Summary: The Council already upheld some of Mr Z’s complaints about poor environmental standards at a care home it funded. It took appropriate action to remedy the injustice and so we made no further recommendations. There was no evidence Mr Y was unkempt and no evidence the family were misinformed about care being free. So we did not uphold these complaints.

The complaint

1. Mr Z complained for his father Mr Y about Devon County Council (the Council) and about a care home, Mayfield Hall (the Care Home) which the Council arranged and funded for Mr Y. Mr Z complained about:
1. A poor standard of cleanliness, furnishing and equipment
2. Mr Y being unkempt
3. Charging for Mr Y’s care when the family were told it would be free.

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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. The Council arranged and funded the Care Home under powers and duties in the Care Act 2014. We can investigate Mr Z’s complaints about the Care Home which acted on the Council’s behalf.
5. 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

6. I considered the complaint to the Ombudsman, the Council’s response to the complaint and records described later in this statement including comments from the Care Home and recent photos of improvements to the building.
7. I discussed the complaint with Mr Z and the family provided me with photos of the Care Home taken during Mr Y’s stay.
8. Mr Z 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

Relevant law and guidance

9. A council must carry out an assessment for any adult with an appearance of need for care and support, applying national criteria to decide if a person is eligible for care. (Care Act 2014, section 9)
10. If a council decides a person needs support, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether they meet any eligibility criteria and sets out how the council is going to meet them. (Care Act 2014, sections 24 and 25)
11. The Care Act 2014 allows councils to charge for care and support they arrange. Detailed regulations and guidance set out the financial assessment and charging process councils need to follow.
12. Intermediate care is a structured programme of care or rehabilitation provided for a limited time to help a person maintain or regain daily living skills. (Care and Support Statutory Guidance, paragraphs 2.9 and 2.10)
13. Intermediate care is free for up to six weeks and this can be extended in some cases. (Care and Support Statutory Guidance, paragraph 8.14)

What happened

14. Mr Y has dementia. He was in an intermediate care placement in a different care home in January 2020 and then went into hospital due to confusion. Scans revealed he’d suffered a brain bleed. Mr Y was discharged back to the intermediate care placement but readmitted to hospital the same day due to a fall. The intermediate care placement said it could not meet Mr Y’s needs. Mr Y’s wife was in the same care home in a shared room, but her placement was a permanent one.
15. The hospital discharge co-ordinator spoke to Mr Y’s daughter (Mrs X) on 27 January and advised her that if Mr Y would not benefit from rehabilitation, he would not be eligible for an intermediate care bed. The hospital records indicate Mrs X expressed frustration about how long it was taking to find a placement. A doctor noted Mr Y was medically fit for discharge from 24 January. An occupational therapist confirmed Mr Y would not benefit from rehabilitation as he had vascular dementia and a cognitive impairment which had caused his falls and was progressive in nature. A doctor spoke with Mrs X and told her Mr Y had a bleed to his brain and this had likely caused a progression in his dementia. Mrs X said the family would like Mr Y to be placed in the same care home as his wife Mrs Y.
16. On 3 February, a social care assessor met with Mr Y on the ward. He said he wanted to be reunited with his wife. The social care assessor met Mr Y again on 5 February and told Mr Y staff from some care homes would be coming to assess him. The social care assessor noted the family wanted their parents to be placed in Teignmouth (which was close to Mrs X) in the same care home.
17. The social care assessor completed an assessment of Mr Y’s needs. He was eligible for council-funded care. The assessment noted the family’s preference for a care home in Teignmouth because Mrs X could not drive and that Mr and Mrs Y wanted to be in the same care home. The assessment concluded Mr Y required a placement in a care home. Mr Y’s care and support plan set out his needs and how to meet them. The agreed funding was for a temporary placement.
18. On 7 February, the social care assessor saw Mr Y again and told him there were no care homes in Teignmouth with two vacancies currently, but placing the couple together was the intention. Later that day, a member of staff from the Care Home assessed Mr Y and offered a place. He moved to the Care Home on 9 February.
19. The Council has no record of the social care assessor telling Mrs X that Mr Y’s care would be free. Responding to my enquiries, the social care assessor said she had spoken to Mrs X at the end of February and Mrs X had said an unidentified member of staff at the hospital told her Mr Y’s care would be free.
20. I have looked at the Care Home’s records for Mr Y’s care. He needed assistance with personal care. The daily notes indicated Mr Y was assisted with washing, dressing and shaving every day, but on occasion refused care and that Mrs X has spoken to staff to say she did not think the Care Home was the right place for Mr Y. There were no further details about why Mrs X was of the view that the Care Home was not right. Another entry indicated Mrs X was unhappy after visiting Mr Y and said he was ‘in a terrible state’ and should be with Mrs Y. Mrs X reportedly left the building before staff could speak to her to discuss her concerns in any detail. The records indicate Mr saw the GP later on the same day and was prescribed antibiotics for a chest infection.
21. Mrs X spoke to a member of staff about the lift not working and was told that it could not be used to evacuate if there was a fire and the residents would be moved behind two fire doors.
22. Mr Y moved to a different home in Teignmouth in the last week of March. Mrs Y moved to the same care home two weeks later (I am told her move was delayed because she was unwell).
23. Another of Mr Y’s relatives complained to the Council about the issues raised with us. The Council’s response said:
• Due to Mr Y’s needs changing, he could not go back to the first care home (the intermediate care placement). Officers tried to find a placement for the couple together in Teignmouth, but there were no vacancies in February 2000. Mr Y was therefore placed in the Care Home with the intention of finding another placement with vacancies for them both
• The records show NHS clinicians and the Council considered Mr Y was not eligible for intermediate care, so the social care assessor worked on finding a temporary care home
• The family were offered to visit the Care Home before accepting a place, but Mrs X was unwell and so spoke to the Care Home’s manager and confirmed she was happy for the placement to go ahead, despite her stated preference for a placement for both parents
• The Council had contacted the Care Home to ensure there was refurbishment work happening
• It would reduce the outstanding bill by £100.
24. The Care Home told me the lift was out of action for about two weeks and it could not be used in a fire in any event and so there was no additional evacuation risk during this period. The Care Home also apologised for tape on carpets and damage to paintwork as well as for discarded items awaiting collection. It provided recent photos of parts of the building showing better decoration, tidy outdoor areas and repaired carpet and flooring.

Findings

Complaint a: A poor standard of cleanliness, furnishing and equipment

25. The Council has already accepted the physical environment in the Care Home was not as it should have been which was fault. It reduced Mr Y’s bill by £100. The Care Home has completed repairs. It was unfortunate that the lift broke, but appliances do break down and this was no-one’s fault. I am satisfied the actions taken were appropriate to remedy the injustice and no further action is required of the Council.

Complaint b: Mr Y being unkempt

26. There is no evidence the family raised any specific concerns about Mr Y being unkempt in their complaint to the Council or in any of the Care Home’s records. I note Mrs X was unhappy and upset about her father on at least two visits, but she did not explain why in any detail. And Mr Y may have appeared unwell on the second occasion as he was diagnosed with a chest infection the same day. There is evidence the Care Home provided daily support with Mr Y’s personal care. So I do not uphold this complaint.

Complaint c: Charging for Mr Y’s care when the family were told it would be free.

27. There is no evidence the Council or the NHS told the family Mr Y’s care would be free. The hospital discharge co-ordinator (who is an NHS employee) said care would only be free if Mr Y would benefit from rehabilitation. And an occupational therapist confirmed that he did not have any potential for rehabilitation because of his cognitive problems.
28. I am satisfied that the family knew residential care would not be free anyway as Mrs Y was already in a residential care placement which was chargeable.

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Final decision

29. The Council upheld some of Mr Z’s complaints about poor environmental standards at a care home it funded. It has already taken appropriate action to remedy the injustice and so I made no additional recommendations. There is no evidence Mr Y was unkempt and no evidence the family were misinformed about care being free. So I do not uphold these complaints
30. I have completed the investigation.

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Investigator's decision on behalf of the Ombudsman