Summary: Mr B complained about the care and support provided to his mother and about the Council’s actions in arranging it. We found no fault.

The complaint

1. Mr B complained on behalf of his mother, Mrs F, that:
1. The Council commissioned home care in 2024 was sporadic and unsuitable and the Council failed to respond to the family’s complaints about it in September 2024. He says this caused distress, Mrs F’s health to deteriorate and for her to fall and have to go to hospital.
2. And that the Council:
1. Delayed paying Mrs F’s personal assistants in October 2024 and refused to provide cover for breaks, putting the provision at risk.
2. Withdrew the personal assistants support against Mrs F’s wishes, causing distress.
3. Failed to assess Mrs F’s care and support needs in October 2024, so she did not have the right equipment, putting her and her carers at risk.

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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. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, sections 24A(1)(A) and 25(7), as amended).
5. 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.
6. 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

7. I considered the information Mr B sent, the Council’s response to my enquiries and the Care and Support Statutory Guidance.
8. Mr B 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

Relevant law and guidance

Care and support

9. The Care Act 2014 requires local authorities to carry out an assessment for any adult with an appearance of need for care and support. The assessment determines what the person's needs are and whether the person has any needs which are eligible for support from the council. 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.
10. Everyone whose needs the local authority meets must receive a personal budget as part of the care and support plan. A personal budget can be administered as a managed account held by the council with support provided in line with the person’s wishes, or as direct payments to enable the person to commission their own care and support.
11. Where a council arranges care and support to meet a person’s needs, it may charge the adult for the cost of the care. Councils must assess the means of people who have less than the upper capital limit, to decide how much they can contribute towards the cost of their care.

Complaint procedure

12. Councils should have clear procedures for dealing with social care complaints. Regulations and guidance say they should investigate a complaint in a way which will resolve it speedily and efficiently. A single stage procedure should be enough. (Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)
13. Where a social care provider is acting on behalf of the council, we consider that any complaint response sent by the provider is provided on behalf of the council. Councils should have suitable commissioning arrangements in place to ensure care providers respond appropriately to complaints about commissioned services and placements. The Regulations say that when a council receives a social care provider complaint it must send details of the complaint to the provider.

What happened

14. Mrs F lives alone in a warden-supported property and had home care arranged by the Council to help her with personal care and meals. Mrs F has health conditions which cause her pain and affect her mobility.
15. In January 2024, the Council reviewed Mrs F’s care and support needs and found she needed an increased care package due to finding it difficult to stand. Home care of three visits a day (one x 60 minutes and two x 30 minutes) was put in place, provided by Agency X.
16. Agency X’s records show that in September 2024 Mrs F had falls, was in pain and was struggling to get out of bed, making personal care difficult. Mrs F had contacted her GP.
17. On 24 September, the GP was called as Mrs F had very poor mobility. Agency X called the Council and asked for a fourth daily care visit to be commissioned to help Mrs F go to bed. The GP referred Mrs F to physiotherapy and advised the carers to encourage Mrs F to walk if possible.
18. Mr B called the Council as he was concerned about the quality of care from Agency X. He said carers left early and care was not completed. The Council advised him to complain to Agency X in the first instance. Mr B emailed Agency X saying it was only providing 40 minutes of care per day, rather than the commissioned two hours. He said he would make a formal complaint once he had more information.
19. Mrs F found it difficult to sit up and take pain medication. On 27 September, she fell and was helped into bed. The records say she would call her GP.
20. When Agency X visited on the morning of 29 September, Mrs F was unable to get out of bed or to sit up. The carer was unable to move her on her own and was concerned that Mrs F had now been in bed for two days. The carer called NHS 111 who said a doctor would call Mrs F back.
21. The next morning Mrs F was found on the floor by the carer. Agency X called an ambulance and Mrs F went to A&E. She was discharged later that day; a frailty and falls rapid response team would visit the next day. Mrs F’s daughter called the Council and asked for a review of Mrs F’s care and support needs and a referral to an occupational therapist (OT).
22. The rapid response team and the physiotherapist visited on 1 October. Mrs F was still unable to stand or sit up. The physiotherapist emailed the Council. He had ordered a profiling bed and a mechanical standing aid [Sara Stedy] that would be delivered on 2 October. He recommended that two carers were needed for each visit.
23. Agency X called the Council on 1 October advising that two carers were needed but it did not have capacity to provide double up care until 8 October. Mrs F’ s daughter was able to help the carer that day. Agency X said carers had sometimes had to stay longer than scheduled as Mrs F’s pain and poor mobility made it difficult to provide personal care.
24. The Council agreed to four care visits a day with two carers (one x 60 minutes and three x 45 minutes) and made a referral to occupational therapy. Mrs F’s care and support plan was updated on 2 October and passed for authorisation. The Council contacted some care agencies and found two personal assistants who were able to provide double up care from the evening of 2 October until Agency X had capacity from 8 October.
25. Personal assistants would usually be paid with a direct payment so the social worker contacted the direct payments team advising that in this instance the assistants would need to be paid with the Council’s internal mechanism (a Wighntnet form).
26. The Council spoke to the personal assistants on 3 October. The payment process was explained and the assistants were aware that it would take two weeks to pay their invoice once it was submitted.
27. The assistants said four x 60-minute calls per day were needed, due to Mrs F’s complex needs. They would also need a higher hourly rate due to travel costs. The social worker agreed to seek approval for this.
28. Mrs F and her daughter told the Council on 4 October that they were very happy with the personal assistants and would prefer to continue to use them, using a direct payment, rather than return to Agency X. Mrs F said Agency X carers often changed, did not always come at the same time and sometimes left early.
29. The Council spoke to the personal assistants who were happy to continue to support Mrs F. They said they would need other carers to cover their holiday or sickness absences. The assistants said they knew some who they could ask. The Council advised Agency X that it was no longer needed on 8 October.
30. The assistants submitted an invoice on 7 October for four x 60-minute visits per day. The direct payments team noted there was a discrepancy as the care plan was for one x 60 minutes and three x 45 minutes visits and had only been agreed until 8 October. They advised the social worker that if the amended care plan was authorised by 14 October, payment could still be made by 21 October as normal. If not, it may be possible to use an emergency card to make payment.
31. On 10 October the personal assistants told the Council that the other carers would not be able to provide cover, so they would not be able to continue to support Mrs F.
32. The assistants called the Council on 11 October to say they were stopping Mrs F’s care package as they could not afford to continue. They would be unable to visit that evening as they did not have enough funds to pay for fuel. The social worker went to meet the assistants at a petrol station so the Council could pay for their fuel to enable them to provide care to Mrs F. The assistants then agreed they could continue until 14 October so that Agency X could resume on 15 October. The social worker spoke to the finance team which advised it could pay the assistants for the support from 2 to 14 October using the Wightnet form.
33. The social worker spoke to Mrs F’s daughter; to avoid upset, it was agreed not to advise Mrs F of the change in care provider until the situation was confirmed.
34. The Council assessed Mrs F’s finances and found she needed to make no contribution to the cost of her care
35. Mr B called the Council on 14 October. He was angry that care was going to be provided by Agency X. He said this was only because the Council had refused to pay the personal assistants.
36. The Council’s panel authorised the care plan for four x 60-minute visits a day. The Council spoke to the assistants who agreed to continue to provide the support and were aware there would be a wait for payment. The social worker placed an advert to find cover for the assistants and chased up the referral to the OT, who said he could visit Mrs F on 18 October.
37. Mr B made a formal complaint to the Council that:
• Agency X’s care had been sporadic and unsuitable, with 15-minute visits.
• The assistants had had to withdraw as the Council had refused to allow them to have holiday cover and had refused to pay them.
• The Council had not told Mrs F about the change in care provider.
• Mrs F had not been properly assessed so she did not have the right equipment.
38. The OT visited on 18 October and recommended a powered stand aid which was delivered on 21 October. Arrangements were made to set up the direct payment to pay the personal assistants.
39. The Council replied to Mr B’s complaint on 20 November. It said the personal assistants were aware of the Council’s payment system as they had used it before but they had asked to be paid outside of this process and this had not been possible.
40. Mr B came to the Ombudsman. He said the Council’s actions had directly led to Mrs F falling and being taken to hospital because it had ignored his concerns about Agency X. He also said the Council had ignored requests for additional help and assessment and had failed to update Mrs F’s care plan.
41. The Council sent a further complaint response on 19 December. It said Mrs F now had a new care and support plan in place, the OT had visited and made recommendations that the Council was considering. The Council said no 15-minute visits had been commissioned.

My findings

42. I have dealt with each element of Mr B’s complaint below:

Agency X’s care was sporadic and unsuitable.

43. I have reviewed the electronic recordings of the times of visits for about a month prior to Mr B’s contact on 24 September. This shows that about 20% of the visits (23 of 111) were shorter than commissioned. There were 10 visits where carers stayed longer than commissioned.
44. Agency X told the Council that due to Mrs F’s poor mobility, sometimes personal care could not be completed. This is likely to have impacted on the length of the visits.
45. Our view is that a short care visit does not automatically cause an individual an injustice. If a task cannot be completed in one visit, we expect carers to try again later that day or the next day. Carers should also report any concerns about a person’s health and wellbeing to their supervisor and take medical advice as necessary.
46. I have seen that Mrs F was in contact with her GP about her mobility and pain, and that Agency X contacted NHS 111, the GP and the Council about it. I have seen no evidence that the care provided by Agency X was unsuitable or poor quality or that the Agency did not provide the care set out in Mrs F’s care and support plan. Nor have I seen evidence that care was not completed or that visits were not made. I do not find fault.

The Council failed to respond to their complaints about Agency X in September 2024.

47. When Mr B contacted the Council on 24 September 2024, it advised him to complain to Agency X in the first instance. This is in line with the usual process and regulations so was not fault.
48. Mr B then advised Agency X he would make a formal complaint but I have seen no evidence one was made until 14 October. I do not find fault.

The Council delayed paying Mrs F’s personal assistants in October 2024

49. The personal assistants were aware that the Council’s payment process was to pay their invoice within 14 days. They submitted the invoice on 7 October. I have seen no evidence payment was delayed after 21 October.
50. On 11 October the personal assistants advised the Council they could not afford the fuel to continue to travel to Mrs F. The social worker went to the petrol station to pay for the fuel. She also sought approval for their request for longer visits and a higher rate to pay for travel. There was no fault.

The Council refused to provide cover for a break, putting the provision at risk.

51. There is no evidence the Council refused this. Initially the personal assistants said they would ask other carers they knew to provide cover. When this was not successful, the Council placed an advert to look for additional carers. There was no fault.

The Council withdrew the personal assistants support against Mrs F’s wishes, causing distress.

52. Mrs F wished to use the personal assistants and did not want to go back to using Agency X. However there is no evidence the Council withdrew the personal assistants’ support. The assistants told the Council on 10 October that they could not continue in the long term as they had no cover in place. There was no fault.

The Council failed to assess Mrs F’s care and support needs in October 2024, so she did not have the right equipment, putting her and her carers at risk.

53. The Council updated the care and support plan on 2 October to increase the care package to four visits and two carers. The day after Mrs F had been to A&E, the rapid response team and physiotherapist visited to assess her. The physiotherapist ordered equipment that was delivered the next day.
54. The Council made a referral to the OT on 3 October. After the OT visited on 18 October, they recommended a powered stand aid which was delivered a few days later. There was no fault.

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Decision

55. There was no fault. I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman