Summary: The Council failed to provide adequate support to Mr D to meet his adult social care needs. Mr D’s mother (Ms C) provided support instead; the Council failed to give her a carer’s assessment. Ms C suffered from stress and anxiety; she took time off work, had sleepless nights, and suicidal thoughts. Mr D suffered stress which caused an increase in absence seizures. The Council should pay Ms C a sum equivalent to the support hours she provided to Mr D in lieu of that support from the Care Provider. The Council will apologise, and pay Ms C £500 to recognise her distress, and £500 to Mr D. The Council should complete its action plan of improvements and monitor the Care Provider’s compliance with that.

The complaint

1. The complainant, who I will call Ms C, says following the Council investigating concerns in June 2018 she expected her son’s (Mr D’s) care and support to improve at his supported living home; but it did not. The Care Provider did not adequately support Mr D or understand his needs. In January 2019 Mr D’s bedroom had got into an appalling state, full of flies and rotten food, because nobody was supporting him to take care of himself and his belongings. Mr D had been eating raw sausages in his bedroom. To support Mr D, Ms C reduced her hours at work and was travelling every day from her home to his. Ms C also took him to all appointments. The whole thing has been very upsetting for both Ms C and Mr D. Ms C has had to have counselling and medication. Mr D has had an increase in absence seizures during the time he was living with the Care Provider.

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The Ombudsman’s role and powers

2. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended). I have exercised discretion to investigate the events from 2018 onwards, as at that time Mr D was negatively affected by the ongoing events and the complaint so Ms C was concentrating on his care. Now that Mr D is settled, in new accommodation, Ms C can concentrate on the complaint.
3. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended). Mr D has given Ms C consent to act for him.
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). Affinity Trust act on behalf of the Council to provide adult social care and support to meet Mr D’s eligible needs.
5. 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)
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)
7. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers who show they meet the fundamental standards of care, inspects care services and issues reports on its findings. It also has power to enforce against breaches of fundamental care standards and prosecute offences.
8. Under our information sharing agreement, we will share the final decision of this case with the Care Quality Commission.

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How I considered this complaint

9. I considered:
• Information provided by Ms C, including during a telephone conversation.
• Information provided by the Council in response to my enquiries.
• The Care Quality Commission’s Fundamental Standards.
• The Mental Capacity Act 2005 and associated statutory guidance.
10. Ms C 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

11. Mr D is a young adult who lived in a supported living accommodation ran by Affinity Trust, arranged by the Council. Supported living is a combination of suitable accommodation with some forms of personal care, like help with washing or cooking.
12. The Council knew this placement was not ideal because Mr D was the only young adult living there and had different needs to the other residents. The Council was trying to find an alternative placement, but it took years to achieve. Ms C accepts this was not the Council’s fault.
13. Towards the end of 2017 Affinity Trust served notice on Mr D’s placement, as the relationship between the Care Provider, Mr D and Ms C had broken down. Despite serving notice, Affinity Trust continued to support Mr D until the Council found a new placement in April 2019. However, Mr D spent a lot of time away from the accommodation so was not receiving the support detailed on his care plan from the Care Provider; Ms C spent a lot of time supporting him.
14. Although Mr D can do things for himself, he needs a lot of prompting to make him do things such as personal care and cleaning. Mr D can easily neglect himself if not properly supported. Because Mr D was spending a lot of time away from his accommodation, the staff could not complete his one to one support. Ms C did not enter the accommodation because of the relationship breakdown with the staff; she picked up and dropped off outside.
15. In 2018 Ms C made a formal complaint to the Council about:
• finances and debt
• The way staff at Affinity Trust treated her and blamed her behaviour for the relationship breakdown.
• Affinity Trust not supporting Mr D with medication.
• Safeguarding issues.
16. The Council thoroughly investigated, responded, and recommended improvement actions. The Care Provider wrote off debts that Mr D accrued, and the Council and Care Provider supported Ms C in a benefits application for Mr D. The Council paid Mr D money to account for benefits he had lost out on. The Council updated Mr D’s care plan to ensure accuracy, and the Care Provider met with its staff to discuss any issues. At the time Ms C was satisfied and thought this would improve matters. The Council had identified a new and suitable placement for Mr D, but they needed to wait for a room to be available.
17. At the start of January 2019, the Care Provider contacted Ms C to raise concerns about Mr D’s room. Staff had noticed flies coming from the room, and Mr D would not allow staff to enter. Ms C went into the room and found mouldy fruit and empty sausage packets. Ms C says Mr D told her he ate the sausages raw, whereas the Care Provider recorded at the time that it was pre-cooked sausages. Mr D did not suffer any ill effects from eating the sausages, but it made Ms C very sad to think he had been eating raw sausages in his room.
18. The Care Provider is supposed to prompt Mr D to ensure he keeps his room clean and tidy. As Mr D was out for a lot of the day the Care Provider was finding it hard to provide the one to one support hours to him. The Council accepts there was no flexibility in the timetable which did not allow Mr D choice on when to receive the necessary support. Mr D agreed that a staff member could access his room without him present, so they could check on cleanliness. Mr D started to accept some support in this area but did also sometimes decline support. The Care Provider deemed Mr D had capacity to make decisions about cleaning his room, even if those decisions may be considered unwise by others. This is in accordance with the Mental Capacity Act 2005. However, the Care Provider has accepted it had a lack of awareness about Mr D’s health condition, and that may have affected how they supported him. Ms C confirms that as Mr D appears very capable, people assume he does not need help, but he requires a lot of prompting to complete tasks and to look after himself and his environment.
19. Despite Ms C’s complaint and the Council’s involvement, the relationship between Ms C, Mr D and the Care Provider did not improve. There was still a lot of tension and negative atmosphere.

