The Ombudsman's final decision
Summary: The Council is at fault for delay reviewing Mr Z’s care and support needs and delay completing an NHS continuing healthcare checklist. The Council also failed to consider whether Mr Z needed adaptations to his property. The Council is not at fault for visiting too many times or for how an officer behaved during a visit in August 2021. The Council has agreed to apologise, pay Ms X and Mr Z £750, and act to improve its services.
The complaint
Ms X complained about the Council’s handling of her father’s need for care and support to remain safe in his own home. In particular, that the Council: Delayed deciding whether to provide 24-hour live-in care Delayed notifying the NHS that Mr Z might be eligible for Continuing Healthcare Visited too many times across different departments instead of coordinating and sharing information Delayed providing necessary aids and adaptations Behaved in an offensive and intimidating manner during a visit in August 2021.
As a result, Ms X says her father was at avoidable risk of harm and they both experienced avoidable distress.
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 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) 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)
How I considered this complaint
I spoke to Ms X about the complaint and considered the information she provided.
I made written enquiries of the Council and considered its response along with relevant law and guidance.
I referred to the Ombudsman’s Guidance on Remedies, a copy of which can be found on our website.
Ms X and the organisation had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
What I found
Adult social care assessments 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. 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.
Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs.
NHS continuing healthcare (CHC) NHS CHC is care arranged and funded solely by the NHS when an individual has a ‘primary health need’ resulting from disability, accident, or illness.
Where it appears a person may be eligible for NHS CHC, local authorities must notify the relevant Clinical Commissioning Group.
What happened Ms X’s father, whom I shall call Mr Z, has care and support needs resulting from his age and health conditions. He lives at home. Ms X and her son both have Lasting Power of Attorney to make decisions about Mr Z’s health and welfare.
In May 2021, Mr Z had a fall at home and was admitted to hospital. The hospital discharged him back home in early June. The discharge information says Mr X would have a package of care where two care workers would visit him four times a day. Each visit would be an hour.
Within a week, Mr Z’s social worker visited. At this visit, Ms X told the social worker the care workers had to stay much longer than one hour to meet Mr Z’s needs. The social worker said the Council would complete a CHC checklist.
About a month later, in July, the social worker sent Ms X the consent form for the CHC referral. Ms X returned this in early August and the Council sent the referral to the NHS the same day.
Ms X told Mr Z’s social worker on several occasions that she thought Mr Z needed more support at home than the four visits a day to keep him safe. In early August, the social worker suggested a live-in carer to support Mr Z and four visits from a second carer to support with Mr Z’s personal care needs. The Council arranged for a live-in carer to start at the end of August.
In August, an OT (Occupational Therapist) assessed Mr X at home and ordered a different bed and other equipment as an urgent order. The equipment was delivered and installed the next day.
Some of the equipment was damaged and needed to be replaced. The Council was concerned that two “bed levers” had been installed on the same side of the bed. Usually, there is one on each side to aid with sitting up in bed. The Council was concerned that the position of the bed levers was an inappropriate restriction on Mr Z’s liberty and there was risk of entrapment. It would also put Mr Z and those caring for him at risk of injury when supporting Mr Z to transfer to and from the bed or to return to bed after a fall.
The Council asked the equipment provider to return to replace the damaged equipment and move the bed-levers so there was one on each side of the bed. Ms X told the Council there was no need to move the bed levers. Ms X felt they helped Mr Z to stand from the edge of the bed and prevented him falling out of bed. Ms X told the Council she would not allow them to be moved. The equipment provider told the Council it had been unable to move the bed lever as Ms X told them it was in use.
An OT tried to visit Mr Z to assess him and how the carers used the equipment in late August. The Council considered this to be important because of the risks identified when Ms X provided photo and video evidence of Mr Z trying to get out of the bed. Ms X asked the OT not to visit since the care workers would not be there. When the OT visited, Ms X did not let them into the property. She explained that Mr Z was asleep, and she did not want to disrupt his routine.
The OT completed a partial assessment by talking to Ms X and her son. The assessment record says the OT explained to Ms X why the second bed lever was a risk but that Ms X considered it helped Mr Z to move and turn in bed. The OT said that further assessment was needed to consider how the care workers and Ms X and her son helped Mr Z off the floor and to look at the bathroom and toilet arrangements.
My findings
Delayed deciding whether to provide 24-hour support The Council identified during a home visit in June 2021 that carers needed much longer than the allotted time to meet Mr Z’s needs. This should have prompted the Council to review, and if needed increase, the support in place. Failure to review the care plan in June was fault.
Had it done so, the Council might have identified earlier that Mr Z needed 24-hour live-in care. Instead, Ms X had to repeatedly tell the Council about the risks to Mr Z when alone at home before the Council suggested the live-in care in August. It then took almost a month to put this in place. I therefore find the Council delayed providing the appropriate level of care and support by two months. This put Mr Z at avoidable risk of harm and caused Ms X avoidable distress.
Delayed referring for CHC The Council identified it needed to complete the CHC checklist in mid-June. However, it took over a month to send the necessary consents to Ms X. This delay is fault.
Ms X then did not return the consent forms until early August. Once received, the Council sent the referral to the NHS the same day. I therefore do not find fault with the Council for any delay between July and August.
Mr Z is entitled to CHC. The Council’s delay therefore delayed Mr Z’s access to this service. This is an injustice to Mr Z.
Visited too many times and didn’t coordinate and share information The Council did visit Mr Z several times between his discharge from hospital in June and the end of August. I appreciate these visits distressed and unsettled Mr Z. However, the Council considered them necessary to assess Mr Z’s needs for equipment and observe how he and his care workers used the home environment to identify and manage risk. This is a matter of professional judgement. There is no evidence of fault in how the Council decided to conduct these visits.
Ms X says the Council should have shared information between the social work and OT departments. She says had the Council coordinated better, it wouldn’t have needed to visit so many times. The records show the social worker and OTs were communicating about Mr Z’s needs. Furthermore, the social worker could not provide the information to the OTs necessary to conduct their specialist assessments. I therefore do not find fault.
Delayed providing necessary aids and adaptations Ms X says Mr Z needs a downstairs wet room for the care workers to safely support him with his personal care. She provided evidence this was first identified as an issue in 2019.
There is no evidence the Council considered this issue as part of the discharge planning or assessments in June or at any time since. There is no evidence the Council provided Ms X with information about Disabled Facilities Grants. This was fault.
The OT identified concerns about how Mr Z was supported to access the upstairs bathroom and issues with the downstairs toilet. However, because Ms X did not allow the OT to enter the property during the late-August visit, the OT could not assess these. The OT report states that to make any recommendations, further assessment was necessary.
Behaved in an offensive and intimidating way during a visit In refusing to allow the OT to enter the property, I consider Ms X was acting in a manner intended to support and advocate for her father. It is understandable that she wouldn’t want to disturb him if he was asleep. It is Ms X and her son who must deal with the impact of such visits on Mr Z’s behaviour, when he becomes unsettled and distressed.
However, the purpose of the OT visit was to consider equipment needs and assess risk to Mr Z. This included addressing a particular concern about the entrapment risk posed by the position of the two bed-levers. Ms X’s view that these were necessary to prevent Mr Z falling out of bed and supported him to sit up and turn over contradicted the Council’s assessment of the risk. Therefore, it seems likely the conversation was confrontational and challenging. However, there is no evidence the OT acted in anything other than Mr Z’s best interests. I therefore do not find fault with how the Council conducted this visit.
Agreed action
To remedy the injustice to Mr Z and Ms X from the faults I have identified the Council has agreed to: Apologise to Ms X Pay Ms X £250 in recognition of her avoidable distress Pay Mr Z £500 in recognition of the avoidable risk of harm caused by delay reviewing his care package Provide Ms X with information and advice about Disabled Facilities Grants.
The Council should take this action within four weeks of my final decision.
The Council should also take the following action to improve its services: Share a copy of this decision with staff in the relevant departments.
Remind relevant staff that NHS Continuing Healthcare referrals should be made quickly when it appears a person may be eligible.
Remind relevant staff of the circumstances in which OTs and social workers should tell people about Disabled Facilities Grants. Provide training or guidance as needed.
The Council should tell the Ombudsman about the action it has taken within eight weeks of my final decision.
Final decision
I have completed my investigation. There is fault by the Council. The action I have recommended is a suitable remedy for the injustice caused.
Investigator's decision on behalf of the Ombudsman