Summary: Miss L complained the Council failed to assess and meet her late mother, Mrs X’s, care needs, to assess her need for care or to assess her and her stepfather, Mr X’s, support needs as carers. She also complained the Council failed to take action about her safeguarding concerns and failed to respond to her complaint. The Council failed to offer Miss L a care needs assessment or a carer’s assessment, delayed taking action on safeguarding concerns she reported and delayed responding to her complaint. This caused Miss L distress, frustration and uncertainty. The Council agreed to apologise, pay Miss L a symbolic amount of £500 and remind staff of its adult social care duties and its complaints procedures.

The complaint

1. Miss L complained about how the Council met the care needs of her late mother, Mrs X, and about how it safeguarded her from harm. Miss L also complained about its treatment of her as Mrs X’s carer. Specifically, Miss L complained:
1. the Council failed to create a care plan or allocate a social worker to Mrs X;
2. the Council failed to carry out a care needs assessment for Mrs X or herself;
3. the Council did not carry out a carers assessment for Mrs X’s husband, Mr X, and herself;
4. the Council did not take action on multiple safeguarding concerns she raised for Mrs X in relation to Mr X and his family; and
5. the Council failed to respond to her formal complaint; and
6. about the way a social worker conducted a telephone call with her.
2. Miss L states this caused harm and distress to her mother, financial loss to her mother’s estate and distress to herself.

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What I have and have not investigated

3. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:
• there is not enough evidence of fault to justify investigating, or
• we could not add to any previous investigation by the organisation.

(Local Government Act 1974, section 24A(6), as amended)

4. I have not investigated point a) of the complaint. This is because Mrs X was receiving continuing healthcare (CHC) from the NHS. CHC is a complete package of on-going NHS and social care support, arranged and funded by the integrated care board. The Council was not responsible for Mrs X’s care and therefore, there is insufficient evidence of fault in the Council’s actions to justify investigating this point further.
5. I have not investigated point f) of the complaint because the Council has investigated and responded. I could not add anything to the investigation completed by the Council.
6. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended). I have not investigated the Council’s actions in relation to a carer’s assessment for Mr X, at point c) because I do not have Mr X’s consent.

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The Ombudsman’s role and powers

7. 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)
8. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
9. 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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How I considered this complaint

10. I read the information Miss L provided.
11. I considered the documents the Council provided in response to my enquiries.
12. Miss L and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Relevant legislation and guidance

Assessment

13. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.

Carer’s Assessment

14. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
15. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

Continuing Healthcare

16. Guidance states that where an individual is eligible for Continuing Healthcare funding the local Integrated Care Board (an NHS organisation) is responsible for care planning, commissioning services and case management.

Safeguarding

17. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (Section 42, Care Act 2014)
18. The Council’s policy states when it receives a safeguarding concern, it will make an evaluation of the risks and decide if the case is deemed ‘medium’ or ‘high’ risk. It will do this the same day the concern is raised. The policy says if the case is ‘medium’ then actions and decisions will be made within 48 hours of the concern being logged. The Council will then gather initial information from the referrer, its records and the adult involved to determine what actions it needs to take next..
19. If the Council decides it needs to do a safeguarding enquiry it will hold a strategy discussion with relevant partners to establish the lines of enquiry and who will lead the enquiry. The enquiry will then report back to a case conference within 28 days. The case conference will decide if further action and a safeguarding plan is required, or if no further action is needed.

Council complaint procedure

20. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently. A single stage procedure should be enough. The council should include in its complaint response:

• how it considered the complaint;
• the conclusions reached about the complaint, including any required remedy;
• whether it is satisfied all necessary action has been or will be taken by the organisations involved; and
• details of the complainant’s right to complain to the Local Government and Social Care Ombudsman.

(Local Authority Social Services and National Health Service Complaints (England) Regulations 2009)

What happened

21. This section sets out the key events in this case and is not intended to be a detailed chronology.
22. Mrs X lived at home with her husband, Mr X. Mrs X’s daughter, Miss L, lived nearby and visited often. Miss L said she provided care and support to her mother and her stepfather and managed their finances.
23. In March 2021 Mrs X had an accident and had to be nursed in bed. Mr X and Miss L arranged a care provider to meet Mrs X’s care needs. They funded this privately.
24. In May 2021 Mrs X’s care became planned, commissioned and managed by the Integrated Care Board under CHC funding.
25. Miss L emailed the Council in late February 2022. She said she had a safeguarding concern about Mrs X and asked it to contact her. The Council did not respond to Miss L.
26. On the same day the Council said the district nurse team, who provided some care to Mrs X contacted it and said family members wanted to consider respite care for Mrs X. The Council said it did not consider this was a safeguarding concern as it did not indicate any areas of abuse or neglect.
27. Miss L said she contacted the Council by phone about her safeguarding concerns. The Council records show Miss L contacted it twice by phone and asked about a safeguarding referral from the district nurses.
28. Miss L sent an email to the Council at the beginning of March. She provided a detailed history of many events and said there was domestic abuse in Mr and Mrs X’s relationship. Miss L raised concerns about the care Mrs X was receiving and financial abuse she was suffering from family members. Miss L said she was chronically ill and disabled herself and did not have any support. Miss L stated that she had been providing care and managing finances for Mr and Mrs X for ten years.
29. The Council open a safeguarding contact record about Miss L’s concerns for Mrs X the following day. It did not take any further action at that time.
30. Nearly two weeks later Social Worker A contacted Miss L to discuss her email. The Council records show Miss L said she had been assaulted at her parent’s house. Miss L had reported the matter to the police. Miss L told Social Worker A she was vulnerable and asked if there was anything that could be done to protect her. Social Worker A provided the contact number for Miss L to make a safeguarding referral for herself to the Council.
31. The Council decided that it should begin a safeguarding enquiry for Mrs X the following day. It identified there was a medium risk to Mrs X which required a response within 48 hours, and it should gather information to decide the next steps.
32. The Council began to make enquiries a week later. It spoke with Social Worker A regarding the phone call with Miss L. It recorded Mrs X was caught in a dispute between family members about her care and finances and both sides had made allegations. It decided it would speak with Mrs X to gather her wishes before proceeding with a safeguarding strategy discussion.
33. A Council social worker emailed Miss L to arrange to discuss her concerns two weeks later, in the middle of April. Miss L responded and told the Council Mrs X had died four days earlier.
34. The Council decided to stop the safeguarding enquiry as Mrs X had died and there was no further safeguarding role to carry out. There is no record the Council told Miss L of that decision.

