Summary: Mr X complains about the Council’s handling of various matters surrounding the care needs of, and care home placement for, his mother. The complaint was closed because we did not find fault by the Council in the matters raised by Mr X.

The complaint

1. I refer to the complainant here as Mr X. Mr X complains about the Council’s handling of various matters surrounding the care needs of, and the care home placement for, his mother. Mr X says:
• In 2018, a social worker should have raised a safeguarding alert when it came to light that his mother was being allowed to walk around a care home independently.
• His mother’s care needs were not assessed by the Council when she was discharged from hospital in January 2019 and she was only assessed more than a year afterwards.
• The Council allowed his mother to remain in a care home that cannot meet her needs in particular around pain relief.
• The Council told him that he had to accept a place at the care home where his mother now resides despite the high cost of the placement. The weekly cost is £1100 whereas the indicative budget the Council gave for the cost of meeting his mother’s care needs was £470 per week.
2. Mr X wants his mother to be in a placement that meets her needs. He wants a refund of the care costs that he considers should not have been paid from his mother’s savings.

Back to top

The Ombudsman’s role and powers

3. 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)
4. 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)

Back to top

How I considered this complaint

5. I examined the complaint and background information provided by Mr X and the Council. I discussed matters with Mr X by telephone. I sent a draft decision statement to Mr X and the Council. I considered the comments of both sides on the draft statement.

Back to top

What I found

Background

Continuing Health Care funding

6. Some people with long-term complex health needs qualify for free social care arranged and funded solely by the NHS. This is known as NHS continuing health care.
7. To be eligible for NHS continuing health care, a person must be assessed by a team of health and social care professionals. The team will look at all a person’s care needs and relate them to the following:
• what help the person needs
• how complex the person’s needs are
• how intense the needs can be
• how unpredictable the needs are, including any risks to a person’s health if the right care is not provided at the right time.
8. If a person is not eligible for NHS continuing healthcare they can be referred to the local authority which will then consider whether the person is eligible for support from it. Local authority funding is means tested. So the local authority will conduct a financial assessment of the person. If a person has capital or savings above a threshold of £23,500 then the expectation is that the person will pay for social care out of their savings.

Background

9. In July 2018, Mr X’s mother was placed in a care home that has an elderly mental dementia (EMD) unit following hospital admission due to problems with her kidneys. Mr X’s mother was assessed for continuing health care funding (CHC). She was not found eligible.
10. The Council carried out a care needs assessment in August 2018. It concluded she needed 24 hour care in a care home which provided for EMD.
11. In September 2018, there was a best interests meeting to decide whether Mr X’s mother would be discharged to a care home which provides for EMD or return to her home with a care package in place. Mr X holds power of attorney for his mother’s property and finance. He disagreed with the Council’s recommendation. He wanted his mother to return to her home. As there was no agreement the matter was referred to the Court of Protection for a decision.
12. Whilst at the care home, Mr X’s mother had a fall. She was admitted to hospital in November 2018.
13. Mr X’s mother was discharged from hospital in January 2019. Mr X says a discharge coordinator at the hospital told him his mother had a high level of need and should be discharged to a care home that has an elderly mentally infirm or EMI unit. This is a unit that cares for residents with advanced dementia and where the care home employs mental health staff round the clock to supervise the residents.
14. Mr X says he was not given a choice of care homes by the Council. He followed the advice he was given by the hospital discharge coordinator and sought out care homes which would meet his mother’s higher level of need. Four care homes refused to take his mother before one care home agreed to accept her. However, the care home cost £1100 per week which was far higher than the indicative budget set out by the Council.
15. Mr X says his mother’s needs were not assessed by the Council after surgery and before she was discharged even though her needs had changed. He says it was over a year before she was assessed by the Council again.
16. Mr X says his mother was allowed to remain in a placement that could not meet her needs, particularly around pain relief.
17. The Council indicated in its response to Mr X’s complaint that his mother had been assessed by the Rapid Assessment and Interface Discharge (RAID) team prior to hospital admission in October 2018. The RAID team is part of Pennine Care, an NHS Trust. The assessment concluded that his mother needed dementia friendly nursing care due to physical health grounds. The assessment had been done in relation to the referral to the Court of Protection.
18. The Council says the RAID team attended the ward to review Mr X’s mother during her hospital stay. The Council points out the Trust leads on identifying the requirement for formal nursing or if a higher level of care is needed for a patient upon discharge. It says any such finding is then shared with it and then passed on to potential care homes prior to discharge being arranged. The RAID team did not pass on any information on a higher level of need for Mr X’s mother to it.

Finding

In 2018, a social worker should have raised a safeguarding alert when it came to light that his mother was being allowed to walk around a care home independently

19. Mr X says he found out from his mother’s records that she had been walking in a care home independently. He says the social worker should have raised a safeguarding alert because it was unsafe for his mother to have walked around unaided.
20. The Council did not respond to this particular point in its complaint response. It said it various safeguarding enquiries had been instigated in relation to concerns Mr X raised at the time.
21. I do not find there is an injustice caused to Mr X’s mother that now warrants further pursuit of this point by the Ombudsman. This is because of the length of time since the incidents occurred. Mr X found out his mother had been walking after the incidents. But there is no indication of harm in the records. I do not find Mr X’s mother suffered a level of harm because the Council did not initiate a safeguarding enquiry when the social worker noted she had been walking around the care home unaided.

Mr X’s mother’s care needs were not assessed by the Council when she was discharged from hospital in January 2019 and she was only assessed more than a year afterwards.

22. Mr X’s mother care needs had been assessed in August 2018 with a mental health assessment by the NHS RAID team in October 2018.
23. So I am satisfied there was a recent needs assessment and care plan in place when Mr X’s mother was admitted to hospital in November 2018. When in hospital the Council was involved in the discharge assessments led by the hospital. The assessment prior to the hospital admission concluded Mr X’s mother needed dementia care in a care home with support from 2 staff. That assessment appeared to remain the same when the RAID team reviewed Mr X’s mother in hospital. It is outside the Ombudsman’s purview to investigate the actions of the RAID team or the hospital staff regarding their assessment of Mr X’s mother. So, I cannot comment on either the views of the RAID team or the hospital discharge coordinator who apparently told Mr X his mother had severe mental health needs.
24. However, I do not find fault by the Council because it did not initiate its own or a new care needs assessment of Mr X’s mother when she was in hospital. The assessment that she needed dementia care due to physical needs was unlikely to have changed due to her stay in hospital. The only outstanding issue was whether her mental health had deteriorated during her stay in hospital and that was a matter to be determined by the NHS RAID team and not the Council.

The Council allowed his mother to remain in a care home that cannot meet her needs in particular around pain relief

25. Mr X had power of attorney regarding his mother’s property and finances. His mother was a self-funder. He chose the care home. I do not find fault by the Council because it allowed his mother to remain in the care home. If his mother was not receiving adequate pain relief then Mr X could have moved her to another home. The Council could have intervened to initiate safeguarding enquiries had Mr X complained to the social worker that the care home was not providing his mother with adequate pain relief. But I do not find the Council was responsible for his mother remaining in the care home given her self-funding status.

The Council told him that he had to accept a place at the care home where his mother now resides despite the high cost of the placement. The weekly cost is £1100 whereas the indicative budget the Council gave for the cost of meeting his mother’s care needs was £470 per week

26. I do not find fault by the Council on this point.
27. I do not have any record of a conversation which supports Mr X’s allegation the Council told him he had to accept a place at the care home and Mr X has not provided any evidence to support the allegation.
28. It is likely the Council told Mr X that his mother had to go to a care home upon discharge and this would have to be one that has EMD support.
29. There is a difference between the cost of a privately sourced placement at a care home and the cost that local authorities pay when they source care home places. Furthermore, the care home in question here provides a specialist service for a higher level of need. So, it charges more for a placement than other care homes. Had the Council commissioned the placement it would also have paid a higher rate than the cost set out in the indicative budget. The difference in cost noted by Mr X is not due to fault by the Council.

Back to top

Final decision

30. I closed this complaint because I did not find fault by the Council in the matters raised here by Mr X.

Back to top

Investigator's decision on behalf of the Ombudsman