Summary: The Council was not at fault in deciding to trial home care for Mrs Y. It completed the relevant assessments and considered the risks before making its decision. Where there is no evidence of fault in the decision-making process, the Ombudsman cannot question the merits of the decision itself.

The complaint

1. Mrs X complains that the Council advised her that her mother, Mrs Y, who has dementia, was required to accept a domiciliary care package before residential care could be considered. Mrs X felt that her mother required residential care from the outset and believes that the Council failed to properly consider her views. She also considers that the domiciliary care provided was inadequate and placed Mrs Y at risk.

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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 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 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(1), as amended)

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How I considered this complaint

4. I have:

• considered the complaint and discussed it with Mrs X;
• considered the Council’s complaint response;
• made enquiries of the Council and considered the responses;
• considered relevant legislation;
• offered Mrs X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

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What I found

Relevant legislation

5. Under sections 9, 18 and 24 of the Care Act 2014, councils must assess eligible care and support needs and, where those needs are eligible, arrange services to meet them. Care and support planning should be person-centred and take account of the individual's wishes, preferences and wellbeing.
6. The Care and Support Statutory Guidance states care and support should be personalised, proportionate and designed around the individual's needs and preferences. Councils remain responsible for the quality of commissioned services and must monitor arrangements to ensure providers deliver care appropriately.
7. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make decisions for themselves. The Act (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so.
8. A key principle of the Mental Capacity Act 2005 is that any act done for, or any decision made on behalf of a person who lacks capacity must be in that person’s best interests. The decision-maker also must consider if there is a less restrictive choice available that can achieve the same outcome. Section 4 of the Act provides a checklist of steps decision-makers must follow to determine what is in a person’s best interests.
9. If there is a conflict about what is in a person’s best interests, and all efforts to resolve the dispute have failed, the Court of Protection might need to decide what is in the person’s best interests.

Background

10. Mrs Y is in her eighties. At the time of the events complained about, she lived in her own home, with some support from family and friends.
11. Mrs Y had a history of involvement with social services. In May 2024, concerns were raised that she was no longer managing safely at home and that her behaviour, both at home and in the community, indicated possible concerns about her mental capacity. The Council considered it necessary to assess her mental capacity.
12. The Council allocated a social worker and completed a Care Act assessment on 24 May 2024. The assessment found that Mrs Y had eligible care and support needs. A package of care was arranged to provide assistance with medication and prompts to eat and drink.
13. In July 2024, Mrs X contacted the Council to cancel the care package, explaining that Mrs Y could not afford the contribution towards the cost of her care. The final care visit took place on 15 July 2024.
14. In November 2024, a memory clinic referred Mrs Y to the Council because of concerns about her ability to care for herself. Following further professional input, including support with medication, the Council decided to monitor Mrs Y's mental health while considering whether a home care package should be provided. The records show that Mrs X disagreed with this approach and considered that the support proposed was insufficient. Some weeks later, a further referral was made by the mental health team and a joint visit involving mental health and social services was arranged for December 2024.
15. In early December 2024, the Council completed a reassessment of Mrs Y's needs, together with a mental capacity assessment. The community mental health nurse involved in Mrs Y's care was also present. Both Mrs Y and Mrs X participated in the assessment process.
16. The mental capacity assessment recorded that Mrs Y had Alzheimer's disease, which appeared to have progressed. It concluded that Mrs Y lacked insight into her care needs and lacked capacity to make decisions about those needs. The assessor identified a risk of self-neglect and noted that Mrs Y relied heavily on family and friends for support. The assessment also recorded that Mrs Y had previously been reluctant to accept home care and that the family had consequently cancelled the earlier care package. Mrs X considered that Mrs Y was unsafe at home and required 24-hour care in a residential setting.
17. A best interests decision about how Mrs Y's care needs should be met was made. The mental health nurse considered that a home care package should be trialled before residential care was considered. The professional view at that time, was that there was insufficient evidence at that stage to justify 24-hour residential care and that Mrs Y was familiar with her home and surroundings.
18. The assessor also noted that Mrs Y had been engaging well with the mental health team and considered this evidence that she was able to engage with and accept support from professionals. It was acknowledged that a home care package might not be successful, but that a trial would provide further evidence about Mrs Y's needs and help inform consideration of alternative arrangements. On that basis, it was decided that a four-week trial of home care should be provided.
19. A package consisting of two care visits each day was commissioned, with a review after four weeks. Mrs X disagreed with this decision. The home care package commenced on 12 December 2024.
20. In early January 2025, Mrs X contacted the Council numerous times to express her concern that the home care package was not meeting Mrs Y's needs and that the arrangements were unsafe. She reported that, on one occasion, a neighbour found smoke in Mrs Y's property and opened the doors to clear it before alerting Mrs X. When Mrs X visited, she found that the heating had been switched off and that Mrs Y was in bed and very cold. Mrs X said she left notes for carers explaining what food should be prepared, but that Mrs Y hid food because she believed Mrs X was trying to poison her. She also alleged that carers provided Mrs Y with out-of-date food. She reiterated her view that Mrs Y required 24-hour residential care.
21. A social worker from the Council's duty team visited Mrs Y on 13 & 14 January 2025 to reassess her care needs and her mental capacity. The assessment concluded Mrs Y lacked capacity to make decisions about her care needs. The social worker also carried out a risk assessment, which identified the risks associated with her remaining at home, including, a lack of understanding of electrical safety and the use of appliances, which had nearly resulted in several fires. It also identified concerns about Mrs Y not eating proper meals, retaining out-of-date food and hiding meat and other food around her home.
22. The review & risk assessment concluded that Mrs Y could remain at home at that time, but her needs had increased and that further support was required, either through increased home care or by exploring respite or short-term residential care. It recommended a further visit and liaison with other professionals.
23. A referral was also made to the fire service to assess the fire risks and identify measures to help reduce them.
24. Mrs X disagreed with this decision. She said that she regularly had to intervene to support Mrs Y and that, without her intervention, Mrs Y would have been at risk of neglect and harm. She said carers had used a microwave despite advice not to from the fire service.
25. The Council says following this, ‘management discussions’ took place to consider Mrs Y's circumstances and Mrs X's dissatisfaction with the care arrangements.
26. At the end of January 2025, the Council allocated a social worker to undertake longer-term work. On 3 February 2025, the social worker contacted Mrs X. Mrs X explained that she was unable to attend the reassessment because she was going on holiday. She was concerned that, while she was away, there would be no one available to oversee Mrs Y's care or provide additional support when required, leaving Mrs Y at risk.
27. The Council agreed that Mrs Y should receive four weeks' respite care in a residential care home. Mrs Y entered respite care on 5 February 2025.
28. At the end of February 2025, following her return from holiday, Mrs X contacted the Council and said that it would not be safe for Mrs Y to return home.
29. The Council began a further review of Mrs Y's needs on 13 March 2025. As part of this process, it sought information from the care home about Mrs Y's presentation and support needs.
30. On 27 March 2025, the Council reviewed information provided by the care home. This recorded:

• Mrs Y had settled into the care home but continued to express a wish to return home.
• She required support with washing and dressing and was considered likely to self-neglect without such support.
• She had started hiding food.
• Her weight had increased slightly since admission.
• She had been found eating Steradent tablets because she believed they were sweets.
• She required full support with medication.
• She would be at risk of self-neglect and harm if she returned home without full-time support.

31. Following this review, the Council concluded that Mrs Y required 24-hour care and her residential placement was made permanent on 15 April 2025. On the same day, Mrs X requested that Mrs Y be moved to a different care home.
32. On 16 April 2025, the Council completed a further review of Mrs Y's needs and concluded a move would be in her best interests. The reasons included the opportunity for greater social stimulation and the fact that the family could not sustain the top-up fee required at the existing placement.
33. Mrs Y moved to another care home on 17 April 2025.

Complaint to the Council

34. Mrs X considers that Mrs Y required residential care from the outset. She says the trial of home care continued beyond the four-week period initially agreed and that this placed Mrs Y at risk.
35. Mrs X submitted a formal complaint to the Council on 30 June 2025. She complained that the home care had been imposed without Mrs Y's consent and/or lawful authority. She said the care provided was unsafe and had continued beyond the agreed four-week trial. She also considered that Council officers had downplayed the concerns about Mrs Y's safety.
36. Mrs X alleged that Mrs Y received poor-quality care which placed her at risk. She also said she felt bullied and intimidated by Council officers, who she believed had disregarded her views and pressured both her and Mrs Y into accepting home care.
37. The Council issued its final response on 24 September 2025. It did not uphold the complaint that the care workers assigned to Mrs Y were insufficiently equipped to meet her needs. It partially upheld the complaints concerning carers' use of unsafe appliances in Mrs Y's home and the use of expired food. The Council said care workers had a responsibility to provide care to an appropriate standard but recognised that carers were not responsible for maintaining equipment within Mrs Y's home or purchasing food for her.
38. Mrs X remained dissatisfied with the Council's response and brought her complaint to the Ombudsman. She is seeking an apology from the Council and believes it should review its procedures.
39. Mrs X also considers that Mrs Y should not have been charged for care provided beyond the initial four-week trial. She believes Mrs Y should not have been charged for what she considers to have been a poor-quality and unwanted home care service.

Analysis

40. The Ombudsman does not decide what care or support a person should receive. The Ombudsman considers whether the Council acted in accordance with the relevant legislation and guidance and properly considered the available information when assessing a person's needs and deciding how those needs should be met.
41. In this case, the evidence shows the Council undertook several assessments of Mrs Y's care and support needs and her mental capacity. The December 2024 assessment concluded Mrs Y lacked capacity to make decisions about her care needs. A best interest’s decision was then made about how those needs should be met. The Council considered several factors, including Mrs Y's familiarity with her home, her engagement with professionals, the risks associated with remaining at home and the absence of sufficient evidence at that time to justify 24-hour residential care.
42. The principle of least restriction is relevant to a best interest’s decision under the Mental Capacity Act 2005. Where a person lacks capacity, decision-makers should consider whether the proposed course of action is the least restrictive option that can effectively meet the person's needs. The evidence shows the Council considered this principle when deciding to trial a package of home care before moving to residential care. The decision was also intended to provide further evidence about whether home care could safely meet Mrs Y's needs.
43. The Ombudsman recognises that Mrs X strongly disagreed with this approach and considered that Mrs Y required residential care from the outset. However, the assessments and mental capacity assessment were completed properly and with input from relevant professionals. The Council also involved Mrs Y and Mrs X in the assessment process. In these circumstances, the Ombudsman cannot substitute its view of the merits of the professional decision for that of the Council. There is no evidence that the Council's decision to trial home care was reached without proper consideration of Mrs Y's circumstances or that it was so unreasonable as to amount to fault.

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Final Decision

44. I have found no fault in the Council’s decision to trial home care for Mrs Y. The Council completed the relevant assessments and considered the risks before making its decision. Where there is no evidence of fault in the decision-making process, the Ombudsman cannot question the merits of the decision itself.
45. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman