The Ombudsman's final decision
Summary: We have not found fault with the way the Council decided to offer assistance to Mrs B while her husband was in hospital. The Council also amended the factual inaccuracies in the care plan.
The complaint
Mrs B said the Council did not provide her with the necessary support while her husband, Mr B was in hospital. She said the care plan was full of inaccuracies and did not meet her needs.
The Ombudsman’s role and powers
We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. 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 have discussed the complaint with Mrs B and I have considered the evidence that she and the Council have sent and the relevant law, guidance and policies.
What I found
Law, guidance and policies The Care Act 2014 and the Care and Support Statutory Guidance 2014 set out the Council’s duties towards adults who require care and support.
The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Council must consider whether: The adult’s needs arise from a physical or mental impairment or illness.
As a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes.
As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.
The outcomes are: Managing and maintaining nutrition Maintaining personal hygiene Managing toilet needs Being appropriately clothed Being able to make use of the home safely Maintaining a habitable home environment Developing and maintaining family or other personal relationships Accessing and engaging in work, training, education or Making use of necessary facilities or services in the local community Carrying out caring responsibilities for a child.
What happened Mrs B lives with her partner, Mr B, who is also her main carer. She has physical and mental health needs. She and Mr B rent a housing association property. There were concerns about hoarding at the property and the housing association had started legal proceedings in relation to this. The housing association had put in place support from a cleaning agency (agency 1) to declutter and clean the flat.
Assessment of Mrs B’s needs and care plan – March 2022 The social worker assessed Mrs B’s needs. She said Mrs B walked with a wheeled walker or walking stick but said she found it painful to weight bear for long. She was able to stand for a period of time and sometimes wore a knee brace.
In terms of Mrs B’s ability to prepare meals, Mrs B said she could only stand for a short time so Mr B prepared meals. The social worker said that there were no safe clear walkways because of the clutter in the property so this made it difficult for Mrs B to prepare meals.
The social worker noted that some of Mrs B’s needs related to her mental health diagnosis as Mrs B had a diagnosis of depression and anxiety.
Mrs B’s main request was to attend a day centre to do arts and she asked for assistance to go out into the community. She said she was at risk of loneliness and depression when her husband was out as he worked 4 nights a week and then slept during the day.
The care plan said Mrs B was entitled to: Attendance at a day centre 2 days a week. The Council would provide transport to and from the centre.
Support by a care worker 4 hours a week to take Mrs B into the community.
Chronology of events Agency 1’s worker contacted the Council on 4 April 2022 as Mr B had been taken to hospital. Mrs B had been provided with a meal and drink that evening and he would do the same in the morning.
On 5 April 2022, Mrs B was offered a meal delivery service but refused the offer. The social worker said she would ask funding so that Mrs B could attend the day centre 4 days week.
Agency 1’s worker spoke to the social worker on the same day and said he had cleaned a lot of the kitchen. He said he provided Mrs B with breakfast and would provide her with meals for that day and the following day.
On 6 April 2022 the Council received a referral from the police as Mrs B told the police she was going to overdose her medication. Mrs B had told the police that she did not have any food.
On the same day the Council provided a support worker to carry out laundry for Mrs B. As Mrs B had refused the meal delivery service, her son organised an online shop to be delivered. He also provided a fridge/freezer so that Mrs B could store the meals in there. Mrs B already had the support of a care worker to take her out 4 hours a week and the social worker had also obtained agreement for Mrs B to attend the day centre 4 days a week (rather than just 2 days a week), to start from 8 April 2022.
The Council also noted that Agency 1’s worker had collected Mrs B’s medication from the pharmacy and her son would also ensure that medication was picked up. Mr B’s son had also agreed for online meals to be delivered.
Mrs B was taken to hospital on 9 April 2022 as she had taken an overdose of medication. She asked for support from the Community Mental Health Team.
The Council put in place support from agency 2 from 10 April 2022. Agency 2 provided Mrs B with a take-away on 10 April 2022 and completed her shopping. However, agency 2 stopped providing support after two days because of the poor condition of the home environment and Mrs B’s behaviour towards the workers.
Mr B returned home on 12 April 2022. The social worker visited Mr and Mrs B on 13 April 2022. The couple refused offers of a meal delivery service or ready meals which could be heated up. Mr B said he wanted someone to cook fresh meals at their home, but the social worker explained that the Council would not provide that service.
Mrs B’s complaint – 13 April 2022 Mrs B contacted the Council on 13 April 2022 and said: The Council left her to ‘starve’ while Mr B was in hospital.
Nobody checked up on her during that time to ensure she was safe.
The care plan was full of inaccuracies and did not meet her needs.
Council’s response – 4 May 2022 The Council responded on 4 May 2022. The Council’s response did not address the complaint that Mrs B had made about the support she received when Mr B was in hospital. The response referred to a conversation that the manager had with Mrs B about her complaint and responded to the complaints raised in that conversation.
The complaints were: Mrs B wanted the Council to send her the care plan. Mrs B said the social worker sent her the care plan on 25 March 2022 but she did not know whether the amendments she had asked for had been actioned.
Mrs B wanted to be consulted on any decisions regarding her care plan.
The Council responded and said the social worker had corrected the information in the care plan relating to involvement of Mrs B’s GP, nurse and attendance at hospital. The manager had asked the social worker to update the information regarding Mrs B’s medical condition, how it was managed and to ensure that it reflected the fact that Mr B was Mrs B’s carer. She had asked to send the document in larger print. The Council admitted it had not sent the updated plan to Mrs B after she asked for this on 13 April 2022.
The Council said that it would always take the person’s wishes into account. However, there had been occasions where the Council had to discuss matters regarding Mrs B’s housing directly with the housing association. The social worker was allowed to do this and had explained her actions and reasons for this.
Support plan – June 2022 The Council reviewed Mrs B’s care plan in May and June 2022 and said Mrs B was entitled to: Attendance at a day centre, 2 days a week with transport.
Support with laundry, 1.5 hours a week.
Support to go out into the community, 4 hours a week.
Mrs B was also linked to the mental health crisis centre and had an emergency help line provided by the Mental Health team. She had a mental health community psychiatric nurse.
Council’s response to the complaint The Council provided a response to the complaint dated 13 April 2022. It listed the support that had been offered to Mrs B while Mr B was in hospital, both by the Council and by the housing association. The Council said that, in terms of the current care plan, it had offered an increase in the day service if there was an emergency again.
Analysis The Council did not have a duty to provide mental health support to Mrs B as this was the role of the NHS. However, the Council did have a duty to ensure that Mrs B’s needs for care and support were met, and it had to consider needs that arose from a physical or mental health condition.
It is not for the Ombudsman to say what support Mrs B should receive or what her care plan should be. Only the social worker can do this, in cooperation with Mrs B. I can only investigate whether there was fault in the way the Council made its decisions.
Mrs B said that she was left without nutrition and that nobody checked up on her while Mr B was in hospital.
I do not underestimate the distress Mrs B suffered while Mr B was in hospital. However, I note that, in terms of nutrition, Mrs B was provided with meals by agency 1’s worker. The Council offered a meal delivery service and food deliveries were organised by Mr B’s son. The Council also put in place agency 2 which provided a meal and shopping for Mrs B.
I also note that the Council put in place attendance at the day service 4 days a week, as well as a laundry service, 4 hours to go into the community and care and support from agency 2. Mrs B also had the ongoing support from agency 1 provided by the housing association. Therefore, I cannot say that the Council did not ensure that Mrs B had been offered nutrition and that she was monitored and provided with support while Mr B was in hospital. I note that the Council took into consideration Mrs B’s mental health needs as well as her physical needs in offering the additional support.
In terms of the care plan itself, Mrs B said that some of the factual information was incorrect and I note the Council has made the necessary amendments to the care plan as a result of this. If there is any further factual information that needs to be changed, then Mrs B should let the Council know.
The Council re-assessed Mrs B’s needs after Mr B returned from hospital. If Mrs B is of the view that the current plan does not meet her needs, then she would need to make a complaint to the Council first and explain why this is the case and what further support she is seeking.
Final decision
I have completed my investigation and have not found fault with the Council.
Investigator's decision on behalf of the Ombudsman