Summary: there was fault in the way the Council considered Mr X’s request to move to an alternative residential care home. However we cannot say that Mr X would have moved sooner but for this fault. The Council’s handling of his case caused some inconvenience to his mother, Mrs Y, who was actively involved in planning his care.

The complaint

1. This complaint was made by Mrs Y on behalf of her adult son, Mr X, who has given consent for her to act as his representative.
2. Mrs Y complained that the Council failed to find a suitable alternative care home placement for Mr X which can meet all his care and support needs. Mr X moved to his current placement on a temporary basis a few years ago. Mrs Y says the care home does not meet his emotional, social and nutritional needs and he has become more anxious and withdrawn as a result. She wants the Council to complete its review of his care needs and find a suitable alternative placement so he can move as soon as possible.

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The Ombudsman’s role and powers

3. 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 investigate a complaint from a person we decide is a suitable representative. (section 26A or 34C, Local Government Act 1974)
4. 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)
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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How I considered this complaint

6. I have spoken to Mrs Y and considered all the information she provided. I made enquiries to the Council and considered its response and evidence from Mr X’s social care records.
7. Mrs Y and the council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

The relevant law and guidance

8. Local authorities have a legal duty under section 1 of the Care Act 2014 to promote the person’s wellbeing when they carry out any of their care and support functions. This is known as ‘the wellbeing principle’ which puts the person’s wellbeing at the heart of care and support planning. It emphasises the need to take account of the individual’s views, wishes and feelings.
9. Wellbeing is a broad concept. It includes the person’s physical and mental health, their emotional wellbeing and control over their day-to-day life, including the way care and support is delivered.
10. The Care and Support and Aftercare (Choice of Accommodation) Regulations 2014 set out what people should expect from a council when it arranges a care home place for them. Where the care planning process has determined a person’s needs are best met in a care home, the council must provide for the person’s preferred choice of accommodation, subject to certain conditions.
11. The person must have the right to choose between different providers of that type of accommodation provided that:

• the accommodation is suitable in relation to the person’s assessed needs;
• to do so would not cost the local authority more than the amount specified in the adult’s personal budget for accommodation of that type;
• the accommodation is available;
• the provider of the accommodation is willing to enter into a contract with the local authority to provide the care at the rate identified in the person’s personal budget on the local authority’s terms and conditions.

The Council must not limit the choice to settings or individual providers with which it already has a contract, or those in its geographical area. It must provide a genuine choice across all the appropriate provision.

12. Annex A to the Care and Support Statutory guidance says that a person’s ability to make an informed choice is an important element of the care and support system. It also reminds local authorities that the regulations and guidance on choice of accommodation and additional costs apply equally to those entering care for the first time, those who have already been placed by a local authority, and those who have been self-funders.

The background to this complaint

13. Mr X was born with a physical disability which means he cannot walk and uses a wheelchair. He has a visual impairment and has been diagnosed with anxiety and depression. He needs assistance from others to meet all his personal care needs.
14. Mr X has mental capacity. He can make decisions about his care and support needs and communicate his views and wishes verbally.
15. Mr X moved to Care Home A in April 2019 after a short time in a supported living scheme which did not work out. The Council did not arrange the placement at Care Home A and Mr X self-funded for the first few months. Care Home A is a residential care home which provides personal care for a small number of adults who have a physical disability, a learning disability or who are on the autistic spectrum. It caters for adults over 65 and younger adults.
16. The Council took over responsibility for funding Mr X’s placement in June 2019. It agreed Care Home A would be a short-term placement until a suitable long term care home could be found.
17. A Support Plan was prepared following an assessment of Mr X’s care needs in September 2019. It identified his need for a placement in a residential care home for people with physical disabilities aged under 65. It said he needed support to achieve eight outcomes. For the purposes of this investigation, the following outcomes are particularly significant:

Outcome Seven: Developing and maintaining family and other personal relationships: [Mr X] requires physical support to access social and personal relationships. He requires support to communicate with others, for example, with reading, writing correspondence (to scribe for him,) using the telephone, sending text messages. Without support to maintain his social and personal relationships [Mr X's] emotional wellbeing would deteriorate.

Outcome Nine: Making use of necessary facilities or services in the local community, including public transport and recreational facilities or services. [Mr X] uses his manual wheelchair to access outside the home. Due to a visual impairment, he requires assistance of one person to push/guide him on differing surfaces. He requires support to organise and plan opportunities to access community resources, transport. He would like some 1-1 support time to access community interests he enjoys.

18. In January 2020 a social worker visited Mr X at Care Home A to review his Support Plan. Mrs Y and her husband were also present. She recorded that Mr X needed support to find a suitable long term care home placement. She noted Mr X still wished to move but was happy to stay at Care Home A until it was safe to move due to the COVID-19 pandemic.
19. The same social worker conducted a telephone review of the Support Plan in early October 2020. Mr X and Mrs Y participated in the review along with a manager from the organisation which operates Care Home A. The social worker’s notes say Mr X felt much happier at the care home than in the supported living scheme. According to the review records, Mr X said he was content to remain at Care Home A until it was safe to move. He would contact Adult Social Care, with support from the care home staff and his parents, when he felt the time was right.
20. The October 2020 Support Plan changed the description of the placement to a long-term service. The Council has confirmed it was treated as a permanent placement from that date.

Events in 2021

21. At the beginning of August 2021 Mr X telephoned the social worker to raise concerns about the suitability of his placement at Care Home A. According to her notes, he said he did not feel staff were treating him with sufficient respect.
22. The social worker did a telephone review with Mr X and Mrs Y on 3 August. Mr X expressed concerns about the lack of person-centred care provided by some care assistants and said he did not feel valued. She noted Mr X was isolated and did not join in with organised group activities. He preferred to spend time alone in his room. She noted that his mental health had declined during the COVID-19 pandemic and he needed support to maintain social and personal relationships to promote his wellbeing. The social worker recorded that Mr X and Mrs Y had expressed interest in moving to a care home outside the Council’s area. She agreed to produce a new Support Plan and arrange for an Occupational Therapist to assess Mr X.
23. Mrs Y says Mr X used to be supported by a personal assistant in his former home who accompanied him to activities in the community. She said the group activities and trips Care Home A arranged for residents did not match Mr X’s interests. She also said Mr X found it difficult to have conversations with the other residents, some of whom had learning disabilities. The Council’s records noted Mr X was clinically vulnerable and this restricted his opportunities to access the community during the COVID-19 pandemic.
24. A specialist Occupational Therapist conducted a telephone assessment on 4 August. She spoke to the manager of Care Home A and Mr X was present for part of the call and expressed his views. The Occupational Therapist also spoke to Mrs Y on 9 and 10 August.
25. The Occupational Therapist completed a report which recorded Mr X’s needs for aids and equipment to inform the decision about a suitable alternative care home placement.
26. Mrs Y told the Occupational Therapist that, in her opinion, Mr X required a ceiling hoist for transfers. The Occupational Therapist did not agree. She said Mr X could be transferred safely by two carers using either a fixed ceiling hoist or a mobile hoist. She also noted on the form that Mr X’s weight had increased since her previous assessment in September 2019. (The Occupational Therapy reports show his weight remained constant between assessments in January and August 2021).
27. From the records I have seen so far, it seems no progress was made in searching for an alternative care home between late August and late October 2021.

The referral to the Council’s Brokerage Service – Care Match – in October 2021

28. The Council has an online portal called Care Match to procure placements from care providers who have registered with the service. It aims to match service-users who need a nursing or residential care home placement to providers with vacancies. A social worker makes a referral to the Brokerage service and gives details of the service-user’s social care needs and the type of service required. This information is uploaded to the portal to enable providers to decide whether to make a bid and offer a placement.
29. Mr X’s social worker made a referral to Care Match in late October 2021. The Council’s records show it received several bids from providers between 29 October 2021 and May 2022. Each time a bid was received, the social worker forwarded the care provider’s details to Mrs Y and asked her to contact them to decide if they might be suitable. It seems the social worker did not check first if Mr X met the provider’s criteria.
30. During this period, the social worker forwarded bids from nine different providers, some of whom responded more than once. Mrs Y contacted all of them but none proved to be suitable for Mr X for the following reasons:
• Mr X did not meet the age criteria for two care homes – he was too young for one and would be above the age range for another care home on his next birthday;
• One care home only catered for residents with learning disabilities;
• One home only provided nursing care placements - Mr X did not need nursing care;
• One care home had an outbreak of COVID-19 so Mrs Y and Mr X could not visit. Mrs Y spoke to the care home staff who told her it was unlikely the available room would be large enough to accommodate Mr X’s wheelchair;
• One care home only catered for people with autism;
• One care home catered for residents with dementia, challenging behaviour or mental health conditions. Mrs X decided this would not be suitable for Mr X because he had a negative experience with a resident who had challenging and violent behaviour in a previous care setting.
31. Between December 2021 and February 2022 there was a COVID-19 outbreak in Care Home A. Mr X, other residents and several staff caught COVID-19. The care home was quarantined and residents could not move during this period.
32. The Brokerage service closed Mr X’s case in February 2022 because the social worker had not updated them about the outcome of previous bids. The social worker sent Mrs Y an email in mid-February 2022 to say she was ending her involvement because Mrs Y had declined all the referrals and Mr X’s needs were adequately met at Care Home A. She also did not consider it safe for Mr X to move to a new care home then.

Mrs Y’s complaint to the Council

33. Mrs Y complained to the Council two days after she received the social worker’s email. She expressed concern that Care Match had suggested care homes that were not suitable for Mr X’s needs. She challenged the social worker’s account of events. She said she had not declined any care homes: Mr X did not meet the criteria for some and the others could not meet his needs. She also challenged the social worker’s view that Mr X’s needs were being met at Care Home A. She said his emotional and social needs were not met and she asked for a change of social worker.
34. An officer in the Council’s complaints team replied to Mrs Y’s complaint in late April 2022. It partially upheld her complaint that Care Match did not come up with suitable placements. It agreed to allocate another social worker to work with Mr X and Mrs Y. It said the Council would continue searching for an alternative care home placement and arrange a further review of Mr X’s care and support needs.
35. Mr X’s case was resubmitted to the Brokerage service in April.
36. Mrs Y requested a review of the decision on her complaint. On 1 June 2022 another officer in the Complaints team wrote to Mrs Y to say she had reviewed the Stage One reply and stood by its findings. She confirmed that the Team Manager had agreed to reallocate Mr X’s case to another social worker.

Direct approach to a charity

37. In mid-May 2022 Mrs Y asked Mr X’s social worker to make direct contact with a charity which operates residential care homes. Mrs Y expressed interest in a specific home where Mr X had lived some years earlier. The social worker contacted the charity who told her it was a nursing home. The social worker then told Mrs Y this was not a suitable placement for Mr X. However the charity told the social worker about two residential care homes it operated outside the Council’s area which might be able to meet Mr X’s needs. In early June 2022 Mrs Y expressed interest in both homes and asked if they could make arrangements to visit.
38. In late June 2022 the Team Manager asked a locum social worker to complete a further review of Mr X’s needs in August 2022. She asked the locum social worker to work jointly on the case with Mr X’s social worker. The locum social worker met Mr X and Mrs Y in early August. Mrs Y told me she was very satisfied with the thoroughness of the locum social worker’s assessment. The manager of Care Home A told her Mr X had isolated himself and did not want to be there. The manager felt the care home could still meet Mr X’s needs but he was clearly not happy and would not allow staff to provide full support.
39. Mr X started to refuse personal care. Mrs Y visited him every day to help with personal care and to check he was eating and drinking. The manager told the locum social worker Mr X had deteriorated since she first arrived in March and Care Home A may no longer be appropriate. The locum social worker agreed Care Home A did not meet Mr X’s needs for these reasons.
40. Meanwhile Mr X’s social worker contacted the charity to clarify the cost of the placement at Mrs Y’s preferred care home. The care home also had to go through the Council’s procedures to be approved as a contracted provider and join the Care Match system.
41. By early September the charity confirmed it could offer Mr X a placement at one of the care homes within the Council’s maximum weekly rate.
42. Mrs Y and Mr X visited the preferred care home in late September 2022. It confirmed it could meet Mr X’s care and support needs. The Council approved funding and Mr X was due to move to the new care home when a room became available in late October 2022. Unfortunately that placement has since fallen through because the current resident is not leaving the care home.

The impact on Mr X and Mrs Y

43. Mrs Y has no concerns about the overall quality of care at Care Home A but says it did not meet Mr X’s emotional and social needs. It was not intended to be a long-term placement. As time went by Mr X became very withdrawn and anxious and spent most of his time alone in his room. He ate in his room because he was disturbed by noise in the dining room and this triggered a startle reflex.
44. Mrs Y told me Mr X used to have a good appetite. But from late 2021 he started to eat less because of his low mood. His GP prescribed nutritional supplements. Mr X stopped taking his anti-depressant medication with his GP’s knowledge. Mrs Y started to visit Mr X daily to support him when he had his evening meal.
45. Mr X does not participate in the group activities offered to residents. In a previous care home, he had funding for a personal assistant to accompany him to activities of his choice in the community. At Care Home A, the group outings and communal activities organised by the home do not match his interests. Mr X does not feel he can engage in conversations with other residents and Mrs Y says this has accelerated his mental deterioration.
46. Mrs Y does not consider the Care Match service is adequate. She says care providers made bids even when Mr X did not meet their criteria or they could not meet his assessed needs. For example, one bid was made by a nursing home even though Mr X does not require nursing care so this was never a viable option. As she was not familiar with the providers, she spent a lot of time following up these suggestions only to find out they were not suitable.
47. She is also dissatisfied that the Council told her it would reallocate Mr X’s case but the locum social worker continued to work jointly with the same social worker. Mrs Y was very satisfied with the locum social worker’s input and her assessment of Mr X’s needs but she says the Council misled her when it told her Mr X’s case would be reallocated.
48. Mrs Y says Mr X wants to move as soon as possible to a suitable long-term care home where he can be happy and settled and engage in activities of his choice in the community which will improve his mental health and wellbeing.

My analysis

49. Mr X moved to Care Home A on the understanding it was a short-term placement. Care Home A can meet Mr X’s personal care needs and it provides a safe and wheelchair accessible environment. When the COVID-19 pandemic broke out in 2020, Mr X agreed to stay at the home on an interim basis.
50. In August 2021 Mr X contacted the social worker to say he was not happy with the placement. The social worker also noted in her report that Mr X was withdrawn and isolated, his mental health had declined, and he needed support to access the community. From that point on, Mr X made it clear that he wished to move to an alternative care home.
51. There was a delay until late October 2021 in making a referral to the Care Match service. That was fault. The Care Match service then produced several bids from providers which did not match Mr X’s assessed needs. He needed a residential care placement for people with physical disabilities aged under 65. Several of the bids the social worker forwarded to Mrs Y were unsuitable either because they catered for the wrong age group, only provided nursing care, or catered for clients with learning disabilities or autism. That may have happened because the information uploaded to the Care Match portal did not give sufficient details about Mr X’s age and client group. Whatever the reason, the social worker did not assess whether these were viable options which would meet Mr X’s needs before she sent them to Mrs Y. That was fault. As a consequence, Mrs Y was put to some inconvenience and time and trouble in contacting providers who could not offer a suitable placement for Mr X. There should have been an initial check by the social worker to screen out any bids which were obviously unsuitable.
52. I also found fault with the decision to close Mr X’s case with the Brokerage service in February 2022. This resulted in no further placement options being considered until April. The evidence suggests the social worker considered Mrs Y had unreasonably vetoed suitable placements. But Mrs Y contacted all the providers and had good reasons for concluding they would not be suitable for Mr X. Furthermore Mrs Y was never informed there was a time limit or restrictions on the number of bids she and Mr X could consider.
53. In deciding to close the case because it considered Care Home A a suitable permanent placement, it seems the Council focused too narrowly on whether Care Home A could meet Mr X’s physical care needs, which it could. But it did not have sufficient regard to the wellbeing principle and take into account that Mr X was not happy at Care Home A and this had a detrimental impact on his mental health and emotional wellbeing. That was a significant failing.
54. It was also fault not to consider sooner the option of contacting providers who were not registered on Care Match, and who did not have an existing contract with the Council, particularly given the difficulty of finding residential placements for younger adults (under 65) with physical disabilities. Mrs Y initiated this in May 2022 when she asked the social worker to make enquiries to a specific charity which operates care and nursing homes. The statutory guidance makes it clear that service-users must have a genuine choice about providers and must not be restricted to providers with existing contractual arrangements with the Council or operating in the Council’s area.
55. Mrs Y was misled when the Council said Mr X’s case would be reassigned to a different social worker. In fact, the locum social worker worked jointly with Mr X’s social worker. As Mr X and Mrs Y were satisfied with the locum social worker’s assessment, and the subsequent decision to approve a new placement with the charity, I do not consider this had any significant adverse impact on Mr X or Mrs Y. But the Council should have been more open and transparent when it explained to Mrs Y how it would manage Mr X’s case following its investigation of her complaint.
56. Although I have found delay and other faults, I cannot say this necessarily resulted in Mr X waiting longer for a suitable alternative placement. There are too many factors outside the Council’s control which could have affected the time it took to find an alternative placement:
• there are generally fewer residential care placements available for younger adults with physical disabilities;
• there may not have been any vacancies in suitable alternative homes or they may not have been taking new admissions if they were affected by the COVID-19 pandemic;
• there was a COVID-19 outbreak in Care Home A which prevented Mr X from moving for a period of around two months;
• any care home had to agree to the Council’s terms and conditions for contracted providers and be willing to offer a placement at a weekly rate within the agreed personal budget.

Due to these factors, I cannot say that Mr X would have been able to move sooner but for the Council’s faults.

57. Mrs X was put to some inconvenience and avoidable time and trouble in contacting providers who could not have met Mr X’s needs because the bids received via Care Match were not checked first. I have recommended a remedy for this injustice.

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Agreed action

58. Within one month of my final decision, the Council will:
• Work closely with Mr X and Mrs Y to identify a suitable alternative residential care home;
• Apologise to Mrs Y and pay £150 to recognise the time and trouble to which she was put in contacting providers who could not meet Mr X’s needs or where Mr X did not meet the provider’s specific criteria;
• Review its working practices to screen Care Match bids before they are forwarded to the client or their representative to ensure (a) they meet the person’s assessed care needs and (b) the person meets any of the provider’s admissions criteria relating to age, personal or nursing care or client group;
• Review the need for written advice to staff about searching for providers not currently registered on Care Match when the client has complex needs or is in a client group known to be particularly hard to place;
• Remind officers who investigate complaints about the importance of giving accurate information to service-users when they convey decisions about a request for a change of social worker.

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Final decision

59. I have completed the investigation and found the Council was at fault and this caused injustice. The Council has agreed to provide a suitable remedy.

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Investigator's decision on behalf of the Ombudsman