Summary: There was fault in record keeping but this did not cause injustice to the person who complained.

The complaint

1. Ms X complains about her late relative Mr Y’s care and support, provided by Care First Bristol (the Care Provider) and commissioned by Bristol City Council (the Council). Ms X says Mr Y lived in squalor and there were large sums of money withdrawn from his bank account with no evidence of how this was spent.
2. Ms X also complains:
• Mr Y’s flat had no heating or hot water and had mould.
• The police told her mother that Mr Y had died and not the Care Provider or Council.
3. Ms X said this caused her and her mother, Mr Y’s sister avoidable distress.

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The Ombudsman’s role and powers

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, section 25(7), as amended)
5. The Council commissioned the Care Provider to deliver Mr Y’s care under powers and duties in the Care Act 2014. We can investigate the Care Provider’s actions. Any fault we find, is fault by the Council.
6. 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 we use public money carefully. We do not start or continue an investigation if we decide there is not enough evidence of fault to justify investigating. (Local Government Act 1974, section 24A(6), as amended, section 34(B))
7. 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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What I have and have not investigated

8. I have investigated the complaints in paragraph one. I have not investigated the complaints in paragraph two because there is not enough evidence of fault. And because further investigation would not lead to a different outcome.
9. Ms X told me Mr Y’s landlord upheld complaints about disrepair and so I do not consider anything further could be achieved by investigating the Care Provider’s actions. It appears the landlord was aware of repairs issues and the Care Provider was not responsible for carrying out repairs to heating, hot water or for treating mould, only for supporting Mr Y to liaise with his landlord. The records indicate Mr Y told the Care Provider not to liaise with the landlord.
10. It is standard practice for the police to inform relatives of a death where it is in the person’s home and they were alone, where the person lives on a different area, the relative will receive a visit from the local police force. Social services or a care provider would not need to tell the relative, because it is established practice for the police to do this in person.

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How I considered this complaint

11. I considered Ms X’s complaint to us and photos of Mr Y’s flat. I discussed the complaint with her. I also considered the Care Provider’s responses to her complaint and records from the Care Provider and Council set out later in this statement.
12. Ms X, the Care Provider 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

Relevant law and guidance

13. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (the 2014 Regulations) set out the requirements for safety and quality in care provision. The Care Quality Commission (CQC) issued guidance in March 2015 on meeting the regulations (the Guidance.) The Ombudsman considers the 2014 Regulations and the Guidance when determining complaints about poor standards of care.
14. Regulation 13(1) requires care providers to have effective systems to prevent abuse of service users (including financial abuse or theft.)
15. Regulation 17 requires care providers to keep an accurate, complete and contemporaneous record of care provided and decisions taken.
16. The Care Provider’s policy and procedure around financial abuse says “the agency ensures it keeps secure written records of all financial transactions in which staff have some part to play. Even if the worker is only indirectly involved, for example, as an escort, it insists that the situation is fully recorded.”
17. The Mental Capacity Act and Code of Practice to the Act sets out the principles for making decisions for adults who lack mental capacity. An assessment of a person’s mental capacity is required where their capacity is in doubt (Code of Practice paragraph 4.34)
18. A person lacks mental capacity to make a decision if they have a temporary or permanent impairment or disturbance of the brain or mind and they cannot make a specific decision because they are unable:
• To understand and retain relevant information or
• Weight that information as part of the decision-making process or
• Communicate the decision (whether by talking using sign language or other means.) (Mental Capacity Act 2005, section 3)
19. A person must be assumed to have capacity unless it is established they lack capacity. Making an unwise decision does not necessarily mean a person lacks capacity to make a decision. (Mental Capacity Act 2005, section 1)

What happened

Background

20. Mr Y had cognitive problems and physical disabilities. He lived in a rented flat and had a package of home care of 32 hours a week commissioned by the Council and delivered by the Care Provider. In February 2023, Mr Y died in his flat, alone.
21. Photos Ms X has provided show very poor conditions in the flat. The chair and bed are soiled and there is no bedding on the bed. The kitchen, bathroom and living room look unclean. One photo shows a blocked sink, dirty hand towels and dishcloths and a basket of soiled laundry.
22. Ms X told me a care worker found Mr Y, dead. She said the police visited his sister some days later to inform her. Ms X also told me there was no inquest into Mr Y’s death and the cause of death was a heart condition.

Care records

23. The Care Provider’s care plan noted Mr X’s front door was unlocked and said he needed support with all housekeeping. He had three care visits a day and two a week for domestic tasks. The plan noted Mr X had been taken advantage of by ‘friends’ who asked him for money. It said he did not need help with collecting money and had mental capacity to make decisions about care.
24. The Council’s care and support plan in 2020 said staff were concerned Mr X was keeping money in a tin in his home. An assessment of his capacity to manage his finances had been completed and he had capacity. In addition, he left his front door unlocked so his friends could deliver alcohol.
25. The Council’s care and support plan of January 2022 for Mr Y said:
• He had capacity to make decisions around his care while not intoxicated and explained his legs would become ulcerated if he declined care.
• His drinking made him vulnerable to self-neglect and to falls
• He had a consistent male care worker which was positive
• He wanted community support and to remain living in his flat. He did not want to move
• He had support from a care worker to access the post office once a week to withdraw money and buy shopping and alcohol
• He had a care worker complete a thorough clean of the flat weekly and light daily cleaning and issues continue with cleanliness in the home, especially if the catheter leaked
• He had daily support for personal care and getting dressed, laundry, medication administration, meal preparation, light cleaning and changing his catheter bag
• His neighbours bought alcohol for him.
26. The Council’s assessment of Mr Y’s mental capacity to make decisions about his finances concluded he had capacity. The record of the assessment indicates the assessor considered Mr Y’s understanding of his income, the risk of having cash in his home and of leaving his door unlocked.

The Council and Care Provider’s responses to the complaint

27. The Care Provider’s complaint responses said:
• It had reported mould to the housing association. Mr Y had then told staff not to get involved and had instructed the housing association to deal with him only
• He had mental capacity to make decisions about his case and so tasks could only be done if he agreed
• Once a week a care worker completed a thorough clean of the home, did laundry and changed bedding
• Mr Y was incontinent when intoxicated.
• His friends bought him alcohol and visited most afternoons
• The care worker washed bedding every other day due to space issues
• Mr Y did not always let the care worker do everything. The care worker encouraged him to wash, helped with shopping and meal preparation.
• He would refuse care and ask care workers to leave
28. In a statement for this investigation, the Care Provider told me:

“We were not aware of the alleged withdrawals; I have spoken with the care assistant involved in Mr X’s care and he has informed me that he never withdrew cash without Mr X being present. I am aware Mr X had friends and neighbours that would be in his home most days but do not have details of this as Mr X was a private person and would not divulge in detail. 

The only contact with Mr X’s money was when they went to the cash point, the care worker would park right next to the cash machine and open the windows. Due to Mr X………. needing his wheelchair, it was difficult for him to do this task on his own, he asked the care worker to go to the cash point for him, in full view and withdraw the cash for him. The care worker would immediately pass the cash and receipt over to Mr X.”

Was there fault?

29. There is no fault by the Council or the Care Provider acting for it. Mr X’s flat was unhygienic, but the records are clear that this was a lifestyle choice for him. He prioritised other things over self-care and maintaining his home. The care workers did what they could to support him in line with the agreed plan of care. He had capacity to make the choices he made, even though many people would not make similar choices.
30. The Care Provider has no knowledge of the cash withdrawals Ms X complains about. My view is there should have been a written record of the times when the care worker withdrew Ms X’s cash, even though it was within Mr X’s sight and on his instruction, as this was in line with the Care Provider’s own policy and is required by Regulations 13 and 17 of the 2014 Regulations. The failure to keep a written record was fault, but there is not enough evidence to conclude that this would have prevented the large cash withdrawals. There is no way of establishing who made the withdrawals.

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Final decision

31. There was fault in record keeping but this did not cause injustice to the person who complained. I have completed the investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman