Summary: Ms A complained about the way the Council managed the care and treatment of her late mother Mrs X. We have not found fault on the part of the Council.

The complaint

1. Ms A (the complainant) complains about the way her late mother was moved into residential care against her wishes in 2020, and the failure of the Council to consult properly with her then. She also complains the Council did not adequately investigate safeguarding concerns in 2024 and that her mother suffered from poor standards of care in each care home.

Back to top

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. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council/care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
4. 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

What I have and have not investigated

5. I have not investigated complaints about matters in 2020 as they are outside the Ombudsman’s jurisdiction. There is no good reason why those complaints were not raised with us before now.

Back to top

How I considered this complaint

6. I considered evidence provided by Ms A and the Council as well as relevant law, policy and guidance.
7. Ms A and the Council had an opportunity to comment on my draft decision.

Back to top

What I found

Relevant law and guidance

8. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The Act (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves.
9. A key principle of the Mental Capacity Act 2005 is that any act done for, or any decision made on behalf of a person who lacks capacity must be in that person’s best interests. The decision-maker also has to consider if there is a less restrictive choice available that can achieve the same outcome.
10. The Deprivation of Liberty Safeguards provide legal protection for individuals who lack mental capacity to consent to care or treatment and live in a care home, hospital or supported living accommodation. The DoLS protect people from being deprived of their liberty, unless it is in their best interests and there is no less restrictive alternative. The legislation sets out the procedure to follow to obtain authorisation to deprive an individual of their liberty. Without the authorisation, the deprivation of liberty is unlawful. It is the responsibility of the care home or hospital to apply for authorisation.
11. A Relevant Person’s Representative (RPR) is a role stipulated under the Deprivation of Liberty Safeguards (DoLS). It is the role of the RPR to maintain regular contact with the relevant person who has been deprived of liberty, and represent them in all relevant matters. This can include: appealing against a DoLS authorisation, requesting a review, ensuring least restrictive practices are in place or raising a complaint.
12. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)
13. Where it appears a person may be eligible for NHS Continuing Healthcare (NHS CHC), councils must notify the relevant integrated care system (ICS). NHS CHC is a package of ongoing care arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care. Such care is provided to people aged 18 years or over, to meet needs arising from disability, accident or illness

What happened

14. Ms A is one of the late Mrs X’s three daughters. Mrs X, who had advanced dementia, lived in residential care from 2020 after Ms A had looked after her at her home for some time. Ms A had a number of historical complaints about the way in which Mrs X was moved into residential care.
15. In February 2024 Mrs X suffered an unwitnessed fall onto the crash mat in her room and was admitted to hospital. The care home submitted a safeguarding concern to the Council. The concern did not proceed to s42 enquiries.
16. Once Mrs X was deemed medically fit for discharge from hospital in March 2024 there was a Best Interest meeting held at the hospital to determine the appropriate placement. The consultant indicated that Mrs X would not tolerate any further clinical investigations and even if such investigations were undertaken, treatment would not be in Mrs X’s best interests. Both Ms A and her sister considered that Mrs X should be eligible for CHC or FNC funding but it was explained that at present Mrs X did not require nursing care. After discussion of potential placements, they chose a dual-registered care home which would be appropriate for Mrs X as her needs increased.
17. The records show that the DoLS authorisation which was in place at the previous care home was terminated and a fresh DoLS authorisation initiated for the new care home. Ms A’s sister was the RPR for Mrs X.
18. At Ms A’s request a CHC assessment was undertaken in April but the outcome was for Mrs X to remain in long-term residential care.
19. Safeguarding alerts were raised by Ms A including allegations of organizational abuse (the care home answerphone was left on all evening); neglect (Mrs X was not given her evening meal at the correct time) and physical abuse (Mrs X had an unexplained black eye). All alerts were considered, and no further action was taken. In another instance Ms A alleged that two carers had moved Mrs X inappropriately with the bed sheet and hit her head against the wall. It was found that Mrs X had suffered no harm but the carers had used the wrong sheets and further training was given. The care provider raised a separate alert about the way Ms A had fed Mrs X and a protection plan was put in place.
20. Mrs X died in July 2024.
21. Ms A complained to us. She complained about events which took place in 2020 which I have not investigated, as explained above. She also complained that the Council had not adequately investigated the safeguarding alerts.
22. The Council has provided me with details of how it considered each safeguarding alert and indicated where further action was taken. It has explained the police involvement where that was a factor, and the plans put in place to avoid further incidents arising.

Analysis

23. I have not seen evidence of fault in the way Mrs X’s transfer from one care home to the next was managed. The RPR was properly consulted about the DoLS authorisations in each case.
24. I have not seen any evidence there was fault in the standards of care provided to Mrs X.
25. The Council made appropriate enquiries where safeguarding alerts were raised and took action where necessary.

Back to top

Decision

26. I have completed this investigation as I have not found evidence of fault by the Council.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman