Summary: Mrs X complains the Council and its care provider, Voyage 1 Limited, failed to ensure her daughter, Ms Y, received all the one-to-one (1:1) support she had been assessed as needing, resulting in her lacking support with social activities and leading to her becoming withdrawn. The Council accepts Ms Y did not receive all her 1:1 support and has offered to pay financial redress for two and a half years. But, Ms Y did not receive all her 1:1 support for three and a half years from March 2021. This left Ms Y without the support she needed with personal care and limited, if not removed, opportunities for social activities. The Council needs to extend its offer of financial redress to cover the period from March 2020.

The complaint

1. The complainant, Mrs X complains the Council and its care provider, Voyage 1 Limited, failed to ensure her daughter, Ms Y, received all the 1:1 support she had been assessed as needing, resulting in her lacking support with social activities and leading to her becoming withdrawn.

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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. 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)
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, sections 24A(1)(A) and 25(7), as amended)

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How I considered this complaint

5. I have considered evidence provided by Mrs X and the Council, as well as relevant law, policy and guidance.
6. Mrs X and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

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What I found

What happened

7. Ms Y has a learning disability and communicates non-verbally. She has lived in the same care home for 17 years. The care home is run by Voyage 1 Limited (the care provider), and is in the same county her mother lives in.
8. Ms Y’s 2020 care and support plan provided for a personal budget of £1,504.11 a week. This included 64 hours a week of 1:1 support. The plan identified the need for 1:1 support:
• with personal care (2:1 support for hoisting) for 5.1 hours a day
• with eating and drinking
• to make use of the home safely
9. The plan provided for 3 hours of social activities a day. It said Ms X’s activity timetable needed reviewing regularly. The plan did not say who else had been involved in discussing Ms Y’s circumstances. However, Mrs X says representatives from the care home and the care provide would have been present.
10. It is not clear what plan the care home had in place in 2020, as the care provider has only sent Ms Y’s current care plan. This refers to the need for 1:1 support:
• when using her wheelchair to access the community;
• when in the kitchen;
• with memory;
• with attention skills;
• while waiting for medical help after any sign of an adverse or allergic reaction.
11. Mrs X says she started raising concerns about the lack of support with the care home and the care provider in 2020. In September 2021, she raised concerns about the lack of support for Ms Y to engage in activities with the Council. The Council passed them on as safeguarding concerns to the local authority where the care home is based. The Council asked the care home to provide Ms Y’s care logs, but it did not do so.
12. The Council updated Ms Y’s care and support plan in November 2021. The updated plan continued to provide for a personal budget of £1,504.11 a week, including 64 hours of 1:1 support a week.
13. In July 2022 the care provider told the Council it wanted to discuss Ms Y, as a parent had shared a care and support plan which included more care hours than its fees provided for. The Council noted it had no record of the hours it had negotiated with the care provider. The Council did not respond to the care provider.
14. In August 2022, the care home asked the Council to take part (remotely) in a review of Ms Y’s needs. The Council told the care home that, because of a backlog, it would not have the time to review Ms Y’s needs until 2023. It told the care home to go ahead with its own review and to let the Council know the result.
15. In October 2023 the Council updated Ms Y’s care and support plan. The updated plan provided for a personal budget of £2,607 a week. This provided for 66.3 hours of 1:1 support a week (5.5 hours of 1:1 a day plus 4 hours of 2:1 support).
16. Mrs X complained to the Council in October 2023 about the failure to provide her daughter with the hours of support she had been assessed as needing between November 2021 and October 2023. She asked the Council to pay Ms Y £50,000, based on what she understood it had saved by not providing all her daughter’s 1:1 support.
17. When the Council replied to her complaint in May 2024, it said:
• It had assessed Ms Y as needing 64 hours a week of 1:1 support from February 2020;
• Ms Y only received 17 hours a week of 1:1 support until October 2023;
• During this time Ms Y received 64 hours a week of 1:2 support (one care worker supporting two residents);
• Although COVID-19 was a factor during this time, it should not have impacted on Ms Y’s care hours;
• It offered to pay Ms Y £5,000 to remedy the injustice arising from the shortfall in support between 9 November 2021 and 11 October 2023 (this was based on waiving a proportion of Ms Y’s assessed charge for her care);
• In future, it would ensure Ms Y received the support it had assessed her as needing;
• It accepted there had been delays in responding to Mrs X’s complaint, at first because it had to wait for safeguarding enquiries to end (in December 2023), but also because it took another five months to respond. It offered to pay Mrs X £400 for this.
18. Mrs X asked the Council to clarify its response. When the Council replied, it said:
• It increased its final offer to Ms Y to £6,555.45, by taking account of the period from 8 March to 9 November 2021 (when the COVID-19 lockdown was lifted);
• Ms Y and other residents struggled during COVID-19 and afterwards, as it took time for them to regain the confidence to take part in activities, in particular accessing the community.
19. When the Care Quality Commission (CQC) inspected the care home in May 2023, it found it required improvements to become safe and well-led. The inspection report included these findings:
• The service could not show how they were meeting all the underpinning principles of right support, right care, right culture.
• People had not always received the care they needed to live safe, fulfilling and happy lives. There had been a strong focus on improving these areas in recent months.
• People had not received high quality care and support. There had been a significant decline in the quality of the service. There had been a lack of clear, consistent leadership which had contributed to the decline and lack of structure, support and guidance for staff.
• People's quality of life had not been enhanced by a culture of learning and improvement. Neither the provider nor the various managers had effective oversight of the quality of care, staff practice or risk management. This had led to people receiving poor or unsafe care
20. The report noted the local authority (for the county where the care home is based) had placed it in a “whole service safeguarding“ process, to ensure people remained safe while it made significant improvements.

