Mrs X any fees she may have paid for her temporary placement and waive any further fees.
• Pay Mrs X £250 in recognition of the distress caused.
• Pay Mrs X’s representatives £100 for the time and trouble taken to complain and for the poor communication about Mrs X’s care needs.

42. Within 12 weeks of the final decision, the Council should

• Review how it manages escalation requests for Complaints Reviews to Senior Managers in both Health and Adult Services and also Social Complaints.
• Remind Care and Support workers of the need for timely assessments for long term care following a person’s discharge from hospital, particularly where there is an expressed desire and expectation that they will return home.
• Ensure that Team Managers are aware of the need to reallocate cases in a timely way when workers are absent from work.
• Remind Care and Support workers of the need for regular and consistent communication with people and their families so they do not need to chase for information / updates.

Back to top

Final decision

43. I have now completed my investigation. I find fault with the Council for unreasonable delaying the assessment of Mrs X’s care needs. This meant she remained in a temporary placement for longer than necessary and incurred charged.

Back to top

Investigator's decision on behalf of the Ombudsman