Summary: Miss X complains the Council failed to deal properly with her and her parents when safeguarding concerns were raised and she asked for help in November 2018. The Council delayed in contacting Mrs Y about the safeguarding concerns and delayed in reassessing her needs. This resulted in her paying too much for her care and caused unnecessary distress to her and her daughter. The Council needs to apologies, pay financial redress and take action to prevent similar problems from happening.

The complaint

1. The complainant, whom I shall refer to as Miss X, complains the Council failed to deal properly with her and her parents when safeguarding concerns were raised and she asked for help in November 2018

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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 an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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, sections 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I have:
• considered the complaint and the documents provided by Miss X;
• discussed the complaint with Miss X;
• considered the comments and documents the Council has provided in response to my enquiries; and
• shared a draft of this statement with Miss X and the Council, and invited comments for me to consider before making my final decision.

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What I found

5. Miss X’s parents, Mr & Mrs Y, lived at home together, Mr Y with care provided by the NHS, and Mrs Y with care provided by the Council. They both had dementia. Mrs Y has now died.

What happened

6. On 31 October 2018 a care agency raised safeguarding concerns with the Council. It reported:
• Mrs Y had bruising to her right shoulder, alleging Mr Y hit her and punched her in the face although there were no visible marks to her face;
• Mr Y complained his back was hurting and he was bleeding from an elbow;
• there had been a similar incident a few days before;
• Mrs Y was quite dominating and Mr Y usually very compliant, so the behaviour was uncharacteristic for them both;
• their family said CCTV showed Mr Y left the house at 01.30 with no trousers on, while Mrs Y called for help inside;
• the family arranged for respite in a care home for one to two weeks but wanted some help dealing with the issue.
7. Two duty Social Workers visited at 15.30 on 1 November. The record of their visit says:
• neither parent had capacity to make decisions about “care and residence”;
• Miss X and her brother, who have power of attorney for health and welfare, had arranged respite placements in a care home.
8. Miss X told the Social Workers the care home would not take her parents because they did not want to go. The Social Workers told the care home her parents lacked the capacity to make that decision. The care home then agreed to take them and to apply for deprivation of liberty safeguards (DoLS). Miss X says the Social Workers told her the Council would assign someone to assess her mother. She says they also told them not to pay the care home as the Council would do a financial assessment. Mrs Y paid £960 a week for the placement at the care home.
9. The Council told the NHS about Mr Y’s placement in the care home. The NHS said it would arrange funding for his placement.
10. The Council decided to make enquiries into the safeguarding concerns, with Mrs Y identified as the alleged victim, by contacting health services, the care agency, Miss X, her brother, and Mr & Mrs Y.
11. Mrs Y’s GP Surgery recommended an urgent assessment due to a deterioration in her mental health, probably due to a suspected urinary tract infection. It also told the Council Mrs Y had dementia.
12. The Council granted an urgent authorisation for Mrs Y’s DoLS for seven days from 1 November.
13. On 17 November the assessments for a standard authorisation for Mrs Y’s DoLS were completed. They confirmed she had dementia and the need for a DoLS.
14. The Council visited Mrs Y at the care home on 19 November as part of its safeguarding enquiries. Miss X said:
• her mother was more likely to be the perpetrator;
• there was no evidence from the CCTV that her father had ever done anything;
• there was no mark on her mother’s face.
15. Mrs Y said her husband had never hurt her and she had no recollection of telling a carer he had. She said she did not like being asked questions and wanted to go back home. The safeguarding records identify both Mr & Mrs Y as the potential “source of risk”. The Council stopped its safeguarding enquiries because Mrs Y asked it to do so.
16. The Council visited Mrs Y at the care home on 6 December to assess her needs. It agreed temporary funding for the placement from 6 December, with a view to funding a permanent placement from 21 December. When the Council started funding the placement its cost went down to £560 a week.
17. On 17 January 2019 the Council signed off Mrs Y’s DoLS until 16 April 2019.
18. The Council received another safeguarding referral about an incident on 1 February 2019. Staff had separated Mr & Mrs Y when Mr Y was shouting at her. He returned to where she was and hit her on the back of the head. The Council asked the care home to produce a protection plan for Mrs Y. It did not make formal enquiries into the safeguarding incident.

Miss X’s complaint

19. Miss X complained to the Council on 2 December. She explained about the events which led them to arrange respite placements for her parents at the care home, but it would not take them. She said:
• the Social Workers who visited on 1 November said they would assign a care manager to her parents.
• Social Worker B contacted her weeks after the safeguarding referral to discuss it and said she would be her mother’s care manager if she stayed in care but that was not the case;
• Social Worker B upset her mother by asking her questions about the safeguarding incident and trying to persuade her she was better off staying in care;
• Social Worker B questioned Mr & Mrs Y’s diagnoses of dementia, despite the Council being aware of this;
• Social Worker B said it was a problem her parents being in a care home when they did not want to be there, despite the fact the Council had satisfied itself of the need for a DoLS;
• Social Worker B would not discuss her father’s case and said she would have to make another referral;
• Social Worker C contacted her on 30 November about assessing her mother’s needs and said the family would be responsible for top-up payments;
• she should have been eligible for respite care.
20. On 7 December Miss X added to her complaint. She said:
• officers had told them there was no record of the Social Workers visiting on 1 November, helping her parent’s move to the care home or ordering an ambulance to take her mother there;
• she had heard nothing about her father’s referral and feared NHS Continuing Healthcare funding was still paying for his home care rather than the care home.
21. When the Council replied to Miss X’s complaint, it said:
• Mr & Mrs Y’s placement in the care home was a private arrangement. It only got involved when the care home said it could not keep them there as they both wanted to leave;
• on 28 November the Council assigned a Social Worker to Mrs Y. Mr Y would already have had an assigned worker within the NHS Continuing Healthcare Team;
• although the Council did not assign Social Worker B to the safeguarding concern for two weeks, the two duty Social Workers had resolved the immediate crisis on 1 November;
• it had to get Mrs Y’s views of the safeguarding incident and ended its enquiries because of what Miss X and her mother said;
• Social Worker B may have questioned whether Mrs Y had dementia because often people do not have a formal diagnosis;
• Social Worker B had to take account of the fact Mr Y told her he wanted to go home;
• Mr Y did not need a Social Worker as the NHS Continuing Healthcare funds him;
• it completed Mrs Y’s DoLS assessment on 17 November and Mr Y’s on 19 November. DoLS assessors are not involved in needs assessments;
• all Social Workers have access to the electronic records;
• it only assigned Social Worker B to deal with the safeguarding enquiries; Social Worker C dealt with Mrs Y’s assessment;
• Mrs Y’s care home did not charge a top-up, but some confusion had arisen as it had referred to its dementia premium of £50 a week as a top-up. The Council apologised for this;
• the Council had not agreed funding for respite care and Miss X had not asked for it;
• the two Social Workers arranged an ambulance on 1 November, but Miss X’s brother cancelled it as he said it would be quicker for him to take them to the care home;
• Miss X and her brother had decided it was in their parents’ best interest to move to a care home and, on that basis, the Social Workers understood this was a private arrangement;
• she had contact with five Social Workers because they had different roles.
22. The Council did not uphold Miss X’s complaint. As she was not satisfied with this, Miss X asked the Council to refer it to the next stage of its complaints process. She said:
• it had failed to explain why it had not assigned a Social Worker to her mother’s case after the visit on 1 November;
• the care home only accepted her parents because of the two Social Workers;
• the two Social Workers advised them not to pay the care home as there would be a financial assessment;
• Social Worker C had told her there was no record of Social Workers visiting on 1 November and Social Worker B did not know her parents were in a care home;
• Social Worker B had refused to make a referral for her father and no one told her the Council could not do anything because the NHS was dealing with him;
• Social Worker’s B’s approach to the safeguarding enquiries had been insensitive, upsetting Mrs Y, and unnecessary;
• Social Worker B refused to consider the risk to Mr Y from his wife;
• the Council should have had a record of her asking for a referral for her father;
• Social Worker C did not attend a pre-arranged meeting with her brother but turned up the next day;
• the meeting went ahead without a family member to support Mrs Y, leaving her distressed after the meeting;
• Social Worker B did not ask whether her parents had formal diagnoses of dementia but said the Council had no record of them having dementia;
• Social Worker B should not have questioned the need for Mr & Mrs Y to be in residential care when the DoLS assessment had already established this;
• why did Social Worker C tell her she would be responsible for a top-up;
• Social Worker C had given misleading information;
• the service she had received from the Council had caused much distress and she had received no reassurance.
23. When the Council replied it said:
• it knew the family were arranging respite care for 1-2 weeks and would need help after that – not upheld;
• the two Social Workers helped ensure the move to the care home went ahead but that was not an assessment recommendation – not upheld;
• there was no evidence the two Social Workers told Miss X not to pay for the care home – not upheld;
• case notes had been made on 1 November. Social Worker B would not have known whether her parents’ circumstances had changed since they entered the care home as it was a private arrangement – not upheld;
• it apologised no referral had been made to the Contact Centre for her father – upheld;
• Social Worker B needed to speak to Mrs Y about the safeguarding concerns, but this needed doing sensitively – partly upheld;
• the safeguarding concern related to Mrs Y but Mr Y could also be regarded as vulnerable – partly upheld;
• the Council’s response to Miss X asking for a referral for her father had been unacceptable – upheld;
• there was confusion and poor communication over the date of a meeting which resulted in Mrs Y not being supported by a family member – upheld;
• it was not responsible for any distress Mrs Y experienced because of the meeting – not upheld;
• there was no mention of Mrs Y having dementia in its records before November 2018 nor in the safeguarding referral – not upheld;
• Social Worker B had no recollection of saying there was a problem with Mr Y being in residential care when he said he wanted to go home – not upheld;
• Social Worker C was not responsible for the misunderstanding about the care home charging a top-up – not upheld;
• the service Miss X received could at times have been better and apologised.
24. The Council said that because of the complaint it would:
• ensure better understanding of NHS Continuing Healthcare processes;
• provide instructions about making referrals when asked to do so;
• consider her feedback on the safeguarding interview;
• follow up with her any safeguarding concerns about her father;
• monitor adherence to recoding duty Social Worker actions;
• review the impact of delays in feeding back telephone enquiries to allocated workers.

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

25. The Council accepts the experience of Miss X and her parents could have been improved. It has apologised for this.
26. The Care and Support Statutory Guidance makes it clear that alleged victims need to be involved in any safeguarding activities. The Council waited 19 days before doing this. Given that the Council knew Mrs Y had memory problems and lacked the capacity to decide where she should live, it should have acted more quickly. The failure to do so was fault by the Council. It seems likely this added to both Mrs Y and Miss X’s distress when the Council finally involved Mrs Y in the safeguarding process. It cannot remedy the injustice this caused to Mrs Y because she has died. But it can remedy the injustice to Miss X by apologising and paying financial redress.
27. Mr & Mrs Y’s family arranged for them to stay in the care home before the Council got involved. They only involved the Council when the care home refused to keep them there. But that does not alter the fact that it was a private arrangement. However, when the Council got involved on 1 November it knew the placement was intended as respite for up to two weeks and that support would be needed after that. It should therefore have identified the need to reassess Mrs Y’s needs and done this well within two weeks. The failure to do so was fault by the Council. This caused injustice as the Council should have started funding Mrs Y’s placement four weeks before it did, which means she paid £1,600 more than she should have done. The Council needs to remedy this injustice by paying £1,600 to her estate.
28. The Council was wrong to question Mrs Y’s diagnosis of dementia on 19 November. Mrs Y’s GP Surgery had confirmed this on 1 November, as had the DoLS assessments by 17 November. This caused unnecessary distress to Miss X.

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Agreed action

29. I recommended the Council:
• within four weeks:
1. writes to Miss X apologising for its failings and pays her £300 for the distress it has caused and time and the trouble it has put her to in pursuing her complaint;
2. pays £1,600 to Mrs Y’s estate;
• within eight weeks considers what action to take to ensure:
1. safeguarding enquiries involve the people affected at the earliest stage possible, particularly when there are mental capacity issues;
2. officers identify the need to reassess people when there has been a significant change of circumstances, as was the case with Mr & Mrs Y in November 2018; and
3. officers take account of the information in the Council’s own records and avoid questioning people unnecessarily.

The Council has agreed to do this.

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Final decision

30. I have completed my investigation as the Council has agreed to take action to remedy the injustice it has caused.

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Investigator's decision on behalf of the Ombudsman