Summary: Mrs X complained about the actions of the care provider arranged by the Council after her father, Mr Y, fell at home. There was fault in how the care provider, acting on behalf of the Council, arranged for Mr Y to go into a care home, without seeking the Council’s approval first. This led to Mr Y being charged for care he would not have been. The Council agreed to apologise, reimburse some of the care fees Mr Y was charged and remind its providers about the correct procedure to follow in future.

The complaint

1. Mrs X complains, on behalf of her deceased father Mr Y, about how the Council managed his home care and delays in arranging for his return from a care home. She says:
• care staff arranged by the Council did not tell it before arranging to temporarily transfer Mr Y to a care home; and
• it was difficult to contact the Council to arrange for Mr Y’s return home.
2. As a result, Mrs X says Mr Y was charged for his stay at the care home he did not agree to and that these charges would have been lower had the Council arranged for Mr Y’s return home sooner. She wants any charges Mr Y paid while he was in the care home to be waived.

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The Ombudsman’s role and powers

3. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
5. We may investigate a complaint on behalf of someone who has died or who cannot authorise someone to act for them. The complaint may be made by:

• their personal representative (if they have one), or
• someone we consider to be suitable. (Local Government Act 1974, section 26A(2), as amended)

6. When considering complaints we make findings based on the balance of probabilities. This means that we look at the available relevant evidence and decide what was more likely to have happened.
7. 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

8. I considered the information Mrs X provided and discussed the complaint with her.
9. I also considered the Council’s comments on the complaint and the supporting information it provided.
10. Mrs X 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

Meeting adult social care needs

11. Councils must meet the eligible care and support needs of adults in its area, subject to certain rules and restrictions. (Care Act 2014, Section 18)
12. Where a Council had to meet someone’s care and support needs, they can do this in a number of ways, including by arranging for a care provider to meet those needs on its behalf. (Care Act 2014, Section 8)
13. In its contract with home care providers, the Council sets out what it expects care providers to do when someone needs urgent or temporary changes to their care. The contract says that, in exceptional circumstances, care providers can provide up to two hours in emergencies. If more than two hours are needed, providers must seek approval from the Council.

What happened

14. Mrs X’s father, Mr Y, received care at home arranged by the Council and provided by a home care agency (Provider B) on the Council’s behalf. The Council charged Mr Y a contribution towards the costs of his care under the rules which allow it to do so.
15. In late 2022, Mr Y fell while at home and used an emergency call system to summon help from paramedics. The system also altered Mr Y’s son, Mr Z.
16. Paramedics arrived first, followed by Mr Z and care staff from Provider B. The paramedics told Mr Z and the carers that Mr Y did not need to go to hospital. However, Mr Y was not confident that he would be able to cope alone at home that day due to the aftereffects of the fall.
17. The carers from Provider B contacted their manager who advised that they had available space in a care home run by the same company. With Mr Y and Mr Z’s agreement, the paramedics transported Mr Y to the care home. Provider B also notified the Council that it needed to suspend his home care for two weeks while Mr Y went into respite care in the care home.
18. Mrs X said the care home did not explain to them that Mr Y would need to pay for his stay at the care home until several weeks later. She and Mr Z expected that either the Council or the NHS would pay for the costs of Mr Y’s care home stay.
19. When they were told, just under two weeks later, by the care home that Mr Y would need to pay for his stay, Mrs X said both she and Mr Z tried to contact the Council to arrange for Mr Y to return home. Mrs X said they both tried calling the Council several times but either could not get through or were not called back as promised. They said they managed to speak to someone about Mr X’s return home two days later.
20. After speaking with Mrs X, just over two weeks after Mr Y went into the care home, the Council arranged to reassess Mr Y’s needs and he returned home around three weeks after he went into the care home.
21. Mrs X complained to the Council about Mr Y being charged for his stay in the care home. The Council investigated Mrs X’s complaint and, in its final response to her complaint, told her the care fees were a private matter between Mr Y and the care home which it could not get involved with.

My findings

22. In its response to my enquiries, the Council accepted that Provider B did not properly follow the process it should have done before it transported Mr Y to the care home run by the same company. According to the contract between the Council and Provider B, the carers should have notified the Council that Mr Y needed further care before arranging for him to go into a care home.
23. Had Provider B done this, and the Council agreed that Mr Y needed to be in a care home, the Council had arrangements with other care homes for short term placements, which it would have funded. Instead, Mr Y moved into a care home, stayed there for 23 days and was charged for this by the care home.
24. Since it knew Mr Y would be paying his own care fees, the care home had separate responsibilities to notify Mr Y, and possibly his family, about this. I have not investigated the care home’s actions as part of my investigation.
25. However, the carer’s working for Provider B, acting on the Council’s behalf, had a responsibility to follow the Council’s procedures for changes in care needs. I am satisfied the evidence shows they did not do this and that was fault. I am satisfied that fault led to Mr Y being taken to the care home run by the same company as Provider B.
26. On the balance of probabilities, I am satisfied that Mr Y’s family first started to contact the Council about Mr Y returning home around two weeks after he went into the care home. The Council then arranged a review of Mr Y’s needs and he returned home 9 days later.
27. Even if the care home had notified Mr Y or his family about the fees straight away, it is likely it would have taken the same length of time to arrange for Mr Y’s return home. Therefore, I am satisfied that Provider B’s failure to follow the correct process led to Mr Y being charged for around 10 days of the care home fees. The Council should reimburse Mr Y’s estate for these fees, or arrange with the care home to pay these directly.
28. Since Mrs X’s complaint, the Council has reminded Provider B about the need to follow the correct process if someone has an urgent change in their care needs. The Council should also remind the other providers it has similar contracts with.

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Agreed action

29. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of the care provider, I have made recommendations to the Council.
30. Within one month of my final decision the Council will:
• apologise to Mrs X that its home care provider did not follow the correct process and that, as a result, Mr Y was charged for his care at the care home; and
• either reimburse Mr Y’s estate for 10 days’ worth of the care home fees, or arrange to pay this to the care home directly.
31. Within three months of my final decision the Council will remind other care providers with which it has similar contracts of the process they should follow when someone requires an urgent change to their care. This could be through a provider bulletin or similar, if the Council publishes such a bulletin.
32. The Council should provide us with evidence it has complied with the above actions.

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Final decision

I have completed my investigation. There was fault in how the care provider, acting on behalf of the Council, arranged for Mr Y to go into a care home, without seeking the Council’s approval as it should have done. This led to Mr Y being charged for care he would not have been. The Council agreed to apologise, reimburse some of the care fees Mr Y was charged and remind its providers about the correct procedure to follow in future.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman