Summary: Mr B complains that a Council-commissioned care provider did not provide the support in his care plan. He says this caused his care package to break down. Mr B also complains about the Council’s response to his safeguarding concerns. There is fault and the Council will put in place a clearer care plan.

The complaint

1. Mr B complains that:
• In June or July 2019 a carer visited. However, she only stayed 27 minutes when the call was for 45. She also failed to wash Mr B properly after he had soiled himself, which resulted in a rash. The incident resulted in a breakdown of the care provision and Mr B was without care until February 2020.
• The care provider’s response to Mr B’s concerns was that washing was not included in his care plan. However, Mr B says his needs had changed, which is reflected in his most recent review.
• After the incident, Mr B made a safeguarding referral. However, the Council told him the incident was not a safeguarding issue and agreed to review his care needs. Mr B says the Council then took too long to complete the review.

Back to top

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. 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)

Back to top

How I considered this complaint

4. I have considered an online complaint form from Mr B and I have discussed the matter with him. I have asked the Council for its comments and considered its response with supporting records, including Mr B’s assessments, care plans and safeguarding records.
5. Mr B and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

What should have happened

6. The Care Act 2014 gives local authorities a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the local authority must involve any carer the adult has. The support plan may 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.
7. A council must make necessary enquiries if it has reason to think a person may be at risk of abuse or neglect and has needs for care and support which mean he or she cannot protect himself or herself. It must also decide whether it or another person or agency should take any action to protect the person from abuse or risk.

What did happen

8. The Council completed an assessment and care plan for Mr B in April 2018. The following points are relevant:
• Mr B’s view was that he needed a lot of help and did not feel safe using his shower. He commented that he did not wash regularly and struggled to bend down.
• Mr B had a support person with him who expressed the view that Mr B needed a ‘bit’ of support but was capable of more than he would admit. She also agreed Mr B needed help every week to have a shower.
• The assessor agreed Mr B needed help to shower as he felt unsafe doing so independently. However, she recorded her view that Mr B’s expectations of the assessment were higher than his actual support needs.
• Finally, the assessment said the care agency would need to be clear about the structure and boundaries of its role.
9. In July 2018, the Council reviewed Mr B’s needs. The assessment noted Mr B was able to manage showering but struggled with his ‘lower half’ and needed support with this. The care plan allocated three, 45-minute visits a week to support Mr B with a shower.
10. Mr B wrote to the care company in June 2019. He explained that he had returned from holiday recently with sepsis and had been admitted to hospital. Upon discharge, he explained, he was experiencing bad diarrhoea and was very red and sore. A carer visited on 3 July and was helpful with supporting him to shower and apply cream. However, the carer that visited two days later did not support him to shower properly. Mr B had soiled himself and the carer failed to help him clean properly. Mr B said he had to call a friend to help him shower later that day. Mr B further said another carer visited him on 7 July, cleaned him properly and helped him to apply cream. Mr B expressed concern the agency failed to send the same carers. He also referred to having shouted at agency staff on the telephone.
11. The care company replied in late July 2019. It said Mr B’s care plan said he needed support with his mobility and showering rather than cleaning him after he had soiled himself.
12. Mr B contacted the Council in July 2019 to raise safeguarding concerns. He explained that he was concerned about the quality of care he had received from the care company. He explained he was not able to move into position to clean himself properly when he had a bowel movement and the care company was refusing to wash him as this was not in his care plan.
13. The Council concluded that Mr B’s concerns did not meet the threshold for a safeguarding enquiry as he had capacity and was not at risk of abuse and neglect. However, the officer considering the safeguarding concern recommended a new care needs assessment and review for Mr B. The safeguarding alert says the officer discussed Mr B’s concerns with him and he explained he wanted a review of his care package.
14. In August 2019, the care agency completed a review of Mr B’s needs. The review said Mr B’s needs in relation to personal hygiene remained unchanged and he was able to wash himself in between visits. The review said carers provided moral support, helped Mr B reach his back and legs and applied cream where necessary.
15. In early 2020, the Council carried out a review of Mr B’s care needs. The review noted Mr B had stopped accepting carers from the care agency as it was unable to provide specific carers consistently. The review concluded Mr B needed the support of one person to wash himself as he was unable to do this independently. The assessment suggested Mr B was unable to wash himself when he was soiled. As a result of the assessment. Mr B’s support was increased to 45 minutes every day. This increase was to support with personal hygiene to increase his self-esteem.

Analysis

Care planning

16. The 2018 care plan does appear to attribute Mr B’s support needs to his motivation. However, there is clear reference to him having difficulties bending down. The plan is not specific as to how Mr B was to be supported in the shower but said that the care agency needed to be clear about its role. The fact that some carers helped Mr B with washing after he had soiled himself may have raised his expectations of what should be provided. The lack of clarity in the care plan and the lack of guidance from the care agency about the extent of its role is fault. This has led to an injustice for Mr B in terms of uncertainty and confusion about the specific support to which he is entitled.
17. However, I am not satisfied Mr B has suffered an injustice in relation to the specific day when he says the carer failed to wash him properly. He commented that he was already suffering from a rash when he was discharged from hospital. He further explained that when the carer did not wash him properly, he called a friend who was able to assist. Mr B was satisfied with the care the following visit.
18. The 2020 review increased Mr B’s care package. However, this appears to have been in relation to supporting Mr B to shower every day, rather than to specifically address the issue of washing after toileting.
19. Finally, I cannot conclude the lack of clarity in the care plan resulted in a breakdown in the care provision. I have seen evidence Mr B was in dispute with the care company about regular carers. He appears to have used inappropriate language in writing and on the telephone on more than one occasion. It therefore seems the breakdown in care package was a result of Mr B’s relationship with the care company rather than the care plan.

Safeguarding

20. I do not consider there is fault in how the Council considered the safeguarding alert. Mr B’s main concern was about how his needs were being met. The Council decided this concern was best addressed through the care planning process rather than as a safeguarding concern as it did not consider Mr B was at risk. It explained its reasons to Mr B. It is not for me to question the merits of the Council’s decision provided it gave its reasons and explained them to Mr B.

Delay in completing the review

21. The Council decided to review Mr B’s needs in July 2019. The care agency did the review on the Council’s behalf in August 2019. The fact Mr B’s care package was increased in May this year does not mean it should have been increased at the August 2019 review, provided the review addressed his needs. There is no evidence of fault here.

Agreed action

22. The lack of clarity around how exactly Mr B should be supported to shower has caused him uncertainty and confusion. I do not consider the care plan addressed whether Mr B is entitled to support with washing after he has soiled himself, or whether carers are visiting for moral support only. The Council will therefore put in place a new care plan that specifically addresses whether the support relates to promoting Mr B’s motivation and getting in and out of the shower or whether it includes assisting Mr B to wash, in particular, after he has soiled himself. The Council will do this within one month of my decision.

Back to top

Final decision

23. There is some evidence of fault in relation to the clarity of Mr B’s care plan. This has possibly raised his expectations about whether he was entitled to support to wash after soiling himself. There is no evidence of fault in relation to the safeguarding alert or completing Mr B’s review.
24. I have therefore completed my investigation.

Back to top

Investigator's decision on behalf of the Ombudsman