Summary: Mr X complained the Council refused to fund the additional care required to meet Mr Y’s needs. This led to the placement giving notice while Mr Y was in hospital and meant he was unable to return to the care home when discharged from hospital. There is no evidence of fault in the way the Council considered the requests for additional support and the Council was not at fault for the termination of Mr Y’s placement.

The complaint

1. The complainant, whom I shall refer to as Mr X complained that despite being aware of his brother, Mr Y’s worsening condition the Council refused to fund the additional care required to meet his needs. This led to the placement giving notice while Mr Y was in hospital so that care staff were unable to support him and meant he was unable to return to the care home when discharged from hospital.

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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. As part of the investigation, I have:
• considered the complaint and the documents provided by Mr X;
• made enquiries of the Council and considered the comments and documents the Council provided;
• Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

5. Mr Y had lived at Placement A since 2000. He had a package of care of 6 hours one to one support each day to support him in the community and 8 hours of shared support each day with shared waking support overnight.
6. In 2022 Mr Y’s health declined and his mobility deteriorated. In July 2022 the care provider at Placement A suggested a reassessment of Mr Y’s needs as he now required two members of staff for all transfers and care. The care provider said Mr Y was not weight bearing and required a hoist for all transfers. The Council asked the care provider for detail of Mr Y’s care and to confirm how many of the one to one support hours for access to the community Mr Y was currently using.
7. A review was arranged for early September 2022. Shortly after this review the care provider informed Mr Y’s family that another care provider would be taking over management of Placement 1.
8. The new care provider contacted the Council to request an increase in Mr Y’s care package. In addition to the existing package, the new provider asked the Council to provide a further 14 hours one to one support each day and 10 hours one to one support each night.
9. The Council asked the new care provider for more information regarding this increased care so that Practice Review Group (PRG) panel could consider this. The care provider advised Mr Y needed one to one support all of the time due to being epileptic. The Council questioned why Mr Y would still need shared hours if he had 14 hours one to one support and six hours two to one support. It also noted that Mr Y had been seizure free for a number of years and that his epilepsy was well managed by medication. It asked the care provider to explain the need for shared hours and 14 hours one to one support.
10. In October 2022 the PRG rejected the request for increased hours as Mr Y’s increased needs appeared to be health related and a Continuing Healthcare (CHC) checklist had been completed for consideration by the NHS. The panel also asked for a breakdown of the hours of support Mr Y needed.
11. The Council again asked the care provider to provide additional information regarding how Mr Y’s needs were being met in order to take the case back to the PRG panel. The care provider confirmed it needed two to one care 24 hours a day as it needed two people to change Mr Y’s pad at all times and for hoisting. The Council then resubmitted the CHC checklist for assessment.
12. Mr Y was admitted to hospital in October 2022 and again in early November 2022. The care provider told the Council Mr Y’s needs were now more nursing and it may be necessary to consider a nursing placement. Placement 1 was a supported living placement and was not registered to meet nursing needs.
13. The Council discussed Mr Y’s placement with the care provider then wrote to Mr X to explain that as the care provider does not meet nursing needs they would need to start looking for an alternative placement for Mr Y. Mr X asked that the Council urgently consider placements in the London area.
14. Mr X also contacted the care provider and then made a formal complaint to the Council. He noted there has been a longstanding disagreement between the Council and the previous care provider about additional funding to meet Mr Y’s needs. Mr X said to the new care provider had reported the same issue and had ruled out caring for Mr Y in these circumstances. Mr X wanted Mr Y to remain at placement 1 and receive proper funding for the double handed care now required.
15. A review meeting was arranged to discuss Mr Y’s current needs and to decide whether it was in Mr Y’s best interests to remain at Placement 1 or move to an alternative placement.
16. On 29 December 2022 Mr Y was admitted to hospital. The care provider told the Council it would provide Mr Y’s one to one support during the day but would not provide night staff. Mr Y was sleeping through the night, and hospital staff would support him.
17. The Council responded to Mr X’s complaint on 4 January 2023. The Council noted Mr Y’s social worker had apologised for informing them of what could be a major changed in Mr Y’s life by email and accepted it would have been better to inform them by telephone.
18. They noted the care provider had advised Mr Y’s needs had changed but this did not mean they were giving notice for Mr Y to leave the placement. A meeting had been arranged to discuss Mr Y’s needs and his best interests. The Council also noted the family’s preference was for Mr Y to remain at Placement 1 but that they would not insist on this if his needs could not be met there.
19. The Council explained the care provider was clear that Placement 1 was not registered to met nursing needs and would not be registered for this purpose. Should the care provider feel Mr Y’s needs are above what it can deliver the Council would seek alternative accommodation for Mr Y.
20. In relation to a longstanding disagreement between the Council and the previous provider the Council advised this was an issue brought and managed by Placement 1’s local council. It involved many local and placing authorities and the Council was asked to take part in the enquiries.
21. The Council confirmed it would continue to work with Mr X and Mr Y whatever the outcome of the upcoming meeting.
22. The records of the review meeting note that three members of staff at Placement 1 had tested positive to COVID 19 so staff were not currently supporting Mr Y during the day at hospital. The care provider said Placement 1 does not have the right skills to meet Mr Y’s current needs and was liaising with medical professionals. Mr X did not attend the review meeting, but Ms Z, his sister attended. The notes state the hospital had told Ms Z that Mr Y was fit for discharge. Ms Z did not want Mr Y to be discharged to Placement 1 given the COVID 19 cases there and felt he would be safer in hospital with trained staff to meet his nursing needs.
23. The meeting outcomes and proposals included:
• Placement 1 was no longer a suitable placement for Mr Y. His health needs had changed and staff did not have the skills and knowledge to support him safely.
• The care provider is not registered to provide nursing care and would not be able to meet Mr Y’s needs. They were not therefore prepared to take Mr Y back but would support him in hospital.
• A placement search would begin. The family would like a placement near London so they are able to visit
• Mr Y’s package of care would be reviewed to consider the support care provider had been providing at placement and support at hospital.
24. On 9 January 2023 the care provider wrote to the Council advising that given the increase in Mr Y’s needs it was unable to accept him back at Placement 1. It gave formal notice to end Mr Y’s placement with immediate effect. It would also end its support at the hospital with immediate effect. Mr Y moved to another hospital on 13 January 2023.
25. The Council identified possible nursing placements which Mr Y’s family considered. Not all placements had a nursing bed available and the family did not consider some placements acceptable based on reviews of their service. As Mr Y was fit to be discharged the hospital asked for him to move to a temporary placement while a long term placement was identified. Mr Y’s family were reluctant to move Mr Y to a temporary placement as this would cause Mr X further unnecessary stress.
26. The Council identified an alternative placement, Placement 2 in February 2023 which Mr Y’s family were happy with. Mr Y was discharged from hospital to Placement 2 on 15 March 2023. Unfortunately Mr X was re-admitted to hospital later that day. Mr X asked for a member of staff from Placement 2 to support Mr Y while he was in hospital. Staff from Placement 2 visited Mr Y in hospital but did not stay to provide one to one support. Mr Y was discharged from hospital to Placement 2 on 30 March 2023.
27. Mr X remains unhappy with the Council’s actions and has asked the Ombudsman to investigate his complaint. In response to my enquiries the Council says the care provider kept it up to date with the deterioration in Mr Y’s health. It says it was working closely with the care provider to put in place a package of care that met Mr Y’s changing health needs. It notes that the 6 hours one to one support to access the community was not being utilised due to the deterioration in Mr Y’s mobility. At that time it was also contacted by Placement 1’s local council regarding an investigation it was conducting.
28. The Council states it did not refuse to increase Mr Y’s care package but wanted the care provider to give a breakdown of how the requested additional 14 hours would be used. The Council says it was waiting for a response from the care provider when Mr Y was admitted to hospital.
29. In relation to one to one support in the hospital the Council says this was met by the provider until they served notice ending the contract with immediate effect. The care provider offered to support Mr Y in hospital under a new contract but there was an outbreak of COVID 19 at Placement 1 which meant there was a shortage of staff at Placement 1 it was not safe for staff to go into the hospital to support Mr Y.
30. The Council states while Mr Y was in hospital the hospital staff were supporting his needs and if there had been a need for extra one to one support the hospital would have reported this.

Analysis

31. It is unfortunate that Mr Y could not remain at Placement 1, where he had been settled for many years, but there is no evidence this is due to fault by the Council.
32. There is no dispute that Mr Y’s needs changed in 2022 and he needed additional support, including nursing support. The Council held a review meeting and considered the care provider’s request for increased support. The care providers requested a significant increase in support hours and it was appropriate for the Council to seek a breakdown of how these hours would be used. The care providers provided some information regarding the need for the increased hours but had not responded to all of the Council’s queries when Mr Y was admitted to hospital.
33. The records suggest the care provider was providing the additional support Mr Y needed even though this had not yet been agreed with the Council. There is no suggestion Mr Y was not receiving appropriate support. Payment for any additional support provided is a matter between the Council and the care provider.
34. The care provider’s decision to give notice to end Mr Y’s placement is based on Mr Y’s need for medical support, which Placement 1 was unable to provide. It is a supported living placement and is not registered to provide nursing care.
35. The Council took appropriate steps to identify an alternative placement Mr Y’s family were happy with. Mr Y has now moved toa nursing home.
36. I recognise that Mr X wanted Mr Y to continue to receive one to one support while in hospital and note that this was in place until 10 January 2023. But I do not consider the failure to identify an alternative provider after 10 January 2023 is fault. While in hospital Mr Y’s needs would have been met by the hospital staff.

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Final decision

37. There is no evidence of fault in the way the Council considered the requests for additional support and the Council was not at fault for the termination of Mr Y’s placement.

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Investigator's decision on behalf of the Ombudsman