Summary: Mr Y complains about the Council’s involvement with various aspects of his mother’s care and support following her discharge from hospital in 2023. Some of the complaints raised by Mr Y are on behalf of his mother, Mrs W. Mr Y does not have authority to represent a complaint on Mrs W’s behalf and we have not investigated them. Some of the other complaints relate to the actions of a health body and Mr Y can pursue those separately. Of the remaining complaints, there was some delay by the Council in discussing the residential care charges with Mr Y, but it has provided a remedy for this, and we do not recommend any further action.

The complaint

1. Mr Y complains about the Council's involvement in various aspects of his mother’s care and support needs following her discharge from hospital in February 2023. I will refer to her as Mrs W. In particular, Mr Y says:
1. The Council told him that his mother's placement in the care home would not be chargeable due to her diagnosis and the nature of her needs. The Council started charging Mrs W despite no change to her diagnosis or needs. The Council gave no warning of the changes for up to two months after they had started charging Mrs W and then only informed Mr Y to ask for money.
2. The Council has not ensured Mrs W’s medical requirements have been met. For 20 months, Mr Y has been pursuing a formal diagnosis for his mother’s current condition and still no formal diagnosis has been ascertained. This has also impacted a police investigation as Mr Y still does not know if Mrs W’s condition is due to Dementia, Alzheimer’s or as the result of a blow to the head.
3. The Council did not consult him before completing a social care assessment to determine Mrs W’s eligible care and support needs. The Council decided at which points in the conversation Mrs W was cognitively aware despite not being medically trained and having never met her before.
4. In April 2023 a family member took Mrs W out of the care home for a day despite an ongoing police investigation at the time. Whilst out of the home, Mrs W sustained injuries and Mr Y was not notified. The Council failed to properly investigate the injuries at the time.
5. The Council did not inform the care home that Mr Y was the primary point of contact for his mother. The care home was also not informed of the ongoing police investigation and that it should not allow the removal of Mrs W from the home by Mr Y's brother. Mr Y says this error occurred because the Council had closed the safeguarding case prematurely.
6. In May 2023, the Council appointed a new case worker who agreed to Mrs W leaving the care home to return to her residence. The case worker did not introduce herself to Mr Y, was unaware of the history, the safeguarding issues and how much help Mrs W would need. Mr Y was informed by his brother and acted swiftly to stop the process of Mrs W returning home.
7. The Council has not been transparent regarding Mrs W’s wishes for Mr Y to look after all issues relating to Mrs W, including financial matters. In January 2023, Mrs W informed the Council of her wishes, but these wishes were not communicated until September 2023. Despite having been interviewed by the police who accepted Mrs W’s cognitive state, the Council decided Mrs W was not cognitively aware when she made the comment. This conclusion was made by someone who did not know Mrs W and was not appropriately trained.
8. For more than 12 months, Mr Y has had to fight to ensure his mother received the most basic care that she requires. The Council has made several errors, especially maintaining accurate documentation, which has caused Mr Y significant distress. This is because he is unable to properly process his mother’s decline and deal with the associated emotions, but instead having to deal with the Council and its errors.

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The Ombudsman’s role and powers

2. We may investigate complaints from the person affected by the complaint issues, or from someone else if they have given their consent. If the person affected cannot give their consent, we may only investigate a complaint from a person we decide is a suitable representative. (Section 26A or 34C, Local Government Act 1974)
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 another body better placed to consider this complaint (Local Government Act 1974, section 24A(6), as amended, section 34(B))
4. The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6)
5. 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

6. The Local Government Act 1974 sets out our powers but also imposes restrictions on what we can investigate. I have not investigated the following parts of Mr Y’s complaint because he does not have authority to represent a complaint on behalf of Mrs W. The Council is currently applying to the Court of Protection to be a court-appointed deputy for Mrs W.
1. The decision to charge Mrs W for her care home placement.
2. Complaints about Mrs W’s medical needs and diagnosis.
3. The method used by the Council to assess Mrs W’s cognitive awareness.
4. Complaints about the decision to allow Mrs W to leave the care home and the subsequent investigation into any injuries she sustained.
5. The decision not to inform the care home about any ongoing police investigations.
6. The decision to change the allocated caseworker to an officer who did not know Mrs W and the subsequent decision for Mrs W to return home.
7. Complaints about the cognitive assessment for decisions about Mrs W’s finances and whether she had capacity to nominate Mr Y to manage her affairs.
7. I have not investigated the following parts of Mr Y’s complaint because there is no evidence that Mr Y has raised a complaint with the Council about these matters. In our view, these complaints are premature:
1. Failure of the new caseworker to introduce themselves to Mr Y.
2. Failure to maintain accurate documentation.
8. I have not investigated the following complaints because they relate to the actions of the NHS Trust who passed on the details of Mrs W’s next of kin when she was discharged from hospital. Mr Y may wish to make a separate complaint to the relevant NHS Trust:
1. and e) The failure to notify the care home that Mr Y was the primary point of contact for Mrs W, which in turn meant that Mr Y was not notified of Mrs W’s injuries in April 2023.
9. I will only investigate elements of the complaint affecting Mr Y where he has potentially experienced an injustice in his own right. Those complaints are:
1. Contact with Mr Y about residential care charges for Mrs W.
2. The failure to consult Mr Y before completing Mrs W’s social care assessment.
3. The failure of the caseworker to notify Mr Y of the decision made for Mrs W to return home in May 2023.
4. The distress Mr Y has experienced from any Council fault.

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How I considered this complaint

10. During my investigation I discussed the complaint with Mr Y and considered the information he submitted.
11. I made enquiries of the Council and considered its response.
12. I consulted the Ombudsman’s Guidance on Jurisdiction when deciding whether Mr Y’s complaint is within the Ombudsman’s jurisdiction.
13. Mr Y 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

Summary of key background information relevant to the complaint

14. Until early 2023 Mrs W lived at home with one of her sons, whom I will call Mr Z. In December 2022 Mrs W went into hospital and received surgery. Records show that, at times, Mrs W presented as confused and professionals had concerns about her mental capacity to make decisions about her long-term accommodation and support needs.
15. The hospital discharged Mrs W to an ‘interim health bed’ in a residential care home. This is called the ‘discharge to assess’ pathway and is initially funded by the NHS until a decision is made regarding the adult’s longer term social care needs.
16. Mr Y’s complaint relates to events which happened around the hospital discharge, the decision to charge for social care and some of Mrs W’s experiences in the care home until she left in December 2023.
17. A mental capacity assessment has concluded that Mrs W no longer has capacity to make decisions about where she should live. The Council has applied to the Court of Protection for corporate deputyship as Mrs W does not have a Lasting Power of Attorney.

Complaints relating to Mr Y

Complaint a) Contact with Mr Y to request payment on behalf of Mrs W.

18. The records show a telephone call between the social worker and Mr Y on 9 February 2023 whilst Mrs W was still in hospital. The written notes of the call show the social worker explained the different discharge pathways and the possibility of delirium being the cause of Mrs W’s cognitive decline.
19. The social worker told Mr Y that Mrs W would need a formal assessment by health professionals to confirm a diagnosis. The written notes of the call show the social worker went on to say: “if Ms [W] does not go to a delirium bed, then we will assess her for a social interim bed as her care and support needs cannot be met with a care package at home. [Mr Y] understood and thanked me for my time. I said that I will call with any updates as they arise”.
20. During the social care assessment which the Council competed on 20 April, the social worker discussed the possibility of Mrs W returning home with a package of domiciliary care.
21. On 18 May the Council emailed Mr Y to say, “As your mother is in a social care bed, she is required to pay towards the cost of that care. I will need to send a financial assessment referral to determine whether she is required to pay a contribution towards that care”.
22. On 12 July the records show the social worker had a discussion with Mr Y about the possible charges for Mrs W’s care. The written notes say, “I explained to [Mr Y] that the offer of social care is a chargeable service. I advised him that if his mother's saving was above the capital limit (£23250), she would pay the full cost of any care that she receives. [Mr Y] shared that his mother's savings was below the capital limit. A financial assessment referral request has been made and sent to [Mr Y]. Failure to return this documentation in the timelines set out can result in a full charge being applied. The financial assessment will calculate the client contribution. Any questions regarding the financial assessment please contact the numbers on the form. Further information on Paying for Care is available on the Cambridge County Council website. Leaflets have been sent at the assessment stage. (Adult Social Care complaint and feedback form and Paying for care)”.
23. In the complaint response sent to Mr Y on 19 September, the Council explained that Mrs W would only be charged her client contribution from 12 July as this is when Mr Y received notification that Mrs W’s placement was likely subject to a charge.
24. There is little evidence of any discussions around the possible charges between 20 April, when the NHS funding ended, and 12 July when the social worker spoke to Mr Y. However, the Council has already acknowledged this oversight and agreed to make charges from 12 July only. In my view, there is no outstanding injustice to Mr Y which requires a remedy.

Complaint c) Consultation with Mr Y for Mrs W’s social care assessment.

25. The Council completed a social care assessment on 20 April 2023. The assessment document names Mr Y as an advocate for the assessment. The assessment also confirmed, “Information gathered for this assessment has been collected via discussions with [Mrs W], and her family [Mr Y’s brothers] [Mr Y], mosaic notes, hospital referral documentation and carers who are been supporting [Mrs W] at [the care home]”.
26. The assessment goes on to detail the concerns raised by Mr Y about Mrs W’s safety when living in her own home. The assessor noted Mr Y’s view that Mrs W required a placement in a care home because she would not be safe at home and with Mr Z. Further information is also provided about the safeguarding concern previously raised by Mr Y.
27. In my view, and based on the information seen, I do not uphold this part of Mr Y’s complaint. The records show Mr Y was involved in the social care assessment completed for Mrs W on 20 April. Mr Y’s views were clearly considered as part of the assessment and care planning process.

Complaint f) Failure of the caseworker to notify him of the decision made for Mrs W to return home.

28. Mr Y received a text message from his brother on 9 May 2023 to say the Council had agreed for Mrs W to return home to live with her other son, Mr Z. Mr Y spoke with the Council on 9 May 2023 and notes of that call show the social worker told Mr Y, “… there are no notes suggesting [Mrs W] is leaving [the care home] and would not be able to leave without a mental capacity assessment and a best interests decision completed by the local authority and each family member involved would have a say”.
29. Nine days later the Council assessed Mrs W’s mental capacity to make a decision about her residence. The Council decided that Mrs W lacked capacity to make a decision about where to live and that a best-interests decision would be delayed until the completion of an ongoing police investigation about Mr Z’s alleged abuse of Mrs W’s finances.
30. Mr Y raised a safeguarding alert on 23 May regarding concerns he had about Mrs W returning home.
31. There is no evidence in the Council’s records of any agreement made by the Council for Mrs W to return to her home in May 2023. To the contrary, the Council was aware of the ongoing police investigation into the alleged financial abuse and agreed that any decisions regarding Mrs W’s long-term accommodation would be made via a best-interests decision. Mrs W remained in the care home before moving to another care home in December 2023.
32. Mr Y’s recollection of the conversation he had with the social worker on 9 May differs to the call notes. In response to Mr Y’s complaint, the Council apologised for any misinformation provided by the social worker and confirmed it has addressed the issue for ‘future learning’.
33. In my view, the apology already provided by the Council is a sufficient remedy for any confusion or upset caused by any miscommunication with the Council in May 2023 about Mrs W’s residency.

Complaint h) Distress Mr Y has experienced from pursuing contact with the Council

34. The Ombudsman can only recommend a remedy for distress caused by fault. I appreciate the events experienced by Mr Y since the decline of Mrs W’s health, and her admission into residential care, have been a great cause of distress for him. However, in my view the Council has already provided an appropriate remedy for the parts of the complaint where there was fault causing injustice.
35. There is no fault in the other parts of the complaint, or we are unable to investigate them for the reasons explained in paragraphs six to nine of this statement. Therefore, so we do not recommend any further remedy in recognition of Mr Y’s distress.

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Final decision

36. I have completed my investigation. We did not investigate some parts of Mr Y’s complaint for the reasons explained in paragraphs six to nine of this decision.
37. In the parts of the complaint we have investigated, we find there was some delay by the Council in advising Mr Y about the need to charge for Mrs W’s social care. However, the Council has already provided a remedy for this because it has only made a charge from the date it informed Mr Y of the decision.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman