Summary: There is no evidence that the Council delayed Mr X’s move from the assessment unit unnecessarily while his family was looking for a care home. The care provider acknowledged there may have been a lack of communication about the assessment unit and some other facilities were less than ideal, for which the care provider apologised.

The complaint

1. Ms B complains about the delay in discharging her late father Mr X from an assessment unit to another care home; she also complains about a lack of information surrounding his move to the care home. Ms B and her family say the assessment unit conditions were poor and Mr X deteriorated during his stay there.

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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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions. Part 3A is for complaints about care bought directly from a care provider by the person who needs it or their representative, and includes care funded privately or with direct payments using a personal budget. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act)
4. 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(i), as amended)

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What I have and have not investigated

5. Ms B has made some complaints about Mr X’s care by the NHS and has now complained about those matters separately to the Parliamentary and Health Service Ombudsman.

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How I considered this complaint

6. I considered the information provided by Ms B and by the Council: we spoke to Ms B. Both Ms B and the Council had an opportunity to comment on an earlier draft of this statement and I considered their comments before I reached a final decision.

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What I found

Relevant law and guidance

7. The NHS should try to give the council as much notice as possible of a patient’s impending discharge. This is so the council has as much notice as possible of its duty to start a needs assessment. The Care and Support Statutory Guidance says local agreements should be in place between NHS bodies, councils and other relevant partners to set out each organisation’s responsibilities to achieve timely and safe hospital discharge.
8. The council must assess the person’s care and support needs and (where applicable) those of a carer to determine whether it considers the patient and carer have needs. The council must then decide whether any of these identified needs meet the eligibility criteria. If so, it should confirm how it proposes to meet any of those needs. The council must inform the NHS of the outcome of its assessment and decisions.
9. The NHS body should tell patients and carers the discharge date at the same time as, or before the council does. Hospital staff may give the council early warning of when discharge is likely, to help their planning.
10. Discharge to assess (D2A) is about funding and supporting people to leave hospital, when safe and appropriate to do so, and continuing their care and assessment out of hospital. They can then be assessed for their longer-term needs in the right place.
11. The capital limits, specified in regulations issued under the Care Act 2014, set the levels of capital (excluding any capital that has been disregarded) that a person can have while qualifying for financial support from their local authority. A person with assets above the upper capital limit is responsible for the full cost of their care in a care home.

What happened

12. Mr X was admitted to hospital in February 2023 after he had a second stroke. The Council’s records show that by 20 March the hospital ward had indicated he was ready to discharge for ‘bed based reablement’ and the notes state, “have liaised with his wife and son who are in agreement with bed-based discharge”. However, Ms B says it was only when she was leaving the ward after visiting his father on 16 April that she was told Mr X was shortly to be moved to the assessment unit, Millbrook Lodge, run by the Order of St John..
13. Mr X moved to Millbrook Lodge on 18 April. His admission record describes him as ‘pleasantly confused’ and notes he lacked capacity to make decisions about his care. A social worker visited Mr X on 20 April and also met Mr X’s son who was concerned about the prospect of his father returning home. By 26 April the care home had put extra care in place for Mr X as he was disorientated and wandered into other residents’ rooms. Ms B says as far as she knows this only happened once, although the care home records show it happened on multiple occasions.
14. On 28 April the social worker met Mr X’s wife and son and Ms B at the care home. She noted their comments that since Mr X had a stroke in 2022, he had been prone to wandering and had lost his enthusiasm for former hobbies. The social worker then visited Mr X again and noted that he “was very confused and having met him twice now I feel that he lacks capacity and understanding of his current care and support needs and is unable to tell me where he wants to go when he leaves the unit.” She recorded that he did not understand his wife would be unable to care for him without help if he went home. She also noted the surprise of the assessment unit manager that Mr X did not already have a formal dementia diagnosis.
15. The social worker arranged to meet Mrs X to discuss Mr X’s future care (which he would fund himself). Ms B and Mr X’s son also attended the meeting on 7 June. Mrs X and Ms B said they had started to look for care homes.
16. The case recording over the next weeks shows the family’s attempts to arrange an assessment of Mr X by a suitable care home. There was some concern expressed in July by Ms B who said the assessing care home had requested information from the care home but not received it. The manager explained she could not send the care notes by email to the potential new home as requested as it was a breach of data rules.
17. The case recording shows that the manager from the preferred new home had arrived several hours late on 26 July to assess Mr X by which time Mrs X had already left. The assessment of Mr X had been short as Mr X was tired. Mrs X agreed to take some notes to the new home for information so they could reach a view on whether they could accept Mr X.
18. Mr X (who was deemed to be at high risk of falls) fell a number of times in the home: Ms B says she believes this was due to a shortage of staff. After a fall on 9 July, he complained of pain in his back. The care home called the GP who examined Mr X and prescribed painkillers and said to expect a gradual improvement. Mr X did not improve. Ms B says Mrs X was told he could not have an x-ray. The GP was called again on 23 July and ordered blood tests, urine tests and arranged an x-ray. The results showed poor liver function and a repeat of the tests a week later did not show an improvement. The GP ordered a liver scan on 3 August which he discussed with Mrs X.
19. The new care home agreed they could provide the appropriate care for Mr X. His family arranged for him to be taken straight to the new home after a liver scan on 8 August. The social worker spoke to the manager at the new home on 21 August. The manager there said “it was a shame that it had not been picked up earlier about his back discomfort and subsequent liver issues.”
20. Mr X died in September.

