Summary: Mrs X complained about the Council commissioned care package her mother, Mrs Y, received after discharge from an intermediate care facility. There were faults in the information the Council provided when commissioning the care package and care workers were unable to use the equipment. There were also faults in the way the Council and the Trust responded to the complaint. The Council and Trust have agreed to apologise and makes payments to Mrs X and Mrs Y to acknowledge the distress, frustration and uncertainty they were caused by the faults with the care arrangements. The Council has already made a symbolic payment to remedy the impact of its complaint handling faults. The Trust and Council has agreed to provide evidence of the action taken to improve joint complaint handling and discharge arrangements.

The complaint

1. Mrs X complained about the Council commissioned care package her mother, Mrs Y received after a stay in an intermediate care facility, Ascot House. Specifically, Mrs X complained:
1. A longer term care solution was not explored with the family when she was discharged, which was only focused on quick release. A longer term option may have been cheaper and better for her mother.
2. The Council and intermediate care facility Ascot House failed to share appropriate information about Mrs Y’s health conditions and medication with the care provider, Delta Care.
3. The care workers were not properly trained to use the equipment Ascot House provided to Mrs Y.
4. The Council took too long to complete a safeguarding investigation and did not communicate effectively during the process.
5. The Council delayed completing a needs assessment.
6. There was a delay in Mrs Y receiving a Continuing Healthcare (CHC) assessment.
7. Communication between Ascot House’s therapy team and the care provider Delta Care was poor and caused issues in Mrs Y’s care.
8. The Council failed to deal with her complaint in a timely manner and failed to involve the Manchester University NHS Foundation Trust (the Trust) to provide a coordinated response, addressing all her concerns.
2. Mrs X says Mrs Y was injured when trying to use equipment because the care workers did not know how to use it. Mrs X says this had an impact on her mother’s long-term health and left her immobile. It took eight months for an assessment because her mother had savings, but it should have happened straight away and she would not have incurred so many care home fees. This caused them both distress and frustration.
3. Mrs X wants a formal acknowledgement of the failings and for processes to be reviewed to prevent a recurrence of the faults. She wants an acknowledgement of the impact the failings had on Mrs Y.

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The Ombudsmen’s role and powers

4. The Local Government and Social Care Ombudsman and Health Service Ombudsman have the power to jointly consider complaints about health and social care. (Local Government Act 1974, section 33ZA, as amended, and Health Service Commissioners Act 1993, section 18ZA). The Local Government and Social Care Ombudsman investigates complaints about adult social care providers. (Local Government Act 1974, sections 34B, and 34C, as amended). The Health Service Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’ in the delivery of health services (Health Service Commissioners Act 1993, section 3(1)).
5. We investigate complaints about ‘maladministration’ and ‘service failure’. We use the word ‘fault’ to refer to these. If there has been fault, we consider whether it has caused injustice or hardship (Health Service Commissioners Act 1993, section 3(1) and Local Government Act 1974, sections 26(1) and 26A(1), as amended).
6. If it has, they may suggest a remedy. Our recommendations might include asking the organisation to apologise or to pay a financial remedy, for example, for inconvenience or worry caused.  We might also recommend the organisation takes action to stop the same mistakes happening again.
7. If there was no fault in how an organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended, and Health Service Commissioners Act 1993, sections 3(4)- 3(7))
8. When investigating complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that during an investigation, we will weigh up the available evidence and base our findings on what we think was more likely to have happened. 
9. If the Ombudsmen are satisfied with the actions or proposed actions of the bodies that are the subject of the complaint, they can complete their investigation and issue a decision statement. (Health Service Commissioners Act 1993, section 18ZA and Local Government Act 1974, section 30(1B) and 34H(i), as amended

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How I considered this complaint

10. I considered evidence provided by Mrs X and the Council, the Trust, Ascot House and Delta Care (the care provider) as well as relevant law, policy and guidance.
11. Mrs X, the Council, the care provider and the Trust had the opportunity to comment on a draft of this decision. I considered any comments before making a final decision.

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What I found

Relevant legislation and guidance

Hospital discharge and reablement

12. Department of Health and Social Care issued statutory guidance: Hospital discharge and community support guidance (the National Discharge Guidance) in April 2022 (updated January 2024). This provides guidance to NHS bodies and local authorities on discharging adults from hospital. It said local areas should adopt discharge processes that best meet the needs of the local population. This could include the ‘discharge to assess, home first’ approach.
13. The terms ‘reablement’, ‘rehabilitation’ and ‘intermediate care’ are sometimes used interchangeably. NICE Quality Standard Intermediate care including reablement published in 2018 sets out four types of intermediate care:

• bed-based intermediate care – services delivered away from home, for example, in a community hospital
• crisis response – services providing short-term care (up to 48 hours)
• home-based intermediate care – services provided to people in their own homes by a team with different specialities but mainly health professionals such as nurses and therapists
• reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.

Needs assessment

14. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment of any adult who appears to need care and support. They must assess anyone, regardless of their finances or whether the council thinks they have eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the outcomes they want to achieve. It must involve the individual and where appropriate their carer or any other person they might want to be involved.
15. An assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs. Councils should let the individual know of the proposed timescale for when their assessment will be conducted and keep the person informed throughout the assessment process.

Continuing health care

16. CHC is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. The first step in assessment is for a health or social care professional to complete a CHC Checklist. The threshold for meeting the CHC Checklist is set low.
17. If the completed CHC Checklist indicates the person may be eligible for CHC, the next step is a full multidisciplinary assessment. This assessment is completed using a decision support tool (DST). The DST is a record of the relevant evidence and decision-making. The DST should be completed within 28 days of the CHC Checklist unless there are ‘valid and unavoidable’ reasons for it taking longer.
18. The DST makes a recommendation about whether a person is eligible for CHC or for NHS-funded nursing care, which is set at a weekly rate. The relevant ICB will then make a final decision which must uphold the recommendation of the DST in all but exceptional circumstances.

Complaint handling

19. Under The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (the ‘Complaints Regulations’) there is a duty to investigate complaints properly and in a way that will resolve them efficiently. There is also a duty to cooperate when a complaint is made to one organisation and contains material relevant to the other.
20. The Complaints Regulations say that the organisations must “co-operate for the purpose of (a) coordinating the handling of the complaint; and (b) ensuring that the complainant receives a coordinated response to the complaint.” This involves a duty on each of them to agree who should take the lead in coordinating the handling of the complaint and communicating with the complainant. They must both provide each other with relevant information if so requested by the other and must attend, or ensure they are represented at any meeting held about the complaint.

What happened

21. Mrs Y lived at home with one of her daughters and son in law Mr and Mrs Z. She previously had a stroke which resulted in right hand side weakness. Mrs Y was unable to walk and used a wheelchair to move around. Mrs Y could make her own decisions, but the stroke impacted her speech. She went into hospital in July 2022 after falling and breaking her arm when her legs gave way. In Summer 2022 Mrs Y moved to an intermediate care facility, Ascot House, for rehabilitation. The referral said Mrs Y had difficulty with transfers due to weakness again on the left leg. The aim for her stay at Ascot House was to reduce her need for help when transferring so she could safely return home.

Care at Ascot House

22. Mrs Y’s notes from Ascot House state:
• On 9 August 2022 a Physiotherapist carried out an initial assessment. They recommended Mrs Y use a ross return (a transfer aid) to transfer from bed to chair/commode. They noted Mrs Y was ‘only able to use her left arm. Some control in stand-sit chair, loses control and plonks down last few inches of sitting’.
• On 11 August the notes record the physiotherapist practised transfers with Mrs Y. They trialled using the ross return with a belt (which is used with the ross return to provide greater support and stability where the user’s ability to support their own weight is variable). They noted Mrs Y was ‘able to take pressure from her left arm while being transferred from wheelchair to chair, also helped prevent [Mrs Y] just dropping into the chair when being transferred’.
• An Occupational Therapist (OT) assessed Mrs Y on 12 August 2022 as needing support from two people with washing and dressing and bathing using a ross return for transfers. On the same date the physiotherapist practiced using the ross return and belt with Mrs Y. They noted Mrs Y ‘was not pulling up with her arm and was expecting to be lifted’.
• On 17 August the notes record Mrs Y practised going from sitting to standing five times using the ross return and belt. Mrs Y reported ‘her pain was okay but her right knee was tender’. The notes record Mrs Y was ‘unable to fully extend knees so tended to sit back down unless encouraged’.
• On 22 August the notes record ‘staff reported [Mrs Y] was struggling with transfers and declined sit stand practice. They noted her right knee remained painful when extending it’.
• On 24 August the notes record ‘two carers stated they were struggling with patient using the ross return. On initial stand managed to pull herself up however quickly dropped to seated position. Second stand able to hold stance with slight hands on assistance. Raised bed for assistance and ross belt. Third stand went well and with assistance of two, completed transfers.’
• Mrs Y managed transfers well the following day.
23. On 30 August the physiotherapist and OT completed a report (the activities of daily living report) which summarised the support Mrs Y would need when she went home. This noted Mrs Y required a wheelchair to move around and the use of the ross return and belt with help from two people to transfer from the bed to a chair/commode. It said Mrs Y required the assistance of one with medication management. It gave this to the Council. Ascot House contacted Mr Z and explained Mrs Y’s discharge home would be arranged by social care.
24. The social worker spoke to Mrs X to discuss Mrs Y’s discharge plans. They explained they could put a stabilise and make safe (SAMS) reablement care package in place with two care workers visiting four times a day. This is a package of short term intensive support for up to three weeks, without charge, to help and encourage people to regain their independence and to support them to remain at home. The social worker noted Mrs X felt this would be the best option for Mrs Y. The social worker said Mrs Y would be reviewed after two weeks to establish Mrs Y’s long-term needs.
25. The social worker completed a SAMS request in early September 2022. This said Mrs Y needed support with personal care, dressing, toileting, meal preparation and medication. It said she required assistance from two people with transfers using a ross return.
26. A care provider, Delta Care, agreed to pick up the care package. The SAMS request made no reference to the use of a belt with a ross return, to Mrs Y’s right hand side weakness or to Mrs Y’s speech difficulties.
27. The social worker explained to Mrs X that as this was a reablement package the times of visits could change. They could give specific times for a long-term package but that would be chargeable right away. They explained visits would last as long as needed to complete all necessary tasks. The SAMS package would not be chargeable for three weeks after this, depending on the outcome, Mrs Y would be financially assessed.
28. The family met with the social worker on 9 September to discuss Mrs Y’s discharge. The social worker noted Mrs Y and the family were happy for the discharge to go ahead with Delta Care. They arranged to discharge Mrs Y home on 15 September. Ascot House’s notes record on the day of discharge Mrs Y was ‘very poor on standing using the belt and ross return with the assistance of two. Able to step to side with ross and into wheelchair’.

Mrs Y’s return home

29. The physiotherapist and OT carried out a home visit when Mrs Y went home on 15 September. They noted ‘transfers were a little more difficult on discharge than normal and [Mrs Y] was not assisting with standing as much as normal’. Later the same day, Mr Z called the social worker to tell them the care workers had been but they did not know how to use the ross return. They did not know which way the belt should go and Mrs Y was now refusing to use the ross return with the care workers. Delta Care’s notes record Mrs Y’s ‘belt slipped a bit when they were lifting her up so she sat down and now is refusing to get up and let the care workers help her’.
30. The social worker contacted Delta Care. The social worker noted Delta Care said it had spoken to the care workers who did not tighten the belt enough when using the ross return so Mrs Y slipped and Mrs Y now did not feel confident using it with those specific carers. It said the care workers were fully trained in using the ross return and it believed it was ‘teething problems using the ross return as staff at Ascot House may have done it in a different way’.
31. The social worker spoke to their manager who advised they could not change care providers immediately. The social worker spoke to Mr Z who told them he had found a private provider who could start immediately if the Council would pay its rate and the family would top up. The social worker explained this was not possible and that Mrs Y could make her own decisions and if she refused support from the care workers the Council had to accept her decision.
32. The social worker spoke to Mrs X. They explained the family could pay a private provider over the weekend at Mrs Y’s cost. Mrs X went to visit Mrs Y.
33. The notes of the teatime visit record Mrs Y was helped to the commode and back to the chair: ‘used stand aid to lift but was really difficult. Finally managed to use it and get to commode……explained she needed a mechanical lift as she can’t lift herself. Rang on call to let them know’. Mrs X telephoned the social worker and said she had to assist the care workers with Mrs Y’s transfer. She did not feel the staff were trained properly in using the ross return and belt. She said it was also difficult for the care workers to support Mrs Y after toileting due to a lack of space. The social worker noted Mrs X said Mrs Y may need to go into respite if the issues could not be resolved. At the evening visit the care workers noted ‘used lift aid to get into wheelchair…get her on to bed’.
34. Mrs X emailed the Council that same day. She summarised her concerns and said the timing and lack of consistency in care workers was an issue as Mrs Y could not explain where things were. Mrs X said when she visited Mrs Y she indicated her legs were very sore when people touched them to move her. She said Mrs Y winced in pain when she touched her left leg so she wondered why this was and if it had been noted at Ascot House. Mrs X said if care at home could not be sorted and agreed the following week then Mrs Y required some sort of residential care or respite. Mrs X emailed again the next morning and reported staff were struggling to use the belt properly to enable safe use of the ross return.
35. The following morning, the care workers noted they supported getting Mrs Y from the bed to the chair. The social worker emailed Mrs X. They said a manager from Delta Care would attend the lunchtime visit and complete a full risk assessment. Ideally they would resolve the issues or the social worker would look for another provider and would look to commission a long term service with specified visit times. Alternatively, the family could arrange its own private support or Mrs Y could go into respite care.
36. A physiotherapist from Ascot House spoke to Mr Z. They noted he was happy with the therapy but complained about the carers. The physiotherapist advised him to liaise with the social worker. The social worker spoke to the physiotherapist who said Mrs Y was able to use the belt and ross return in all transfers at Ascot House. The only other equipment would be a hoist which Mrs Y was not assessed as needing.
37. A manager from Delta Care visited Mrs Y at lunchtime. The notes record the manager reported Mrs Y ‘was in too much pain to stand up. Rang doctor for emergency equipment and pain relief. The doctor refused as it was 2pm on a Friday. Only other option was to ring ambulance as this lady cannot be moved out of the chair she is in safely without being in pain and screaming out’.
38. Delta Care telephoned the social worker and said Mrs Y could not weight bear on her leg as she was in too much pain. It considered she needed a hoist. The social worker phoned Mr Z who said they were awaiting an ambulance to take Mrs Y to hospital as she could not manage at home. He considered the pain in Mrs Y’s leg was caused by rough handling when using the ross return. The social worker raised a safeguarding concern.
39. The Council’s records note the hospital should complete a reassessment for equipment and decide on a discharge pathway.
40. The Council noted in late September that the hospital said Mrs Y was well enough to leave hospital with a care package but could not return home due to it being redecorated. In October 2022, Mrs Y was discharged to a care home for respite which she self-funded. The Council spoke to Mrs X who said she had arranged this for eight weeks to address damp in the property. The notes recorded Mrs Y would then need support from adult social care for an assessment to ensure she had care workers on her return home.

CHC and needs assessments

41. In December 2022 Mrs X said she contacted Mrs Y’s GP to request a CHC assessment but this did not happen.
42. In February 2023 Mrs X contacted the Council. She said Mrs Y’s funds were reaching the level where she required assistance from the Council. Mrs X believed it would be better for Mrs Y to remain in 24 hour care and wanted her assessed for a long term placement at the care home. Mrs X also requested an assessment for CHC funding.
43. In late March 2023 the Council carried out a needs assessment. It noted Mrs Y’s funds would drop below the threshold in late April 2024 and approved Mrs Y’s continued placement at the care home. Mrs Y was referred for a CHC assessment. Mrs X also emailed the Foundation Trust directly regarding this.
44. A multi-disciplinary meeting in May 2023 decided that Mrs Y was not eligible for CHC funding. Mrs X was advised of the outcome in June 2023.

The safeguarding investigation

45. A Council officer spoke to Mrs X in late September 2022 and explained a social worker would gather evidence and hold a multidisciplinary team meeting towards the end of October 2022.
46. The safeguarding social worker arranged a safeguarding planning meeting in mid October 2022 and contacted Ascot House and Delta Care for information. The safeguarding social worker arranged a meeting for late November 2022 which was twice postponed as they had not obtained all the information they needed for the safeguarding enquiry. The social worker visited Mrs Y in the care home in late November 2022 but Mrs Y found the visit upsetting so they left.
47. The safeguarding meeting was held in early December 2022.
48. Two weeks later the Council sent out the minutes of the meeting. These were incorrect and the amended final minutes were not sent out until early February 2023. The safeguarding concluded the concern was substantiated but the risk was removed as Delta Care no longer supported Mrs Y. It recommended Delta Care complete an unsafe discharge form, provide further equipment training to staff, retrain its staff on what the SAMS service was and send a notification to CQC.

The complaints process

49. Mrs X complained to the Council in early 2023. It decided, due to the nature of the complaint, to appoint an independent investigating officer at stage one who met with Mrs X in mid March. The Investigating Officer carried out staff interviews, reviewed files and produced their report in August. In September the Council sent Mrs X a copy of the report and advised an adjudication letter was being prepared in response to the investigation report and recommendations.
50. In late October, the Council wrote to Mrs X. The letter set out that some of the matters considered by the Investigator related to health led services who were not consulted as part of the investigation. It proposed reopening the investigation as a joint Health and Social Care complaint so all elements could be investigated with oversight from all the agencies involved.
51. The Council met with representatives from the Trust in mid November. Following this it emailed the Trust setting out Mrs X’s complaints and the elements which it considered required its input. The Trust said it sent a response to the Council in early January 2024 which was not included in the complaint response to Mrs X. I have not seen a copy of this.
52. The Investigating officer completed an addendum report which they said considered information provided by the Trafford Local Care Organisation and the Head of Personalised Care (Trafford) NHS Greater Manchester.
53. The Council wrote an adjudication letter to Mrs X in May 2024. It apologised for the delays during the reopened investigation.
54. It did not uphold Mrs X’s complaints about: not exploring a long term package of care; about the information the commissioning team shared with care providers; that Delta Care was commissioned; the lack of a risk assessment before the care package started; or delay in carrying out a CHC assessment.
55. It partially upheld Mrs X’s complaint about delay in carrying out a needs assessment. It apologised that an officer suggested Mrs Y would not be assessed as she was self funding her care. It said this was inaccurate and Mrs Y had a right to be assessed whether self funding or not. It also apologised for the delay in distributing the minutes of the safeguarding meeting.
56. It made no finding on her complaints about the information provided to the care provider by the Council, that no information was provided to the care provider about Mrs Y’s medication and that she was on blood thinners , that care workers were not properly trained to use the equipment or about communication between Ascot House and Delta Care. It considered responsibility for these matters lay with the health team.
57. It recommended Mrs X be paid £850 in respect of the delays incurred in progressing the complaint investigation. It also made recommendations regarding information sharing and joint investigations.
58. Mrs X remained unhappy and complained to the Trust in June 2024. It responded and said several of the issues she raised were for the Council to respond to. It said it had asked it to respond but the Council said it had already responded to her complaint, the issues were now historical and it had already made a remedy payment.
59. The Trust said Ascot House completed the handover of care as part of the activities of daily living report. It said the handover to the care agency was the responsibility of the adult social care assessor. It said it was the responsibility of the Council to ensure care staff were appropriately trained in moving and handling and using the equipment safely. It said learning highlighted the need for a joint discharge process used by health and social care to ensure better coordinated care on discharge which has been operational since April 2023.
60. Mrs X remained unhappy and complained to us.

Response to our enquiries

61. In response to our enquiries the Council said despite its best efforts, collaboration with the Trust was largely unsuccessful due to ‘differing professional opinions of the complaint parameters’. It said:
• It had introduced a robust process in relation to complaints relating to Ascot House, with senior leadership oversight of all complaints to clarify the parameters of individual complaints before starting an investigation.
• For joint investigations it would arrange a meeting with the appropriate health representative to clarify who would lead the investigation.
• In June 2024 it also introduced adult social care practice standards which also covered the joint complaint working protocol.
• The Trust was also to review the current joint complaint working protocol to establish clear and mutual lines of communication between both organisations.
• It was working with the Trust to strengthen discharge arrangements. It had arranged a series of meetings using Mrs Y’s experience as a driver for improvement.

Findings

A longer term care solution was not explored with the family when she was discharged

62. The records show the discharge options were discussed with Mrs Y, Mrs X and her wider family and I am satisfied the Council properly investigated this complaint through its complaints’ procedure. There is no evidence of fault in the Council’s decision to use a SAMS care package to support Mrs Y to assess her long term care needs.

Information provided to the care provider about Mrs Y

63. Ascot House completed an activities of daily living report which it submitted to the Council. The Council then used this to complete a request for a SAMS package which its commissioning team used to source a care package. The SAMS request did not refer to Mrs Y’s right sided weakness, speech difficulties or to the requirement to use a belt with the ross return. This was fault.
64. Delta Care was the only company that accepted the SAMS package. The lack of detail in the SAMS request meant Delta Care did not have all the required information to make an informed decision over whether to accept the care package. The lack of detail leaves uncertainty over whether, if it had the full details, it would have accepted the care package.
65. Mrs X complained that no information on Mrs Y’s medication was provide to the care provider. In particular Mrs Y was on blood thinners and that the care provider was not made aware of this. There was no reference to this in the activities of daily living report or in the SAMS report provided to the care provider. It is accepted care providers should have known this as any accident or fall could have led to a bleed. However, there is no evidence Mrs Y suffered a bleed or was caused an injustice because of this and Mrs Y was admitted to hospital two days after her discharge from Ascot House, in which time the care provider had yet to carry out a full assessment. In addition the discharge process changed in April 2023, so I make no further recommendation regarding this.

The ross return and belt

66. Ascot House’s records show Mrs Y did not consistently use the ross return and belt. There were days when she refused to use it and her notes show she also had pain in her knees which made her not want to use it. Although Mrs Y did use it on 25 August, there are no records of any further reviews between then and her leaving the facility on 15 September. On the day she left, her notes record her use of the ross return and belt was very poor.
67. The therapist who assessed Mrs Y at home noted she ‘had a little difficulty in using the ross return and belt’. They were however satisfied she could use it. The decision over whether Mrs Y was able to use the ross return is a matter for the therapist’s professional judgement and they were satisfied she could use it at home. However, the failure to review Mrs Y for nearly three weeks prior to discharge was fault. This leaves some uncertainty over whether it was the most appropriate solution to meet her needs.
68. The records show the care workers had difficulty using the equipment. This was fault. As the Council commissioned the care, the responsibility lies with it to ensure the care workers it commissioned were able to use any equipment safely. Delta Care understood Mrs Y would use a ross return and said all care workers were trained in moving and handling techniques. Had the care workers any difficulty they would be expected to contact their head office for help. However, as set out above, this was impacted by the lack of information in the SAMS request. Care workers were not fully aware of Mrs Y’s needs or her communication difficulties and this affected her ability to use the ross return and impacted the care worker’s ability to communicate effectively with her.

The safeguarding investigation

69. The records show the Council appropriately investigated Mrs Y’s concerns under its safeguarding procedures and made recommendations to Delta Care. There were some delays in the process when meetings were cancelled and rearranged but this was not fault as it was due to the need to collect further information. The Council took too long to distribute the corrected minutes after the safeguarding meeting, which was fault. The Council has already apologised for this which was an appropriate remedy for the frustration this caused.

