Summary: Ms C complains her mother was taken into hospital with hypothermia, and about the time it took to move her mother back to her own home again, after she had been discharged from hospital. We found the Council should have ensured that, when it became aware of a heating problem at the property, that appropriate steps were taken to resolve this immediately. The Council has agreed to apologise for this.

The complaint

1. The complainant, whom I shall call Ms C, complans on behalf of her mother, whom I shall call Mrs M. Ms C complains that:
• She went into hospital (and subsequently a care home) due to fault by the care agency, which was commissioned by the Council. As such, the Council should pay for her stay in the care home.
• The Council failed to recognise her mother did not have capacity to make decision about her care, during the first few weeks in the home.
• There was an initial delay in her mother being able to return home, because the Council initially pushed and pursued the option of residential care / sheltered accommodation, even though her mother and her family had said she wanted to return home (and has since successfully returned home).
• After the family fitted a new boiler in her mother’s room on 11 March 2019, to support her return, there were further delays in her going home, because there were delays by the Council in:
1. Carrying out further assessments
2. Waiting for correct equipment to be delivered and in place, without which she was not allowed to return home (a profile bed, a pressure relieving mattress).
3. Setting up an increased care package and identifying a care agency to provide this.

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended).
3. 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, section 25(7), as amended).
4. 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

5. I considered the information I received from Ms C and the Council. I shared a copy of my draft decision statement with Ms C and the Council and considered any comments I received, before I mad my final decision.

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What I found

The complaint about Mrs M’s admission to hospital and her subsequent discharge to a care home

6. Mrs M lived at home with her husband who provided suppport to her, together with support from a homecare agency commissioned by the Council. Their oil burner broke down on 25 December 2018.
7. The care agency started to provide Mrs M’s support on 18 January 2019. At this time, work on repairing the heating system had not taken place. The Council’s needs assessment showed that Mrs M needed support with transfers, personal care, (un)dressing, meals preperation and toileting. Mrs C says her parents were unable to manage the heating in the rooms. As such, this should have been identified as a risk during the Council’s assessment of her mother’s needs and should have been managed and included as part of the support package. The Council says that Mrs M had capacity to make decisions around her care and support needs. However, she did not mention that she and her husband were unable to manage the heating. The family did also not raise this as a concern. If this had been raised as a concern, the Council would have included this in the support plan.
8. Mrs M told the Council she wanted the last visit of the day, to be after 9pm. However, the care provider was unable to do a call that late. As such, Mrs M told the social worker to scrap this call altogether, and her husband would continue to help her with going to bed instead. The care support was reviewed with a family member present on 22 January 2019, during which no concerns were raised about heating, carers missing visits etc.
9. Ms C says:
• Her mother ended up in hospital because the care agency failed to ensure her mother’s bedroom was warm enough at night, between 24 and 27 January, which resulted in her hospital admission with hypothermia. As such, the Council should pay for her subsequent temporary stay at a care home.
• Her mother decided on 25 January 2019, that she would no longer sleep upstairs with her husband, but would sleep downstairs instead. However, the downstairs room was more difficult to heat up.
10. In response, the Council told me that if Mrs M had accepted the 9pm visits, there would have been a possibility the carer may have noticed her bedroom was too cold. However, Mrs M had capacity and could have raised any concerns about cold bedrooms with the carers or her family.
11. On 24 January 2019, a staff member from the care agency raised a concern with the Council about the heating at the property. The heating system was still not working and only one of the heaters was available. The Council subsequently contacted the care agency who agreed to look into this. However, I have not seen evidence that this issues, and potential risk, was subsequently immediately resolved.
12. The Council received a call on 28 January 2019 from the police, who said that Mr M had been in his garden refusing to return to the house. The Police called an ambulance who found that Mrs M was hypothermic. They took both to the Emergency Department.
13. The Council established that Mr M could not return home and would therefore no longer be able to provide support to his wife when she would return home. This meant Mrs M needed an increase in her homecare support package if she would go back home.
14. The hospital assessed Mrs M as being medically fit to return home, on 29 January 2019. The Council said that: were it not for the environmental risk within the home (there was no heating) she could have returned home on 29 January 2019, because her care package was still in place. However, this was only partially true:
• Ms C says it was possible to heat key areas in the house sufficiently, especially with support from a care agency with managing this.
• Furthermore, the Council had just launched a safeguarding investigation into concerns the care agency had not provided all the support Mrs M had needed. As such, the Council would have had to find a different care agency for Mrs M, which would have taken some time to organise.
15. The Council had a discussion with Mrs M on 28 January 2019 about her options. Mrs M said she wanted to stay with her husband, and care home X was the only option available that could meet both their needs. The Council says it explained to her that the placement would cost £1,300 a week. However, there is no evidence the social worker mentioned this amount to her. This should have been discussed with Mrs M to ensure she could make a fully informed decision. The Council’s records do show that the social worker also discussed the placement with Mrs M’s son, who agreed to it.
16. Ms C says her mother did not have capacity when the hospital discussed the discharge with her mother. The Hypothermia left her confused and temporarily unable to make decisions. As such, Ms C says her mother did not understand the information she was given by the Council and could not make an informed decision. However, the Council said there was absolutely no reason to suspect that Mrs M lacked capacity to consent to the placement. The social worker’s record of the discussion shows she discussed the option of Mr and Mrs M going into sheltered accommodation. However, Mrs M explained why she did not want this. She was able to express very clearly that she wanted to be placed near to her husband. Accordingly, Mrs M confirmed she would prefer to go into residential care.

Analysis

17. There was no fault that ‘managing the heating’ was not part of the support plan. Neither Mrs M, nor her family, raised any concerns about the heating at the home, or that the care agency should assist with this.
18. However, when the Council asked the care agency to look into the concern raised about the heating on 24 January 2019, the care agency failed to ensure it addressed this. This was fault. This may have played a part in the events that eventually resulted in Mrs M going into hospital with hypothermia.
19. I am unable to verify now, to what extent the heating situation at Mrs M’s home was still sufficient on 29 January 2019, so as not to pose any risk of her experiencing hypothermia again. Nevertheless, as there was no appropriate care package in place yet, it was clear that Mrs M had to go into a care home for several days before she could return home. This meant the Council carried out a financial assessment to determine how much she would have to contribute towards this temporary stay. There was no fault with regards to the Council’s decision to charge Mrs M.

The time it took until the decision was made for Mrs M to return home

20. Ms C says there was a delay in her mother being able to return home, because the Council initially pushed and pursued the option of moving her mother permanently into residential care or sheltered accommodation, even though she (and her family) had said she wanted to return home, and has since successfully returned home.
21. The social worker visited Mrs C on 30 January. The record said she would like to have care at home and the social worker would need to see what there would be to help her at home”.
22. The social worker spoke to Mrs M’s son later that day. She explained she could look at options for a care package, or alternatively look at sheltered accommodation and explained the differences in care support. Mrs M’s son was concerned there would be gaps between visits when Mrs M would be at home alone. The social worker explained the next day that the Council would not provide 24-hour support at home, but Sheltered Accommodation could provide more flexibility than a care package at home, with regards to when support can be provided throughout the day.
23. The social worker visited Mrs M on 4 February. The record states the social worker discussed the various options available: care at home, sheltered accommodation or a nursing home placement. Mrs M said she wished to go to a nursing home placement near her daughter. The social worker subsequently informed the family by email and provided four dates on which she could meet with the family. The Council says it was very clear to the social worker that Mrs M was able to understand, retain, and use the information she received to make and communicate this decision. At the meeting on 4 February 2019, the social worker also had a full discussion with her about finances. Mrs M told the social worker about the approximate value of her house, the value of her savings and the fact she had put half of the house in a Trust a year ago. Furthermore, none of the other professionals involved with Mrs M’s care raised a concern about her capacity to make such decisions.
24. The family emailed the social worker on 5 February and said that her mother was now also talking about going home. The family said they believed this would be possible but not necessarily the best option. The family contacted the social worker again later that day and said that Mrs M had decided she would want to go into sheltered accommodation. The social worker explained that if Mrs M had more than £23,250 of capital (which she did), she could arrange such a placement herself.
25. A nurse contacted the Council by email on 7 February to say that Mrs M had said she was deeply unhappy about her current stay and wished to go home. The social worker explained the current status of the case.
26. The social worker visited Mrs M on 12 February. Mrs M said she was unhappy and wanted to be at home. The social worker explained the differences between care at home and sheltered accommodation. Mrs M said she knew it would be better to go into sheltered housing and said the name of the placement that was her first preference.
27. The social worker met with Mrs M’s family at her house. The records state the family agreed again that sheltered housing was the more appropriate option and pointed out that this is what her mother wants. The family was still in the process to obtain relevant documents as part of the process of applying for such a placement.
28. The social worker visited Mrs M again on 19 February 2019. The records state tat:
• Mrs M said she was not happy at the home and asked how much it cost. The social worker told her it was £1,200 per week.
• The social worker again discussed the differences between a homecare package and sheltered accommodation and explained she would have to wait for a vacancy. Mrs M decided that she would stay at the home to wait for a vacancy to become available in sheltered accommodation.
29. The family subsequently challenged the basis on which the Council was charging Mrs M for her temporary placement at the home. The Council obtained legal advice, which confirmed its view that the Care Act does not say councils have a duty to provide emergency respite care for free for up to four weeks.
30. The family told the social worker on 3 March 2019 that Mrs M had now confirmed that she would like to go home. The family said it had decided to now carry out the work required to fix the heating system, which would be up and running on 11 March. The family asked the social worker to start the work needed to set up the necessary care support and confirmed that it would be a good idea to have a hospital bed in the downstairs room.

Analysis

31. I did not uphold this aspect of the complaint. Mrs M initially said she wanted to go back home. The social worker subsequently discussed the differences in care support with Mrs M and her family. As a result, Mrs M said she would want to go into a nursing home, and later said she wanted to go into sheltered accommodation and wait until a vacancy would become available. The family agreed that this would be the best option and that this was what Mrs M wanted.
32. The family told the Council on 3 March that Mrs M had changed her mind and now wanted to return home.
33. The Council has explained why it did not have any concerns about Mrs M’s capacity to decide where she wanted to live. I have reviewed the care records and have not seen evidence that the Council did not properly consider this.

The alleged delay by the Council in subsequently setting up the care support at home

34. Ms C says that, when the Council finally agreed to enable a return home, her family went ahead and fixed the heating. The new boiler was fitted on 11 March 2019. Her mother had hoped to be able to return home immediately, but there were two weeks of further delays due to:
• Carrying out further assessments
• Waiting for a profile bed and pressure relieving mattress to be in place, without which she was not allowed home.
• Setting up an increased care package and identifying a care agency to provide this.
35. As Mrs M was self-funding, it would usually be up to her (supported by her family) to hire a care agency. The social worker sent an email to the family on 5 March in which she offered any help needed. The social worker also made a referral to the OT service. The social worker also told the family on 7 March that she would:
• Refer Mrs M to the continence service for nurses to support Mrs M with pads.
• Refer Mrs M for a wheelchair assessment. This was not something that had to be done before she would return home.
• Involve the OT with regards to the wet room, track ceiling hoist and ramp for outside the home. This could only really start with Mrs M in situ at home.
• Start the process to arrange a hospital bed via the district nurses.
36. The family chose to have the Council arrange a care provider, so the social worker also made an internal referral to find a long-term care provider. The Continence Team said on 11 March 2019 they would be able to provide support to Mrs M once she would live at home.
37. The Council found a care provider on 12 March 2019, with the care package planned to start three days later. The social worker explained to Mrs M that the continence support and wheelchair referral would only be completed after she went home. The social worker and Mrs M agreed to start the package on 18 March, after the weekend.
38. In the meantime, an OT visited Mrs M’s house on 14 March 2019. The record says Mrs M would need a hospital bed, air mattress and pressure cushion, which would need to be ordered by the community nurses. The OT told the social worker it would be difficult to get this in place by 18 March.
39. The social worker recorded that it was important to get a pressure cushion in place because she would sit in one position for a while. She also added that it would also be good to have a profiling bed in place to ensure carers could properly prepare the care she needed, and Mrs M would be able to change her position on the bed.
40. The Community Nurses said it would take a week to get the equipment in place. The records state “Have spoken to Mrs M. We have delayed discharge until 25 March 2019”.
41. The Council says there was a one-week delay to get the bed and mattress supplied. It did not prevent her from going home on 18 March 2019. It explained to her why it would be of benefit to her to have the equipment in place, after she agreed to postpone her return home by a week.

Analysis

42. I found there was no fault in the Council’s actions. After the family chose to ask the Council to find a homecare agency, the Council found one within a week. This was a reasonable timeframe.
43. There was subsequently a one-week delay in getting equipment in place, including pressure relieving equipment to keep Mrs M safe from pressure sores developing. This was not an unreasonable timeframe.

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Agreed action

44. When a council commissions a home care agency to provide services on its behalf, it remains responsible for those services and for the actions of the care agency providing them. So, although I found fault with the action of the care agency, I have made a recommendation to the Council.
45. I recommended that, within four weeks of my decision, the Council should provide an apology to Mrs M and Ms C for any distress the fault in paragraph 18 caused them.
46. The Council has told me it has accepted my recommendation.

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Final decision

47. For reasons explained above, there was fault with the way the Council responded to the concern raised about heating. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.

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Investigator's decision on behalf of the Ombudsman