Summary: Ms X complained about the Council’s decision not to fund residential care placements for her parents, Mr and Mrs Y. We did not find fault in the Council’s assessments of Mr and Mrs Y’s care and support needs.

The complaint

1. Ms X complained about the Council’s decision not to fund residential care placements for her parents, Mr and Mrs Y.
2. Ms X considers both her parents have eligible care and support needs, and that Mr Y needs residential care. Mr and Mrs Y are running low on savings and Ms X worries they may be separated.

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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 consider whether there was fault in the way an organisation made its decision. If there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
4. We normally name care homes and other care providers in our decision statements. However, we will not do so if we think someone could be identified from the name of the care home or care provider. (Local Government Act 1974, section 34H(8), as amended)
5. If we are satisfied with an organisation’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. As part of the investigation, I considered the complaint and the information Ms X provided.
7. I made written enquiries of the Council and considered its response along with relevant law and guidance.
8. Ms X and the Council and the organisation 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

Assessment

9. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
10. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Choice of care homes

11. The Care and Support and Aftercare (Choice of Accommodation) Regulations 2014 set out what people should expect from a council when it arranges a care home place for them. Where the care planning process has determined a person’s needs are best met in a care home, the council must provide for the person’s preferred choice of accommodation, subject to certain conditions. This also extends to shared lives, supported living and extra care housing settings.

What happened

12. I have summarised below some key events leading to Ms X’s complaint. This is not intended to be a detailed account of what took place.
13. Mr Y has Alzheimer's and Mrs Y has a diagnosis of dementia. They sold their home to go travelling after their retirement, giving some of the proceeds to their children.
14. After travelling, Mr and Mrs Y moved into an apartment. However, Mrs Y’s dementia made her forgetful, and she was unable to manage Mr Y’s support needs. The couple therefore moved in with their son. They also paid for an extension to their son’s home, so they had their own separate space.
15. Unfortunately, relations with Mr and Mrs Y’s son’s wife broke down, so Mrs Y decided they should move into a nursing home.
16. Mr and Mrs Y moved into Fairmount Nursing Home in January 2023.
17. The Council assessed Mr and Mrs Y’s care and support needs in January 2023.
18. The Council’s assessment for Mrs Y recorded she had no issues with walking, mobility, managing stairs, or personal care. It noted she monitored her bank balance, but Ms X manages her finances. Mrs Y said she could manage her own needs, but lost confidence in cooking, so preferred meals prepared for her. The Council concluded Mrs Y had no eligible care and support needs.
19. The Council’s assessment for Mr Y found he used a walking stick outside but can walk unaided inside and can walk down stairs slowly. Nurses gave Mr Y his medication, but he did not know what it was for. Mr Y knew he was staying in a care home and that he previously lived with his son, but did not know where he lived before. Mr Y had a daily strip wash and was supported by carers when showering. Mr Y can use the toilet independently but needed help with cleaning and wore continence pads.
20. The nursing home manager said Mr Y could be aggressive without Mrs Y, he cannot function without her and panics. Nurses said they administer Mr Y’s medication, but he is quite independent.
21. Mr Y’s care notes at the home state he struggles with short term memory, has challenges with his memory when tired, and can struggle with conversations and decisions. Mr Y struggles with dexterity and fine motor controls. He needs assistance with dressing, but eats well. He can get frustrated when encouraged to do something he does not want to do, like personal care or showering. Mr Y can clean easily accessible areas, but needs assistance with hard-to-reach places. He also needs support brushing his teeth and needs encouragement to wear hearing aids. Mr Y can use the call bell for assistance. Tasks carried out by staff were personal care in the morning, lunch, and administering medication.
22. The Council found Mr Y had eligible care and support needs. However, it found he did not need 24-hour residential care. It considered his needs could be met in the community.
23. The Council finalised Mr and Mrs Y’s assessments, which they signed in March 2023.
24. Ms X appealed the result of the care assessments in April 2023. She felt Mr Y has needs which can only be met in a 24-hour care setting. She said Mr and Mrs Y both needed 24-hour care. She said their health improved in the care home and Mrs Y got a break when nurses cared for Mr Y.
25. The Council treated Ms X’s appeal as a formal complaint and decided to re-assess Mr and Mrs Y.
26. The Council made a joint visit to reassess Mr and Mrs Y in May 2023. They were now living at Brookfield Residential Home, located next door to Fairmount Nursing Home, after it closed in April 2023.
27. The Council spoke to Ms X, who said there was about six months’ worth of funding left. She said her parents were more confused and could not live independently.
28. The care home manager said staff did very little for Mr and Mrs Y, apart from administering medication, and giving Mr Y some personal care. They said Mr and Mrs Y go on regular local walks, Mr Y goes to the onsite gym, and Mrs Y enjoys swimming.
29. The Council suggested an alternate care provider to Mr and Mrs Y, closer to where Ms X lives. Mrs Y said she could not settle anywhere else.
30. Mr Y expressed a wish to stay at the care home. The Council considered Mr Y did not understand he was in a care home with people who are significantly more dependent on receiving care and support than he is. The Council also considered Mr Y did not understand the financial implications of staying at the care home.
31. The Council witnessed Mr Y mobilise independently from a chair to the bathroom. It considered his care needs had not changed since his last assessment. He had eligible care needs but was not eligible for 24-hour care.
32. The Council explained to both Mr and Mrs Y that neither had eligible need for 24-hour care and their needs could be met within a more independent environment, such as extra care housing.
33. The Council sent its formal complaint response to Ms X on 23 June 2023. It said it allocated a social worker who assessed Mr and Mrs Y in January 2023, informing them about the process. Apart from a slight error in previous employment, the Council said Ms X did not challenge the assessments. It said updated assessments were signed in March 2023. Ms X then appealed the outcome. Due to the appeal, another social worker carried out a second assessment in May 2023. They concluded Mr and Mrs Y’s needs could be met in the community and they did not need a 24-hour care setting. They therefore suggested alternative options, such as extra care housing schemes, including one close by to Ms X. The Council said it did not ask Mr and Mrs Y to move to assisted living accommodation or another part of the city. The Council also said it did not say Mr and Mrs Y could not remain at the care home. However, due to the outcome of the assessments, this would not be funded by the Council.
34. The Council met with Mr and Mrs Y at Brookfield Residential Home again in July 2023. They were supported by the care home manager. Ms X did not want to be present as she felt Mr and Mrs Y would look to her for answers.
35. The Council concluded Mr Y does have eligible care needs but there is no new evidence to suggest his needs could not be met within a less restrictive environment, such as extra care housing, with support from care staff and Mrs Y.
36. The Council found Mrs Y still had no eligible care needs.
37. The care home manager agreed to accompany Mr and Mrs Y to an introductory visit to an extra care housing provider so they can see what the scheme has to offer. Mrs Y agreed to this.
38. The Council emailed Ms X confirming the outcome of the visit and the need to explore extra care housing options.
39. Ms X emailed the Council to advise Mrs Y would be living with her due to the stress of having to consider moving out of the care home. Ms X asked the Council to reassess Mr Y as a result of being separated from Mrs Y.
40. The Council telephoned Ms X on 14 August 2023, advising it was arranging a visit to the care home to assess Mr Y on 16 August at 2pm. The Council requested Mrs Y was not present. Ms X agreed. Ms X said Mrs Y was still living at the care home as she had paid until the end of August. Ms X said she would wait for the outcome of the new assessment before making plans with Mrs Y.
41. A social worker met Mr Y on 16 August 2023. Mr Y recognised the social worker from their previous visit. He appeared well groomed and said he was on his way to the on-site gym, which he visited every day to do 15 minutes on the exercise bike. He said he did not need any help to do this. The care home assistant manager confirmed Mr Y visits the gym independently and there have been no incidents.
42. The social worker discussed Mr Y’s needs with him. Mr Y said he can wash and dress himself and go to the toilet independently. His sleep pattern was settled, and care staff administer his medication.
43. The social worker noted Mr Y’s care records show staff do very little for him. They rarely help with personal care but help with a shower when Mr Y allows. They administer medication and prepare all meals and drinks. Mr Y had good appetite and stable weight. There were no falls recorded and the notes indicated Mr Y can mobilise independently, including managing stairs. He will use a walking stick for longer walks. Mr Y confirmed this was correct.
44. Mr Y’s records also showed he had no night time needs. Mr and Mrs Y lock their door, which is their preference, and staff do not check on them.
45. The social worked recorded Mr Y was more alert and talkative during this visit. However, Mr Y did not accept his needs were lower than most residents at the care home, or that he can do a lot more.
46. Mr Y left the meeting and went to the gym, inviting the social worker to join him when they finished. The social worker went to find Mr Y at the gym, accessed by stairs at a clubhouse which is beyond a bowling green. They found Mr Y in the clubhouse drinking coffee, having finished exercising. Mr Y showed the social worker the gym and took them back to the bar area, where he said he sometimes comes on an evening. The social worker observed Mr Y walking back independently and managing stairs with no difficulty.
47. The social worker telephoned Ms X on 24 August 2023. They explained their assessment showed Mr Y does not have eligible needs for 24-hour care. They said the Council would therefore end its involvement.

My investigation

48. Ms X told us Mr Y needs help with everything he does and needs to be told what to do. She said he needs 24-hour care. She said Mrs Y’s dementia is getting worse and she does not feel she could cope with looking after Mr Y in extra care housing.
49. The Council told me it found Mrs Y had no eligible needs under the Care Act on both occasions it assessed her.
50. On the four occasions it assessed Mr Y, he had eligible needs under four outcomes:
• Managing and maintaining nutrition.
• Managing personal hygiene.
• Being appropriately clothed.
• Maintaining a habitable home environment.
51. However, the Council said it considered those needs were not at a level where they could not be met in the community, or where Mr Y needed a 24-hour residential environment.
52. The Council said it provided information and advice on what was available for all the needs identified. Extra care housing was identified as a less restrictive option for Mr and Mrs Y and could meet their current needs. It gave Ms X support and guidance on the application process.

Analysis

53. I did not find fault by the Council in its assessments of Mr and Mrs Y’s care and support needs.
54. The circumstances are not typical, because Mr and Mrs Y made the decision to voluntarily go into residential care before approaching the Council for an assessment. Ordinarily, the Council would assess someone’s care and support needs in their home before deciding whether they needed residential care.
55. Nevertheless, I found the Council followed the assessment process we would expect. Social workers met with Mr and Mrs Y and involved them in the assessment, seeking their views about their needs and where they wished to live. They also sought views from Ms X and the care home staff involved in Mr and Mrs Y’s care.
56. Two different social workers met Mrs Y on separate occasions. Both independently decided she did not have any eligible care and support needs. In the absence of fault in the way the assessments were carried out, I cannot question the professional judgment of the social workers.
57. Likewise, different social workers also independently concluded Mr Y did not need 24-hour residential care. That was after four separate assessments and after considering Mr Y’s care records detailing the input of care home staff. The social workers considered Mr Y’s needs could be met in the community or in supported living accommodation. I am satisfied the social workers carried out their assessments properly, taking account of the relevant views and information. I therefore cannot question their professional judgement about whether Mr Y needs residential care.
58. Ms X said there was a decline in Mrs Y’s condition, and she could not cope looking after Mr Y in supported living accommodation. I appreciate the situation is stressful for Mrs Y, but no clear evidence was raised of any eligible care and support needs, or that Mrs Y could not continue the care she gave Mr Y in another setting. If the situation changes, Ms X can ask the Council for another assessment.

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Final decision

59. I completed my investigation. At this stage, I did not find fault in the Council’s assessments of Mr and Mrs Y’s care and support needs.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman