Summary: Mr X complains on behalf of his mother, Mrs Y, the Council has failed to take account of professionals’ views when deciding the best care placement for Mrs Y. As a result, he says the Council’s flawed decision making has left his mother without the care she needs. We have found fault in the Council’s decision-making process, and it has agreed to make a financial payment to Mrs X and Mr Y and make service improvements.

The complaint

1. Mr X complains on behalf of his mother, Mrs Y, the Council has failed to take account of professionals’ views when deciding the best care placement for Mrs Y.
2. Mr X says the Council’s flawed decision making has left his mother without the care she needs.

Back to top

The Ombudsman’s role and powers

3. 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)
4. When considering complaints, we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
5. 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)

Back to top

How I considered this complaint

6. I have discussed the complaint with Mr X and considered the information he provided. I also considered the information the Council provided in response to my enquiries.
7. Both Mr X and the Council were invited to provide comments on my draft decision. Any comments received have been considered before a final decision was issued.

Back to top

What I found

8. Sections 9 and 10 of the Care Act 2014 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. It must also involve the individual and where suitable their carer or any other person they might want involved.
9. 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.
10. Section 13 of the Care Act 2014 and the Care and Support (Eligibility Criteria) Regulations 2015 set out the national eligibility criteria which must be followed to determine if an individual has eligible needs for care and/or support.
11. The Council says it assess people’s needs in line with the Care Act and that the following is a non-exhaustive list of what it determines night time needs as:

• Physical support to use the commode or toilet, not supervision only.
• Pad changing or turning and repositioning due to fragility of skin.
• A cognitive impairment, which causes a person to be anxious or distressed at nighttime where one person or more is needed to reassure the person and support them safely back to bed.
• Wandering during the night.
• Behaviour that puts the person or other persons at risk of harm.

What happened

12. The Council received a request for a care needs assessment in May 2023 for Mrs Y. The Council began its assessment of Mrs Y and completed it in June 2023.
13. The Council’s assessment said in the assessor’s professional opinion Mrs Y needed 24-hour care support within a care home setting.
14. The Council completed a further assessment in October 2023 and decided Mrs Y should move to an Extra Care Housing Facility to enable her to have support but live independently in her own flat.
15. The Council contacted a provider to try and locate a placement for Mrs Y in an Extra Care Housing Facility in mid-November 2023.
16. The provider the Council contacted replied towards the end of November to say it felt Mrs Y was not suitable for a place. The provider said it had previously assessed Mrs Y for a place at its residential care placement and this would be more appropriate for Mrs Y. The Council replied to the provider to say Mrs Y did not meet the criteria for residential care.
17. The provider sent the Council an email in late November saying it was confused as to why it was now referring Mrs Y to the extra care service. The provider said Mrs Y had previously been referred for a residential care placement. The Council responded to say it had completed a re-assessment of Mrs Y and she did not have 24-hour care needs.
18. The provider sent a referral to another placement for Mrs Y. However, the placement declined the referral.
19. I understand Mrs Y agreed to move to an extra care housing placement after discussions in December 2023. Mr X contacted the Council towards the end of December 2023 to explain he was unhappy with this.
20. Mr X emailed the Council in mid-January 2024 and explained the reasons he was unhappy with the decision the Council had made. Mr X explained the original decision the Council made was that Mrs Y needed residential care and that several placements had declined to take Mrs Y due to her needs. Mr X went on to say staff at the placements the Council had tried to arrange for his mother told him Mrs Y needed residential care rather than assisted living. The Council responded to say based on its assessment Mrs Y did not meet the criteria for residential care.
21. The Council emailed the provider in late January 2024 to ask if any placements could help with changing Mrs Y pad during the night. The provider emailed the Council back to say it was confused as it had been told Mrs Y did not need care at night.
22. The Council again said in February 2024 that it had assessed Mrs Y as having eligible needs but that she was not eligible for a residential placement.
23. The provider emailed the Council in March 2024 to say it was concerned it had been around four months since it last assessed Mrs Y. It said it would need to do a re-assessment to continue with the referral.
24. The Council responded to say it had assessed Mrs Y as requiring care but not residential care and that was what the provider needed to focus on. The Council went on to say there hadn’t been any changes to Mrs Y’s situation.
25. The provider emailed the Council in April 2024 to say there had been a marked deterioration in Mrs Y’s condition and in its opinion, she needed residential care. The Council responded to say Mrs Y was not eligible for residential care and did not have 24-hour care needs and asked the provider to reconsider.
26. The provider replied to the Council to say it did not think Mrs Y was suitable for extra care and believed residential care was a more appropriate placement.
27. Mrs Y went into hospital in May 2024 and the Council completed a review of her care and support needs in June 2024. The Council said Mrs Y should be discharged to an extra care placement and that Mrs Y had no nighttime needs which needed support.
28. A care and support plan dated four days after the review said the writer’s professional opinion was that Mrs Y needed a residential care placement.
29. The provider the Council were consulting with emailed the Council in late June 2024 to say it couldn’t meet Mrs Y’s needs in its extra care setting.
30. Mrs Y’s care notes from July 2024 record that extra care housing has been declined due to high needs and that Mrs y needed a residential placement.
31. I understand Mrs Y was placed in a residential care placement and a further assessment has recently been completed.
32. In response to enquiries made of the Council it provided a list of what nighttime needs would include. Pad changing or turning and repositioning due to fragility of skin were included as an example of nighttime needs.

Analysis

33. The Council’s original assessment of Mrs Y in May 2023 says the professional opinion of the assessor was that Mrs Y needed residential care. The Council then amended this view following a further assessment in October 2023 to say Mrs Y needed a placement with extra care.
34. The provider the Council contacted to try to locate a placement for Mrs Y repeatedly told the Council Mrs Y’s needs were greater than it could provide for in an extra care placement. However, the Council insisted Mrs Y had no nighttime needs and therefore did not meet the eligibility for residential care.
35. The provider also emailed the Council to say it was concerned it was referring Mrs Y for extra care placements when she had been previously accepted for a residential care placement.
36. The Council emailed the provider in January 2024 to ask if it would be possible to help Mrs Y with changing a pad at nighttime. But continued to say Mrs Y did not have nighttime needs. This appears to be in contradiction to the list of scenarios the Council sent which would count as nighttime needs.
37. The Council also told the provider that a re-assessment did not need to take place as nothing had changed. However, when the provider completed its reassessment, it said there had been a marked deterioration in Mrs Y.
38. The Council then completed re-assessments of Mrs Y which stated conflicting opinions about placement she required within a few days of each other. Even after noting Mrs Y would be better placed in residential care the Council continued to try to locate a placement with extra care. The provider refused this as it again explained it could not meet Mrs Y’s needs.
39. The provider contacted the Council several times to explain Mrs Y’s needs were greater than could be met under the type of placement it was seeking. It was also aware that Mrs Y needed help changing a pad at nighttime as it asked if the provider could complete this but refused to note this meant Mrs Y had nighttime needs. The Council also had notes to show assessments had recorded that Mrs Y was suitable for residential care.
40. The Council’s decision making was flawed. The Council has repeatedly contradicted itself as to what Mrs Y’s needs are, and at times has gone against its own findings and professional evidence from the provider. The Council has not provided a convincing rationale for continuing to say Mrs Y was not eligible for residential care based on the information it had received. This is fault and has caused both Mrs Y and Mr X distress and uncertainty about the level of care Mrs Y needed.
41. I cannot say what decision the Council should have reached. However, the process the Council has followed appears to be flawed based on the information it had available to it.

Back to top

Agreed action

42. Within one month of a final decision, the Council should:

• Write to Mr X and Mrs Y to apologise for the faults identified.
• Pay Mrs Y £350 for the distress and uncertainty caused to her.
• Pay Mr X £350 for the distress and uncertainty caused to him.
• If not already completed, finalise the reassessment of Mrs Y completed in September 2024.
• In writing, remind officers to consider all information available to them when reaching a decision and keep detailed decision-making notes.

43. The Council should provide us with evidence it has complied with the above actions.

Back to top

Final decision

44. I have found fault in the Council’s decision-making process.

Investigator’s final decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman