Summary: Mrs X complains the Council failed to support her late father, Mr Y, properly after he left hospital in July 2024. Both the council and the care provider were at fault for failing to recognise the need for an urgent review of Mr Y’s needs. This caused avoidable distress to Mrs X and delayed funding for Mr Y’s care home placement. The Council has agreed to apologise and make a symbolic payment to Mrs X. It will also reassess the charges for Mr Y’s care and take action to improve working practices.

The complaint

1. The complainant, Mrs X, complains the Council failed to support her late father, Mr Y, properly after he left hospital in July 2024.

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The Ombudsman’s role and powers

2. 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)
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)
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)

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How I considered this complaint

5. I have considered evidence provided by Mrs X and the Council, as well as relevant law, policy and guidance.
6. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

What happened

7. In July 20204 Mr Y was in hospital, having received treatment for cancer. Mrs X says he had been given around six months to live. When he was ready to leave hospital, the Council arranged for Ablecross Care Services (Ablecross) to support him in his own home from 12 July. It visited him four times a day.
8. Mrs X has her own health issues, which prevented her from visiting her father, so she could only support him remotely.
9. On 19 July Mrs X arranged for Ablecross to provide waking night support for Mr Y, because he was wandering from his home putting him at risk of harm. This was extended to include a daytime sit-in service.
10. On 22 July Mrs X told the Council her father had not slept well in the last 48 hours and may have had a urinary tract infection. She said the family were paying Ablecross to provide 24-hour support for her father, but it had not yet started. She said they were worried Mr Y could wander off. The Council told her to contact Ablecross, as they were paying privately for care, and to contact the NHS about any underlying health concerns.
11. Ablecross also contacted the Council. It said:
• Mrs X got in contact around 22.45 on 19 July, after a neighbour found Mr Y wandering outside, appearing confused, and returned him home. Mrs X had contacted the Council’s duty team, but it was unable to help. Mrs X had asked for an emergency waking night service and had been happy to pay privately. It had contacted the emergency services and a doctor was due to check Mr Y.
• On 20 July Mr Y told the morning care worker he could not remember what had happened. A paramedic had assessed Mr Y and suggested taking him to hospital for further observations, but Mr Y had declined. A nurse had arrived at 11.40 to take bloods. In the evening Mrs X reported two neighbours returned Mr Y to his home, after they found him wandering along the road.
• Around 15.30 on 21 July paramedics visited but Mr Y refused to go to hospital. Around 00.05 on 22 July paramedics visited again but Mr Y still declined going to hospital. The paramedics said Mr Y needed 24-hour support.
• On 22 July it had asked the GP for an urgent home visit, but Mrs X had already arranged a telephone consultation. It asked the Council for an urgent intervention.
12. The Council passed the message on to the relevant team, noting Mr Y was waiting for a social worker to be assigned to his case.
13. On 23 July Mrs X told the Council Ablecross had asked her to pay £2,694.22 in advance for that week’s care, and would withdraw care if it did not receive payment by 20.00. She said she had agreed to pay by the end of the next day and on that basis Ablecross had agreed to continue supporting her father. The Council advised Mrs X to make a complaint to Ablecross, as she was paying privately for care, or to contact the Care Quality Commission (CQC), which regulates care providers.
14. The Council noted Mrs X was looking for a care home. It agreed to send her a list of care homes, which it said would reduce the risk of Mr Y being moved again, if she had placed him privately by the time it became involved. It noted whoever was assigned to Mr Y’s case would need to assess him for residential care.
15. On 25 July the Council told Mrs X it had asked for an urgent allocation for a review of Mr Y’s care and support plan. The relevant team told Mrs X it would assign a social worker “in the upcoming days”. Mrs X said she had arranged a private room in a care home from teatime on 27 July. She said her father was now too weak to walk and asked how she could get a wheelchair.
16. A social worker contacted Mrs X on 26 July and arranged to visit Mr Y at the care home on 5 August to review his needs.
17. Mr Y moved to the care home on 27 July.
18. Mrs X complained to the Council on 14 August.
19. On 20 August the Council told Mrs X it was funding her father’s placement at the care home, on a temporary basis, from 14 August to 11 September, so Mr Y could decide on his future care wishes. Mrs X asked if this meant her father had to pay for the care home. The Council said it would get back to her.
20. On 12 September, having visited Mr Y on 11 September, the Council told Mrs X her father wanted to remain in the care home. It said it would arrange for a financial assessment for a long-term placement, including a deferred payment agreement, so Mr Y did not have to sell his home while he was alive.
21. Ablecross commissioned an independent investigation into Mrs X’s complaint. On 2 October, Mrs X received the outcome of the investigation. This said:
• An Ablecross care worker should have realised that Mr Y was not safe to leave alone on 20 July. Ablecross had agreed to put protocols in place, agreed with family and commissioners, for leaving service user in a vulnerable state. Where no such protocol was in place, it would operate a stay put policy.
• Ablecross care workers were not adequately monitoring Mr Y’s hydration, resulting in him becoming severely dehydrated. It would be introducing a more advanced care monitoring system to address this.
• Ablecross accepted there was no clear protocol for managing the way in which controlled drugs were stored at Mr Y’s home. It was introducing new protocols and a more sophisticated system to address this failing.
• Ablecross had offered to refund 50% of the fees it had charged Mr Y.
22. When the Council replied to Mrs X’s complaint on 21 October, it said:
• It had been Mr Y’s informed choice to return home when he left hospital in July. There had been no concerns about his capacity to make that decision. NHS staff had noted Mr Y may get up at night, but this had not been identified as a barrier to him returning home.
• It would address Mrs X’s concerns about not administering medication appropriately (leaving Mr Y’s medication in a bag on a table in his home) and not providing additional care to support Mr Y, via its safeguarding process.
• On 22 July Ablecross told the Council it had contacted NHS emergency services three times since 19 July, but Mr Y had refused to go to hospital for further observation.
• On 22 July Mrs X told the Council Mr Y was unwell and the NHS’s virtual hospital team was due to provide support and she had arranged private support for a waking night.
• On 23 July Mrs X told the Council Mr Y needed a care home placement, so it provided her with the details of local care homes, as requested.
• On 26 July the Council assigned a social worker to review Mr Y’s needs, but before they could do this Mrs X placed him privately in a care home.
• The NHS would respond to medication concerns (morphine incident).
• It could not respond to comments made by an external agency (the provider of a pendant alarm), which Mrs X said had not helped her father when he pressed the button for help.
• If someone needed more care and support than identified in their care and support plan, the Council would arrange a review of their care needs. If Mr Y became unwell, it was the responsibility of the NHS, not the Council, to provide the intervention and support. The NHS Virtual Hospital Team was supporting Mr Y at the time.
• On 20 July the ambulance service told the Council Mr Y’s care needs needed reviewing. It apologised that no contact was made until 23 July, after it received further correspondence.
• There were no restrictions to prevent Ablecross from providing a private care package. It acknowledged Mrs X felt there were no other options at the time.
• It did not uphold Mrs X’s complaint about the financial implications of arranging care privately. It had addressed this as a safeguarding concern but decided it did not amount to financial abuse, as Mrs X had entered into the contract as Mr Y’s lasting power of attorney and in his best interests.
• It apologised for not sharing its guidance on what constituted financial abuse.
23. On 6 November the Council arranged to fund Mr Y’s placement in the care home on a permanent basis from 11 September, paying £950 a week.
24. On 25 November, Ablecross refunded Mr Y £3,071.76 for the care he had paid for privately.
25. Mr Y died in December.
26. In February 2025 the care home refunded Mr Y’s estate £4,065.71 for 14 to 31 August 2024, which the Council had funded.

Is there evidence of fault by the Council which caused injustice?

27. The Council had accepted a duty to meet Mr Y’s needs under the Care Act 2014 when he returned home from hospital in July 2024. It soon became clear that the package of care comprising four calls a day was not enough to keep Mr Y safe from the risk of harm. While people are entitled to commission private care to supplement council commissioned care, when Mrs X asked Ablecross to provide a waking night care worker, this should have prompted it to ask the Council if this was something it should be funding under the Care Act. The failure to do so was fault, for which the Council is accountable.
28. Ablecross waited three days before contacting the Council. By that time, the Council had received a referral from the ambulance service. The Council did not treat that referral with the urgency it required. The Council also heard from Mrs X but did not treat the situation with any urgency until 25 July. The delays prevented a review of Mr Y’s needs until after he moved to the care home.

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Action

29. When a council commissions or arranges for another organisation to provide services we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions. Where we find fault with the actions of the service provider, we can make recommendations to the council alone. Here we have found fault with the actions of Ablecross, as well as the Council, and make the following recommendations to the Council.
30. I recommend the Council:
• Within the next four weeks:
1. writes to Mrs X apologising for the avoidable distress she has been caused and pays her £500; and
2. reassesses the charges for Mr Y’s care on the basis the Council funded the care home placement from 27 July 2024 (temporarily until 24 August and permanently after that);
• Within the next eight weeks identifies the action it needs to take to ensure:
1. its officers recognise the need to urgently review care needs;
2. care providers, already providing Council commissioned care for an individual, do not enter into private arrangements to provide care for that individual which should be funded by the Council under the Care Act.
31. The Council should provide us with evidence it has complied with the above actions.
32. Under the terms of our Memorandum of Understanding with CQC and information sharing protocol, I will send it a copy of my final decision statement.

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Decision

33. I find fault causing injustice. The Council has agreed to remedy the injustice it has caused.

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Investigator's decision on behalf of the Ombudsman