Is there evidence of fault by the Council which caused injustice?

21. There is no dispute over the fact Ms Y did not receive all the 1:1 support she had been assessed as needing. The evidence shows this was the Council’s fault, as it did not make it clear to the care home what support it expected it to deliver for the money it was paying it.
22. There was further fault by the Council after the care home asked to discuss Ms Y’s support in July 2022. Although officers were aware they had not made it clear what support the care home should be providing for her, the Council failed to respond. It also failed to accept the care home’s August 2022 request to review Ms Y’s needs, despite the fact it should have been clear she was not receiving the support it had assessed her as needing. It took another 14 months to resolve the issue, leaving Ms Y with inadequate support.
23. Ms Y only received 17 hours a week of 1:1 support until October 2023. This was not enough to meet her need for 1:1 support with personal care (35 ¾ hours a week). It will also have restricted her freedom to take part in meaningful activities in the community. The Council calculated its payment from around the time COVID-19 restrictions were lifted. However, Ms Y did not have a reduced need for 1:1 support during the pandemic. Her personal care needs will have been the same, and she still needed the opportunity to take part in meaningful activities, even if that did not involve accessing the community in the same way as she had done before the pandemic.
24. It is clear from CQC’s report that the problems Ms Y experienced coincided with a period of significant decline at the care home. This can only have made her experience worse.

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Action

25. When a council commissions or arranges for another organisation to provide services we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions. Where we find fault with the actions of the service provider, we can make recommendations to the council alone. Here we have found fault with the service of the care provider and the Council, and make the following recommendations to the Council.
26. I recommend the Council:
• Within four weeks, increases its payment to Ms Y to take account of the period from March 2020, and pays Mrs X £400, if it has not already done so.
• Within eight weeks, identifies the action it needs to take to ensure: care providers receive copies of care and support plans; the Council is commissioning the support it has assessed people as needing; and officers accept requests to review people’s needs.
27. The Council has agreed to do this. It should provide us with evidence it has complied with the above actions.
28. Under the terms of our Memorandum of Understanding with CQC and information sharing protocol, I will send it a copy of my final decision statement.

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Decision

29. I find fault causing injustice. The Council has agreed to remedy the injustice caused.

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Investigator's decision on behalf of the Ombudsman