Summary: Miss X complained the Council did not provide appropriate sign language interpreters and did not meet her grandfather’s communication needs during the period he received care. Miss X said the Council’s actions caused avoidable distress to her grandfather and to herself. We found fault by the Council. The Council has agreed to provide an apology and a financial remedy and review its processes regarding the provision of communication support to deaf service users.

The complaint

1. Miss X complained about the Council’s care and support provision for her late grandfather, Mr Y. Miss X complained:
1. The Council did not provide Mr Y with a British Sign Language interpreter and/or a deaf relay interpreter when assessing his care needs and when making decisions about his care;
2. The care package and communication support for Mr Y was inadequate during the period he received care at home; Miss X said the home-care workers were not British Sign Language trained, and
3. The Council failed to meet Mr Y’s communication needs as part of his stays at a respite care home and a nursing home. Miss X says the care home staff were not British Sign Language trained.
2. Miss X says the Council’s actions caused avoidable distress to Mr Y and herself and placed an unfair responsibility on her to act as an interpreter. Miss X says this had a significant emotional toll on her and negatively impacted her wellbeing. She would like the Council to apologise and acknowledge its actions. Miss X would also like the Council to review its processes and provide a financial remedy to recognise the distress caused.
3. Miss X also complained about safeguarding and a lack of monitoring at the care home.

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The Ombudsman’s role and powers

4. 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)
5. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable (Local Government Act 1974, section 26A(2), as amended)

6. The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6)
7. 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(1), as amended)

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What I have and have not investigated

8. I have investigated the complaint referred to in paragraph one. I have not investigated the complaints referred to in paragraph three because these matters did not form part of Miss X’s initial complaint to the Council.

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How I considered this complaint

9. I considered evidence provided by Miss X and the Council as well as relevant law, policy and guidance.
10. Miss X and the Council had an 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

Care Act 2014 and statutory guidance

11. The Care Act 2014 requires councils to carry out an assessment for any adult with an appearance of need for care and support. The assessment must involve the individual and where suitable their carer or any other person they might want involved.
12. Good, person-centred care planning is particularly important for people with the most complex needs. Many people receiving care and support may have mental impairments, such as dementia or learning disabilities. The principles of the Care Act apply equally to them, in addition to the principles and requirements of the Mental Capacity Act 2005 if the person lacks capacity.
13. The duty to involve the person remains throughout the process. If lack of capacity is established, it is still important that the person is involved as far as possible in making decisions.
14. A person must be able to communicate their views, wishes and feelings whether by talking, writing, signing or any other means, to aid the decision process and to make priorities clear. 
15. Councils must support the person to understand and weigh up information and to help people to exercise informed choice. A person must be given all practicable help to make the specific decision before being assessed as lacking capacity to make their own decisions.
16. 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. 

Mental Capacity Act 2005

17. The Mental Capacity Act states that a person should not be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success. A person is not to be regarded as unable to understand the information relevant to a decision if they are able to understand an explanation of it given to them in a way that is appropriate to their circumstances.

Deprivation of Liberty Safeguards

18. The Deprivation of Liberty Safeguards (DoLS) 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 authorisation, the deprivation of liberty is unlawful. Once there is or is likely to be a deprivation of liberty, it must be authorised under the DoLS scheme in the Mental Capacity Act 2005.
19. The ‘managing authority’ of the care home (the person registered or required to be registered by statute) must request authorisation from the ‘supervisory body’ (the council). There must be a request and an authorisation before a person is lawfully deprived of their liberty.
20. On application, the supervisory body must carry out assessments of the six relevant criteria: age, mental health, mental capacity, best interests, eligibility and ‘no refusals’ requirements. A minimum of two assessors, usually including a social worker or care worker, sometimes a psychiatrist or other medical person, must complete the six assessments.

The hospital social work team

21. The Council is one of a group of three local authorities who work together (as a tri-borough service) to support residents from any of their areas when they present at a hospital within their local borough.

What happened

22. The amount of information provided as part of this investigation was considerable. In this decision statement, I have not made reference to every element of that information, but I have not ignored its significance. This chronology includes key events in this case and does not provide details of everything that happened.
23. Miss X’s grandfather, Mr Y, had several health conditions, was profoundly deaf and used sign language to communicate. Mr Y’s daughter, Ms Z was the main carer for Mr Y.
24. Miss X is a qualified British Sign Language (BSL) interpreter.
25. In March 2024, Mr Y went into hospital. When Mr Y returned home later that same month, he received a package of care at home.
26. The Council carried out an occupational therapist’s assessment at Mr Y’s home in April 2024. Ms Z was present at the time of the assessment. At about the same time, the Council received a request for respite care for Mr Y.
27. The Council provided Mr Y with a care plan in April 2024. The plan recorded that Mr Y’s first language was BSL, and that he required a BSL interpreter. The plan stated that as the Council was unable to find carers with BSL skills to support Mr Y at home, Ms Z would help the carers to understand basic BSL in order to assist with communication with Mr Y.
28. Mr Y began a period of respite care at Care Home A in April 2024.
29. On 1 May 2024, the Council visited Mr Y at Care Home A to carry out an assessment. A BSL interpreter also attended the meeting.
30. Miss X emailed the Council on 3 May 2024 and said she was concerned about the care provided to Mr Y and his ability to communicate effectively. Miss X said Mr Y needed a BSL and a deaf relay interpreter to ensure proper understanding, as a BSL interpreter alone may not be sufficient. In a separate email sent on the same day, Miss X said she was willing to provide assistance to the Council.
31. Mr Y returned home in mid-May 2024. The Council arranged a package of care to support Mr Y at home with carers to attend four times a day.
32. The Council carried out an occupational therapist’s assessment with Mr Y at his home on 22 May 2024. Miss X and Ms Z also attended.
33. The Council emailed Miss X on 24 May 2024 and said Mr Y’s GP had recommended that Mr Y move to a permanent nursing placement. The Council said Care Home A only had beds for respite care, whereas Mr Y required a permanent placement that also provided nursing care. The Council said it would look for a placement for Mr Y.
34. On 28 May 2024, Mr Y’s family told the Council they would no longer act as interpreters on Mr Y’s behalf.
35. On 30 May 2024, Mr Y’s family told the Council they would cease to provide support for Mr Y from 31 May 2024. The Council increased Mr Y’s care package with effect from 31 May 2024, including providing overnight support.
36. A few days later, Ms Z contacted the Council to request a reduction in the number of daily carer visits to Mr Y, as she said he was unhappy with having carers attend every hour. The Council says it received a request to end the overnight support at about the same time. Overnight support ended in early June 2024.
37. On 14 June 2024, Mr Y went into hospital following an accident at home.

Miss X’s complaint

38. Miss X complained to the Council on 12 September 2024 and sent a revised complaint on 22 September 2024. Miss X complained the Council had not provided Mr Y with access to a BSL and/or deaf relay interpreter during assessments and when making decisions about his care. Miss X also said Mr Y’s care package was inadequate and the Council had not provided communication support to Mr Y at home.
39. During Mr Y’s stay in hospital, the Council, as part of the tri-borough service, assisted in seeking a care home placement for Mr Y, to be ready for him when he left hospital.
40. On 25 September 2025, another care home, Care Home B, told the Council it had met with Mr Y’s family. It said his family were happy for Mr Y to go to Care Home B provided that BSL outreach support was provided.
41. The Council approved BSL outreach support for Mr Y at Care Home B on 18 October 2024.
42. On the same day, the Council issued its complaint response. It said Mr Y’s respite care at Care Home A was an emergency placement and staff had basic tools to communicate with Mr Y. The Council said when Mr Y returned home, it carried out an OT assessment when Miss X and Ms Z were present. It said the Council had increased Mr Y’s care package to include overnight support, but this stopped at the request of Mr Y’s family. The Council acknowledged Mr Y went into hospital in June 2024 and said it considered it had provided adequate support in line with the Care Act 2014.
43. Mr Y was discharged from hospital and moved into Care Home B on 21 October 2024. The Council provided a placement care plan for Mr Y which specified that staff should secure basic BSL skills.
44. BSL outreach support started soon after Mr Y moved to Care Home B.
45. The Council began its DoLS assessment on 25 October 2024.
46. On 8 November 2024, the Council called Care Home B. The care home told the Council it had some difficulty communicating with Mr Y. It said it had received no training in BSL or deaf awareness.
47. Miss X escalated her complaint to stage two on 13 November 2024. She maintained the Council had not provided Mr Y with access to a BSL and/or deaf relay interpreter and had not provided communication support to Mr Y.
48. The Council carried out a DoLS assessment visit to Mr Y on 15 November 2024. Mr Y’s social worker contacted the DoLS team on the same day. They said the DoLS team did not arrange for a BSL interpreter to be present at the visit, and the meeting was conducted using a pen and paper. The social worker said this was highly inappropriate and that Mr Y required a BSL interpreter to be present for all communication with him.
49. The DoLS team responded to Mr Y’s social worker on the same day. It apologised that the meeting had gone ahead without the presence of a BSL interpreter and said it had sent an email to the relevant person to reiterate that an interpreter was required.
50. The Council carried out a placement care plan review on 18 November 2024. The care plan stated that no-one except Mr Y’s family was able to communicate with him unless a BSL interpreter was present. The care plan referred to the DoLS meeting carried out without an interpreter and stated that Mr Y’s relationship with the staff at Care Home B was strained because they were unable to communicate with him.
51. Mr Y’s social worker called Care Home B a few days later to discuss Mr Y’s physiotherapy. The social worker recorded that the physiotherapist had carried out an initial visit to Mr Y but had not undertaken any further assessments due to communication difficulties.
52. The Council arranged for further DoLS assessments to be carried out on 4 December and 7 December 2024.
53. The Council issued its stage two complaint response on 10 December 2024. It said it considered the Council had taken reasonable steps during Mr Y’s emergency respite placement and had provided adequate support in line with the Care Act 2014. The Council said it considered it had not failed to meet Mr Y’s communication needs.
54. Some days later, Mr Y transferred from Care Home B back to Care Home A. Shortly after this, Mr Y was admitted to hospital but sadly died a few days later.
55. Miss X brought her complaint to the Ombudsman as she remained dissatisfied with the Council’s complaint response.

Analysis – Miss X’s complaint that the Council did not provide a BSL and/or deaf relay interpreter when assessing Mr Y’s care needs and when making decisions about his care

56. The Council says its understanding was that Mr Y’s family was willing to provide BSL support up to May 2024. It says it provided BSL interpreters for the majority of Mr Y’s assessment visits and for key decisions. The Council says the DoLS assessment arranged for 4 December 2024 was not completed because neither a BSL interpreter nor a member of Mr Y’s family was present. The Council says it instructed the assessor to return and complete the assessment on 7 December 2024, and it disregarded the assessment of 4 December 2024. The Council says the DoLS assessment on 7 December 2024 took place with an interpreter and a family member present.
57. I acknowledge the Council’s explanation. However, the Council’s records indicate it made arrangements with a family member to be present for two appointments in December 2024, one on 4 December and the other on 7 December. The family member did not attend on 4 December, so the assessment did not go ahead. The family member did attend the visit on 7 December, and the visit went ahead with the presence of a BSL interpreter.
58. The Council’s enquiry response does not however refer to the DoLS visit on 15 November 2024. The Council’s records show Mr Y’s social worker raised concerns that the visit on this date took place without an interpreter, and this is also referenced in Mr Y’s placement care plan review. The DoLS team acknowledged the assessment took place without an interpreter in its email to Mr Y’s social worker dated 15 November 2024. The failure to provide a BSL interpreter for Mr Y during this visit is fault.

Miss X’s complaint that Mr Y’s care package and communication support was inadequate during the period he received care at home

59. The Council says Mr Y’s family initially commissioned their own carers via a direct payment. It says the expectation was that Mr Y’s family would therefore arrange for the necessary training of the care staff to meet Mr Y’s communication needs at that time.
60. The Council says it provided commissioned care from May 2024 to June 2024. It acknowledges that Mr Y’s care review states he would benefit from BSL carers. However, the Council also acknowledges there is no evidence to indicate it ensured that carers were able to communicate with Mr Y, other than with basic care giving tasks.
61. I acknowledge the Council’s explanation and agree there is no evidence to indicate the Council took steps to ensure Mr Y’s home carers had BSL skills. The Council was aware Mr Y communicated via BSL, and the lack of action taken to ensure this was provided as part of his care package is fault.

Miss X’s complaint that the Council failed to meet Mr Y’s communication needs as part of his stays at Care Homes A and B.

62. The Council’s records show it discussed the care arrangements at Care Home A with a family member prior to Mr Y’s respite care. The records state the family member considered it was ok if care staff were not able to use BSL as long as they had consideration for the fact that Mr Y was deaf, and that they understood the importance of facing him when speaking so he could see their mouths.
63. As a result, and having reviewed the Council’s records, there is no fault regarding this aspect of the complaint in relation to the period of respite care.
64. However, the Council’s enquiry response does not refer to the period Mr Y was at Care Home B. Prior to Mr Y moving to Care Home B from hospital, Miss X asked that the care home staff were trained in BSL.
65. The Council’s records dated 3 October 2024 and 15 October 2024 respectively state that Care Home B offered to train its staff to use basic BSL and was provided with a link to facilitate this. Mr Y’s placement care plan dated 21 October 2024 also states the care home staff were to secure basic BSL skills.
66. The Council’s record dated 8 November 2024 confirms staff had not undertaken any training in BSL or deaf awareness at that time. In addition, I have seen no evidence the staff at Care Home B received this training after this date. This is contrary to the requirements of Mr Y’s care plan and is fault.
67. The fault identified caused an injustice to Mr Y, namely distress caused by barriers to communication, and an inability to engage with staff at Care Home B. The injustice is also to Miss X, namely avoidable distress and uncertainty as to whether the Council took sufficient action to ensure Mr Y could communicate effectively with his carers.
68. Where someone has died, we will not normally seek a remedy for injustice caused to that person in the same way as we might for someone who is still living. We would not expect a public or private body to make a payment to someone’s estate. Therefore, if the impact of a fault was on someone who has died, we will not recommend an organisation make a payment in recognition of, for example, the impact of poor care that person might have received while they were alive. This is because the person who received the poor care cannot benefit from such a payment. However, if we consider the person who has complained to us has been adversely affected by seeing the impact of that poor care on their relative, we may recommend a symbolic payment to them as a remedy for their own distress.

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Action

69. To address the injustice identified, the Council has agreed to take the following actions within one month of the final decision:
1. Provide an apology to Miss X for the fault identified. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings, and
2. Make a symbolic payment to Miss X of £450 in recognition of the distress and uncertainty identified.
70. The Council has also agreed to take the following additional action within three months of the final decision:
1. Review the Council’s processes regarding the provision of British Sign Language and deaf relay interpreters to service users, to ensure effective communication support is provided where necessary, and to ensure appropriate training is provided to relevant staff.
71. The Council should provide us with evidence it has complied with the above actions.

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Decision

72. I have found fault causing injustice. The Council has agreed to take the above action to remedy the injustice and I have therefore concluded my investigation.

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Investigator's decision on behalf of the Ombudsman