London Borough of Newham (19 006 386)

Category : Adult care services > Residential care

Decision : Upheld

Decision date : 24 Mar 2020

The Ombudsman's final decision:

Summary: Mrs B complains about the care provided by Romford Care Centre (RCC) to her father, Mr D. There was fault by the Council and the care provider. The Council will apologise and make a payment to Mrs B.

The complaint

  1. Mrs B complains about the care provided by Romford Care Centre (RCC) to her father, Mr D. The Council commissioned the care so the complaint is against the Council. She complains that:
    • There was inadequate personal and medical care for her father;
    • The home wrongly called an ambulance for her father and did not accompany him into hospital;
    • Gave her and the Council inadequate notice of its decision to end the placement.
  2. Mrs B said that her father spent two months in hospital because RCC would not allow him to return and was left unwashed and not properly cared for while he was in the home.

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The Ombudsman’s role and powers

  1. 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)
  2. 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

  1. I considered the complaint and documents provided by Mrs B and spoke to her. I asked the Council to comment on the complaint and provide information. I sent a draft of this statement to Mrs B and the Council and considered their comments.

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What I found

Summary of what happened

  1. Mr D moved into RCC in November 2018. Towards the end of March 2019 Mrs B contacted the Council to raise her concerns about her father not being washed and that he had not received any medical care for a lump. The Council contacted the home and started the process to assess him to see if he would qualify for continuing health care (CHC) funding. In early April in exchanges between the Council and the home it requested a full review as they considered they were no longer the right home for Mr D and were struggling to meet his needs.
  2. Mr D was assessed at the beginning of May with a recommendation that he should be accepted for CHC funding. At the end of May the home called an ambulance and Mr D was taken to hospital. The next day the deputy manager called Mrs B and told her that Mr D would not be able to return to the home.
  3. Mr D was accepted for CHC funding which meant the NHS became responsible for his care.
  4. The home is not located in the Council’s area. The Council where it is carried out a safeguarding investigation. The outcome of that was the allegations of neglect and acts of omission were substantiated.
  5. The care provider responded to Mrs B’s complaint at the end of November 2019. It accepted fault in the care provided to Mr D, in the records it held about Mr D’s contact with healthcare professionals and a failure to have an individualised behaviour support plan.


The ending of the placement

  1. The first reported problems to the Council with the placement came at the end of March when Mrs B raised concerns about the care. The home agreed there were problems because of Mr D’s aggression and refusal to accept care. It said it considered it could no longer meet his needs and asked for a review. The Council instigated an assessment for CHC funding but it did not take any other action to support the placement in the meantime.
  2. The crux of this complaint was the home calling an ambulance for Mr D and then refusing to allow him to return to the home. Mrs B considered that this meant that Mr D spent over two months in hospital before an alternative placement could be found when there was no medical need for him to be in hospital.
  3. The terms of the Council’s contract with the care provider were that it should give the Council four week’s notice of its intention to end a placement. There was no formal notice given but the home had made its position clear at the beginning of April and the Council had done nothing to support the placement in the meantime or to find alternate provision. This is fault.
  4. It was also wrong the care provider refused to take Mr D back after the hospital admission, it had not properly served notice on the Council to end the placement.
  5. The consequence of this is that Mr D was admitted to hospital and spent over two months there when there should have been a planned move to another placement. There had not been a sudden worsening in Mr D’s behaviour and the Council had been told the home considered it could no longer meet his needs.

Care provided

  1. Both the safeguarding investigation and the care provider has found there were shortcomings in the care provided to Mr D. This has caused an injustice to Mr D and also to Mrs B as she will have been worried about the lack of proper care for her father.

Complaint handling

  1. Mrs B complained about the ending of the placement and the Council asked the care provider to respond. It did so and the Council sent it on to Mrs B at the end of June. There was no information given to Mrs B about how she should escalate the complaint. Mrs B complained to the care home but the home did not deal with her complaint so Mrs B complained to the Ombudsman.
  2. The Council contacted the care provider who agreed to respond to Mrs B’s complaint. The Council’s failure to properly consider Mrs B’s complaint under its complaint process meant the time taken for her to get a proper response from the care provider was delayed by four months.

Agreed action

  1. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I intend to find fault with the actions of both the care provider and the Council, I am making recommendations for remedy to the Council.
  2. The Council should apologise to Mrs B and should pay her £500 for the injustice caused to her father and an additional £250 to reflect the particular injustice to her from the worry about her father when he was in the home and the care being provided and from the move to the hospital and the way that was done. It should do so within a month of the final decision.

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Final decision

  1. There was fault by the Council and the care provider. The Council will apologise and make a payment to Mrs B.

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Investigator's decision on behalf of the Ombudsman

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