Summary: Mr X complained the care provider commissioned by the Council, failed to consider his mother, Mrs Y’s needs when it decided it could no longer deliver her care package and she would have to move to a nursing home. He also complained the Care Provider replaced his mother’s key worker because she disagreed with the Care Provider’s decision. He said this matter has caused his mother distress and emotional upset. There was no fault in the Care Provider’s actions.

The complaint

1. Mr X complained the Care Provider did not consider his mother’s physical and mental health when it decided it could no longer meet her needs and she would have to move to a nursing home.
2. He also complained the Council replaced Mrs Y’s key worker, Ms D, and would not allow her to attend a review meeting because she did not support the Care Provider’s decision.
3. Mr X said this caused him and his mother stress and upset.

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The Ombudsman’s role and powers

4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. 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)
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. 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

7. I have contacted Mr X and discussed his view of the complaint.
8. I considered the Council’s submission to the Ombudsman which included Mrs Y’s care and support plans and internal emails shared between the Council and the Care Provider. I also considered Mr X’s complaint form and the Council’s final response.
9. I wrote to Mr X and the Council with my draft decision and gave them an opportunity to comment before I made a final decision.

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What I found

The law

10. Part 3 of the Local Government Act 1974 covers complaints where local councils provide services themselves or arrange or commission care services from social care providers, even if the council charges the person receiving care for the services. The Act says we can treat the actions of the care provider as if they were the actions of the council in those cases.
11. In this case, the Council arranged and commissioned the Care Provider to care for Mrs Y.
12. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan. A care and support plan is for someone who needs or provides care. The plan should clearly set out the services and support to be provided when they will be provided and who will provide them.
13. Section 27 of the Care Act 2014 states councils should conduct a review of the care and support plan at least every 12 months. The Council should carry out the review within a reasonable timeframe and in proportion to the needs to be met. The Act also states councils should conduct a review if the carer or the person receiving care asks for one.

Background

14. Mrs Y moved into the Care Provider’s residential home in June 2012 after suffering a stroke which restricted her ability to speak, communicate and swallow.
15. At the time, the residential home specialised in offering long term residential care.
16. Mrs Y suffered a fall several years later and fractured her hip, which restricted her mobility and meant she could only walk with support from a carer.
17. In 2017, the Care Provider stopped offering long term residential care to new clients and began offering short term and respite care. The Care Provider agreed to continue caring for residents already living at the home as long as it could fully meet the resident’s needs.

Mr X’s complaint

18. In early February 2019, Mrs Y suffered several coughing and choking episodes and had to be admitted to hospital.
19. The Care Provider asked the Council to arrange a review of Mrs Y’s needs because her issues with swallowing and choking had become more frequent and staff at the home were concerned they could not properly care for Mrs Y.
20. In April 2019, the Council carried out an assessment of Mrs Y’s needs. Mr X and Mrs Y’s key worker, Ms D, was present.
21. Mrs Y’s care and support plan stated she required:
• a soft diet because she was at risk of choking
• support from 1-2 carers with all personal care and toiletry needs
• support from 1-2 carers with moving around and walking
• support from 1-2 carers with personal hygiene and changing continence pads
22. According to an internal email discussing the assessment, Ms D was surprised that staff had expressed concern about Mrs Y’s choking issues, as they had begun monitoring her eating more closely and this had solved the problem.
23. The internal email concluded that, “All agreed Mrs Y should remain at the care home but if there are any concerns staff should contact social services for another assessment.”
24. In June 2019, the Care Provider made a further request to the Council for an assessment for Mrs Y. This time, the Care Provider said Mrs Y’s mobility had decreased and she now required 2 - 3 carers and sometimes a hoist to help her stand up. The Care Provider also said Mrs Y’s issues with choking had resurfaced and it was struggling to care for her.
25. The Council held a review of Mrs Y’s needs in September 2019. Mr X was present, but Ms D did not attend as she had been removed as Mrs Y’s key worker. A team leader from the care home was present.
26. During the review, the Care Provider explained that Mrs Y’s needs had changed, she now required a hoist to stand and on rare occasions 3 carers had been needed to support her. The Care Provider said it could no longer meet Mrs Y’s need as it did not have the staffing or resources to care for her and she would need to move to another residential home.
27. Mr X wrote to the Council in September 2019 to complain he was unhappy with the decision. He said the move would cause his mother distress and could be detrimental to her health. Mr X did not accept the Care Provider’s explanation that it could not accommodate Mrs Y’s night-time needs. He also said he was unhappy the Care Provider replaced Ms D as Mrs Y’s key worker, as this had caused Mrs Y further emotional upset.
28. The Council wrote to Mr X in October 2019. It had asked the care home manager to investigate. They cited Mrs Y’s deteriorating health, growing mobility needs and difficulty swallowing as the reason for its decision. The manager said the care home did not have the necessary staff numbers to ensure Mrs Y could be safely taken care of, particularly at night.
29. The manager said they had discussed Ms D’s concerns with her prior to carrying out the review. They said a senior employee of the care home attended the review instead of Ms D because it was the senior employee’s role to determine whether resident’s needs were being met by the Care Provider.
30. The manager concluded the letter by stating the home changed its care model in 2017 and could no longer accommodate Mrs Y’s increasing needs.
31. Mr X was unhappy with the complaint response. He did not feel the Care Provider had addressed the impact moving Mrs Y to another home could have on her health and felt it was exaggerating Mrs Y’s health issues to justify moving her to another home. He therefore referred his complaint to the Ombudsman.
32. In January 2020, the Council reassessed Mrs Y’s care needs. The notes record family were invited but did not attend. Her care and support plan stated she required:
• 1-1 supervision throughout all meals.
• support from 2 carers with all personal care and toiletry needs
• support from 2 carers with all tasks requiring mobility
• support at night-time due to Mrs Y being a high risk of falls
33. The Council held a meeting with Mr X and the Care Provider in March 2020 to discuss the outcome of Mrs Y’s needs assessment of January 2020. The Care Provider explained that Mrs Y’s needs had significantly increased, and it could no longer meet them as well as care for the other residents at the home.
34. The Care Provider contacted Mr X shortly after the meeting and he agreed for the Care Provider to begin sourcing an alternative nursing placement for Mrs Y.
    The Care Provider sent Mr X a list of nursing homes soon after this.
35. During the investigation, the Council confirmed it had discussed how to reduce the impact of the move on Mrs Y’s health and wellbeing with the Care Provider.
36. After the discussion the Council and Care Provider agreed that once a suitable home had been identified, it would take a phased approach to moving Mrs Y into her new home and have new carers visit her to discuss her needs and prepare her for the transition.
37. The Care Provider suspended its plan to move Mrs Y because of the Covid pandemic. Mrs Y suffered a stroke in May 2020 and died in hospital approximately a week later.

Findings

38. The Council carried out two assessments of Mrs Y in 2019 and it was decided that the Care Provider could still meet Mrs Y’s needs. The Council responded appropriately to the Care Provider’s request for a further assessment in January 2020. Internal emails indicate this was triggered by staff concerns about the Care Provider’s ability to care for Mrs Y. The evidence indicates Mrs Y’s needs had increased considerably as she now required 1-1 support with eating and increased staff to help her move around. Mrs Y had also been hospitalised several times due to her issues with swallowing. The Care Provider had a duty to ensure the safety of Mrs Y and its other residents. The Care Provider decided it could no longer safely manage Mrs Y’s care package because of her decline in health and the fact it was operating a reduced service. There was no fault in the way the Care Provider reached this decision. We cannot question the merits of decisions made without fault.
39. A large part of Mr X’s complaint concerns the Care Provider’s failure to demonstrate it had considered the impact to Mrs Y’s health were she to move to another care home. Internal emails indicate the Council intended to work with the Care Provider to carry out the move in stages, to give Mrs Y time to adapt.
    The Care Provider did not serve notice. The evidence also indicates the Care Provider was willing to work with the new home to introduce new carers to Mrs Y and ensure it could meet Mrs Y’s needs before she was moved. The Care Provider put its plans to move Mrs Y on hold because of the pandemic. The evidence indicates the Care Provider considered Mrs Y’s health and wellbeing on an ongoing basis to ensure neither were negatively affected by the move. There was no fault in the Care Provider’s actions.
40. Mr X complained the Care Provider replaced Mrs Y’s key worker with an employee who was less likely to object to the decision to move Mrs Y to another residential home. The Care Provider explained it replaced Ms D due to structural personnel changes which took place at the home. There is no evidence that the Care Provider was at fault in the way it reached the decision to change key workers. The Care Provider has confirmed it took Ms D’s views on board before conducting the review and decided it was more appropriate for another member of staff to attend the review to determine Mrs Y’s suitability to remain in the home as this was her role. There is no evidence to suggest the Care Provider would have reached a different decision if Ms D had been present at the review. There was no legal or policy requirement for Ms D to attend the review. There was no fault in the Care Provider’s actions.

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Final decision

41. There is no evidence the Council was at fault. I have therefore completed my investigation.

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Investigator's decision on behalf of the Ombudsman