The Ombudsman's final decision:
Summary: The Care Provider which acted for the Council failed to deliver two to one support for Mr B. This was not in line with the agreed plan of care and was fault causing avoidable distress. The Council will apologise within one month of my final decision. We do not uphold other complaints about Mr B’s care.
- Mrs A complains for her son Mr B about Mr B’s placement at a supported living scheme run by Endurance Care (the Care Provider) and arranged and funded by Kent County Council (the Council). She says:
- Staff did not look after Mr B’s personal hygiene; he was covered in faeces
- Staff did not look after his eczema
- He did not receive one- to-one or two-to-one care as set out in the care plan
- She had to drive staff back to work after they dropped him off at her house
- Staff did not give her a full explanation about how the car became damaged. They said Mr B had punched and kicked it, but gave her no further details
- He made no progress and the statement that he had learned to speak one or two words was not progress because he could already speak.
The Ombudsman’s role and powers
- 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)
- 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)
- 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)
How I considered this complaint
- I considered Mrs A’s complaint to the Ombudsman, the Council’s response to the complaint and documents described later in this statement. The parties received a draft of this statement and I took comments into account.
What I found
- 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. When investigating complaints about council-funded care placements, the Ombudsman considers the 2014 Regulations when determining complaints about poor standards of care. Regulation 9 of the 2014 Regulations requires care and treatment to be appropriate, to meet a person’s needs and to reflect their preferences. Care providers should carry out an assessment of needs and preferences and design a care plan to meet needs and preferences.
- If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
- Mr B is a young adult with learning disabilities and autism. He has challenging behaviour and communication difficulties. Mr B lives with Mrs A and she is his main unpaid carer.
- There was a mental capacity assessment in February 2018 which concluded Mr B did not have capacity to make decisions about his care arrangements. A best interests meeting took place in April where attendees included council officers and Mrs A. The outcome of the meeting was it was in Mr B’s best interests to move to supported living. The minutes indicate Mrs A gave her views and agreed to the placement. She wanted Mr B to stay with her at weekends.
- Mr B moved into supported living run by the Care Provider in May 2018.
- The Council completed a care and support plan for Mr B in 2017. This was before he moved into supported living. There was no up to date care and support plan completed in 2018. The 2017 plan said Mr B needed:
- Support with all aspects of personal care
- Specialist support from the mental health of learning disability team around his challenging behaviour
- Support with laundry and cooking
- Support to manage health appointments, take medication and apply creams
- Support from Mrs A to manage his finances
- Two to one support in the community to access appropriate activities.
- He needed full support with personal care and reminders to go to the toilet
- Mr B needed full support with his physical health including acting on health professionals’ feedback and ensuring he received any treatment if his skin broke down (eczema) and support to take medication, apply creams
- He needed two staff to accompany him in the car because he had in the past grabbed the steering wheel when a person was driving.
- Mr B had a GP check for his skin, ears, weight and blood pressure. The GP prescribed cream for his skin and an antibiotic for the sore on his foot
- Mr B received antibiotics and creams for his skin. Staff gave him all his medication and helped him apply creams
- Mr B received about six hours a day on average of one to one support and about two hours support at two to one staff for external activities (on the days these were arranged)
- It was too far away and too expensive for her to visit
- His car had dents and she was not told about them until she rang
- Mr B’s benefits had been reduced and this meant she could not afford her flat
- She was concerned about Mr B’s sore skin
- No-one was listening to her
- He was only accompanied by one carer – the driver – when staff brought him home.
- Staff had taken Mr B to the GP as his eczema had flared up, he had medication for this which had been applied by staff
- Staff completed body maps showing a mark on his ankle from his sandal rubbing which had healed and dry skin on his nipples, which were moisturised
- Mrs A expressed concerns about losing benefits. She was Mr B’s appointee (managed his state benefits) and would not say what his income was
- Professionals were concerned about Mrs A’s ability to meet Mr B’s care needs
- There was no risk identified if Mr B returned to the placement
- Referrals were to be made for an advocate to support Mr B to express his wishes about his care. An application was to be made to the Court of Protection
- Mrs A has a mobility car to support Mr B’s mobility needs. The car went with him when he was in the supported living placement. She had the choice of going to collect him. As she had no car of her own, staff at the placement offered to drive Mr B home and Mrs A agreed to drive them back to the placement
- The Council then decided to fund a taxi for Mrs A as professionals noted he was spending a lot of time in the car. This arrangement was not implemented as Mrs A removed Mr B from the placement
- Mr B became agitated on one occasion and punched and kicked the car. The manager explained this to her at the time
- Professionals noted Mr B had increased his use of signing and seemed calm and happy at the placement. They noted he was developing new skills like tracing round letters and drawing. He was noted to be eating and sleeping well. His self-care was improving
- The Council did not consider it was in Mr B’s best interests to remain at home because he was not accessing the community or developing social and life skills. It was approaching the Court of Protection for a decision about his future care.
Was there fault?
- The Council contracted with the Care Provider to deliver Mr B’s care and supported service at the supported living placement. The Council was responsible for any failings in Mr B’s care.
Complaint (a) Staff did not look after Mr B’s personal hygiene: he was covered in faeces
- There is no evidence in the records that Mr B was covered in faeces. The records indicate Mr B wanted to manage his bowels on his own at night. This resulted in staining to his underclothes. I consider the supported living placement responded to this without fault by agreeing to use a stronger washing powder. The Care Provider was delivering a tailored plan of care reflecting Mr B’s preferences and respecting his dignity and autonomy, in line with Regulation 9 of the 2014 Regulations. There was no fault.
Complaint (b) Staff did not look after Mr B’s eczema
- Records from the placement showed staff took Mr B to the GP and applied prescribed creams and gave him medication as prescribed. There was no fault. The Care Provider delivered care in line with Regulation 9 of the 2014 Regulations.
Complaint (c) Mr B did not receive 1 to 1 or 2 to 1 care as set out in the care plan
- Mr B’s council care and support plan should have been updated in 2018 when he moved into the supported living placement; the plan should have set out Mr B’s needs around care and support and the staffing required to meet those needs. The failure to do so was fault and the Council failed to act in line with Sections 24 and 25 of the Care Act 2014. Although there was no up to date care and support plan, the Council and Care Provider agreed Ms B should have two to one support in the car and in the community and the Care Provider’s detailed care plans reflected this. But, Mr B did not receive two to one support and an incident happened. I note the support had been reduced because of a lack of reported incidents, but this was a change to the agreed care and so Mrs A’s views should have been sought beforehand. Mr B’s care was not in line with Regulation 9 of the 2014 Regulations and this was fault.
Complaint (d) Mrs A had to drive staff back to work after they dropped him off at her house
- The records indicate this was an arrangement Mrs A agreed to at the time. Mrs A then changed her mind and the Council’s intention was to fund a taxi to the placement for her. However, this did not happen because the placement ended. There was no fault by the Council because it responded to Mrs A’s concerns when she raised them and put in place additional funding for her transport.
Complaint (e) Staff did not give Mrs A a full explanation about how the car became damaged. They said Mr B had punched and kicked it, but gave her no further details
- There was a detailed incident report, which stated that staff had told Mrs A about what happened. I consider she received an explanation and there was no fault.
Complaint (f) Mr B made no progress and the statement that he had learned to speak one or two words was not progress because he could already speak
- I have no grounds to criticize the professionals’ views that Mr B was making progress. Those views were based on their observations of Mr B when he was living at the placement. There was no fault.
Did the fault cause injustice?
- The failure to deliver Mr B’s two to one support in line with the agreed care plan caused avoidable distress to Mr B at the time. Mrs A was also caused avoidable distress.
- The Council will, within one month, apologise for the fault I have identified.
- The Care Provider which acted for the Council failed to deliver two to one support for Mr B. This was not in line with the agreed plan of care and was fault causing avoidable distress. The Council will apologise within one month of my final decision.
- I have completed my investigation.
Investigator's decision on behalf of the Ombudsman