Was there fault causing injustice?

20. The Care Quality Commission requires care providers to provide care or treatment that is tailored to you and meets your needs and preferences. The Care Provider accepts it had a lack of awareness around Mr D’s condition and abilities, so may have been in breach of this fundamental standard.
21. The Care Quality Commission requires care providers to treat people with dignity and respect, including giving adequate support to someone so they remain independent and involved in the local community. The Care Provider accepts it was not providing adequate support at all times, so may be in breach of this fundamental standard.
22. The Care Quality Commission requires care providers to keep you safe. You must not be given unsafe care or treatment or be put at risk of harm that could be avoided. Providers must assess the risks to your health and safety during any care or treatment and make sure their staff have the qualifications, competence, skills and experience to keep you safe. The Care Provider may be in breach of this fundamental standard.
23. There were tensions between the Care Provider and Ms C. The constant atmosphere led Mr D to suffer more regular absence seizures because of stress. Mr D spent most of his time away from his home and spent lots of time with his mother. Mr D did not receive his support hours from the Care Provider because of this and lost out on communal time with other residents. Mr D was home in the evenings, but the Care Provider was not flexible to provide him his one to one support then, which might have benefitted him. Mr D took to eating alone in his room at times, and possibly consumed raw sausages. I am investigating from 2018 – 2019, so Mr D was impacted for a year.
24. Ms C spent more time supporting Mr D. Ms C says she reduced her hours at work because of this, but I cannot deduce it was a direct result of the issues complained of. Ms C reduced her hours in 2015 which was before these complaints, and the Council’s records say Ms C reduced her hours to care for an elderly neighbour. The stressful situation worsened Ms C’s anxiety and she had many sleepless nights. Ms C had to take time off work due to stress and had suicidal thoughts. I am investigating from 2018 – 2019, so Ms C was impacted for a year.
25. The Council recognises Ms C was doing Mr D’s one to one support rather than the Care Provider. The Council should have given Ms C a carer’s assessment to see what, if any, support she needed in her role as Mr D’s carer. The Council wishes to apologise and provide a financial remedy to Ms C for this error. The Council has offered to pay Ms C the equivalent of Mr D’s support hours from March 2018 when she first made her complaint to the Council until April 2019 when he moved out, which is in the region of £4,100. I consider this is sufficient to recognise the impact on Ms C of giving up her free time to provide support to Mr D.
26. During my investigation the Council has offered £500 to Ms C to recognise her distress and anxiety, and the time and trouble she has taken to complain. The Council has offered Mr D £250 to recognise his distress and anxiety. I do not consider the offered payment to Mr D is sufficient.
27. The Council is following up the action plan of improvements with the Care Provider. It visited in March 2020 and found the Care Provider had not implemented some of the recommendations it made in March 2018. The Council is working on an action plan and will oversee the implementation of the recommendations on the plan.

Agreed action

28. I commend the Council on accepting its faults in this case, and offering to remedy the impact on Ms C and Mr D.
29. Within one month of the final decision the Council will:
1. Apologise to Ms C for failing to provide her with a carer’s assessment. Apologise to Ms C and Mr D for the inadequate service from 2018 to 2019.
2. Pay Ms C the equivalent of Mr D’s support hours from 15 March 2018 to 28 April 2019, to recognise the impact on her of giving up her free time to support Mr D.
3. Pay Ms C £500 to recognise her distress, anxiety, time and trouble.
4. Pay Mr D £500 to recognise his distress and anxiety caused by the loss of some service.
5. Provide a copy of the finalised action plan to Ms C and the Ombudsman. Keep Ms C and the Ombudsman updated when actions are completed and provide a general update at least every six months to confirm what is happening. If Ms C would rather not receive such updates, she should let us know.

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Final decision

30. I have completed my investigation on the basis the agreed action is sufficient to acknowledge the impact of the Council’s fault.
31. I have shared a copy of this decision with the Care Quality Commission.

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Investigator's decision on behalf of the Ombudsman