Summary: Ms C complained about the Council’s failure to properly assess her needs, its communications with her and its failure to fully respond to her complaint. She also said the care agency did not meet her needs and she complained about the care worker’s communications with her. We found fault in the Council’s failure to respond to the complaint and the care agency’s actions when Ms C had a fall. The Council has agreed to apologise, to pay a financial remedy and to implement a service improvement.

The complaint

1. Ms C says the Council did not properly assess her needs for care and support and the social worker bullied her. She also complains about Apasen care agency, the agency that provided the care package. She says the care worker did not understand her needs, made inappropriate comments to her and failed to properly support her.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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, sections 24A(1)(A) and 25(7), as amended).
4. 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

5. I considered evidence provided by Ms C, the Council and the Agency as well as relevant law, policy and guidance.

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What I found

Law, guidance and policies

6. The Care Act 2014 and the Care and Support Statutory Guidance 2014 set out the Council’s duties towards adults who require care and support. The Council also has its own policies.

Assessment of needs

7. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs.
8. The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Councils must consider whether:
• The adult’s needs arise from a physical or mental impairment or illness.
• As a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes.
• As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.
9. The outcomes are:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Being able to make use of the home safely
• Maintaining a habitable home environment
• Developing and maintaining family or other personal relationships
• Accessing and engaging in work, training, education or
• Making use of necessary facilities or services in the local community
• Carrying out caring responsibilities for a child.
10. In terms of ‘making use of the community’ the CASS Guidance says:
• Local authorities should consider the adult’s ability to get around in the community safely and consider their ability to use such facilities as public transport, shops or recreational facilities when considering the impact on their wellbeing. Local authorities do not have responsibility for the provision of NHS services such as patient transport, however they should consider needs for support when the adult is attending healthcare appointments.

Care Quality Commission

11. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers that meet the fundamental standards of care, inspects care services, and reports its findings.
12. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The CQC has guidance on how to meet the fundamental standards. This says that:
• The care and treatment of service users must be appropriate, meet their needs and reflect their preferences (regulation 9).
• Service users must be treated with dignity and respect (regulation 10).
• The care and treatment must be provided in a safe way for service users. (regulation 12).
• Any complaint must be investigated and necessary and appropriate action must be taken in response to any failure identified (regulation 16).
• The Home must securely maintain accurate, complete and detailed records in respect of each person using the service. (regulation 17)

Background to the complaint

13. Ms C is an adult woman who lives at home and was receiving support from a friend.
14. Ms C contacted the Council on 14 February 2024 and said she needed support urgently as her friend had a medical emergency and was unable to support her.
15. The Council put in a crisis support package and commissioned Apasen care agency (the Agency) to carry out three visits a day, morning, lunch time and evening. The Agency was to provide support with personal care and grooming, preparing meals and hot drinks and prompting medication.
16. The Agency started to provide support to Ms C on 27 February 2024. The social worker spoke to Ms C and explained that the crisis support package would last up to 6 weeks but a social worker would contact her within 3 to 4 weeks to carry out a review assessment.
17. A social worker from the Mental Health Social Care Team carried out a review assessment of Ms C’s needs for care and support on 2 April 2024.
18. Ms C ended the support package on 17 April as she said her friend was out of hospital and would resume providing care for her.
19. Ms C complained to the Council in July 2024. She sent two complaints, one about the Agency and one about the Council.

Complaint about the Agency – July 2024

20. Ms C said:
• The care worker from the Agency spoke to her and about her in a derogatory way.
• The care worker did not understand non-physical disabilities. The care worker told Ms C that when her husband died, she had to do everything by herself and Ms C should do things by herself.
• There was an incident where the care worker left items in the middle of the bathroom and Ms C had to walk around the edge. Ms C fell and broke her arm. Ms C said the care worker did not ring an ambulance and instead told her that her arm was not broken. Eventually the care worker then called the Agency who told her to call an ambulance. The care worker did not accompany Ms C to the hospital.
• The care worker talked about other clients’ private lives to Ms C.

Complaint about the Council – July 2024

21. Ms C said:
• The social worker did not fully understand her needs, particularly the needs related to non-physical disabilities.
• The social worker was ‘aggressive in her speech’ and bullied her. The social worker did not ask her anything about her life with agoraphobia and did not properly consider her physical disabilities.
• The social worker ‘demanded that I get on a bus and get my shopping, she made other demands like this.’
• The social worker did not tell her that she could choose a different agency.

Response to the complaints -

22. The Council responded to the complaint about the Council’s social worker and listed the actions the social worker had taken to address Ms C’s needs. The Council said:
• ‘Therefore, I cannot find any evidence to support the allegations. Nevertheless, I will address the concerns with the worker in supervision to support their development, so we do not have any occurrence of similar issues in future.’
23. There was no response to the complaint about the Agency Council did not forward Ms C’s complaint to the Agency.
24. Ms C was not satisfied with the Council’s response to her complaints and said her complaints not been addressed. She had asked for access to an advocate and expected to be told how the complaint would be handled and by whom and this was ignored. The Council responded and advised Ms C to take the complaint to the Ombudsman.

Evidence – Council

25. The social worker assessed Ms C’s needs on 4 April 2024 and said:
• Ms C had physical health conditions which affected her mobility and Ms C therefore needed support in maintaining a habitable home environment, preparing meals and drinks, getting dressed and personal care.
• Ms C was at risk of falls because of mobility problems caused by osteo-arthritis. To minimise the risk, Ms C mobilised with the help of a frame. She also had a falls pendant. Ms C was unable to use the wet-room independently without supervision and care workers should supervise Ms C in the shower to ensure that she completed the task safely.
• Ms C was unable to access the community because of agoraphobia and physical health conditions which impacted her mobility. Ms C said she was unable to take the bus ‘even when accompanied due to severe agoraphobia.’ Ms C requested transport to access the community as ‘cabs are expensive’.
• The social worker said she would make a referral to the GP as the NHS provided transport for hospital appointments. Ms C could also access Age UK which provided transport.
• Ms C needed floating support for paperwork and managing her finances.
• Ms C was very worried and scared. Ms C said she was limited by her agoraphobia and anxiety around strangers.
• The social worker agreed to increase Ms C’s care package by 2 hours floating support a week to access the community. The support could be used flexibly: ‘hospital appointments, shopping, medication collection and any need that requires accessing the community.’

Evidence – Agency

26. The Agency’s daily case notes set out the tasks performed on each occasion but no other details. There is no record of what the care worker said or of any conversations.
27. As the Agency was not aware of the complaint, there was no investigation into the complaint and the care worker was never interviewed about the allegations.
28. The Agency’s ‘Accident and Emergency’ policy says the goals of the organisation are to ensure that:
• all accidents and incidents involving injury to staff or service users are reported and recorded, no matter how minor
• all reported accidents or incidents are fully investigated
• the results and recommendations from investigations are fully implemented to prevent any reoccurrence of such incidents
29. The policy says:
• In the event of a minor injury or health related incident the First-aid Policy should be followed. Following such an incident an incident or accident form should be completed and the service user’s GP informed.
• In the event of an injury where medical attention is considered advisable or necessary, the service user’s GP or an ambulance should be called as appropriate. If there is any doubt about the need for medical attention, an ambulance should be called immediately and arrangements should be made to take the casualty to hospital.
• Make arrangements for the ambulance to be met by a relative or other person as appropriate and if available.
• Ensure that the service user is accompanied to hospital, when appropriate, by a responsible person.
30. I have considered the records of the fall which happened on 13 April 2024. The case note for that day said Ms C went to the toilet and reached for a towel from the towel rack and then fell. The care worker ‘assisted her off the floor and onto her shower chair, put an ice pack on her left arm and both knees. The client insisted on taking shower, gave client shower…’ After the shower the care worker applied cream to Ms C, got her dressed, made breakfast and assisted with medication. She then contacted the Community Team for assistance and was told to ring an ambulance.
31. The ambulance crew took Ms C to the hospital where she was treated for a broken arm.
32. The Agency completed an incident report on 15 April 2024 and sent it to its Out of Hours team. The report noted that Ms C fell and that the care worker contacted the paramedics. The report asked: ‘Did the organisational arrangements or service delivery influence the accident/incident? If so, how?’ The report said; ‘No.’

Further information

33. In its response to the Ombudsman, the Council said:
• ‘We accept more detailed enquiries into the specific allegations should have been raised with the Agency before the investigation was concluded, and further consideration could have been given to appointing an advocate in July 2024 to provide support. ‘
• ‘The response to the complaint confirmed that officers would address matters in supervision with the social worker to prevent a similar problem arising, however, in recognition of the distress [Ms C] was caused, it would have been appropriate to have included a formal apology and upheld the complaint.’
34. In its response to the Ombudsman, the Agency said:
• There are lessons learned in relation to the day of the accident and we will address this with the care worker and also our wider carer team about calling an ambulance immediately.
• If the complaint was received earlier, we may have been able to provide a statement.

Analysis

35. I have explained to Ms C that certain aspects of her complaint would be difficult to investigate as they relate to how the care worker or social worker spoke to her or to information that the care worker allegedly gave to Ms C about other clients. It is unlikely that this would be documented in the records. Therefore, there are limits to the investigation.
36. I have focussed my investigation on the evidence that I can consider which I have set out above.

Complaint about the Council

37. It is not the role of the Ombudsman to assess Ms C’s needs or to say what her care plan should be. I can only investigate whether the Council’s actions are in line with the law, guidance and policies.
38. The assessment showed that the Council considered Ms C’s needs for care and support and this included the agoraphobia. The social worker considered the impact Ms C’s diagnoses had on her ability to achieve outcomes. Therefore, I find no fault overall in that respect.
39. I cannot find evidence that the social worker demanded that Ms C take a bus, but I accept that there may have been a discussion where the social worker asked Ms C whether she could take a bus.
40. The assessment does not say so explicitly but the social worker appears to have accepted that Ms C could not use the bus, as the social worker referred Ms C to transport services via the NHS and Age UK. I do question what would have happened if those proposed alternatives could not provide all the transport that Ms C needed, but it is impossible to speculate as the care package ended a couple of weeks later.
41. The Council also agreed to provide a care worker to accompany Ms C when she went into the community so the Council accepted that Ms C’s agoraphobia would make it difficult for Ms C to access the community without support.
42. It is true that the social worker did not inform Ms C that she could change agencies, but, at the time, Ms C had not informed the Council that she was dissatisfied with the Agency.
43. However, there was fault in the Council’s failure to fully investigate Ms C’s complaint, both the complaint about the Council and the Agency (see below). I also agree that it would have been good practice to provide Ms C with an advocate when she asked for an advocate.

Complaint about the Agency

44. The Council failed to forward the complaint about the Agency to the Agency which meant that there was no response to that complaint. That was fault by the Council. I accept this would have contributed to Ms C’s perception that the Council was not listening to her and did not understand her needs.
45. Unfortunately, as no investigation took place at the time and as a lot of time has passed, it is impossible to investigate some of the claims at this stage, particularly the claims about the way the care worker spoke to Ms C. The records do not contain this information so it is difficult for the Ombudsman to investigate this aspect. An interview with the care worker, at the time of the complaint may have provided some of the answers.
46. The Council’s failure to forward the complaint to the Agency meant that Ms C has missed out on a full investigation and she will always have the uncertainty that, if she had received a response to her complaint, she may have had a resolution to her complaint.
47. There was also fault in relation to the fall. According to the Agency’s policy, the care worker should have either called the Agency or an ambulance as soon as the fall happened. Instead, the care worker gave Ms C a shower, got her dressed, prepared breakfast and then rang the Agency. This delay in calling for help was not in line with the policy.
48. I also note that the care worker did not accompany Ms C to the hospital. The Agency’s policy said the Agency should arrange for the ambulance to be met by a relative or other person as appropriate and if available or ensure that the service user was accompanied to hospital by a responsible person.
49. Also, the Agency knew that Ms C had agoraphobia and could not access the community without the support a care worker so this would have been even more important in Ms C’s case. I would have expected the Agency to at least consider whether a care worker should accompany Ms C to the hospital. I have not found any evidence the Agency considered this.
50. According to the policy, the Agency should fully investigate any incident and make recommendations from the results of the investigation to prevent a reoccurrence of the incident. I could not find much evidence that an investigation took place and no recommendations were made. For example, I could find no evidence that the Agency spoke to Ms C after the incident to find out what happened.

Remedy

51. Ms C has said she has suffered trauma because of the Council and the Agency’s actions and needs counselling to address the trauma. She wants the Council to pay for counselling sessions.
52. The aim of the Ombudsman’s remedy is to put the complainant into the position they would have been if the fault had not happened. The Ombudsman is not a court and the Ombudsman cannot say whether a person suffered long lasting psychological trauma because of the fault.
53. We can however, acknowledge that Ms C suffered distress because of the fault and we sometimes offer a small symbolic sum to acknowledge the distress. I recommend the Council pays Ms C £250.

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Action

54. When a council commissions or arranges for another organisation to provide services we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions.
55. Where we find fault with the actions of the service provider, we can make recommendations to the council alone. Here we have found fault with the actions of the care provider and the Council and make the following recommendations to the Council.
56. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise in writing to Ms C for the fault.
• Pay Ms C £250 as a symbolic remedy for the distress caused by the fault.
• Remind relevant staff of the importance to forward complaints about care providers to the care provider, if the complainant has not sent the complaint to the care provider directly.
• Remind the Agency of its duty under its Accident and Emergency policy.
57. Under our information sharing agreement, we will share the final decision with the CQC.

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Decision

58. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman