The Ombudsman's final decision
Summary: Ms Z complained about failings in the care assessment process for her mother, Mrs X. There is fault in the failure to follow up on assessments and referrals including a carer’s assessment for Ms Z. On balance, it seems Ms Z and Mrs X missed out on services and support because of these faults. A suitable remedy is agreed.
The complaint
Ms Z, on behalf of her mother Mrs X, complained about failings in the care assessment process. In particular she complains the Council: Failed to properly assess her care needs and only provided an appropriate level of care after a complaint was made; Failed to provide an interpreter relying on Ms Z to do this; Failed to send a copy of the care plan and care assessment after a manager increased the care package in response to Ms Z’s complaint.
Ms Z says she is both physically and mentally exhausted by her caring responsibilities and lack of assistance from the Council.
What I have investigated This complaint is concerned with actions from May 2020 onwards. I explain at paragraph 38 below the issues I have not investigated and the reasons why.
The Ombudsman’s role and powers
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) We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended) 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)
How I considered this complaint
As part of the investigation, I have: considered the complaint and the documents provided by the complainant; made enquiries of the Council and considered the comments and documents the Council provided; discussed the issues with the complainant; sent my draft decision to both the Council and the complainant and taken account of their comments in reaching my final decision.
What I found
Ms Z came to live with her mother, Mrs X, in 2016 after Mrs X suffered a stroke. Ms Z says that she began asking the Council for help in 2016 but it did not provided any support until 2021.
Mrs X was admitted to hospital in April 2020 after suffering a stroke. It was also found that Mrs X had fractured her hip. Mrs X was discharged from hospital on 9 May 2020 with a package of care. Two care visits a day were originally put in place but at a social care review on 3 June 2020 it was noted the evening visit had been cancelled as it was not required. The review document states Mrs X and Ms Z said it was not necessary because Ms Z was providing full support.
The review document says the social worker attempted to speak with Mrs X in Punjabi but they were unable to understand each other and Ms Z had to translate. It was explained the morning carer was not doing much other than talk to Mrs X because they arrived after 10 am and Mrs X would get up around 7 am. It was agreed to change the time of the morning care visit.
Ms Z explained the difficulties she was facing as her mother’s full time carer. She said the main concern was for Mrs X to go to a day centre. She acknowledged they were not open at that time due to the COVID-19 lockdown restrictions. The noted actions following this review included a referral for a financial assessment and a referral for a carers assessment. There is no evidence to show the Council contacted Ms Z about a carers assessment at this time.
Mrs X was readmitted to hospital in August 2020 following a fall which fractured her femur. A social care assessment was completed in September 2020 prior to her discharge from hospital. The reablement package of care included four care visits per day to assist with getting up, washing, dressing, toileting, meal preparation and assistance to change and get into bed. Ms Z stated a preference for female carers and if possible, Punjabi speakers.
A reablement package of care consisting of four visits per day began in September when Mrs X was discharged from hospital. It is my understanding the Council sourced Punjabi speaking carers. However, the carers raised concerns about Mrs X’s behaviour and ultimately withdrew. The Council found another care provider to take over from 5 October but this did not include Punjabi speaking carers.
Ms Z was in contact with the Council and was requesting a different package of care. She said she wanted respite or a sit in service or for Mrs X to attend a day centre. The Council’s notes say a referral had been made to the dementia gateway and told Ms Z she would need to wait for an assessment by the dementia adviser. Ms Z cancelled the care on 4 October 2020 saying it was not working and what she needed was a sit in service. No evidence has been provided to indicate the dementia gateway followed up on the referral or carried out a review.
In June 2021, Ms Z contacted the Council seeking assistance for her mother’s care needs. The care assessment says that Mrs X wanted to maintain her independence and that she could manage some small tasks. It said that Ms Z was providing support and that she was happy to continue to do this. It says Mrs X wanted to connect with her community and would like to be around people who speak Punjabi. It says Mrs X would like to attend a day centre and would like someone to be with her when Ms Z has to go out. Mrs X reported feeling anxious when on her own.
After receiving a copy of the care assessment and care plan, Ms Z complained to the Council that it did not meet Mrs X’s needs. She said the offer of two days at a day centre was not adequate. She said the decision was putting Mrs X’s well being and mental happiness at risk. She said she should not be forced to perform care duties to save the Council money. She said both herself and her mum have been forcibly socially isolated and left to manage on their own. Ms Z asked for her mother’s care needs to be reassessed and for the Council to also assess her needs as a carer.
The Council responded saying the amount agreed could be used for a day centre or to meet any needs identified in the assessment. It said any difference in affordability would need to be raised with the day care provider to see if a rate could be negotiated which allowed her mother to attend for three days. It also said it would look for services within the voluntary sector that could provide additional support and help ease Mrs X’s social isolation.
Ms Z responded saying she wished to make a formal complaint. She said she was requesting funding for three days of day care funding and for a sitting service. Ms Z explained the problems she was experiencing being the sole carer for her mum and that she had to leave her alone to attend her weekly medical appointments. She said it was not possible for her to manage all her own needs and appointments in the two days offered for her mum to attend a day centre.
After speaking with Ms Z on the telephone, a senior social care manager, wrote to Ms Z on 22 July. She said she had reviewed the case and had approved an increased direct payment. She said this could be used flexibly for personal assistant input, day care provision and/or a sitting service to meet the weekly needs. In response to the issues raised by Ms Z about the previous lack of support, the Council detailed the number of assessments and referrals that had been made. The increased amount of the direct payment was backdated to June 2021, the date Ms Z first approached the Council for assistance.
The Council provided a response to Ms Z’s formal complaint on 2 August. It set out the actions undertaken including an occupational therapy assessment, a referral to the Dementia Gateway Service, follow up on the carers assessment recently completed for Ms Z, arrangement of the three day placement at a day centre and providing a copy of the updated care assessment and support plan.
The Council also apologised for the previous lack of support. It says on review it had found a number of requests that were not followed up and occasions when it did not provide the support and standard of care it expected people to receive. The response was not specific in terms of its failings and so I made further enquiries.
The Council provided the following details of the requests that had not been responded to properly: Social Care Assessment: 26.3.20 – social care telephone assessment was provided to family instead of a physical visit. This was due to the Covid-19 restrictions in place.
27.3.20 – Referrals made to long term Occupational team and to the Falls Service for a full assessment to be carried out for Mrs X. As of July 2021 there was no case record evidence that the Falls Service had attempted to make contact with Ms Z; Long Term Occupational Team Support: 7.4.20. contact with Ms Z to provide photograph information of the environment of the property to support the virtual OT assessment.
11.5.20. Bathing assessment not progressed by long term OT team and recorded on case records as low priority as Mrs X could strip wash with assistance. There is no record of this decision being communicated to Ms Z; 13.5.20. Attempt by OT to arrange a telephone assessment but no successful contact made with Ms Z; 4.6.20. Case notes recorded some bathing equipment was in situ at the property but carers could not provide support as no OT assessment had been carried out.
9.6.20. Occupational Therapist attempted to visit Mrs X and Ms Z to carry out a bathing assessment. The Occupational Therapist was late for their appointment and when they did arrive at the property could not gain access.
10.6.20. Case notes record a decision to close case as no contact had been received by family.
23.12.20 Decision made to place Mrs X on waiting list for toilet facility assessment.
1.3.21. decision made to place Mrs X on waiting list for internal ramp to be fitted at her home.
19.7.21. OT telephone assessment carried out with Ms Z and decision made to refer for adaptations for inside and outside of the property to allow for wheelchair access. The Council says the contact from the OT team had not been supportive of either Mrs X’s or Ms Z’s needs and that the lack of progress across many months had exacerbated the family’s difficulties for daily living.
Reablement Occupational Therapy: 29.9.20 Visit made to assess the equipment that had been delivered to support Mrs X with personal care. OT commented that conversation broke down between OT and Ms Z with the outcome that little progress was made. The Council takes the view the OT should have been more empathetic to Ms Z’s circumstances.
Continence Service: 27.3.20 referral made to Continence Services for Mrs X.
The Council says that as of July 2021 there was no case record evidence that this service had carried out any actions to support. The Council takes the view there should have been communication made with Ms Z in respect of support for Mrs X.
Dementia Services: 27.3.20 referral made to Dementia Services for support to Mrs X. Further contact made from the Dementia Service was carried out to Ms Z to confirm diagnosis of Mrs X though it notes that at that point in time offer of full support and respite outlets could not be followed up as day care was closed due to pandemic restrictions.
As of July 2021 whilst there had been welfare telephone contact made by the service, no physical support could be provided due to the closure of the day centres at that time and the inability to provide a sitting service. In circumstances without Covid-19 restrictions, the Council believes the Dementia services would have intervened and supported the family.
Deaf Support Services: 24.4.20. Contact made by Deaf support services to Ms Z.
Outcome recorded that they were unable to proceed with any input as the ENT appointment for Mrs X had been delayed due to the current covid-19 restrictions.
Delays in clinical interventions resulted in social care input being delayed which impacted on both Mrs X and Ms Z.
Physiotherapy Support The Council says information in its case records conflict in terms of whether physio support was given to Mrs X.
4.2.21. OT referred to Dudley Reablement Services for Physio support.
22.2.21. recorded physio involvement though Ms Z confirmed that she had paid on a private basis for therapy for her mother and it wasn’t until August 2021 that a physio from reablement services made a visit and carried out an assessment.
Analysis Ms Z’s complaint covers three specific points, I will deal with each in turn.
Failed to properly assess her care needs and only provided an appropriate level of care after a complaint was made I am looking at actions from 2020 onwards. In 2020, Mrs X was admitted to hospital twice and on discharge a reablement package was provided. The information seen indicates that Ms Z’s main requirement was for help to enable her to have some respite such as a sit in service for her mother or for her to attend a day centre. There is nothing to suggest the Council ever considered this though it is accepted that during 2020 the COVID-19 pandemic limited attendance at day centres for periods of time.
Ms Z did cancel the reablement service on 4 October however she did this in the context of requesting a different type of service. The Council’s notes say this should have been dealt with by the dementia gateway referral. While it appears some contact was made, no services were provided even when COVID-19 restrictions were eased. The failure to follow up on the request for a sitting service and to ensure a proper assessment of Mrs X’s needs was completed is fault.
The Council also failed to provide a carer’s assessment for Ms Z. Her requests for respite and a sit in service clearly indicate that she needed help with her caring responsibilities and completing a formal carer’s assessment would have identified her needs. A referral was made in June 2020 but there is no evidence of any follow up and my request for information about the carer’s assessment does not mention any action in 2020. The failure to complete a carer’s assessment is fault.
When Ms Z did contact the Council again in June 2021 this resulted in a care package being provided. Ms Z was not satisfied with the level of assessed needs and so made a formal complaint. She wanted Mrs X to attend the day centre three days a week and requested assistance for a sit in service. A review by a manager resulted in an increase in the amount awarded as a direct payment. The payment was backdated to June when the assessment was originally completed. As a result of the amended assessment and increased payment, Mrs X could attend a day centre three days a week. This also ensured Ms Z, as the main carer, had time to pursue her own activities and meet her own medical needs. While the manager took a different view to the amount of care required, I am satisfied this has been resolved by the Council backdating the higher assessment amount.
However, it seems to me, on balance, that if the Council had properly completed the assessments after the cancellation of the reablement package of care in October 2020, that care would have been provided at that time. As a result Mrs X has missed out on the social interaction and involvement of attending a day centre and Ms Z lost out on support and left her with all the caring responsibilities. This is a significant injustice which requires a remedy.
Failed to provide an interpreter relying on Ms Z to do this Ms Z explained to me that after having a stroke, Mrs X lost her ability to speak English and reverted to Punjabi. As a result, Ms Z requested Punjabi speaking carers and an interpreter. The information provided shows the reablement package of care provided in September 2020 included Punjabi speaking carers. While the new care provider did not have Punjabi speaking carers, this package of care was cancelled by Ms Z and so I find no fault.
Ms Z says she asked for an interpreter to be present as part of the assessment of Mrs X’s care needs. The Council’s response to my enquiries accepts that Ms Z did request an interpreter but says she later changed her mind and said she could interpret for her mother. I have not seen any evidence which shows this to be the case. I consider that it is better to include an interpreter if one is available as this allows the service user to properly express their views. However, I am satisfied Ms Z is a strong advocate for her mother and so I do not consider Mrs X would have been significantly disadvantaged by the absence of an interpreter.
The Council indicates that it intends to conduct reviews with an interpreter to ensure Mrs X’s views are heard. I endorse this approach and would encourage the Council to ensure this happens.
Failed to send a copy of the support plan and care assessment after a manager increased the care package in response to Ms Z’s complaint Ms Z says she was not sent copies of the updated assessment and support plan. As part of her complaint to us she included a copy of an email from the Council dated 3 August 2021. The email explains the increased level of care agreed and says the completed assessment and support plan is attached. The Council also asks Ms Z to complete and return the direct payment agreement and the cost of care letter. I note the email states there are two attachments. Because I have only seen a copy of the email, not the original, I do not know what those two attachments were. However, the text of the message does suggest more than two documents should have been attached. I asked the Council to provide evidence of how it shared the outcome of its care assessments with Ms Z. In response it said the information was shared on 8 August but the email evidence is no longer available.
I am not able to say with any certainty that the Council did provide an updated copy of the care assessment and support plan following the decision of the manager to increase the care package. However, there is a evidence of a lack of robust record keeping and this is fault.
The details listed at paragraph 22 indicate a number of faults where referrals for services and assessments were made but not followed through. These faults meant Mrs X did not get services she should have received. It also meant the full responsibility of caring for Mrs Z was placed on Ms Z without any support or assistance. A remedy is due to them for this and I shall also recommend service improvements.
Agreed action
To remedy the injustice caused to Ms Z and Mrs X as a result of the faults identified in this case, the Council, within one month of my final decision, will take the following action: Apologise to Ms Z and Mrs X; Make a symbolic payment of £500 to Mrs X to recognise the distress and lack of social interaction experienced; and Make a symbolic payment of £750 to Ms Z to recognise the impact of the lack of service provision, carer’s assessment and impact on her health.
Within three months of my final decision the Council will: Review its record keeping procedures to ensure they are fit for purpose and ensure staff know what is required; and Review its process for making and following up on referrals to ensure actions are carried out, especially where referrals are outsourced to other agencies.
Final decision
I have completed my investigation with a finding of fault for the reasons explained in this statement. The Council has agreed to implement the actions I have recommended. These appropriately remedy any injustice caused by fault.
Parts of the complaint that I did not investigate Ms Z says that she has been seeking help from the Council since 2016. The Ombudsman normally only considers complaints that are made within 12 months of the person first becoming aware of the situation. I am not persuaded there are exceptional circumstances to now look at matters over five years old. I have decided to consider matters from March 2020 onwards as that was when a package of care was first provided to Mrs X.
Investigator's decision on behalf of the Ombudsman