Bristol City Council (18 013 368)

Category : Adult care services > Charging

Decision : Upheld

Decision date : 11 Jul 2019

The Ombudsman's final decision:

Summary: There was fault by the Council. There was delay in allocating a social worker when a hospital discharged an elderly lady into temporary residential care. The Council has apologised for the delay and agreed to continue to charge the resident as a short stay resident.

The complaint

  1. The complainant, whom I shall refer to as Miss B, complains on behalf of her mother Mrs C. Miss B complains there was a delay in allocating a social worker when the hospital discharged her mother.
  2. Miss B also complains the Council did not arrange a home care package for her mother which resulted in her spending 16 months in a care home paying top up fees rather than been discharged home.

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The Ombudsman’s role and powers

  1. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
  2. If we are satisfied with a council’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

  1. I read the papers put in by Miss B and discussed the complaint with her.
  2. I considered the Council’s comments about the complaint and any supporting documents it provided.
  3. I gave the Council and Miss B the opportunity to comment on my draft decision.

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What I found

Key facts

  1. Miss B contacted social services on 16 January 2017. After a telephone call on 23 January, the Council said it would allocate a social worker to complete a care assessment for Mrs C. Miss B contacted the Council twice at the beginning of February to say the situation was becoming urgent, as her and a friend were struggling with her mother’s personal care.
  2. The Council determined that Mrs C did not have mental capacity to make decisions about her care on 14 February 2017. Mrs C went into hospital on 16 February.
  3. The hospital told the social worker on 27 February 2017 that Mrs C needed a care assessment to help her discharge from hospital. The hospital discharged Mrs C on 29 March with a care package, but she went back into to hospital on 31 March 2017.
  4. The social work team sought a new care package of 4 visits a day with two carers on 7 April 2017. Mrs C transferred to a community hospital on 16 April for rehabilitation.
  5. On 3 Mary 2017 a best interests meeting took place. The notes record the decision that Mrs C would go into 24 hour care as she may not be safe at home between carer visits. On 4 May 2017 Miss B asked if a live in carer could be suitable instead. The Council offered to fund a live in carer for an initial 4 week period to help Mrs C’s discharge from hospital and identified an agency at the end of May.
  6. Miss B declined 3 potential carers on 5 June 2017 as they did not have formal qualifications in dementia care. Miss B asked the Council to look into a care company she had found, but the Council said that it would not fund the extra cost as the service already identified met Mrs C’s needs. The social worker said Miss B would need to pay the extra if she wanted to use a different care company or arrange care via direct payments.
  7. Miss B has said the Council did not offer Mrs C a provision of live in care in 2017. She says the Council suggested it could be explored, but the value of the package at that time was not approved and no care plan was in place. Subsequently it was made known to Miss B that the Council do not fund live in care.
  8. On 16 June Miss B spoke with the social worker. They agreed that Mrs C was medically fit to be discharged from hospital and that Miss B could:
    • Agree to carers from the care agency which the Council would fund.
    • Arrange her own care, which would be paid for by direct payments.

The social workers notes say it was agreed that an interim nursing home placement for Mrs C would be a good fit. There is evidence from the social workers notes that the Council was working to find a suitable care home placement from 16 June until Miss B’s further request for a live in carer was declined by the Council on 4 July 2017 due to the cost. Again the Council said that Miss B could get direct payments so she could source her own care or the Council would see if the care agency it could fund had other suitable carers. At this point, Mrs C’s care needs had become greater and so the Council changed the search to find temporary dementia residential care.

  1. Mrs C transferred to the main hospital on 31 July 2017 as she needed acute hospital care. The hospital social work team began to search for an interim placement for Mrs C on 21 August 2017 to help her discharge from hospital. The Council discussed a financial assessment with Miss B at the beginning of September as it explained that Mrs C would need to contribute towards her care.
  2. The hospital discharged Mrs C to a care home on 14 September 2017 and the hospital social worker asked the community social work team to review Mrs C’s care within 3 months, to see if 24 hour care at home would be possible after this time.
  3. Miss B asked for a review of her mother’s care on 2 November and 11 December 2017, as she had concerns about the care home and wanted her mother to be cared for at home. The Council reviewed Mrs C’s support plan on 25 January 2018. The social worker made a referral for an Occupational Therapy (OT) assessment on 26 January and the OT carried out the home visit on 22 March 2018.
  4. The OT recommended equipment be provided and a package of care of 4 care visits plus 2 out of hours visits. This home care package was sent to the planning team on 2 July 2018 and an offer of care made on 12 July 2018. Miss B declined this offer as she wanted flooring installed and was unsure of the financial contribution her mother needed to make.
  5. The planning team resumed the search for the care package on 4 October 2018, as the care home manager confirmed Mrs C would be returning to her home on 24 October. After a meeting on 23 November 2018, the Council could not get a care agency that could offer a home care package and asked Miss B if she wanted to consider direct payments to meet her mother’s needs.
  6. The OT confirmed all equipment was in place at Mrs C’s home on 20 December 2018 and Miss B decided to receive direct payments to meet Mrs C’s care needs.
  7. Mrs C went into hospital on 28 January 2019 and the care home said it could no longer provide care to Mrs C on 5 February 2019. Mrs C confirmed on 12 March 2019 that she had found a care agency and was waiting for her mother to get a discharge date from hospital.

My analysis

  1. Miss B first contacted the Council when she, with a friends help, was still able to help her mother live independently at home. However, her mother needed more help and the situation was becoming urgent.
  2. The Council arranged a mental capacity assessment as a first step, but shortly afterwards Mrs C went into hospital. Mrs C was discharged from hospital on 29 March with a care package, but readmitted to hospital two days later. Mrs C went to a community hospital for rehabilitation on 16 April.
  3. Mrs C became more unwell and was transferred back to the main hospital. Until this time it is clear the Council and Miss B were exploring whether Mrs C could return home or whether an interim residential/nursing home would be more suitable. Mrs C was discharged to a temporary residential placement on 14 September 2017. At this point, the placement was for 3 months, to identify if Mrs C could return home. I can find no fault in the Council’s actions up to this point.
  4. Miss B complains that they had no contact with a social worker for 18 weeks after her mother went to the care home. The Council has accepted in its response to her official complaint there was a delay in allocating her a social worker and apologised in its response of 9 March 2018. Miss B has said that she expected to receive a separate apology letter from the Council but I can find no evidence the Council said it would do this.
  5. The review of the placement was due on 14 December 2017. Miss B asked for the review twice before this date, but it did not happen until 28 January 2018. There was then a further delay of two months until the OT assessment and then until 12 July 2018 when the Council made an offer of homecare to Miss B. So, it took 6 months after the review of the placement was due for an offer of homecare to be made for her mother. I do understand it took some time for the assessments to be carried out. But, I consider there was fault by the Council as there was delay of at least 4 months leading up to this point. This delay was partly caused by the delay in allocating Mrs C a social worker.
  6. However, Miss B declined the offer of homecare for her mother on 12 July 2018 as she wanted to install flooring at her mother’s house. So, I do not consider the delay caused an injustice at this point, as if the Council had made an offer before this point she presumably would not have been able to accept it due to the flooring she needed to install.
  7. Miss B emailed the Council on 30 August 2018 to say the decorator finished at her mother’s house on 26th July, the hoist was installed on 10 August and she was in the process of getting the necessary equipment delivered.
  8. The social workers manager emailed Miss B on 30 August 2018 with a clear statement of the Council’s position. The email said that all the equipment was ready for Mrs C’s return home apart from a mattress. The Council explained that the social worker assessed Mrs C as needing 6 care visits during a 24 hour care period. However, the Council was waiting for the OT to assess whether one or two carers were needed when using the ceiling hoist. The manager stated clearly that the Council had not assessed Mrs C to need a live in carer but Miss B could arrange this via direct payments if she wanted.
  9. The planning team resumed the search on 4 October 2018 for a homecare agency that could provide the care Mrs C needed. The Council were unable to find an agency that could provide the home care needed so suggested to Mrs C that she get direct payments to arrange her mother’s care.
  10. Miss B complains the Council has not provided an acceptable home care package for her mother. It is clear from the start that Miss B wanted the Council to fund a live-in carer for Mrs C. However, the social worker explained to Miss B in June 2017 that the options were that Miss B could agree to carers from the care agency which the Council fund up to a certain maximum payment or arrange her own care for her mother, which would be paid for by direct payments. (In both cases Mrs C would pay towards her care according to a financial assessment.) It is also clear that Mrs C’s care needs have changed over time. I cannot say the Council should have funded a live-in carer, the Ombudsman accepts that councils have limited budgets and that it may not be able to fully fund the choices that people want.
  11. Arrangements were in place for Mrs C to move home in late December 2018, but Mrs C was admitted to hospital in late January 2019. The care home said it could no longer care for Mrs C on 5 February 2019 and Mrs C moved home in late March 2019. Miss B said Mrs C should have only been in hospital for one week, but complains she had to stay for 2 months before she could move home.
  12. I can find no evidence of significant delay at this point. The Council agreed to provide direct payments and there is a note on the file that Miss B told the Council on 12 March 2019 that she had identified a care agency and was waiting for a hospital discharge date for Mrs C.
  13. Miss B’s main complaint is that she considers that her mother should not have to pay the £278 per week costs for the temporary residential care from 14 September 2017 until 28 January 2019. Mrs C owes the Council over £20,000.
  14. Mrs C owns her own property. So, she would be responsible for the full cost of permanent residential care. However, the Council has financially assessed Mrs C as a short stay resident. This means she needs to pay £278 per week, much less than the full cost of her care.
  15. There was fault by the Council. There was delay. But, Miss B turned down the offer of the home care package in July 2018 as Mrs C’s property was not ready so I cannot say that Mrs C could have moved home before this date. Mrs C has used the residential care and the Ombudsman would expect her to pay for the services she has used at the rate financially assessed by the Council. I do not consider the delay led to any financial injustice to Mrs C. The Council has billed her for residential care as a short stay resident, which has meant the charges she owes for the care are lower.
  16. From October 2018 until January 2019, when the property was ready for Mrs C I can see the social worker worked to try to find a home care package but could not do so. Instead she suggested Direct Payments, which Miss B agreed to. Unfortunately, Mrs C was admitted to hospital again so the move home was delayed for unforeseen circumstances. This was not the fault of the Council and so I cannot recommend the Council pay a financial remedy for this period if there is no evidence of fault.

Agreed action

  1. That the Council apologises to Miss B for the delay in allocating a social worker within one month of the date of the decision on this complaint.

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Final decision

  1. I have completed my investigation of this complaint. There has been fault by the Council, but I consider the apology and charging Mrs C as a short stay resident rather than a long term resident is a satisfactory remedy to the injustice caused.

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Investigator's decision on behalf of the Ombudsman

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