Summary: Ms C complains the Council commissioned care provider, Bio Luminuex Healthcare Ltd, failed to provide suitable care and falsified records. Ms C also complains the Council failed to provide proper support for her mother, Mrs D, after she left a care home. The Council is at fault for failing to properly assess Mrs D’s needs before she returned to the community and for inadequate services it commissioned. To put things right the Council has agreed to waive an existing invoice of over £1700, apologise to Mrs D and Ms C for the distress and frustration its actions caused; and make service improvements which include the quality monitoring of the care provider.

The complaint

1. Ms C complains the Council failed to:
1. involve her and her mother, Mrs D, in assessments both for NHS Continuing Health Care and social care support;
2. properly arrange support following a discharge to assess residential care stay;
3. review Mrs D’s needs in a timely manner;
4. ensure the Council commissioned service, Bio Luminuex Healthcare Ltd, the “Care Provider” provided care services to meet Mrs D’s needs and at an adequate standard;
5. respond to her complaint in a timely manner, and provide proper considered reasons for refusing to reduce care charges.
2. Because of these failures Ms C says her mother has not received the care she needed which affected her physical and mental health. Ms C says the Council’s faults caused her frustration, and time and trouble in collecting evidence and making the Council aware of the difficulties she was having.

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The Ombudsman’s role and powers

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:

• further investigation would not lead to a different outcome, or
• we cannot achieve the outcome someone wants, or
• there is another body better placed to consider this complaint, or
• there is no worthwhile outcome achievable by our investigation.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

4. 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, sections 24A(1)(A) and 25(7), 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(1), as amended)

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How I considered this complaint

6. I considered evidence provided by Ms C and the Council as well as relevant law, policy and guidance.
7. Ms C 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

What should have happened

Assessment

8. 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.
9. 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.
10. NHS Continuing Healthcare (NHS CHC) is a package of care for adults aged 18 or over which is arranged and funded solely by the NHS. A check list is used to screen whether a referral is necessary for a full assessment. A social worker can complete the checklist.

Reviews

11. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Complaint handling

12. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. A single stage procedure should be enough.
13. Regulations do not say how long a complaint investigation should take. But they do say an expected timescale must be explained at the start, usually in discussion with the complainant. If the responsible body has not provided its response after six months (or after a longer period agreed with the complainant), it must write to the complainant to explain why. (Regs 13 and 14, Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

What happened

14. Mrs D was in hospital; she left under the Discharge to Assess (D2A) Pathway to a care home. The Council completed a NHS CHC checklist and decided Mrs D did not meet the criteria. Ms C says the Council did not involve either her or her mother in the assessment. The Council says the Integrated Care Board (ICB) cancelled a scheduled full NHS CHC assessment meeting because of the negative CHC checklist.
15. The Council says it completed a review of Mrs D on 20 December 2023 and Ms C said Mrs D wanted to return home with a support package. The Council has not provided a copy of the review and Ms C says this meeting never took place.
16. The Council set a discharge date of 2 January 2024. The Council says Ms C agreed to the discharge date as it would not be possible to arrange care during Christmas. On 2 January the Council made referrals for an Occupational Therapy assessment and for walking aids.
17. The Council says following Ms C’s concerns that some arrangements such as shopping and setting up Mrs D’s home were not in place, it delayed the discharge by a day. On 3 January the Council commissioned care from the Care Provider of four calls per day, 17.5 hours per week. This was to support Mrs D with personal care, food and drink preparation, support with medication, and transfers.
18. Ms C says Mrs D’s discharge was unsafe as the Council did not assess Mrs D’s home or meet with her as part of the assessment process; Mrs D’s assessment was generic and not person centred. Mrs D went home without walking aids and the Care Provider could not give medication as there was no blister pack. Ms C says the Care Provider would not change the support plan without involving the Council, this meant complex needs around eating and medication were not met.
19. Ms C says the Council then failed to review the care package. It was only after Ms C contacted the Council on 29 January that it arranged for an Occupational Therapist (OT) to visit on 19 February. The OT assessed Mrs D as independent in transferring and mobilising.
20. The Council completed a review on 23 February. Ms C raised the following concerns about the Care Provider:
• care workers did not attend at all or for the set amount of time – the Council found service failure by the Care Provider and it took action against a staff member;
• care workers could not use equipment like the microwave;
• care workers did not complete tasks such as prompting Mrs D with food, while other care workers were forceful. This was important as nutrition was a primary health need;
• care workers falsified records:
1. recording actions that had not occurred including visits;
2. recording future events.
21. Ms C says she had to install video recording equipment to verify care calls.
22. Because of these failures Ms C says she spent time reconciling footage with care worker records; and speaking with the Council to address issues to ensure Mrs D’s needs were met. By April Ms C had sought, and the Council provided, a different care provider.
23. The Care Provider accepted it charged for care calls that did not occur. Because of this and in recognition of its poor service the Care Provider reduced its invoice by 46.5 hours and the payment from £3352 to £2379.57. Ms C says the Council did not pass the refund onto Mrs D who remained liable for all the charges. The Council has explained the charging policy allows for a charge which is the maximum a person pays for their care. In Mrs D’s case this was £173.90 a week. This was less than the cost of the care which is significantly higher.
24. Between April and July Ms C received various invoices with different amounts but no explanation about how the Council had calculated the outstanding arrears and missing calls. The Council told Ms C to complain.
25. Ms C complained on 5 September. The Council should have responded by 3 October. Ms C chased the Council on 5, 13 November and 13 December but did not receive a response until 5 February 2025. The Council did not uphold any of Ms C’s complaints.
26. In response to my formal enquiries the Council has accepted the Care Provider’s services were not of an expected standard. In recognition of this it agreed to waive an outstanding invoice for £1792.75. It says it has also addressed the Care Provider’s service failure through its quality monitoring team.

