Summary: Mr C complains about the way in which the Council assessed his mother’s care needs when she lived in the community, and later when she was in hospital and needed a care home. The Ombudsman found fault with the way the Council recorded the first assessment and with the failure to involve Mr C in the second assessment. There was also an unreasonable delay in placing Mr C’s mother in a suitable care home. The Council has agreed to the Ombudsman’s recommendations, which include a financial remedy for the avoidable distress Mr C and his mother experienced.

The complaint

1. The complainant, whom I shall Mr C, complained to us on behallf of his mother, whom I shall call Ms M. Mr C complains the first student social worker, who carried out a home visit to his mother in February / March 2018, failed to complete an appropriate needs assessment of his mother. Mr C says she failed to:
• Properly assess his mother’s needs and
• Provide the support she (and he as her carer) needed.
2. Furthermore, Mr C complains the second student social worker, who carried out a needs assessment while his mother was in hospital, also failed to complete an appropriate needs assessment of his mother. Mr C says this resulted in an incorrect support plan, which resulted in an unreasonable delay, between July and October 2018, in finding a care home for his mother.

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The Ombudsman’s role and powers

3. 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)
4. 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

5. I considered the information I received from Mr C and the Council and interviewed a staff member from the Council who had been involved in the case. I also obtained information from the hospital where Ms M had stayed.
6. I shared a copy of my draft decision statement with Mr C and the Council and considered any comments I received, before I made my final decision on the complaint.

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What I found

The first assessment

7. Mr C contacted the Council on 14 March 2018. He said his mother’s health had rapidly declined since February 2018. He said he lived with his mother, but she could not cope anymore during the day while he was out at work. His mother therefore needed support with dressing, checking up etc. Mr C said he found this difficult to cope with and felt his mother needed a minimum of one-hour support per day.
8. Ms M’s case was allocated to a student social worker in April 2018, whom I will refer to as ‘assessor one’. The Council says she was supervised by a qualified social worker, whose role was to observe the assessor’s assessments, and provide feedback for her learning and development.
9. Assessor one immediately contacted Ms M and Mr C to arrange an assessment for the following day. However, Ms M went into hospital that day and went home again later the same day with a homecare support package from the Rapid Response Team.
10. Assessor one rescheduled the visit to the next day. The assessor visited Ms M in her home, in the presence of Mr C and the social worker responsible for supervising her. Mr C complains assessor one failed to complete an appropriate needs assessment of his mother. He says she failed to properly assess his mother’s needs and therefore failed to provide the support she (and he as her carer) needed.
11. The Council says:
• The assessor responded to the referral within the Council’s timescales, provided Ms M and Mr C with written and verbal information, and gave Mr C written and verbal information on his rights to a carer’s assessment.
• At the time of the assessment, Ms M was receiving temporary homecare support from the Rapid Response service. The social worker identified that Ms M would need to continue to receive homecare support and, following her visit, was arranging to commission and provide this support via the Council.
• The social worker who supervised assessor one concluded that assessor one had prepared well for the assessment visit and carried out a thorough and comprehensive assessment in line with relevant guidelines.
12. However, assessor one failed to upload her assessment onto the Council’s electronic system, before she left the Council after her placement came to an end. As such, the Council does not have a record of the information the assessor collected at the assessment. This was fault. The Council said the assessor should have completed the case recording and assessment on the system, and should have recorded a transfer summary on the file. The Council says it has shared this shortcoming with the supervising practitioner as a significant learning point for her. Although it checks and closes or transfers student cases at the end of a placement, it missed that on this occasion.
13. Following the assessment visit, the social worker contacted the Rapid Response service provider, to ensure they would continue with their temporary support until the Council could put a commissioned service in place to take over. The Rapid Response team agreed to continue. Later that day, Mr C told assessor one that his mother had gone into hospital again.
14. Mr C also complained that assessor one sent him an inappropriate text message, shortly after she had visited his mother. Mr C said the text told him that his mother would not receive a support package because “a financial assessment had not been done”. However, the Council’s record shows that Mr C preferred the Council to update him through text messages. The text said: the long-term package would not be in place on 26 April 2018, because the budget request and support plan had not been finalised. The Rapid Response team agreed to continue the temporary care until the long-term package of care would be in place. If you have any questions, please call me.

