Summary: The Council was at fault for delaying a review of Mrs B’s support. It has agreed to apologise to her daughter to recognise her injustice.

The complaint

1. The complainants, whom I refer to as Mr C and Ms D, complain about how the Council provided care and support to Ms D’s late mother, whom I refer to as
   Mrs B.
2. Mr C and Ms D complain that:
• After Mrs B’s condition deteriorated in December 2022, they contacted the Council to discuss her extra care needs. The Council did nothing about this for two months.
• Although they believed Mrs B needed residential care, they were ignored. Instead, the Council decided she could manage in sheltered accommodation.
• The move to the sheltered accommodation took too long – five months after their initial contact with the Council.
• In September 2023 Mrs B’s condition deteriorated again, and she could not get out of bed. They contacted the Council and asked it to review Mrs B’s support. They got no response, despite trying several times over the following week.
• Eventually, nine days after they had asked for the review, the social worker called them back. However, she had covid and could not start a reassessment for another ten days. There was no system to cover her work in her absence.
• In the meantime, Mrs B was left without television – her only real activity while she was bedridden – for ten days because staff at her sheltered accommodation did not arrange for it to be fixed.
• Mrs B also had problems getting answers to her bell on a specific day in late September. She had to wait a long time before anyone turned up to see her.
• The reassessment meeting was held in October. The meeting was not helpful, and the Council refused to move Mrs B into a nursing home.
• The Council also failed to order an ‘over bed’ table which had been agreed at the meeting to make Mrs B more comfortable.
3. Mr C and Ms D claim that the Council’s failings caused them, and Mrs B, distress.

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The Ombudsman’s role and powers

4. 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)
5. We consider whether there was fault in the way a council made its decision. If there was no fault in how the council made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
6. If we are satisfied with a council’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

7. I considered:
• Information from Mr C and Ms D.
• Information from the Council, including Mrs B’s case records.
• The ‘care and support statutory guidance’, which tells councils how to meet their duties under the Care Act 2014 (and which I refer to as ‘the statutory guidance’).
• The Ombudsman’s guidance on remedies.
8. Mr C, Ms D 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

The statutory guidance

9. A support plan review will help to identify if someone’s needs have changed and, if they have changed, the review can lead to a reassessment.
10. There are several different routes to reviewing a support plan, including a requested review (where the person or an interested party, such as a family member, asks for one). The Care Act places a duty on councils to consider such requests even if not made by the person themselves.
11. If a council receives such a request, it must judge the merits of conducting a review. In most cases, a review should be performed unless the council is reasonably satisfied that the plan remains sufficient, or the request is frivolous, or is based on inaccurate information.
12. In considering whether to undertake a review the council must involve the person, carer, and – where possible – anyone else the person wants to be involved.

What happened

13. In late 2022, Mrs B received a home care package. She had no issues with mental capacity and was able to make her own decisions about her care.
14. In December, Ms D spoke to the Council. She asked for a meeting the following month. She wanted Mrs B to move into sheltered accommodation.
15. The Council spoke to Mrs B’s carers, who said her care package was working well. They said she had refused previous referrals to sheltered accommodation.
16. The Council agreed to a meeting with Mrs B and Ms D in early January 2023. However, it then cancelled the meeting. The allocated worker was sick.
17. In mid-January, having not heard anything more, Ms D contacted the allocated worker again. She said she wanted to discuss Mrs B moving somewhere more suitable. She said she did not think sheltered accommodation would be suitable, but she was prepared to discuss ‘extra care’ sheltered accommodation.
18. Ms D received no response. The allocated worker was still off sick.
19. In late January, Ms D contacted a manager at the Council. She said Mrs B was not coping and needed an urgent reassessment. She asked for this to take place when she was next at Mrs B’s flat, in early February.
20. The manager told Ms D that she had been unable to reallocate Mrs B’s case because of a lack of staff. However, she said she would do so the following week.
21. In early February, Mrs B’s new worker visited her with Mr C and Ms D. The Council noted that:
• Mrs B had become increasingly frail and was unable to leave the flat in an emergency.
• She had also become very isolated.
• The new lift in her building was too small for a wheelchair, so she could not go out with her family.
• She felt that ‘extra care’ sheltered accommodation sounded suitable.
22. The Council completed a reassessment in mid-February and agreed to refer
    Mrs B to its ‘extra care’ panel.
23. In early March, the panel agreed that Mrs B should move into extra care sheltered accommodation. The Council referred her to a suitable setting, and she was placed on its waiting list.
24. The Council sought updates from the sheltered accommodation in March and April on Mrs B’s impending move. She moved there in early May.
25. In mid-September, Ms D asked the Council, again, to reassess Mrs B and move her to more suitable accommodation.
26. Shortly after this, Mrs B’s television stopped working. Her care records show that she did not watch television for nine days (at which point her aerial was fixed). She spent the time listening to music and the radio.
27. Nine days after Ms D contacted the Council, it called her and confirmed that it would reassess Mrs B’s needs. However, Ms D says this was not completed for more than another week because the allocated worker was off sick.
28. In late September, Mr C and Ms D say that – on a specific day – Mrs B could not get hold of staff and was left waiting for a long time. Her care records say she received nine visits from carers over the course of the day, between 06:50 and 23:50. At least one of these visits was in response to her pulling her cord.
29. In early October, the Council completed a reassessment visit to Mrs B. Its records say:
• Mrs B was bed-bound.
• Her GP had asked the Council to consider a nursing home placement.
• However, the Council did not feel she needed nursing care, and a move to a nursing home would not be in her interests.
• Ms D agreed that Mrs B did not need a nurse.
• Mrs B’s occupational therapist was “exploring appropriate options” for Mrs B, including a hoist and a speciality armchair.
30. Shortly after the visit, Ms D spoke to Mrs B’s occupational therapist, and said an ‘over bed’ table would be suitable for Mrs B as she could not reach the table at the side of her bed.
31. The therapist ordered the new table on the same day, and it was delivered to
    Mrs B the following day. The Council’s records say that Ms D was informed.
32. Mrs B died shortly afterwards.

My findings

First contact from Ms D

33. There was a delay when Ms D first contacted the Council about Mrs B’s increasing needs. She wanted a review of the provision available to Mrs B.
34. The Council has a duty to consider such requests, and there is a presumption that a review will take place unless there are specific reasons (as set out in the statutory guidance) why it should not.
35. The Council intended to conduct a review soon after hearing from Ms D. It agreed to visit Mrs B and it sought information from her carers. However, the allocated worker became sick and had to cancel the visit.
36. The worker was then off work for some time. This led to a two-month period during which Ms D was asking for the Council to consider whether Mrs B needed to move to more suitable accommodation, but it did not do so (until early February 2023).
37. Although I accept that the Council had no control over its allocated worker being off sick, this was, nonetheless, a delay. And it likely caused Ms D distress because she had to contact the Council about the review more than once. Her worry about Mrs B’s living arrangements was also extended unnecessarily.
38. The Council should apologise to Ms D.

Mrs B’s reassessment and move

39. I acknowledge that Mr C and Ms D are unhappy that Mrs B was moved into sheltered accommodation, not a nursing home.
40. However, the Council assessed Mrs B’s needs, took account of her preference – as she had the capacity to make decisions about her own care – and made a decision which, in light of the evidence available at the time, does not appear to have been obviously unreasonable. I have no power to question such a decision.
41. After first deciding sheltered accommodation was likely suitable for Mrs B and referring her to its extra care panel, it took the Council almost three months to move her into her new accommodation. This meant a total period of five months, from Ms D first raising concerns.
42. This does not appear to have been caused by any delay by the Council itself, and does, in fact, seem to have been a process of waiting for a space to become available.
43. Given Mrs B’s deteriorating health in what we now know was the final year of her life, five months was a long time for her to be in accommodation which, it appears, was unsuitable for her needs.
44. The Council’s view is that it could not have done more, quicker, to get Mrs B into her new accommodation. Having considered Mrs B’s case records, I have decided this view is not unreasonable.
45. The Council quickly identified the accommodation and chased this up twice when it was not made aware of any developments. It did take a while to move Mrs B. But, on balance, my view is that the Council did as much as could have reasonably been expected, and therefore was not at fault.

September 2023 onwards

46. Although Mr C and Ms D say they tried get hold of the Council several times in early September, there is no evidence of this.
47. However, there was a wait of just over a week between Ms D asking for a review and anybody contacting her about it. It was then just over another week before the Council did its reassessment visit.
48. Although the Council could probably have kept Mr C and Ms D updated about its intention to reassess Mrs B earlier, this was not a significant delay and therefore does not amount to fault by the Council.
49. On the day Mr C and Ms D say Mrs B had difficulty getting support from staff at her sheltered accommodation, she was visited nine times, with at least one of those (and, more likely, two) being in response to her pulling her cord.
50. With this in mind, the evidence does not show that Mrs B had to wait an unreasonable amount of time in her room without support.
51. There is also no convincing evidence that Mrs B suffered a significant injustice from being without her television (although I am satisfied, from the case records, that she was likely without it for around nine days).
52. Mrs B listened to the radio and to music in the meantime, and there is no implication that she was in any kind of distress. For these reasons, her injustice was not significant enough to justify further comment.
53. Although Mr C and Ms D were unhappy with the outcome of the reassessment visit, I have no reason to question the Council’s view that a nursing home would have been unsuitable for Mrs B. Ms D herself agreed that Mrs B did not need nursing care at that point.
54. Furthermore, the Council provided the new ‘over bed’ table for Mrs B within three days of agreeing to it.
55. Consequently, I have found no other fault in how the Council dealt with Mrs B’s case.

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Agreed action

56. Within a month, the Council has agreed to write to Ms D and apologise for the distress she likely experienced from having to contact the Council several times in December 2022 and January 2023 to request a review of Mrs B’s support.
57. The Council will provide us with evidence it has done this.

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Final decision

58. The Council was at fault for a delay in reviewing Mrs B’s support.

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Investigator's decision on behalf of the Ombudsman