London Borough of Tower Hamlets (23 008 593)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 28 Mar 2024

The Ombudsman's final decision:

Summary: Mr X complains the Council unfairly reduced Mrs Y’s care hours, leaving her health and wellbeing at risk. The Ombudsman intends to find fault with the Council for failing to carry out a review of Mrs Y’s care and for how it communicated with Mr X about her care. The Ombudsman finds fault with the Council for failing to review Mrs Y’s care and tell Mr X of the change in care. The Ombudsman does not find fault with the Council for how it initially assessed Mrs Y’s care needs or arranged her care. The Council has agreed to apologise and pay a financial remedy for the distress caused.

The complaint

  1. Mr X complains the Council reduced his mother, Mrs Y’s care and support without reason, and without involving him in the decisions.
  2. Mr X complains the Council unfairly reduced the care from care staff, which meant Mrs Y did not receive the double handed care she was supposed to receive.
  3. Mr X says this led to Mrs Y’s health and wellbeing being at risk.
  4. Mr X complains the Council and the care provider working on its behalf has failed to understand the impact to Mrs Y.

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The Ombudsman’s role and powers

  1. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
  2. We consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), 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

  1. I considered Mr X’s complaint to the Council and information he provided. I also considered information from the Council.
  2. I invited Mr X and the Council to comment on my draft decision and considered any comments received.

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What I found

Legislation and guidance

  1. The Care Act 2014 (the Act) is the legislation that sets out local authorities’ powers and duties in respect of adult social care services.
  2. Sections 9 and 10 of the Act 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.
  3. Where councils have determined that a person has any eligible needs, they must meet those needs. The person’s needs and how they will be met must be set out in a care and support plan. The plan should be proportionate to the needs to be met and should reflect the persons wishes, preferences and aspirations.
  4. The Care Act spells out the duty to meet eligible needs (needs which meet the eligibility criteria). (Care Act 2014, section 18)
  5. The Care Act explains the different ways a council can meet eligible needs by giving examples of services that may be provided:
  • Accommodation in a care home or other premises
  • Care and support at home
  • Counselling and social work
  • Information advice and advocacy (Care Act 2014, section 8)

Reviews

  1. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

What happened

  1. Mrs Y was discharged from hospital with discharge to assess support plan on 8th June 2023. The discharge to assess plan from the hospital would provide services from the NHS for four weeks until the Council had arranged to assess Mrs Y and provide an integrated care and support plan.
  2. The discharge to assess support plan said Mrs Y would return home and receive visits four times a day, with two carers each time, providing double handed care. Each session was to be one hour long, totalling 56 hours a week.
  3. The Council arranged for a care agency to deliver the agreed care to Mrs Y while it assessed her.
  4. The Council carried out an assessment of Mrs Y’s care needs. It looked at the support agreed in the discharge to assess support plan to see if the support agreed was still needed.
  5. The Council carried out visits to Mrs Y as part of its assessment of her needs. In the final care and support plan, the Council decided that based on its assessment, Mrs Y did not need both carers to stay for one hour during each session. The Council said this was because not every task needed double handed care, and care tasks such as feeding Mrs Y did not need both carers to be present. The final support plan reduced some of the sessions for the second carer.
  6. The Council issued the care plan on 14th July 2023 with the reduced care and additional occupational therapy (OT) equipment. The Council told Mr X of the changes to the care plan on 19th July 2023 and told Mr X the Council would review the plan when the OT equipment was in place.
  7. The care agency delivering care wrote to the Council in on 20th July 2023 asking for the previous support to be reinstated. It said carers needed extra time with Mrs Y to meet her needs. Mr X also asked the Council to reinstate the previous care.
  8. The Council reviewed the care notes from staff and said it did not have reason to believe Mrs Y needed further support. The Council recorded that the care logs from staff contained entries for basic, single-handed tasks and decided that based on the evidence, there was no rationale to increase the care package.
  9. Mr X complained to the Council in August 2023 that it had unfairly cut his mother’s care and had not told him of this.
  10. The Council wrote to Mr X in August 2023. In its response it upheld that it had not told Mr X of the change in care and said that it had since received further concerns from the care agency, and so would increase the care slightly while it carried out a risk assessment. The Council also said it would also arrange a review of Mrs Y’s care.
  11. The Council held a multi-disciplinary meeting in October 2023 to discuss concerns that Mrs Y’s skin maintenance was not being met. Professionals agreed for more information to be shared with the family to prevent risks, and for the occupational therapy service to provide further aids and consider an assessment.
  12. Mr X remained unhappy and bought his complaint to the Ombudsman.
  13. Mrs Y was readmitted to hospital in November 2023 and later died.

Analysis

Care assessment

  1. It is not the Ombudsman’s role to make decisions on what care and support is suitable, or how this should best be delivered. Instead, we investigate how the Council has gathered and considered the relevant information and if it has adhered to the relevant law and guidance when making its decisions.
  2. The care needs assessment and support plan I have seen consider Mrs Y’s needs and what support she was receiving. I find no fault with how the Council assessed Mrs Y’s care needs or how it decided what support was needed.
  3. Based on the information available to it, the Council decided to arrange support for Mrs Y through care services. I do not find fault with the steps the Council took to secure the support set out in Mrs Y’s plan. The Council has a duty to meet Mrs Y’s eligible unmet needs as set out in Section 18 of the Care Act 2014.
  4. Mr X expressed dissatisfaction that the Council chose not keep the previous package of support in place and said the Council was placing his mother at risk. The Council disagrees with this. I have not seen sufficient evidence to conclude the information the Council relied on was wrong. Based on the evidence I have seen, the Council correctly consulted with the relevant parties to consider Mrs Y’s care needs. It followed the right process in deciding what was a suitable package of care for her. I do not find the Council at fault for this part of the complaint.

Care review

  1. Councils should carry out light touch reviews within six to eight weeks of a new care and support plan being issued. In the care and support plan, the Council said Mrs Y needed equipment in the home to meet her needs and reduced her care package. The Council then said it would carry out the review when the equipment was in place. However, Mr X later denied for the equipment to be installed and the Council said further support was to be arranged via the OT service after an OT assessment.
  2. The Council should have carried out a review between six to eight weeks after issuing the care and support plan. The care and support plan was new and provided different support to that of the discharge to assess plan. I appreciate there were some barriers to the review being carried out, however the Council could have recorded this in the review.
  3. Instead, the Council appears to have kept the case under informal review, but not carried out an actual review. In July 2023, it considered the concerns raised by care staff and Mr X, and the evidence provided by the care staff and decided the support was suitable.
  4. Following Mr X’s complaint, the Council recognised Mrs Y was having further difficulties and agreed to increase her care while it carried out a further risk assessment and a review.
  5. Following from the risk assessment, the Council held a multidisciplinary meeting in October 2023 which identified further advice to be given to the family and further actions for the Occupational therapy team to complete. This was a further opportunity for the Council to review Mrs Y’s care, but it did not do so.
  6. There was fault by the Council in not carrying out the review, and for raising Mr X’s expectations by repeatedly telling him it would carry it out.
  7. However, there is limited injustice caused to Mrs Y by this fault. This is because despite not carrying out a formal review, the Council monitored Mrs Y’s care and changed the support for Mrs Y temporarily to meet her needs while it investigated further.
  8. We cannot say that if the Council had reviewed Mrs Y’s care, it would have reinstated the previous package. It was for the Council to decide what care would best meet Mrs Y’s needs, and it may have decided the reduced package could meet her needs. However, I accept there was uncertainty which caused Mr X distress and raised his expectations.

Further findings

  1. Part of Mr X’s complaint is the Council failed to tell him of the change to Mrs Y’s care. The Council did not tell Mr X of the changes to Mrs Y’s care for five days after the decision was made. The Council has already accepted that it should have told Mr X of the change in care for Mrs Y and apologised for this during its complaints process. I find this to be the most suitable remedy for the injustice caused for this part of the complaint.

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Agreed actions

  1. Within four weeks the Council has agreed to:
  • Apologise to Mr X for failing to carry out a review of his mother’s care.
  • Pay Mr X £100 for the uncertainty and distress caused by failing to review his mother’s care.

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Final decision

  1. I have completed my investigation. I find fault with the Council for failing to tell Mr X about the change in Mrs Y’s care, and for failing to carry out a review of Mrs Y’s care. I do not intend to find fault with the Council for how it assessed Mrs Y’s care needs and arranged her care.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman

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