Assessment

15. The Council has acknowledged that it failed to complete the relevant documents on its system with regards to the assessment visit. This is fault. As such, I am unable to determine if assessor one captured all the relevant information correctly during the assessment visit. However, the records that are available indicate the assessor had identified Ms M would (continue to) receive homecare support.
16. I did not find fault with regards to the text assessor one sent to Mr C.

The second assessment

17. The NHS told me that Ms M went into hospital in April 2018 as an informal patient, because of: “visual hallucinations, failure to recognise her children, and verbal abuse towards her son and daughter.”
18. The NHS completed an initial CHC Checklist in May 2019, which concluded that Ms M did not meet the criteria for free NHS Continuing Healthcare.
19. The Council allocated Ms M’s case to another student social worker (whom I will refer to as ‘the assessor’) on 12 June 2018 to plan her discharge from hospital.
20. Mr C complains that, even though he had agreed a date with the social worker to attend and participate in his mother’s needs assessment at the hospital, the social worker carried out the assessment without him. However, the Council told me it invited Mr C to be present at the assessment, but he failed to attend.
21. According to the records, the assessor tried to contacted Mr C on 13 June 2018 to ask him to attend his mother’s assessment. The landline number she was using was incorrect, and she said she would try to contact him on his mobile instead. However, there is no evidence she tried this. As such, the assessment visit went ahead without Mr C being present.
22. The assessor contacted the hospital to ask if Ms M had any communication needs. The hospital said Ms M could speak fluent English.
23. The social worker carried out her assessment visit on 14 June 2018. The record states that:
• A nurse explained:
1. Ms M went into hospital due to her aggressive behaviour. She had also become less independent with personal care.
2. Ms M was fully mobile but had a fall. She was incontinent and needed full support with toileting.
• The medical records showed that Ms M could become verbally aggressive, hostile, confused, disorientated and agitated.
• Ms M agreed to speak to the assessor. However, she answered all her questions by saying ‘I do not know’. Ms M said she was tired, after which the assessor left. The assessor recorded that she would arrange another visit with Ms M to complete the assessment. However, there is no evidence in the records she made a further assessment visit.
24. The assessor tried to contact Mr C on his mobile on 21 June 2018 to talk about his mother. She left a voice message. Mr C called back and left a message to say he would try and call again on 22 June.
25. The assessor spoke to the hospital on 22 June 2018, who said Ms M had been placed on ‘delayed transfer of care’. The assessor made a budget request for residential care later that day.
26. The Council says:
• The supervising practitioner considers that the assessor should have made alternative arrangements for a family member or advocate to be present at the initial visit. Mr C’s involvement would have provided additional information to the assessment and may have provided more clarity to him about the assessment process.
• However, the social worker gathered information for the assessment from a range of valid and reliable sources. The social worker used information from members of the multi-disciplinary team involved in her treatment and assessments (such as Nurses, Occupational Therapists, and Physiotherapists) to complete the assessment.
• The support plan was authorised by a qualified hospital social worker.
27. Mr C complains that, as a result of not involving him, his mother’s needs assessment was inaccurate. However, Mr C was unable to provide me with specific examples of any specific important inaccuracies. I have reviewed the needs assessment form that was completed and found it to be detailed and comprehensive. It stated that:
• Ms M had Alzheimer dementia, which often resulted in low moods and being hostile, confused, disorientated and agitated. There had been some verbal and physical altercations with other service users.
• Ms M was compliant with personal care but needed full supervision and prompting.
• Ms M was in good physical health, slept well, had a good diet and fluid intake and could mobilise and transfer.
28. Mr C complains that when he wanted to discuss the outcome of the need assessment with the student social worker, she refused to meet with him.
29. Mr C sent a text message to the assessor, to say he and his sister were unhappy with some of the information included in his mother’s needs assessment. He said they wanted to have a meeting with the assessor and her line manager to discuss this. In response, the assessor left a voice message to:
• Advise Mr C of the complaint procedure.
• Ask him to call her to discuss the issues he had with regards to the assessment and support plan.
30. The assessor spoke to Mr C, who said he was not happy with his mother’s support plan. The assessor said that if he could mention something specific, she could amend it. However, Mr C said that he was ‘finding the whole process difficult and draining’ and suggested to the assessor to speak to his sister instead. When the assessor spoke to Mr C’s sister, she only asked about Ms M’s capacity to make decisions. The assessor explained her capacity assessment concluded that Ms M did not have capacity to decide where she wanted to live. Mr C’s sister agreed with this and did not raise any other issues.
31. There was a short delay in the Council approving Ms M’s personal budget (a residential care home placement for up to £500 a week), because the assessor did not submit it correctly. When it was agreed on 6 July 2018, the Council’s commissioning team could start to submit a tender for a dementia registered care home, through its brokerage system. This meant it would send out information to all the contracted residential care homes on its system, to ask if any of them would be interested (and had a vacancy) to meet Ms M’s needs. However, not all care homes in the area are registered with the Council, which allows them to become part of this brokerage system. The tender did not initially go out to nursing homes, because Ms M was not initially eligible for NHS funded nursing care. At interview, the Council told me it would expect that its assessors and social workers would encourage a client (or their family) to go out and contact care homes themselves as well, because not all homes are on the system. The records did not show the Council had immediately advised Mr C of this.
32. The assessor told Mr C on 12 July 2018, that she had received three expressions of interest from care homes and asked the care home to carry out an assessment to establish if it could meet Ms M’s needs. The assessor called the home and explained Ms M’s needs over the phone. The care home believed it could meet her needs. The assessor sent a copy of the support plan to inform the home’s assessment. The home said on 16 July they would not be able to accommodate Ms M, because they were a small home and would not be able to keep Ms M in a separate part of the home if she would have a verbal or physical altercations with another resident.
33. The Council arranged a visit by Ms M to a larger home on 20 July 2018. However, following the visit, the care home said they would not be able to accept Ms M, because Ms M refused to interact with other residents and argued with them. The home said she appeared overwhelmed by the large home and would perhaps benefit from a smaller home.
34. Mr C complains that the Council’s inaccurate support plan resulted in significant delays in finding his mother the residential care placement she needed. He says care homes would come to assess his mother and conclude they could not meet her needs, as her needs were significantly higher as set out in the Council’s needs assessment they had received. All this time his mother had to stay in hospital.
35. The records show the Council’s brokerage team submitted tenders on a regular basis. In addition, the assessor was generally quick to contact the care homes who expressed an interest and ask them to complete an assessment. According to the Council, an additional 17 care homes expressed an initial interest to offer a placement to Ms M, between 17 July and 29 November 2018. However, none of these resulted in an eventual actual placement offer.
• In five cases, the care home concluded in the end that it would not be able to meet Ms M’s needs.
• In five cases, the Council failed to record what the outcome was following the initial expression of interest. In one of these there is no evidence the assessor took any action. In two cases, the Council may have concluded the care home was too expensive, because the weekly cost was £575.
• In one case, the family declined the care home as it catered to clients of a specific ethnic background, as a result of which her mother would feel out of place
36. In addition, Ms M’s daughter also found and suggested three nursing homes in August 2018. However, two of the homes did not have a vacancy. I did not see evidence the assessor asked the home to put Ms M on a waiting list, in case anything became available at short notice. This was potentially a missed opportunity. The manager of the third home told the assessor on 30 August that she would speak to the hospital Occupational Therapist about Ms M’s placement. However, there is no evidence in the records that the assessor tried to find out what the outcome was of this discussion.
37. The hospital had a conversation with the Council on 27 July 2018 and agreed to review the CHC Checklist, because of the number of care homes that had declined a placement for Ms M. As a result, the review concluded on 13 August that, due to a deterioration in Ms M’s condition, she was now eligible for NHS funded nursing care. This meant that Ms M now met the criteria for a nursing home placement, which increased her personal budget of £575 per week.
38. A Council record on 31 August 2018 states that: “Please note activity raised by worker is on the community board and should have been sent to brokerage hospital board to be dealt with quickly”. At interview, the Council explained that Brokerage have a community board and a hospital board. The assessor put Ms M’s case on the “community board” instead of the “hospital board”. Due to the fines the Council can get for a delayed discharge, the hospital board gets more priority. There is more urgency in finding a placement and following things up to avoid delays in discharge
39. Another care home expressed an interest on 18 September and 9 October 2018. However, the Council told me that this did not materialise, because Mr C told the Council that he could not afford to pay the weekly top up, because the care home’s weekly fee was more than Ms M’s personal budget.
40. Ms M’s health further deteriorated, and she was transferred on 12 October 2018 to another hospital. From there, she moved into a care home on 4 December 2018.

Assessment

41. The Council failed to ensure that Ms M was supported by her son during her needs assessment. Ms M had substantial difficulties in being involved in her assessment process, and therefore needed her son to support her with this process. The Council has acknowledged that this is fault. While the Council made an attempt on 21 June 2018 to discuss Ms M’s case with Mr C, it did not speak to him in the end and completed the assessment without his input. However, I did not find that this resulted in an inaccurate support plan, as claimed by Mr C.
42. However, when Mr C said he wanted to discuss the outcome of his mother’s assessment, the Council did offer to discuss this with him over the phone. The Council also asked Mr C to let it know if he believed there were any inaccuracies, so it could consider these and make any changes where needed.
43. The records show the Council’s brokerage team regularly put out a request to care homes on its system to determine if they could provide Ms M with a placement. In addition, the Council was often quick to contact the care homes who expressed an interest and ask them to complete an assessment. However, there were also incidents where the records do not show the Council followed up on an expression of interest, or where the Council failed to record the outcome. This is fault.
44. Furthermore, the Council was wrong when it decided that it would not pursue a placement at a specific care home, because: Mr C could not afford to pay a top up (the difference between the personal budget and the care home fee). The “Care and support statutory guidance” of the Care Act 2014, says that: where the Council has determined that a person’s needs are best met in a care home, the Council must ensure that it offers at least one accommodation that is available and affordable within the person’s personal budget. In cases such as these, where the only available care home was more expensive than the agreed personal budget, the Council should not ask the client to pay the difference through a top up. Instead, the Council should increase the personal budget to enable the client to move into the care home and ensure the Council meets the client’s assessed needs. This did not happen, which is fault.
45. Furthermore, the Council was at fault for putting Ms M’s case on the “community board” instead of the “hospital board”. As a result, Ms M’s case had a lower priority in terms of finding a suitable home, than it would have had if it had been put onto the correct board, until 31 August 2018 when the fault was discovered.
46. I found that, on the balance of probabilities, if the faults mentioned in paragraph 42 to 44 had not occurred, Ms M would have been able to move into a care home before she was transferred to another hospital on 12 October 2018. I estimate this to be by around one to two months.
47. The above case identified the need for the Council to review the way in which it supervises and monitors student social workers to ensure any faults or shortcomings are identified in a timely manner.

Agreed action

48. I recommended that, within six weeks of my decision, the Council should:
• Apologise to Ms M and Mr C for all the faults identified above and the distress it has caused them. In addition, it should pay Ms M £200 and Mr C £200 (which includes a remedy for the time and trouble he has spent in pursuing this case).
• Share the shortcomings identified above and the lessons learned with its adult social care staff in the community and in hospital, who are involved in: carrying out assessments, finding care homes, and supervising student social workers.
• Carry out a review of its procedures and guidance to ensure that relevant staff within adult social care know under what circumstances the Council should not ask a client for a top up payment; should increase the personal budget to enable a client to move into a care home.
• Carry out a review of its monitoring and supervision arrangements with regards to student social workers, to ensure that any future faults by student social workers will be prevented as much as possible and (where faults do occur) be detected as soon as possible.
49. The Council has told me it has accepted my recommendations.

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Final decision

50. For reasons explained above, I have upheld Mr C’s complaint. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.

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Investigator's decision on behalf of the Ombudsman