Summary: There was a delay in the Council’s reassessment of Mrs B’s needs following a change in her circumstances. Mx B raised a safeguarding concern as a result. The Council undertook a reassessment and additional care was put in place to meet Mrs B’s increased needs. The Council will now recognise the difficulties which were caused for Mrs B and her family by the delay.

The complaint

1. Mx B (as I shall call him) complains on behalf of his mother Mrs B that the Council delayed in putting in additional care for Mrs B although she was increasingly at risk alone at home.

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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

4. I considered the information provided by Mx B and by the Council. I have not viewed the records from the care provider as Mx B has requested they do not share their records with us. Both parties had the opportunity to comment on a draft statement before I reached a final decision.

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What I found

Relevant law and guidance

5. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
6. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one
7. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. 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)

What happened

8. Mrs B has dementia. She lives with her daughter (Ms B) who has provided significant amounts of care and support; her two sons (including Mx B) provide informal support and monitor her care.
9. The Council reviewed Mrs B’s needs in November 2021 when her daughter was still working from home. The support plan produced says Mrs B would continue to receive support from her daughter.
10. Once Ms B returned to work full time, she left the house at 08.30 and Mrs B was largely alone until her carers arrived to assist with personal care at lunchtime (carers also provided a bedtime call). There was also a befriender service in place two days a week for an hour for which the family was paying privately.
11. Mx B says he contacted the Council in December 2021 for an urgent assessment of Mrs B’s needs. He said his mother was wandering out of the house when no-one was there, was unable to distinguish risk, and would not eat if left alone. In addition he said the commissioned carers did not always attend. The Council’s records show sporadic contact between Mx B and the Council over the next few months, principally about the contribution Mrs B was assessed to make but also, in and after June 2022, about her need for more care. Mx B said he could not understand why the Council had taken no action since December 2021.
12. In August 2022 the Council undertook an unscheduled review of Mrs B’s needs following a further safeguarding concern raised by the befriender who said Mrs B needed more care than was in place. Mrs B’s GP also raised a safeguarding alert on 3 August. Mx B told the Council Mrs B’s condition had deteriorated so she was trying to climb over the wall, was at risk of self-harm, putting the electric kettle to heat on the cooker and so on. He said he had been reporting his mother’s advanced dementia to the Council since the previous December but without extra support. The safeguarding document notes, “Email sent to son and befriender to advise review has now been allocated and safeguarding referral will be recommended for closure. Safeguarding concern is recommended for closure as review has been allocated to Assessment Team SW for urgent review.”
13. The review of Mrs B’s needs identified gaps in provision as she was left alone between 12- 2pm after her sons had left, and 3-5pm after the carers had left. It was agreed the care agency should combine a personal care and sitting service from 12-2pm; the befriender’s visits would increase to 4 times a week for two hours in the afternoon between 2.30 and 4.30pm. The family support would continue outside the funded hours. There would also be a referral to consider whether improved assistive technology would be available.
14. Mx B made a formal complaint to the Council in November 2022 that it had failed to comply with its Care Act duties in respect of his mother for over eight months and had delayed again following the review.
15. The Council responded in December. It apologised for the poor service Mrs B had received and acknowledged there had been delays in providing a responsive service. It noted the actions which had been taken following the unscheduled review and said a one-off direct payment had also been made to Mx B as an informal carer.
16. Mx B remained unhappy and complained to the Ombudsman. In addition to the complaints, he raised with the Council he reiterated a complaint made during the safeguarding investigations, that carers from the care agency were not always attending as planned.
17. The Council says the issue in respect of carers not attending was resolved during the safeguarding investigation. There had been an unwarranted gap while the main carer was away but that had been rectified on her return.
18. The Council also says, “Between December 2021 and August 2022 (Mrs B) had indicated that she had a long-term care package, which consists of daily one-hour visits from carers, seven days a week. It was arranged to be used flexibly during lunch time Monday to Friday or Monday to Saturday as required, as her adult children were supporting her over the weekend. (Mrs B’s) daughter … was also living in the property owned by (Mrs B), and she was supporting with shopping, meals, medication and housework tasks.”

Analysis

19. Mrs B’s situation changed after December 2021 when Ms B returned to working outside the home and was no longer available to support Mrs B during the day. Although Mx B and his brother monitored what was happening during the mornings there were times when Mrs B was left alone and at risk, because of her increased needs.
20. The Council acknowledges there was a delay in providing a “responsive” service to the requests for increased care. The review in August 2022 enabled a more comprehensive service to be put in place to avoid Mrs B being left alone for long periods.
21. However, there was a period of some months when Mrs B was increasingly at risk from isolation, wandering and the inability to look after herself when carers or her children were not present. Once that was reported to the Council it was fault, as it has recognised, not to respond sooner. It should not have reached the point when the family, the befriender and the GP were all raising safeguarding concerns. In addition Mrs B’s family paid privately for the befriender service while they were waiting for the Council to respond.

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Agreed action

22. Within one month of my final decision the Council will pay £500 to Mrs B in recognition of the delay in responding to her increased need and the payments made privately for her care.
23. The Council should provide us with evidence it has complied with the above actions.

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Final decision

24. I have completed the investigation on the basis there was fault on the part of the Council which caused injustice. Completion of the recommendation at paragraph 22 will remedy that injustice.

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Investigator's decision on behalf of the Ombudsman