Delay in completing a needs assessment

70. The Council accepted Mrs Y had a right to a needs assessment whether she was a self-funder or not and accepted some delay in carrying one out. This was fault. However, this did not cause Mrs Y a significant injustice. This is because she was receiving appropriate care at the care home, wanted to remain there and continued to do so following the needs assessment. The Council has previously carried out a financial assessment and Mrs Y’s funding was arranged in a timely manner.

Continuing Healthcare (CHC) assessment.

71. Mrs X said she contacted Mrs Y’s GP to request a CHC assessment. I have not investigated the actions of Mrs Y’s GP so I cannot comment on why this request did not progress.
72. The Council referred Mrs Y for a CHC assessment and Mrs X contacted the Trust direct. The referral was completed in early May 2023 and found she was not eligible for funding. There was no undue delay in carrying out the assessment from when Mrs X contacted the Trust direct.

Complaint handling

73. The Council initially investigated the complaint without involving the Trust. This was fault. In November 2023 the Council met with the Trust. There were differences of opinion on which areas the Trust and Council considered fell within their responsibility. The Trust said it provided a response to the Council but this was not included in The Council’s response to Mrs X.
74. The Trust and the Council did not cooperate effectively to ensure Mrs X received a comprehensive and accurate response to her complaint. I have seen no evidence of further discussion or meetings to attempt to resolve differences in opinion or to explain and agree where responsibility lay. This was fault and caused Mrs X significant frustration.
75. The Council has already paid Mrs X £850 to acknowledge the frustration caused by the faults it identified and the delays in complaint handling. This is an appropriate remedy for the injustice to Mrs X, however there were elements of the complaint which it did not respond to in full.

Injustice

76. Although Mrs Y was able to use ross return and belt on discharge, the lack of review between mid-August and when she left Ascot House causes uncertainty over whether the equipment was appropriate for Mrs Y given her lack of confidence in using it.
77. The records show Mrs Y slipped using the ross return and belt and that care workers had difficulties using the equipment. Mrs Y later reported knee pain and two days after discharge could not stand due to pain. I cannot say, even on balance, the slip directly caused the knee pain. However, the care provider’s faults caused Mrs Y distress as well as affecting her confidence about using the equipment in the future.
78. In addition, I cannot say, even on balance, what the outcome would have been had these incidents not occurred. Mrs Y received a SAMS package so her long term care needs could be assessed. The records show Mrs Y was inconsistent in her willingness to use the equipment at Ascot House and had also reported knee pain.
79. The records show Mrs Y moved into respite accommodation following her hospital admission due to repairs being carried out at home, not because of the difficulties she had using the ross return and equipment. She was later assessed as needing 24 hour care and so stayed at the care home. Even on balance I cannot say this was due to faults identified and not due to the natural progression of Mrs Y’s medical conditions. However, the faults leave Mrs X and Mrs Y with a sense of uncertainty and frustration over what may have happened if the faults had not occurred.

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Agreed Action

80. Within one month of the final decision:
81. The Council and the Trust have agreed to apologise and pay Mrs X £300 (£150 each) to acknowledge the frustration and uncertainty caused by the faults identified.
82. The Council and the Trust have agreed to apologise and pay Mrs Y £500 (£250 each) to acknowledge the distress, frustration and uncertainty she was caused by the faults identified.
83. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisations should consider this guidance in making the apology I have recommended.
84. Within three months of the final decision:
1. The Council has agreed to provide evidence of the actions taken as a result of its meetings with the Trust to strengthen discharge arrangements.
2. the Trust has agreed to send out a briefing note to all of its complaint handling staff, outlining the importance of joint working to resolve complaints and to advise all staff where the joint working protocol information can be found.
85. The organisations should provide us with evidence they have complied with the above actions.

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Final Decision

86. I have found fault which led to an avoidable injustice to Mrs Y and Mrs X. I have closed the investigation as the organisations have agreed to take action to remedy the impact of the fault.

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Investigator's decision on behalf of the Ombudsman