Was there fault causing injustice?

27. The Council has accepted there was service failure by the Care Provider. The Ombudsman welcomes the Council’s attempt at early resolution. I do not intend to investigate these matters as the Council’s offer to waive the outstanding invoice is what Ms C says she wants as an outcome to the complaint. It is also a suitable remedy for Mrs D’s distress of not always having her assessed care needs met. There would therefore be no worthwhile outcome from further investigation.
28. I have also not investigated Ms C’s complaint about the way in which the Council completed the NHS CHC checklist. This is because from the information available which includes the lack of nursing input into Mrs D’s care, on balance it appears unlikely Mrs D would have been eligible for NHS CHC funding. Ms C can also potentially request a retrospective review of Mrs D’s NHS CHC funding.
29. The Council is at fault for failing to ensure Mrs D’s discharge arrangements were in place and met her needs. Although the Council says it met with Mrs D and Ms C to complete a care assessment, it has not provided evidence of this. In the absence of such evidence on balance I consider it is more likely than not there was no meeting on 20 December. Care assessments should be proportionate and a face to face meeting is not a necessity especially where matters are urgent or in this case a person is fit for discharge from hospital. However there is little evidence in the case recording about Mrs D’s needs and preferences. The support plan is generic and does not provide individualised detail about how to meet Mrs D’s needs especially around food which are complex. The failure to complete and record a person centred support plan is not in line with the Care and Support Statutory Guidance and is fault.
30. The Council also failed to get an OT assessment before Mrs D went home, and to properly consider her safety when mobilising. It was not until the review in February 2024 that an OT assessed Mrs D. It is difficult to say now what the outcome of the assessment would have been because when the OT assessed, Mrs D had improved and she could mobilise and transfer independently.
31. Because of the faults identified above, Ms C and Mrs D, have the uncertainty the discharge arrangements could have been better and the care Mrs D received more individualised.
32. Ms C also has the distress and frustration of having to record and reconcile care workers records to ensure Mrs C received the care she needed.
33. The Care and Support Statutory Guidance says councils should review support packages within six weeks of their start date. The Council reviewed Mrs D within this period. While I am aware Ms C says she had to contact the Council to arrange a review; I cannot say the Council would not have acted without this prompt.
34. The Council took six months to provide a substantive response to Ms C’s complaint and did not keep Ms C updated about the complaint’s progress. While the time taken to respond to the complaint is within 6 months the Council did not keep Ms C updated. This is not inline with the complaint Regulations and amounts to fault. This caused Ms C time and trouble in having to chase the Council for a response.

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Action

35. When a council commissions or arranges for another organisation to provide services we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions. Where we find fault with the actions of the service provider, we can make recommendations to the council alone. Here we have found fault with the service of the Care Provider acting on behalf of the Council and the Council acting independently. The following agreed actions by the Council are suitable to remedy the personal injustice caused and to improve future services.
36. Within one month of the final decision the Council will:
1. apologise to Mrs D and Ms C for the distress caused by the service failure of the Care Provider, and the uncertainty caused by the failure to obtain relevant assessments in time for Mrs D’s move home;
2. apologise to Ms C for her time and trouble because of the lack of response from the Council about the progress of her complaint and for the distress and frustration caused by her having to install and reconcile video recording equipment; and make her a symbolic payment of £200 in recognition of the distress, uncertainty and time and trouble the Council’s actions have caused her.
3. provide evidence of the Council’s agreed action to waive an outstanding invoice;
37. Within three months of the final decision the Council will:
1. review why Mrs D did not receive an Occupational Therapy assessment before she went home and provide a plan about how the Council will avoid this happening in the future;
2. provide a reminder by staff circular, team meeting or as part of formal training, to relevant officers about the importance of completing person centered support plans;
3. provide a reminder by staff circular, team meeting or as part of formal training, to relevant officers about the importance of recording interactions including telephone calls;
4. provide an update on what actions the Council has taken about Bio Luminuex Healthcare Ltd to ensure it provides contracted services.
38. The Council should provide us with evidence it has complied with the above actions.

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Decision

39. I find fault causing injustice. I have ended my investigation and closed the complaint based on the above agreed actions.
40. Under our information sharing agreement, I will share this decision with the Care Quality Commission (CQC).

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Investigator's decision on behalf of the Ombudsman