Miss L’s complaint to the Council

35. Miss L complained to the Council on in late March 2022. She said:
• she did not want Social Worker A involved in Mrs X’s care as she lacked empathy and was unsupportive;
• she had been caring for Mrs X and Mr X for a decade but had not been offered a carers assessment; and
36. the Council had not responded to safeguarding concerns she had raised.
37. Miss L complained to us in August 2022. We asked the Council to provide a response to Miss L’s complaint.
38. The Council responded to Miss L in September 2022. It said:
• Social Worker A had not intended any offence in the telephone call and it apologised for any distress caused to Miss L; and
• Social Worker A should have provided Miss L with more information about support available to her when she reported she was vulnerable herself, and should have considered a care needs and carers assessment for Miss L;
• it delayed progressing the safeguarding concern Miss L raised for Mrs X but it had dealt with it appropriately by closing it when she had died.
39. Dissatisfied with the Council’s response, Miss L complained to us.

My findings

Did the Council carry out the required care needs and carer assessments for Mrs X and Miss L?

40. Mrs X’s care needs were being met by the integrated care board through CHC funding. There was no fault in the Council not completing a care act assessment for Mrs X.
41. Miss L told the Council she was providing care for Mr and Mrs X, she was unwell, disabled, vulnerable and without support in March 2022. The Council should have recognised Miss L appeared to have a need for care herself as well as a need for support in her role as Mrs X’s carer. It therefore should have offered Miss L a needs assessment and carers assessment. The Council did not do so which was fault and caused Miss L uncertainty about what care and support she may have been offered at the time had the Council acted without fault. The Council partially recognised that fault in its response but did not take any action to remedy any injustice caused by it.
42. As Mrs X has since died Miss L no longer has caring responsibilities, and so now does not need a carers assessment. The Council agreed to my recommendation at paragraph 47 to remedy the remaining injustice Miss L experienced.

Did the Council take action on multiple safeguarding concerns Miss L raised for Mrs X in relation to Mr X and his family?

43. Miss L raised one safeguarding concern, but had to raise it with the Council several times to get a response. The Council should have carried out an initial risk assessment and decided if it needed to make enquiries when Miss L first contacted it in late February 2022. It did not do so until late March, by which time Miss L had contacted it several more times. The Council should have then taken no more than 48 hours to gather initial information from Miss L and to speak with Mrs X. It took three weeks to contact Miss L, by which time Mrs X had died. The Council did not speak to Mrs X. That was fault and not in line with the Council’s own policies and procedures. The drift and delay caused Miss L distress, frustration and uncertainty about what the outcome would have been had the Council acted without fault.
44. There was no fault in the Council stopping the safeguarding enquiry when it became aware that Mrs X had died. This is because there was no further risk to Mrs X and no likely risk to any other person by the same alleged perpetrators.
45. The Council identified that Mrs X was in the middle of a family dispute with each party raising concerns about the other. I cannot know what the outcome would have been had the Council acted without fault, and therefore I cannot assess any injustice this may have caused to Mrs X. As Mrs X has now died it would also not be possible to remedy any injustice she may have suffered.

Did the Council fail to respond to Miss L’s formal complaint?

46. Miss L raised a safeguarding concern and a complaint in March 2022. The Council did not respond to either of those matters until September 2022, after we asked it to do so. When the Council responded to Miss L it did not acknowledge the delay in its response or the injustice this may have caused Miss L. The delay was fault and caused Miss L distress and frustration.

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Agreed action

47. Within one month of the final decision the Council will:
• write to Miss L and apologise for the injustice caused to her by the Council’s faults and pay her £500 to recognise the same; and
• offer Miss L an assessment of her own care needs, if Miss L accepts the assessment should be completed within one month of her acceptance.
48. Within three months of the final decision the Council will remind all relevant staff members:
• of its duties to offer relevant assessments to people that have the appearance of need for care and support in its area;
• of its procedures and the action it should take when it receives a safeguarding concern about an adult; and
• to respond to complaints about its services in a timely manner and in line with its policies.
49. The Council will provide us with evidence it has complied with the above actions.

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Final decision

50. I have completed my investigation. I found fault causing injustice and the council agreed to my recommendations to remedy that injustice and prevent the fault occurring again.

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Investigator's decision on behalf of the Ombudsman