The complaint

21. Ms B complained to the care provider (of the first care home) in September. She asked why the family had not been told to find Mr X a care home while he was still in hospital. She asked why his stay at the assessment unit had lasted so long. She received a response but complained again about the general standard of care, the poor laundering facilities and use of fitted sheets as covers, and the lack of information about the purpose of the assessment unit.
22. The care provider partially upheld the complaint and agreed the following actions going forwards –

“The Home Manager will review the laundry process for the Assessment Unit.

The Care Team have been informed that correct bedding should be used when beds are made.

All new admissions onto the Assessment Unit will be informed of the Assessment Unit pathway.”

23. Ms B complained to the Ombudsman. She said they had not been given any real information as a family about why Mr X went to the assessment unit or how long he would stay there. She said they were given the false impression he had to stay there. She said communication was poor, there were insufficient staff to cope with the complex needs of residents and Mr X’s condition declined dramatically. She said it was not until he reached the new care home that it was suggested he had a liver scan.
24. The Council says although normally the funding for Mr X’s placement at the assessment unit would have ended on 30 May, in this case it was extended for a number of reasons: “(Mr X’s) initial instability upon admission requiring an initial period of 1:1 additional support due to concerns of him entering other adults’ rooms and unsettled behaviour; Period of (Mrs X) being unwell and (Ms B) stepping in as a secondary LPA to confirm his self-funding status; Exploration of whether (Mr X) could return home in line with his wishes and the ideal outcome communicated by his wife. It was concluded returning home was not in his best interests due to the inability to meet his increased needs in the family home. (Mr X) changing clinical status requiring GP review”.

Analysis

25. The case recording shows the social worker discussed with Mrs X and the rest of Mr X’s family the way forward in terms of finding a care home. I have not seen any evidence of fault there. There is no evidence the social worker told Mrs X that Mr X must stay in the care home: the case recording reiterates that a future placement was the family’s choice as Mr X was self-funding and his family members had power of attorney for him.
26. The care provider acknowledged Ms B’s concerns about some of the facilities in the assessment unit and agreed some improvements. In terms of Mr X’s care, the evidence shows that for example additional care was put in place to manage his disorientation.
27. The case recording is clear that the care provider called for medical attention for Mr X when he complained of back pain after a fall in July. In fact, the liver scan was arranged by the GP before Mr X moved homes. The medical treatment of Mr X (whether a scan or an x-ray) was a matter for the GP and not for the care provider.
28. I have not seen evidence that communication with the family was poor while Mr X was in the assessment unit although at times information may have been shared with different family members.

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Final decision

29. I have completed this investigation. The care provider has already acknowledged and apologised for some poor facilities and put service improvements in place.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman