Summary: Ms Y complains the Council has not completed a satisfactory review of the suitability of a care home to meet her father’s care needs. She says this means she is left with uncertainty about whether the family should be required to pay a top-up fee for his current care home. The Ombudsman has not found fault in the way the Council carried out the review.

The complaint

1. Ms Y complains, on behalf of her father Mr X, the Council is at fault in its retrospective review of the suitability of a care home to meet his needs. Ms Y says the care home – which her father has since left – was unsuitable. And the way the review has been carried out is unsatisfactory and has not been completed in accordance with our final decision on Mr X’s previous complaint. Because of this, the family should not be required to pay a top-up fee for the care home where her father now lives.

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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 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 have spoken with Ms Y and considered the information she has provided together with the Council’s report of its review.
6. I invited Ms Y and the Council to comment on this draft decision and took account of the responses received.

What I found

The Care and Support Statutory Guidance, Chapter 8 and Annex A

7. This provides that where a local authority is responsible for meeting a person’s care and support needs, it must ensure the accommodation it chooses is suitable to meet that person’s assessed needs and identified outcomes established as part of the care and support planning process.
8. The Guidance also explains that where a person actively chooses accommodation which costs more than the amount specified in their personal budget an arrangement will need to be made with the Council for the payment of a “top-up”.

What happened

9. Mr X has a disease which causes a gradual weakening of the muscles, particularly those in the arms and legs. It does not affect his cognitive ability.
10. Following a stay in hospital, Mr X was placed in a care home while the Council completed its Discharge to Assess Process. The Council’s assessment in October 2018 found Mr X needed:

• support with preparing food and drink;
• an environment where he could eat with others;
• help from two people for transfers;
• support with personal care including showering, dressing and toileting;
• help maintaining a clean and tidy living environment;
• regular contact within his family; and
• support to manage his anxiety.

11. Mr X and his family had already identified their preferred choice of accommodation for him: Home G, a care home providing nursing and dementia care, within walking distance of Mr X’s family home. The weekly cost was £1,200.
12. The Council looked at suitable care home placements for Mr X. It identified a number of care homes including Home CL, a nursing care home with younger residents close to Mr X’s family home. Home CL’s weekly fee for Mr X’s care was £1,000. The Council considered Home CL met Mr X’s assessed needs and set the budget for his care at £1,000 a week.
13. Mr X and his family were not happy with the Council’s choice of Home CL. They decided he would stay there only until a suitable room became available at Home G, for which they would pay the weekly top-up fee of £200.
14. Mr X moved to Home CL on 30 November 2018. The support plan for his placement there was due to be reviewed after six weeks. Mr X moved to Home G four weeks later, on 28 December 2018.

Previous complaint to us

15. Mr X and his family were unhappy about the way the Council had dealt with his care needs. Ms Y complained to us, on her father’s behalf. Part of his complaint was about his personal budget of £1,000 a week. Ms Y told us this was insufficient to cover the cost of care to meet Mr X’s needs without the payment of a top-up.
16. We completed our investigation of this part of Mr X’s complaint on the basis the Council had agreed to take the following action:

“The Council has agreed to review its claim that Home CL met Mr X’s needs. It should ask Ms Y and Mr X to provide details of the incidents Mr X experienced while staying at Home CL and any evidence they have which demonstrates their concerns especially in regard to it meeting Mr X’s mental, psychological and social needs. The Council should set out the reasons for its findings clearly in respect of each of Mr X’s assessed needs. If the Council concludes Home CL would not have met Mr X’s needs, it will fund Mr X’s current placement without top-up fees and reimburse the money spent on them since 28 December 2018.”

17. The Council carried out a review. The reviewer completed her report in May 2020 and in her conclusion said:

“…I believe Mr X’s needs could have been met at C.L. should he have worked with the care home to overcome the difficulties he has highlighted. ….”

18. Mr X and his family are not satisfied with the review. Ms Y says:

• the review report is flawed because it does not set out the reviewer’s reasons for her findings in respect of each of Mr X’s assessed needs.
• its conclusions are based largely on the recollections of Home CL’s manager, which they dispute.
• the review has not answered the main reasons they feel Mr X’s needs were not met at Home CL.

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Analysis

Was there fault by the Council causing injustice?

19. It is not for us to decide whether Home CL was able to meet Mr X’s assessed needs. Our role is to decide whether there was fault in the way the review was completed.
20. I have considered the way in which the reviewer for the Council carried out the review and completed her report. She looked at the October 2018 assessment of Mr X’s needs. In her report she said she wanted to hear from Mr X how he felt while he was at Home CL and his experience of being there. She had a meeting with Mr X and Ms Y, noted their concerns, including the impact on Mr X’s emotional and mental wellbeing, and obtained responses from Home CL’s manager. It is clear from the report that both Mr X and Ms Y, and Home CL were able to put forward their respective views about suitability. The main concerns about suitability raised by Ms Y were set out in the report and considered by the reviewer before reaching her conclusion.
21. And although the reviewer did not set out her findings separately for each assessed need, my view is the content of the report shows she considered Mr X’s physical and mental wellbeing needs and clearly set out the reasons for her view Home CL was able to meet these. She provided objective reasons why the Home was able to meet Mr X’s physical needs, she explained why she considered it was a good option and it could have met Mr X’s needs had he worked with it to overcome the highlighted difficulties.
22. My view is by completing this review, the Council has responded satisfactorily to our previous decision.

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Investigator's decision on behalf of the Ombudsman