Summary: Mr P complained about the Council’s failure to provide his mother with appropriate care causing distress and frustration. We have found the Council to be at fault because it did not arrange care for five days and cannot show it responded to concerns about poor care. To remedy the injustice caused by these faults, the Council has agreed to apologise, make a symbolic payment and review its procedures.

The complaint

1. Mr P complains about the Council’s poor response to a request for a care package for his mother, Mrs X. In particular, he complains about the following matters:
1. An initial telephone assessment that did not identify her need for two carers.
2. The failure to provide any care for five days due to a shortage of carers.
3. Poor standard of care initially.
2. Mr P says this caused significant distress and frustration to both himself and Mrs X.
3. Mrs X sadly passed away during the course of this investigation.

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The Ombudsman’s role and powers

4. 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)
5. 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.
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 spoke with Mr P and reviewed the information provided.
8. I made enquiries with the Council and reviewed the relevant law.
9. Mr P and the Council had an opportunity to comment a draft version of this decision. I will consider their comments before making a final decision.

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What I found

Legal context

10. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve.
11. The Council must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs.

What happened

12. Mrs X had dementia and moved into the Council’s area in February 2021. Her family contacted to Council to request a package of care as a matter of urgency. An initial care needs assessment was carried out over the phone due to Covid-19. According to the Council’s records, Mrs X’s daughter said she was able to use a zimmer frame for support and was able to mobilise to and from the bathroom. Mr P disputes this. Mrs X was non weight bearing and he says this information would have been available to the Council if it had made proper enquiries.
13. As a result of the information provided by Mrs X’s daughter, she was assessed as needing assistance with personal care, dressing, feeding and medication.
14. The Council commissioned an agency (Agency 1) to provide this care. The first care call was arranged for 22 February 2021. However, when the carer arrived, she was told by the family that Mrs X needed the support of two carers due to her poor mobility. Agency 1 did not have capacity to support a “double-up” care package and so told the Council it was unable to continue. The Council arranged for its ‘rapid response’ team to provide care until another agency (Agency 2) was able to start on 2 March 2021.
15. Mr P says the level of care provided by Agency 2 was unacceptable. There were occasions where Mrs X’s continence pads were not changed and she was left in soiled bedding and clothes. Mr P says this was raised with the Council on three occasions, but nothing was done.
16. In late March 2021, a new care provider took over and Mr P says he was satisfied with the service. However, he complained to the Council about what happened earlier. In response, the Council made the following points:

• Agency 1 was not responsible for missing the first call because it had been rescheduled at the family’s request.
• Information provided by the family initially to Agency 1 did not suggest two carers were necessary.
• When Agency 1 withdrew, there was a delay of five days in providing a replacement service due to capacity issues. An emergency provider started on 27 February 2021 until Agency 2 was able to take over on 2 March 2021. The Council acknowledged the period when Mrs X went without care was unacceptable and apologised for this.
• The Council advised Mr P that it was recruiting additional staff and improve procedures to prevent this situation reoccurring.

17. Dissatisfied with this response, Mr P complained to the Ombudsman about the following unresolved issues:

• The initial telephone assessment was inadequate. He says that f it had been done properly and taken into consideration information from Mrs X’s previous local authority, the Council would have known she was non-weight bearing and required two carers.
• The Council had still not addressed his concerns about the poor standard of care provided by Agency 2.
• An apology was an inadequate outcome for the failure to provide care for five days.

Analysis

18. 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.
19. I will consider the separate areas of complaint raised my Mr P.

Actions of Agency 1

20. I do not find fault with the actions of Agency 1. In the circumstances at the time, it was acceptable for the initial assessment to be carried out over the telephone. The family made it clear it was an urgent situation. The records from the assessment confirm the Council had no reason to believe Mrs X required two carers. Mrs X’s daughter told the Council her mother was able to mobilise with the support of a zimmer frame.
21. Mr X says the Council should have been aware from a previous Council’s involvement with Mrs X that she would need two carers. While I understand Mr P’s frustration, because it was a crisis situation and the Council had to respond quickly, I consider it was reasonable for the initial assessment to be carried out solely based on the discussion with Mrs X’s daughter.
22. Once Agency 1 was appointed, the records confirm there was some difficulty with the initial arrangements. However, the records show that Agency 1 made its best efforts to contact Mrs X, albeit unsuccessfully due to her not answering calls from unknown numbers. The evidence I have seen confirms Agency 1 was appointed at very short notice, in response to an urgent request, arranged a care package based on information provided by the family. In this context, I am unable to find fault.

The Council’s failure to provide care when Agency 1 withdrew

23. In its complaint response to Mr P, the Council has accepted it was at fault for being unable to provide any care for five days when Agency 1 had to withdraw. As the Council has accepted fault, it is not necessary for me to investigate this further. The Council apologised for this fault but Mr P says this is an inadequate remedy for the distress caused. My role is to decide if the injustice requires an additional remedy.
24. In reaching my decision about this, as above, I cannot ignore the context in which this fault occurred. In February 2021, the care sector was under unprecedented demand due to Covid-19 and it is clear this was the reason why there was a delay in making arrangements, rather than the Council failing to take prompt action. For this reason, I consider an apology to be a sufficient remedy for the injustice caused.

Allegations of poor care by Agency 2

25. In its response to my enquiries, the Council has failed to provide an explanation for what happened regarding reports of poor care made by the family. Because of this, I must rely on the Council’s case notes and what Mr P has said happened.
26. The records confirm that Mrs X’s daughter told the Council that Mrs X had been left in a soiled bed, her pad had not been changed and she had not been dressed in clean clothes. Two days later she told the Council again about the poor standard of care. In response, Agency 2 advised the Council there were some concerns about Mrs X’s welfare at home. This led to a safeguarding alert, but the records are silent as to what happened next.
27. As soon as the Council was told about poor care, I would expect to see evidence of action that had been taken to address this with Agency 2. While there was a dialogue between the Council and Agency 2 about other issues at home, there are no records to evidence any discussion about poor care. On balance, and because the Council has been unable to evidence what action it took in response to concerns raised, I conclude the Council did not act as it should have done and is fault.
28. I am satisfied both Mrs X and Mr P suffered an injustice as a result of the distress caused by this. While it is not possible to remedy the injustice caused to Mrs X, I consider it is appropriate for the Council to apologise and make a symbolic payment to Mr P as set out below.

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Agreed action

29. Within four weeks from the date of my final decision, the Council has agreed to take the following action.
1. Apologise in writing to Mr X.
2. Pay Mr X £100 to acknowledge the distress caused by the Council being unable to evidence what action it took to address concerns raised about poor care.
3. Reflect on the issues raised in this decision statement and identify any areas of service improvement, particularly around record keeping and responding to care quality concerns. The Council should prepare a short report setting out what the Council intends to do to ensure similar problems not reoccur. This report should be sent to the Ombudsman.

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Final decision

30. The Council was at fault, and I have recommended a remedy for the injustice caused. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman