Summary: Mrs X complained the Council did not ensure suitable home care was in place for her husband Mr X and forced her to arrange some of Mr X’s care herself using direct payments. Mrs X also said the Council did not assess her own care needs when she asked it to. There was fault by the Council, and by Care Provider 6, which it commissioned to deliver care for Mr X on its behalf. This caused avoidable distress for Mr and Mrs X and put Mr X at risk of harm. The Council agreed to apologise and pay a financial remedy. It will also issue reminders to its staff, share our decision with Care Provider 6, and consider the faults identified if it works with Care Provider 6 in the future.

The complaint

1. Mrs X complains about the Council’s involvement in arranging home care for her husband, Mr X, and how it considered Mrs X’s care needs when she asked it for help with her own care needs. Mrs X says the Council:
• forced her to arrange Mr X’s care herself using direct payments from October 2021 onwards, even though she repeatedly asked the Council to arrange the care for her;
• did not ensure Mr X was provided with a suitable quality of care and suitable home adaptations between October 2021 and August 2022. She also says the Council did not properly respond to or support Mrs X when she reported issues about this during this time;
• did not assess Mrs X’s care needs or offer her support when she asked it to when she came out of hospital in March 2022; and
• did not respond to her complaint about these issues properly.
2. Mrs X says she had to care for Mr X herself and these issues caused them both distress when they were already both in ill health. She wants the Council to ensure professional, skilled home care is in place for Mr X and resolve any issues with the care.

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The Ombudsman’s role and powers

3. 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)
4. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
5. 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)
6. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate.
7. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
8. The law says we cannot normally investigate a complaint unless we are satisfied the council knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the council of the complaint and give it an opportunity to investigate and reply (Local Government Act 1974, section 26(5))
9. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
10. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
11. 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

12. I considered:
• information provided by Mrs X and discussed the complaint with her;
• documentation and comments from the Council and Care Provider 6;
• relevant law and guidance; and
• the Ombudsman’s Guidance on Jurisdiction and Guidance on Remedies.
13. I considered comments from Mrs X, the Council, and Care Provider 6 about my first draft decision and as a result issued an amended draft decision. They then had an opportunity to comment on the amended draft decision, and I considered their comments before making a final decision.
14. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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What I found

Legislation, guidance, and the Council’s policies

Care and support needs

15. Where it appears to a council that an adult may have needs for care and support it must assess whether they have needs, and if so, what those needs are. (Care Act 2014, Section 9(1))
16. Where a council decides an individual has eligible care and support needs, it must produce a care and support plan. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person. There are three main ways a personal budget can be administered:

• as a managed account held by the council with support provided in line with the person’s wishes;
• as a managed account held by a third party (often called an individual service fund or ISF) with support provided in line with the person’s wishes; or
• as a direct payment.

(Care and Support Statutory Guidance 2014)

Direct payments

17. Direct payments are monetary payments made to individuals who ask for them to meet some or all their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The Care and Support Statutory Guidance 2014 says:
• councils must ensure people have relevant and timely information about direct payments so they can decide whether to ask for them. Where an individual asks for direct payments, the Council should support them to use and manage the payment properly; and
• the gateway to receiving a direct payment must always be through the request from the person. Councils must not force someone to take a direct payment against their will, or place them in a situation where a direct payment is the only way they can get personalised care and support.
18. The Council’s policy about direct payments says they are not compulsory. It says:
• people can choose to take direct payments to meet some or all their assessed needs, or have services arranged and provided for them by the Council to meet all their assessed needs; and
• where people choose direct payments, if they change their mind, the Council will arrange services for them instead at four weeks’ notice.

Fundamental Standards of Care

19. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) is the statutory regulator of care services and has guidance on how to meet the fundamental standards, below which care must never fall.

Record keeping

20. Care providers should keep records relating to the care of each person, including an accurate record of all decisions taken in relation to their care. (Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 17)

The Council’s adult social care complaints procedure

21. The Council’s adult social care complaints procedure has one stage. The procedure says when someone makes a complaint the Council will:
• acknowledge the complaint within two working days;
• ask the complainant from the outset what they think should happen to put things right;
• tell the complainant how it is planning to respond, and the timescales for its investigation; and
• keep the complainant informed about the progress of the complaint.

Background

22. Mr X has dementia. Mrs X acts as his representative and deals with the Council, and any care providers it commissions, on Mr X’s behalf. In 2019 the Council assessed Mr X and commissioned a home care package to meet his needs. In 2020 it re-assessed Mr X and decided to increase the number of daily home care visits. The Council said before 2021 Mr X had received care from nine different care providers. It said it had to repeatedly commission new providers because Mrs X was not satisfied with the care provided and the providers said they could not meet her expectations.
23. In February 2021, the Council commissioned care from Care Provider 1. Mrs X repeatedly raised concerns with the Council about the care. In August 2021 Care Provider 1 said it was struggling to fulfil the agreed contract as many of its care staff refused to visit Mr X due to Mrs X’s behaviour. Therefore, the Council commissioned Care Provider 2 to supplement the care. Mrs X asked to cancel the care from Care Provider 2 after one day. Care Provider 1 then served notice and ended its services.
24. After a three-week gap where Mr X did not have care in place, the Council commissioned care from Care Provider 3 in early-September 2021. Mrs X was not satisfied with the care and asked the Council to end it. Care Provider 3 also said it wanted the care to end because it could not meet Mrs X’s expectations. Mrs X asked the Council to commission care from a new provider she had identified, Care Provider 4. The Council said Care Provider 4 was not on the list of providers it commissioned from and there was no contract for services in place. The Council therefore said Mrs X would need to arrange the care herself using direct payments, as described at paragraph 17.
25. In late October 2021, Mrs X arranged care from Care Provider 4 using direct payments. This began as soon as care from Care Provider 3 ended. Mrs X began raising concerns with the Council about Care Provider 4 after the first week of care. She asked the Council to commission a new care provider as she did not want to use direct payments to arrange the care herself. The Council contacted several care providers, none of which would agree to provide the care. The providers either said they did not have capacity, or they had cared for Mr X in the past and did not want to again due to Mrs X’s behaviour. The Council therefore told Mrs X she would again have to arrange a new care provider using direct payments. When the care with Care Provider 4 ended, both Mrs X and Care Provider 4 had raised concerns with the Council several times and said they wanted the care to end.
26. After a five-day gap where Mr X did not have care in place, Mrs X arranged care from Care Provider 5 in mid-February 2022. Mrs X began raising concerns with the Council about Care Provider 5 after three days of care. Shortly afterwards Mr X was admitted to hospital. While Mr X was in hospital, Mrs X complained to the Council. She said it had:
• forced her to use direct payments to arrange Mr X’s care when she did not want to; and
• failed to support her to resolve the issues she reported about Care Provider 5.
27. Mr X was discharged from hospital in mid-March 2022. Shortly afterwards:
• Care Provider 5 ended its services, at Mrs X’s request; and
• Mrs X complained to the Council again, asking it to commission a new care provider as she did not want to arrange this herself.
28. After a two-month gap where Mr X did not have care in place, the Council responded to Mrs X’s complaints in early-May 2022. It said it “strongly recommended” Mrs X should arrange Mr X’s care herself using direct payments. Mrs X did not want to, so a week later the Council commissioned care from Care Provider 6.
29. Within three weeks of the care beginning with Care Provider 6:
• Mrs X raised concerns with the Council about the care; and
• Care Provider 6 reported to the Council it was “having issues with [Mrs X’s] behaviour”. It described her behaviour as bullying and said she was verbally and physically abusive towards its care staff.
30. Mrs X complained to the Ombudsman in mid-July 2022. The issues between Mrs X and Care Provider 6 continued and the care ended in early-August 2022.
31. After a two-week gap where Mr X did not have care in place, he was admitted to hospital in late-August 2022. Mr X remained in hospital until late-October 2022.
32. After Mr X was discharged from hospital in October 2022, Mrs X arranged care from a new provider using direct payments. The provider gave notice to end the care two weeks later. The Council then commissioned care from two further providers consecutively. Mr X went back into hospital for six weeks at the end of 2022. After he was discharged from hospital in January 2023, the Council commissioned a new provider. At the time of my draft decision, Mr X was still receiving this home care.

My findings

The Ombudsman’s jurisdiction and scope of our investigation

33. Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions. Part 3A is for complaints about care bought directly from a care provider by the person who needs it or their representative, and includes care funded privately or with direct payments using a personal budget. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act)
34. I am satisfied, based on what Mrs X told me about her complaint, it is a ‘Part 3’ complaint, about the actions of the Council. Mrs X said her complaint was about:
• the Council’s actions in forcing her to arrange some of Mr X’s care herself using direct payments when she did not want to;
• how the Council supported her to resolve issues with all care providers, including those she arranged herself using direct payments;
• the quality of care provided to Mr X by Care Provider 6, which the Council commissioned;
• how the Council supported Mrs X with her own care needs when she came out of hospital in March 2022; and
• how the Council responded to her complaint about these issues.
35. Mrs X did not mention Care Providers 1, 2, or 3 in her complaint to us. However, I am satisfied Mrs X’s complaint to us was about how the Council supported her to resolve issues with all care providers across the period we investigated. The law says we cannot investigate events which happened more than 12 months before somebody complains to us, unless we decide there are good reasons to do so. Mrs X complained to us in July 2022. I have investigated events after July 2021, at which point care was in place with Care Provider 1. I am satisfied Mrs X could have complained about events before July 2021 earlier and there are no good reasons to investigate those earlier events now.
36. The law says we can only investigate complaints about things which a council has had opportunity to respond to first. Mrs X’s formal complaints to the Council in February and March 2022 were not about Care Provider 6, because this care had not yet started. When Mrs X came to the Ombudsman in July 2022, she had not yet formally complained to the Council about Care Provider 6 but did so shortly afterwards. When the Council responded to my enquiries, it was satisfied it had fully responded to the issues raised by Mrs X about Care Provider 6. Therefore, I am satisfied there are good reasons to consider the issues with Care Provider 6 as part of my investigation.
37. However, I have not considered events after Mr X was admitted to hospital in late-August 2022 at which point we had already begun our assessment of Mrs X’s complaint. I am not satisfied the Council has had a reasonable opportunity to respond to Mrs X’s complaint about events from late-August 2022 onwards.

Direct payments

38. Mrs X and the Council gave different accounts about the reasons why some of Mr X’s care packages ended. I am satisfied, on the balance of probabilities, there was a pattern of events in that:
• Mrs X continued to raise concerns about the care provided to Mr X by every care provider throughout the period I investigated, and usually directly said she wanted the care to end; and
• every care provider during the period I investigated told the Council it could not meet Mrs X’s expectations about Mr X’s care, and served notice to end the care because of Mrs X’s behaviour.
39. I am also satisfied every time the Council told Mrs X she had to arrange care herself using direct payments, it said this because all care providers on its commissioning list either:
• did not have capacity to take on Mr X’s care; or
• refused to do so based on previous experience of Mrs X’s behaviour.
40. I recognise the difficulties the Council faced in arranging care for Mr X. The evidence showed Mrs X was repeatedly dissatisfied with the care, and care providers repeatedly judged Mrs X’s expectations to be unreasonable and her behaviour to be unacceptable. I also recognise the Council supported Mrs X in sourcing and resolving issues with care providers even when the care was arranged by Mrs X and not commissioned by the Council. However, the Government’s statutory guidance about direct payments is clear. Councils must not force someone to take a direct payment against their will, or place them in a situation where a direct payment is the only way they can get care and support. The Council’s direct payments policy also says these should not be compulsory. The Council recorded Mrs X made it repeatedly clear from early 2021 onwards she did not want to use direct payments, and yet it told her she had to do this anyway. My view is the Council should have properly considered other options within its range of powers, instead of forcing Mrs X to use direct payments, such as:
• commissioning a home care provider that was not on its commissioning list, via a one-off package of support specifically for Mr X;
• using its powers to challenge Mrs X’s suitability to manage Mr X’s care, if it considered Mr X would be without care he needed due to Mrs X’s behaviour; or
• planning to meet Mr X’s care and support needs using a different type of care, if it considered receiving care at home was no longer in Mr X’s best interests.
41. The Council’s decision to force Mrs X to arrange the care using direct payments was fault which caused Mrs X distress, for which it should provide a remedy. However, I do not consider this caused any injustice to Mr X because there is no evidence to suggest he was aware of the issues Mrs X faced in arranging care herself. There were however some gaps in Mr X’s care while Mrs X or the Council were trying to identify potential new providers and I have considered this separately later in this decision statement.

Resolving issues with Mr X’s care from July 2021 to March 2022

42. The Council commissioned Care Providers 1, 2, and 3. Mrs X did not mention these providers in her complaint to us. However, I am satisfied part of Mrs X’s complaint to us was about the Council’s actions in supporting her to resolve issues with all care providers across the period we investigated. I am satisfied there was no fault in the Council’s actions while these three care providers were in place because:
• it responded to concerns Mrs X raised about Care Providers 1 and 3 in good time. I am also satisfied it tried to resolve the issues, including visiting Mrs X to discuss this. However, ultimately both Mrs X and the care providers wanted the care to end; and
• Mrs X asked to cancel the care from Care Provider 2 after one day. The Council recorded she said this was because of the nationality of the care staff.
43. Mrs X arranged Care Providers 4 and 5 using direct payments. Mrs X said her complaint to us was not about the actions of Care Providers 4 and 5. It was about the Council’s actions in supporting her to resolve issues she reported. Because the Council did not commission this care, there was no statutory requirement for it to resolve issues with Care Providers 4 and 5 on Mrs X’s behalf. However, the evidence shows the Council did this anyway, and I have found no fault in how it did this. The Council was at fault because Mrs X repeatedly asked to move back to Council-commissioned care and it did not facilitate this, even when she formally complained about the issue. I have already found fault with this above.

Care provided to Mr X by Care Provider 6 from May to August 2022

44. Part of Mrs X’s complaint to us was about the quality of care provided to Mr X by Care Provider 6, which the Council commissioned. The Council told us it was not the host local authority for Care Provider 6 because it was not situated in its area. It also said it no longer commissioned any care from this provider for any of its service users.
45. Mrs X said she was not provided with a copy of Mr X’s care plan by the Council or Care Provider 6. Council records showed Mrs X twice asked for a copy of the care plan during the care from Care Provider 6. The Council agreed it would send this to her and told us it did so. However, based on the evidence, I cannot be satisfied it did. This was fault, which caused Mrs X confusion about the care that had been agreed to meet Mr X’s needs. The Council should remedy the injustice caused to Mrs X.
46. Mrs X said care staff were not suitably qualified and there were various issues with Mr X’s care. She said care staff did not:
• handle Mr X properly when moving him;
• allow Mr X enough time to use the toilet; and
• properly follow hygiene standards.
47. In response to my enquiries the Council explained how it decided Care Provider 6 had suitably trained staff and was suitable to deliver care on its behalf when it set up its contract for services. I am satisfied with the Council’s explanation about this. I found no evidence the Council did not properly assure itself of the suitability of Care Provider 6. I also considered Care Provider 6’s daily care notes about Mr X, and evidence provided by Mrs X. I found no evidence of the specific issues set out in the paragraph above that Mrs X described.
48. Mrs X said care staff should have provided support with “light housework”, but this did not happen. The Council had not agreed housework as part of Mr X’s care plan or included it in its contract with Care Provider 6, so it was not at fault because it did not provide this.
49. One issue Mrs X raised about Care Provider 6 was she said its staff did not wear correct uniform or identification. It recorded one instance where “a woman” turned its staff away on arrival because they did not have a “uniform and ID card”. The Council met with Mrs X and a manager from Care Provider 6 in early August 2022 and discussed some concerns Mrs X had raised. In this meeting Care Provider 6 explained to Mrs X it did not require its care staff to wear a specific uniform. This was not fault.
50. Mrs X said care staff did not wear correct Personal Protective Equipment (PPE) when visiting Mr X or dispose of PPE and other waste properly. Mrs X provided us with photographs. I considered these but decided they were not evidence of an issue with waste disposal. It is possible there were a small number of occasions where care staff forgot to place sealed rubbish bags inside a bin before leaving Mr and Mrs X’s home. I do not consider this to be evidence of fault. I also noted in the photographs Mrs X provided staff were wearing PPE. The Council’s contract with Care Provider 6 said Mrs X had asked for staff to wear PPE at all care visits and said staff should “dispose of PPE after use” at each visit. Although this was specified in the contract, I would not necessarily expect care staff to make notes about their use or disposal of PPE at each care visit. I do not consider Care Provider 6 to be at fault because it did not make specific records about this. I found no evidence to support Mrs X’s allegation staff did not wear PPE in line with the contract for services.
51. Mrs X said care staff did not ensure her home was secure when leaving care visits and on occasions left the door unlocked. Care Provider 6 disputed this allegation. Based on the limited evidence available about this, I cannot say, even on the balance of probabilities, whether this happened. I have considered how the Council responded when Mrs X reported these issues about Care Provider 6. My view is the Council did all it could to resolve and respond to Mrs X’s concerns given the large volume of contacts it received from her.
52. Mrs X said Care Provider 6 did not visit Mr X at the agreed times, and visits did not last as long as they should have done. I consider there should be a degree of flexibility in the arrival-time of home care staff, to cover situations such as traffic, or emergencies with other service users. Previous care providers had told the Council Mrs X had, what they viewed as, unreasonable expectations about how specific the timing of care visits should be. Because of this, when arranging the care with Care Provider 6, the Council asked Mrs X to be more flexible and allow care staff to arrive up to 30 minutes either side of the agreed visit times. Mrs X agreed to this. Occasionally records showed care staff were more than 30 minutes late and Mrs X said she had already completed Mr X’s care herself. Based on how infrequent this was, I am satisfied these were isolated incidents, and not indicative of fault. However, Mr X’s bedtime care visit was regularly 30 to 50 minutes earlier than agreed and my view is this was fault. This meant care staff regularly put Mr X to bed much earlier than the Council had agreed was suitable for him. This caused distress to both Mr and Mrs X, for which the Council should provide a remedy. I found no fault with the duration of the visits provided to Mr X. Records showed visits were generally of the agreed duration.
53. Mrs X said care staff did not give Mr X the correct medication. The Council’s contract with Care Provider 6 said at each of Mr X’s four daily care visits, there should be a “medication prompt (all in blister packs)”. Occasionally records showed Mrs X asked care staff to give Mr X medication that was not in blister packs, and they explained they could not do this. This was not fault. Care staff consistently recorded they prompted Mr X to take his medication at the morning, teatime, and bedtime care visits. However, staff did not record they prompted this at any of the lunchtime visits. Care Provider 6 was required by its contract to prompt medication at lunchtime and did not do so, which was fault. I consider any failure to prompt Mr X to take medication he needed caused him a possible risk of harm, for which the Council should provide a remedy.
54. Mr X’s needs assessment said he could not prepare his own meals. The Council’s contract with Care Provider 6 said care staff should “offer [a] drink or snack” to Mr X at each of the lunchtime, teatime, and bedtime care visits. Other than a small number of records that care staff ensured Mr X had water available, there were no records that staff offered Mr X food or drink at his care visits. This was out of line with how the Council had agreed it should meet Mr X’s needs, and so was fault. However, I do not consider this caused Mr X any injustice or harm, because I am satisfied Mrs X provided him with food and drinks. My view is it caused Mrs X an injustice because she had to provide this care which Care Provider 6 should have provided.
55. The daily care notes showed there were instances when care visits were not carried out. Sometimes, a satisfactory explanation was recorded. However, there were other instances when visits were missed with no recorded reason. I have considered gaps in Mr X’s care, and the injustice this caused him, separately later in this decision statement.
56. Mrs X alleged care staff pulled, pushed, slapped, and pinched Mr X. She said she witnessed staff bullying Mr X and they raised their voices and behaved rudely towards him. Care Provider 6 disputed these allegations. I considered Mrs X’s comments about this, daily care notes from Care Provider 6, and the Council’s records of Mrs X’s reports about Care Provider 6. On the balance of probabilities, my view is the evidence does not support these allegations from Mrs X.
57. Mrs X also described the behaviour of some care staff as “harassment”. She referred to an incident in late July 2022 where a member of care staff offended her. I cannot say, even on the balance of probabilities, what happened during this incident as I was not there. However, I have considered what Mrs X said, and the Council’s records about this. The evidence showed the Council investigated this incident and discussed it in its meeting with Mrs X and Care Provider 6 in early August 2022. Care Provider 6 explained to Mrs X there had been a misunderstanding. It said the member of staff “was attempting to be humorous and did not mean to cause offence” and “was apologetic and reassured [Mrs X] that this will not happen again”. I recognise Mrs X was upset by the incident. However, I am satisfied the Council properly investigated this at the time, and worked to resolve the issues, which resulted in Care Provider 6 apologising to Mrs X. I found no evidence to suggest a pattern of behaviour from care staff towards Mr or Mrs X which was inappropriate or unacceptable.

Record keeping by Care Provider 6

58. I am not satisfied Care Provider 6 kept sufficiently clear or accurate records about Mr X’s care because:
• some daily care notes were confusing because staff had completed them retrospectively. Notes should be completed at the time of the visit; and
• there were a small number of records which were about a different service user, not Mr X, and included the other service user’s name.
59. This failure to keep proper records was fault. The Council should ensure Care Provider 6 improves its record keeping for services it delivers on the Council’s behalf. However, I do not consider these issues with record keeping caused injustice to Mr and Mrs X.

Gaps in Mr X’s care

60. Mrs X told me she never refused care on Mr X’s behalf or turned care staff away. However, the Council and multiple care providers made consistent reports that she did. On the balance of probabilities, my view is there were instances when Mrs X chose to turn care staff away, through no fault of the Council or care providers.
61. However, there were other gaps in Mr X’s care at times when the Council was either commissioning it, or should have been because Mrs X had made it clear she did not want to use direct payments. I recognise the challenges the Council faced in finding care providers to take on Mr X’s care. However, I consider it still had a duty to ensure he received the care it had decided he needed. Mr X missed care he was entitled to for the following periods.
• Three weeks where no care was in place between Care Provider 1 and Care Provider 3.
• Five days where no care was in place between Care Provider 4 and Care Provider 5.
• Two months where no care was in place between Care Provider 5 and Care Provider 6.
• I am satisfied there were a small number of occasions when Mrs X turned carers away with valid reason because staff were too late and she had already completed Mr X’s care herself. The evidence also showed occasionally care visits were missed altogether with no satisfactory explanation recorded. Care Provider 6 also did not record any visits at all for 11 days at the end of the care. The Council said Care Provider 6 visited during this time and Mrs X turned them away. Mrs X said this was not the case and staff stopped visiting after the early August meeting about Mrs X’s concerns. On the balance of probabilities, I am satisfied the evidence supports Mrs X’s account. Care Provider 6 only recorded it visited and was turned away on the last day of the care. There were no records at all for the 11 days preceding this. In total, I am satisfied two weeks of care visits were missed while the care was in place with Care Provider 6.
• Two weeks where no care was in place between Care Provider 6 and Mr X’s admission to hospital in August 2022.
62. Overall I am satisfied Mr X missed 16 weeks of care he was entitled to due to fault by the Council, or Care Provider 6 acting on its behalf. This caused distress and risk of harm to Mr X. My view is this also caused an injustice to Mrs X. She had to care for Mr X herself during these gaps, and told the Council several times she was struggling to do this. The Council should remedy this injustice.

Home adaptations for Mr X

63. Mr and Mrs X have a stair lift in their home. Mrs X said she told the Council this was broken and only worked intermittently, and it did not properly resolve this.
64. The evidence showed the Council considered Mrs X’s reports about the stair lift and arranged an assessment by an Occupational Therapist (OT). The OT explained to Mrs X several times in 2021 and 2022 that:
• the Council could not fix the existing stair lift because it was now outside its five-year warranty;
• Mr X should not use the existing stair lift even when it worked intermittently. They said that type of stair lift was no longer suitable for his needs due to his reduced mobility, and it was dangerous for him to use; and
• the Council could not fund a like-for-like replacement of the stair lift because that type was no longer suitable for Mr X. However, they said Mrs X could apply for Council funding to either instal a “through-floor” lift to an upstairs bedroom, or move Mr X’s bed downstairs and instal a downstairs-bathroom.
65. Mrs X did not agree with the OT’s assessment about this and declined the choices presented to her for alternative home adaptations. The Ombudsman is not an appeal body. It is not our role to decide what home adaptations are suitable for an individual’s needs, that is the Council’s role. We do not take a second look at a decision to decide if it was wrong. We investigate the processes a council followed to assess whether it made its decision properly. I am satisfied there was no fault in how the Council made its decision about the stair lift. I am also satisfied it properly explained its decision about this to Mrs X several times.

Support provided to Mrs X

66. The Council’s records showed it had carried out annual carer’s assessments for Mrs X since 2019. Because of this, it provided Mrs X with an annual carer’s budget. It also decided Mr X’s care package should include two hours per week of “sitting service” visits, to allow Mrs X a break from her caring responsibilities and enable her to leave the house. During the care with Care Provider 6, Mrs X should have been offered 26 hours of “sitting service” visits. The records showed she was only offered 9 hours of these visits by Care Provider 6, of which she accepted 7 hours. There was not enough evidence the full 26 hours of “sitting service” visits Mrs X was entitled to were made available to her. This was fault. The Council should remedy the injustice caused to Mrs X.
67. Mrs X said she asked the Council for help with her own care needs, before and after she was in hospital for planned surgery in March 2022. The Council’s records showed Mrs X contacted the Council to tell it about her planned surgery and said she would need care for a few days after she came out of hospital. The Council told Mrs X the hospital would assess her and make a direct referral to the Council if it decided she needed support from Adult Social Care services after her surgery. I am satisfied it provided the correct information about this. The hospital did not make a referral to the Council following the surgery.
68. I also reviewed the records of Mrs X’s contact with the Council following her surgery. Although she told the Council about her health problems, I consider the way she described her problems presented them as medical issues. The Council made several referrals to Mrs X’s GP. I am satisfied it properly considered its duties to Mrs X and decided her needs were medical rather than care and support needs. I do not consider the Council received any information which should have caused it to consider it should assess her because she “may have needs for care and support”, as described at paragraph 15.

The Council’s communications with Mrs X and response to her complaint

69. There is no evidence the Council told Mrs X a timescale for its investigation of her complaint. This was fault. The Council should apologise for any confusion this caused Mrs X. However, it responded to Mrs X’s first complaint within two months and her second complaint within six weeks. I do not consider this to be an unreasonable length of time which caused Mrs X an injustice.
70. Mrs X said the Council’s response to her complaint did not properly address the issues she complained about. I am satisfied the Council’s response addressed most of the issues Mrs X raised. However, in Mrs X’s second complaint to the Council, she mentioned the stair lift issues she had reported. The Council did not properly address this in its response to her complaint, which was fault. However, I do not consider this caused Mrs X an injustice, because I am satisfied the Council had already explained its position about this to Mrs X several times. I am also satisfied it would have given the same response had it specifically addressed this in its complaint response. The Council’s position about this had not changed when it responded to my enquiries.
71. Mrs X said Council social care staff behaved rudely towards her and she was upset by their behaviour. Although I accept Mrs X has been upset by these issues, I found no evidence to suggest behaviour from Council staff towards Mr or Mrs X which was inappropriate or unacceptable.

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Agreed action

72. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although we found fault with the actions of both the Council and Care Provider 6, we made all our recommendations to the Council.
73. Within one month of our final decision, the Council will:
1. apologise to Mr and Mrs X for the faults identified and the impact those faults had on them;
2. pay Mr X £350 to recognise the avoidable distress and risk of harm caused to him; and
3. pay Mrs X £1,000 to recognise the avoidable distress caused to her.
74. Within three months of our final decision, the Council will:
1. issue reminders to relevant Council staff, that:
1. where the Council has decided an individual has eligible care and support needs, it has a statutory duty to ensure the care and support set out in their care and support plan is provided; and
2. statutory guidance and Council policy says the Council should not force people to use direct payments to arrange care themselves against their will.
2. place a copy of our final decision on file so relevant Council staff who would be responsible for arranging any future relationship with Care Provider 6 are aware of its failure to:
1. deliver care visits at the correct times;
2. prompt medication at all agreed times;
3. offer food and drink at all agreed times;
4. offer carer’s “sitting service” breaks to Mrs X for the number of weekly hours agreed in its contract for services with the Council;
5. complete clear, accurate care notes at the time of each care visit; and
6. ensure care notes are recorded against the correct service user.
3. share a copy of our final decision with Care Provider 6.
75. The Council should provide us with evidence it has complied with the above actions.

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Final decision

76. I have completed my investigation. There was fault by the Council, and Care Provider 6 acting on its behalf, which caused avoidable distress to Mr and Mrs X and put Mr X at risk of harm. The Council agreed to our recommendations to remedy this injustice. It will also issue reminders to its staff, share our decision with Care Provider 6, and consider the faults identified if it works with Care Provider 6 in the future.

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Investigator's decision on behalf of the Ombudsman