Summary: Ms Y complains about aspects of her mother’s care, both before and after an admission to hospital in 2022. She also says the actions of the Council caused a delay in the hospital discharge and consequently her mother caught Pneumonia. The Council has already upheld most elements of the complaint and offered a remedy. We also uphold some further points. However, in our view, the remedy already offered is proportionate.

The complaint

1. Ms Y says the Council reviewed her mother’s (Ms Z) care and support needs in October 2021 and reduced her care package without consultation. As a result, Ms Y says her mother’s care needs were not met and she lost weight over time.
2. Ms Y complains there was unexplainable delay by the Council when reinstating Ms Z’s package of care during her hospitalisation in May and June 2022. As a result of those delays, Ms Y says her mother stayed in hospital for longer than needed and contracted MRSA Pneumonia. This had a long-term impact on Ms Z, who was later re-admitted to hospital before spending a prolonged period recovering in a residential care home.
3. Ms Y says the Council wrongly stated that her mother expressed a preference to receive care from female staff only. This was incorrect and caused delay when finding a suitable care provider to deliver Ms Z’s domiciliary care.
4. When planning Ms Z’s care and arranging for her hospital discharge, Ms Y says the Council failed to consider all available options, such as a residential care home with nursing facilities.
5. Ms Y says the package of care arranged for her mother did not meet her assessed care and support needs following her discharge from hospital in June 2022. She says the Council sent an outdated care plan to the provider, the call times were insufficient and did not comply with the times recommended by the hospital ‘home safe’ team in July 2021. Furthermore, Ms Y says the care provider failed to keep accessible records showing the medication given to her mother.
6. Ms Y says the Council failed to undertake annual reviews of her mother’s care and failed to allocate a social worker which caused delay when finding and providing extra day care to Ms Z, despite there being availability.
7. Throughout the matters complained about, Ms Y says the Council failed to consult her when making important decisions about her mother’s care and support. This is despite her role as Lasting Power of Attorney (LPA).
8. Ms Y says the matters complained about caused significant distress and suffering to her mother. She also says the fault caused her distress, worry, inconvenience and financial loss.

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The Ombudsman’s role and powers

2. We may investigate a complaint on behalf of someone 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)
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. 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

5. We discussed the complaint with Ms Y by telephone and considered her written submissions.
6. We made enquiries of the Council and considered its response. We also referred to the Care Act and the supporting statutory guidance.
7. Ms 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

Summary background of key events relating to the complaint

8. Ms Z has dementia and other health ailments for which she requires support under the Care Act. In June 2021 Ms Z had a package of domiciliary care. She experienced a fall and spent a short time in hospital undergoing tests. Ms Z was discharged from hospital in early July 2021 and received care at home from Ms Y and an intermediate care agency.
9. After three weeks at home, Ms Z moved to a residential care home where she stayed until October 2021. She then moved back home where she received a package of domiciliary care consisting of four visits a day.
10. In May 2022 Ms Z was admitted to hospital with a suspected Urinary Tract Infection (UTI). Ms Z’s care package was placed on hold whilst she was treated as an inpatient. Six days after her admission, Ms Z was deemed medically fit for discharge. However, the discharge could not take place because Ms Z did not have an open package of care.
11. Two days passed before the Council’s social care team picked up Ms Z’s case. Another seven days passed before the Council completed an assessment of Ms Z’s needs. This concluded that Ms Z required social care support, as before, but with catheterisation.
12. The care provider responsible for delivering Ms Z’s social care prior to her hospital admission told the Council they could not reinstate the package. One of the reasons given by the care provider was that it could not guarantee the allocation of female only workers, which the Council said was Ms Z’s preference.
13. The Council did not consult with Ms Y following its exchange with the care provider.
14. Eight days later the hospital removed Ms Z’s catheter. The Council contacted the care provider again to see whether it had capacity to resume the care package now that Ms Z no longer needed catheterisation. The care provider confirmed it did not have capacity. The Council referred Ms Z’s case to management for review.
15. Almost one week later, the care provider informed the Council that it could resume Ms Z’s care package, but with both female and male carers. The Council declined because it said Ms Z wanted female carers only.
16. Around this time, the Council also contacted two other care providers: one confirmed it did not have capacity and the other said it could begin Ms Z’s care package in a week’s time.
17. Ms Y received news on 14 June that Ms Z had developed a chest infection whilst in hospital and was receiving further antibiotic treatment. The chest infection then developed into hospital acquired Pneumonia.
18. After Ms Z recovered, the hospital discharged her home following the Council’s assessment. The package of domiciliary care comprised of:
• 30 minute call for five mornings each week
• 60 minute call for two mornings each week
• 20 minute calls three times each day for lunch, teatime and bedtime
19. Ms Y says this was less than Ms Z had received before her hospital admission.
20. Six days after her discharge, Ms Z was re-admitted back to hospital with pneumonia. Ms Z stayed in hospital for almost a month before moving to an intermediary care unit. Ms Z went back into hospital for a period in September 2022 with breathing difficulties caused by another chest infection.
21. Ms Z went back to the intermediary unit for six weeks before moving into a residential care home in November 2022 where she stayed until June 2023. Ms Z then returned home with a package of domiciliary care.

Analysis of complaints

Complaint a) reduction of care package in 2021 and subsequent weight loss

22. On 9 July 2021 the Council assessed Ms Z’s care and support needs. The assessment concluded that Ms Z needed a package of domiciliary care comprising of:
• Morning call every day for 45 minutes
• Lunchtime call every day for 30 minutes
• Teatime call every day for 30 minutes
• Bedtime call every day for 45 minutes
23. The records show that Ms Z received this level of support until December 2021 when the Council agreed it was necessary to reduce the package of care. A case note dated 29 November 2021 shows the social worker’s rationale: “spoke to [care provider] and they are literally not staying the length of the calls as the tasks are completed quicker, we have agreed to reduce the morning calls to 30 minutes and the other calls to 20. I’ve cancelled the lunch calls when she is at [the day centre]”.
24. Following this, Ms Z received the following package of care:
• Morning for 30 minutes for five days each week
• Morning call for 60 minutes for two days each week
• Lunch call for 20 minutes for four days each week
• Teatime call for 20 minutes every day
• Bedtime call for 20 minutes every day
25. There is no evidence to show the Council re-assessed Ms Z before making this change. Nor did it consult with or notify Ms Y. This is fault. Consequently, Ms Y was unaware that her mother’s package of care had decreased from December.
26. In February 2022 Ms Y raised concerns with the Council. She recalled a visit with Ms Z, during which the carer who was in attendance prepared a plate of cold ready-made mashed potato. Ms Y said her mother’s nutritional needs were not being met. The records show Ms Z’s weight declined from 55.7kg on 28 June 2021 to 51.2kg on 15 May 2022
27. In our view, the Council’s decision making was not evidence based or person centred. It accepted the assertion of the care provider without first reviewing Ms Z’s needs and discussing the matter with Ms Y. This fault creates injustice in the form of uncertainty because – in the absence of a properly considered decision – we cannot be sure that Ms Z received the level of care she needed between December 2021 and May 2022. The Council should remedy this injustice with the actions listed at the end of this statement.
28. Although there is some uncertainty around whether Ms Z’s assessed needs were being fully met in this period, we cannot conclude that any weight loss was a direct and sole result of the reductions in the care package. We also cannot say whether the Council would have come to a different decision and maintained the previous care package had it reviewed Ms Z. It is evident from the records that Ms Z had suffered a period of ill health requiring hospitalisation in 2021. It is a possibility that Ms Z’s general health may have contributed to her weight loss. It is also relevant to note that Ms Z remained in the ‘normal’ range of BMI.

Complaint b) delayed hospital discharge and subsequent impact

29. There was delay in arranging Ms Z’s care package and facilitating her hospital discharge after she was deemed fit for discharge on 21 May 2022. This was due to the delayed allocation of a social worker and the decision to pursue a female-only care package, which I will consider in more detail in the section below.
30. From the point of being deemed fit for discharge, Ms Z waited nine days for the Council to undertake its assessment of her care needs. In early June the Council started its search for a care provider. It also made a referral to the ‘home safe’ service on 10 June 2022. This is a discharge service which supports clients at home until a long-term care package is found. The referral was declined due to the system showing an open package of care with the previous provider. However, at this point the care provider had already declined to resume Ms Z’s care package. In my view, this referral failed due to an administrative error.
31. In response to Ms Y’s complaint, the Council acknowledged it had a part to play in the delayed discharge of Ms Z and accepted that this caused injustice to her and Ms Y. The Council offered a financial remedy to Ms Y, which she refused. Having reviewed all the available information, I agree with the Council’s conclusions regarding the fault. In my view, the LGSCO would not recommend any more financial remedy than what has already been offered by the Council.

Complaint c) female only carers

32. One of the reasons for the delay in arranging Ms Z’s care package was because the Council thought she wanted female only carers. Ms Y says her mother has never expressed any such preference.
33. We asked the Council for the records which show this documented preference. The Council says it is not recorded on the files – including care assessments, support plans and case recordings – but the social worker and another colleague have a recollection of Ms Z declining male carers previously.
34. In my view, there was a missed opportunity by the Council to check this important point with Ms Y in May and June 2022. Had the Council asked Ms Y whether there was any such preference, she would have likely said no. The Council would then have had more options when searching for care provision, including the reinstatement of Ms Z’s original care package.
35. This fault added further delay in the discharge process. But, in my view, the personal injustice arising from this distress has already been remedied as per the section above.

Complaint d) failure to consider all care options when discharge planning

36. In response to both Ms Y’s complaint, and the LGSCO’s enquiries, the Council accepts it should have considered other short-term alternatives to facilitate Ms Z’s discharge from hospital in June 2022. These options could have included reablement or step-down intermediate care.
37. The Council says that learning from this has been shared. The personal injustice in the form of distress has already been remedied.

Complaint e) inadequacies in care after the June 2022 hospital discharge

38. Upon receiving Ms Z’s updated support plan, Ms Y raised concerns that the 30-minute morning call would not be sufficient to meet her mother’s needs. On 26 June 2022 the new care provider emailed Ms Y and said “… all yesterday’s visits as well as today’s wherein all durations have been longer than specified in the council support plan. On the 25th June 2022, the support worker for the morning visit stayed for 45 minutes rather than the 30 minutes and the lunch carer also stayed longer than her allocated time”
39. We have already found fault in the procedure followed by the Council when it reduced Ms Z’s care package in December 2021 because it did not review Ms Z’s needs or consult with Ms Y. Those reduced care calls were then put into the new May 2022 support plan. In response to Ms Y’s complaint, the Council acknowledged that it did not seek Ms Y’s involvement when it assessed Ms Z in hospital in May 2022. The Council accepts this was fault but says there is no evidence of any detrimental impact to Ms Z.
40. The Council’s analysis of Ms Z’s injustice is contrary to the comments made by the care provider in the email quoted in paragraph 38. The care provider’s visit summary also shows most morning calls exceeded the allocated time. Therefore, it is evident that Ms Z needed more than the allocated 30 minutes every morning. However, Ms Z was not personally disadvantaged because carers stayed more than their allotted time to ensure her needs were met.
41. On 25 June Ms Y contacted the care provider via text message. She raised concerns that the morning carer had not changed Ms Z’s clothing or her incontinence pad. Ms Y also said the carer did not know what medication to administer. Ms Y also emailed the Council’s duty social worker to report her concerns.
42. In response, the care provider told Ms Y: “I have also verbally spoken to the morning carer of the 25th June 2022 who has assured me she changed your mother’s pad as she had defecated and cleaned her…. [Ms Z] said on two occasions she did not wish to change her clothing”.
43. The contemporaneous care notes show that Ms Z received four pad changes on 25 June. The notes also show that Ms Y changed from her nightwear into day clothes during the lunchtime call at around 1pm. For these reasons, I do not uphold this element of Ms Y’s complaint.
44. Ms Y says the care provider was not aware of the prescribed medication and there is no record of what its staff administered to Ms Z. Having reviewed the available records, I can see the care provider completed a Medication Administration Record [MAR] chart for the period it provided care in June 2022. Ms Z’s support plan also lists her medication. For these reasons, I do not uphold Ms Y’s complaint that staff did not know what medication to administer to Ms Z.

Complaint f) failure to allocate a social worker, complete annual reviews and find appropriate day centres

45. Shortly before Ms Z went to hospital in May 2022, Ms Y asked the Council to complete a re-assessment of her mother’s needs. She said this was necessary because Ms Z needed an additional day at the local day centre. Ms Z had attended twice a week, but Ms Y thought she would benefit from three visits to help her access the community and reduce her isolation.
46. The Council’s case notes show it agreed in early May to allocate a social worker to undertake the review. It explained to Ms Y that, in the meantime, Ms Z had an assessed need for two visits per week and any additional visits would need to be privately funded until the Council decided whether to increase the provision.
47. Nine days later, and before the Council had an opportunity to assess Ms Z, she was admitted to hospital. Whilst in hospital the allocated social worker assessed Ms Z and placed her on a waiting list for her preferred day centre. This is because the Council says the centre had no availability for an extra day.
48. Ms Y says the day centre did have capacity because it had agreed to a privately funded placement for the third day. She did not therefore understand why the Council placed Ms Z on a waiting list. I agree there is a contradiction between the information held by Ms Y and the Council and there is no evidence to show the Council checked this point with the day centre.
49. With that said, I consider it caused minimal injustice to Ms Z because she was only at home for a matter of days before being re-admitted to hospital and subsequently to intermediary care. Therefore, there was very little opportunity for her to access any additional day centre provision.

Complaint g) failure to consult Ms Y at key times

50. The Council has already accepted that it failed to consult with Ms Y at key times. This was imperative due to her role as LPA and the absence of any other suitable person to advocate for Ms Z. As a result, several key decisions were undertaken without appropriate consultation and representation. For example, the decision in December 2021 to reduce Ms Z’s care package and the May 2022 social care assessment.
51. This fault caused injustice to both Ms Y and Ms Z. This is because, for the reasons explained in paragraph 27, we do not know whether Ms Z’s support plan correctly reflected her needs. Had Ms Y had the opportunity to provide her input, the Council may have increased the call times. This uncertainty has caused distress to Ms Y.

Complaint h) injustice to Ms Y and Ms Z

52. In my view, the Council’s fault caused significant and avoidable distress to Ms Y and Ms Z for the reasons outlined in this statement. The Council will therefore implement the actions agreed in the section below.

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Agreed action

53. In recognition of the significant distress caused to Ms Y and Ms Z, the Council should make the payment it has already offered to Ms Y. This amounts to:
• £1000 for Ms Z
• £500 for Ms Y
54. The Council has also agreed to also:
• Provide evidence of the staff ‘learning’ undertaken following the failure to consider all available options to facilitate Ms Z’s hospital discharge in May 2022.
• Provide evidence of the action taken (supervisions and agenda items) to ensure amendments to packages of care are only made following a proportionate review or reassessment; and
• Provide evidence of the actions taken to ensure all relevant parties, and particularly LPAs, are consulted during all assessment and support planning decisions, unless dictated otherwise by the service user.
55. The Council has agreed to complete all of the above recommended actions within four weeks of my final decision.

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Final decision

56. I have completed my investigation with a finding of fault for the reasons explained in this statement. In our view, the Council has already offered a proportionate remedy for the injustice caused by fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman