Summary: There is no fault in the Council’s decision on the care needs of Mrs B after discharge from hospital. The social worker considered the views of the medical staff and family before reaching a professional judgement on the care needed without fault. The family say the care home fees they paid for 5 months should be refunded as the home carers were not acceptable to them. But, the Council offered a discharge to assess bed which would have allowed further assessment of Mrs B.

The complaint

1. The complainant, who I shall call Mr X, complains the Council did not adequately consider his families and doctors view that his late mother (Mrs B) did not have mental capacity to reach a sound judgement on her safety if discharged home.
2. Mr X also complains the Council did not offer an alternative when Mrs B told them she wanted to go into a residential care home rather than receive care at home. He said the family had to pay for a care home for 5 months as they did not feel it was safe for Mrs B to stay at home with carers visiting which the Council offered.

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The Ombudsman’s role and powers

3. 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)
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 read the papers put in by Mr X and discussed the complaint with him.
6. I considered the Council’s comments about the complaint and any supporting documents it provided.
7. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Key facts

8. Mrs B lived independently at home, with carers. After several hospital stays due to infections and a respite stay in a residential care home, Mrs B was ready for discharge from hospital in February 2019.
9. The social worker carrier out a care and support assessment on 6 February 2019. Two social workers carried out capacity assessments and decided that Mrs B had capacity to make an informed decision on her care. One medical doctor concluded that Mrs B lacked capacity. Another medical doctor said Mrs B had capacity to make decisions on the risk of falls but later clarified that this capacity was variable. An advocate represented Mrs B.
10. The social worker concluded that in her opinion the Council could support Mrs B at home with carers calling four times a day, providing a falls detector, an incontinence assessment, a key safe, referral to physio and possibly a day centre. The report noted that Mrs B had initially said she wanted to have care at home but later told the advocate that she wanted to go into residential care. The report notes that Mr X disagreed with the social care assessment and believed his mother needed residential care. The social worker also explained to the family there was a third option, for Mrs B to be discharged to a temporary ‘discharge to assess’ bed.
11. Mr X arranged for Mrs B to be discharged into a residential care home on 10 February, which was funded privately by the family. Mrs B was admitted to hospital in July 2019 and discharged to a ‘discharge to assess bed’. Sadly, Mrs B died in October.

My analysis

12. I have noted Mr X’s complaints about the mental capacity assessments carried out by the Council and that doctors held different views on Mrs B’s mental capacity. However, as Mrs B’s view changed to the same as her family, in that she wanted residential care, I am not convinced that this affected the Council’s decision.
13. In this case, the fundamental issue is that Mr X (and then Mrs B) disagreed with the Council officers decision that carers at home or a discharge to assess bed was suitable. My role is not to decide what care was suitable for Mrs B, but to decide, on the balance of probabilities, whether the Council officer made the decision aware of all the facts.
14. The Council has explained that in its view, the care plan involving care workers visiting Mrs B at home meet her needs. So, if Mrs B wanted a higher level of care, it would not be funded by the Council. The Council said the discharge to assess bed it offered the family would have given an extended period of assessment and may have helped to resolve the disagreement. Mr X has said that the family felt the discharge to the assessment bed would have been too disruptive and the Council would have still made the same decision anyway.
15. I have looked at the assessment and the care and support plan. It is clear the social worker considered the views of the medical staff, family, Mrs B and her advocate. The social workers final decision was that domiciliary care would meet her needs. Mr X disagreed with this decision and the social worker accepted the families choice for Mrs B to go into residential care.
16. Mr X complained to the Ombudsman as he felt the social worker should have arranged for funded residential care for Mrs B in February 2019. He wants the Council to refund the costs the family had to pay when they chose for Mrs B to go into a care home.
17. On the balance of probabilities, I consider the Council made the decision without fault. I can understand there were differing opinions on Mrs B’s mental capacity and whether she should be cared for at home. I can see the Council considered all the opinions before reaching a final decision on the care that it considered would meet her needs. On this basis, I do not consider the Council should refund the costs Mr X claims. The Council did offer the family an option of a discharge to assess placement, which would have allowed all parties to get more information on Mrs B’s needs. I can appreciate Mr X wanted a Mrs B to go to the care home she had stayed at previously rather than the discharge to assess care. But, this decision did mean the Council would not fund the placement and the social worker clearly told Mr X this.

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Final decision

18. I have completed my investigation of this complaint. This complaint is not upheld.

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Investigator's decision on behalf of the Ombudsman