Summary: Miss X complained the Council has failed to provide suitable supported housing or an appropriate package of care and support to meet her son, Mr Y’s needs. The Council’s repeated failure to ensure Mr Y received the care and support required to meet his assessed needs is fault. This fault has caused Mr Y and Miss X an injustice.

The complaint

1. The complainant, Miss X complained the Council has failed to provide suitable supported housing or an appropriate package of care and support to meet her son, Mr Y’s needs. This failure has had a detrimental impact on Mr Y’s and Miss X’s health and wellbeing.
2. Miss X is supported in bringing this complaint by Mr Z.

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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 cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, 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)
6. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I have and have not investigated

7. I have only considered events since 2023. I am aware Miss X had concerns about the care Mr Y received in the years prior to 2023 but these do not form part of my investigation. It was open to Miss X to raise these concerns earlier.

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How I considered this complaint

8. As part of the investigation, I have:
• considered the complaint and the documents provided by Mr Z;
• made enquiries of the Council and considered the comments and documents the Council provided;
• discussed the issues with Mr Z;
• Mr Z 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

9. Mr Y requires care and support with all daily activities. He received a package of support but failings in the service meant Miss X had to provide much of Mr Y’s care. This led to a breakdown in Miss X and Mr Y’s relationship and affected their wellbeing.
10. In January 2023 Miss X took Mr Y to the local hospital as she had reached breaking point and could not continue to care for Mr Y. Carers were scheduled to visit four times a day, but Miss X said they often only came once or twice and when they did, the carers did not fully support Mr Y’s needs.
11. The Council agreed to look for supported accommodation for Mr Y. Mr Y was discharged from hospital to temporary supported living accommodation in February 2023, with a view to finding permanent accommodation. As Mr Y’s needs could not be met by the supported living placement, the Council arranged a package of care and additional support. Within a few weeks Miss X raised concerns with the Council about the level of care Mr Y received. Miss X raised further concerns in March 2023 and the Council arranged for a different care provider to support Mr Y.
12. In April 2023 Mr Z complained to the Council about the shortcomings in the care Mr Y received and neglect. He was concerned Mr Y was at risk physically and psychologically unless the Council took action.
13. The Council’s records show it treated this as a safeguarding referral and an officer discussed the concerns with the care providers and managers at the placement. The Council subsequently closed the safeguarding referral as the risks had been mitigated by Mr Y leaving the placement.
14. Miss X had also raised concerns about the care providers not supporting Mr Y and told the Council Mr Y had returned to live with her. A social worker visited Mr Y and Miss X at home in April 2023 to review Mr Y’s support needs. Following this meeting the social worker made referrals to a charity for support at a day centre, and an advocacy service. The also asked Mr Y’s GP for a medication review and completed the Continuing Health Care (CHC) checklist.
15. In mid-May the family ended the care package with the current care providers. Miss X said the carers had repeatedly missed calls and when carers did attend they did not provide the correct support.
16. The Council found a new care provider who began supporting Mr Y at the end of the month. This care provider asked the Council to increase the package to two carers at each visit was Mr Y was unsteady and at high risk of falls. The Council agreed and also increased the package to include a lunchtime call.
17. Miss X immediately raised concerns about the standard of care provided. She was concerned that carers were not supporting Mr Y to be independent and would not assist him to shower. Miss X says Mr Y’s social worker contacted the care provider but the situation did not improve before the social worker left the Council.
18. Miss X asked for an urgent review of Mr Y’s care package in early July 2023. She told Mr Y’s new social worker that when carers turn up they do not stay for the allocated time and often do not know what they are expected to do. Miss X said the carers do not wash Mr Y or change his incontinence pads. As the care providers were not providing the required support she asked them not to visit. Miss X and Mr Y’s brother had resumed providing Mr Y’s care.
19. The social worker visited Mr Y and Miss X in late July 2023 to review Mr Y’s support plan. The notes of the visit say Miss X was the only one providing care to Mr Y and she was finding it difficult to cope or meet his needs. Mr Y told the social worker he did not want to return to supported living and instead wanted new carers. The social worker then made a further referral to the advocacy service and the charity for day centre support for Mr Y. They also made referrals for a carers assessment and an OT assessment and sought an alternative care provider.
20. Mr Z made a complaint to the Council on Mr Y and Miss X’s behalf. The Council responded in early August 2023. It identified five areas of concern and responded to each in turn. It partially upheld a complaint about a lack of contact but noted a new social worker had now been allocated and had contacted Miss X.
21. The Council confirmed that all actions agreed at the review meeting in April 2023 had been carried out. It also confirmed it had not received the outcome of a Continuing Healthcare (CHC) assessment in May 2023.
22. In relation to Mr Z concerns about a lack of emotional and motivational works, the Council noted a placement in a supported living facility, which would have provided social, emotional, and motivational support, did not go ahead. Instead a long-term package of care was put in place at the end of May 2023 as Mr Y was going to remain with Miss X. The support plan was task orientated to meet Mr Y’s personal care needs. The Council said there was no evidence of a discussion or agreement to include emotional or motivational support. It did not uphold this complaint.
23. Mr Z was not satisfied by the Council’s response and asked for his complaint to be considered further. The Council reviewed his complaint and responded in early September 2023. The Council reiterated and expanded on its earlier response but did not change its views save in relation to the CHC assessment. The Council noted the NHS was responsible for communicating the outcome of the CHC assessment but given the passage of time the Council had chased an update.
24. The NHS informed Mr Y in August 2023 that he was not eligible for fully funded NHS Continuing Healthcare but if he decided to move to a nursing home the NHS would contribute towards his fees.
25. The Council identified a new care provider in early September 2023. The care provider carried out a risk assessment and asked for an urgent OT referral before they could provide a package of care. An OT visited Mr Y on 6 September 2023. Following the assessment they advised the Council Mr Y did not need any equipment, but raised concerns that Miss X was at crisis point.
26. The care provider began supporting Mr Y on 6 September 2023. On 13 September 2023 Miss X raised concerns about the carers and asked that they did not attend until a Better Care at Home assessment confirmed whether Mr Y needed one or two carers. The assessment determined Mr Y needed one carer and the family asked for the care package to resume. The package restarted on 22 October 2023.
27. On 23 October 2023 Miss X told the Council the carers were not carrying out the care package properly and had not stayed for the full allocated time. The social worker carried out an unannounced visit the following day to see how the care call was carried out. The Council’s records note the carer arrived 20 minutes late and did not complete all the intended support. The carer then left after 15 minutes.
28. The social worker raised these concerns with the care provider who investigated and advised there had been some misunderstanding with the care the carers had been able to carry out. It was agreed where possible Mr Y would be supported by female carers.
29. The following week Miss X raised further concerns about the carers not completing tasks or staying for the full call. In November 2023 the family asked the Council to identify an alternative care provider. A new provider began supporting Mr Y in December 2023. In late December Miss X told the Council she was unhappy with the service being provided as carers were not carrying out Mr Y’s personal care effectively or supporting him with transfers between bed and the chair. Miss X asked the Council to reassess Mr Y and consider a nursing placement as she was no longer able to manage his care and support needs.
30. Mr Z and Miss X remain dissatisfied with the Council’s actions and response to their complaints and have asked the Ombudsman to investigate their concerns. Mr Z says the Council has failed to follow up on details of the poor care provided or to properly assess Mr Y and Miss X’s needs and make long term plans.
31. Since complaining to the Ombudsman Miss X and Mr Y have again discussed the poor care and support Mr Y has received with the social worker. They asked whether funded nursing care was still available so that Mr Y could move out.
32. The Council submitted a new CHC checklist and a further CHC assessment was completed in April 2024 which confirmed Mr Y was not eligible for fully funded NHS Continuing Healthcare but would be eligible for a funded nursing care contribution if he moved to a nursing home.
33. In May 2024 the Council determined Mr Y meet the criteria for a nursing placement. The Council’s records note that as Miss X and Mr Y had lost faith, Miss X should be involved in finding a suitable placement.
34. Mr Z says the Council told Miss X she had to find a suitable nursing home and has not provided any assistance. Miss X and Mr Z have been unable to identify a placement within the budget indicated by the Council. Mr Y remains at home with Miss X who is struggling to meet his needs.

Analysis

35. It is clear from the documentation that there have been failings in the care and support provided to Mr Y, which have led to Miss X having to try and meet the shortfall.
36. 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.
37. The Council commissioned six different care providers to support Mr Y in 2023, and Miss X has raised concerns about all of them. In the majority of cases Miss X has reported that the carers do not carry out the required personal care, in particular washing or assisting Mr Y to shower, and that carers do not stay for the allocated time. It is concerning that despite repeatedly changing care providers Mr Y did not consistently receive a care package that met his needs.
38. The same failings in care appear to have followed on from one care provider to the next. And there is no evidence the Council has taken action identify why, or to address this.
39. The records show the Council spoke to the supported living placement and first care provider as part of the safeguarding investigation. It says it also completed a service quality and deficiencies form in relation to this care provider. But there is no record of any investigation into the reported failings in the service provided by the other care providers.
40. Even after the unannounced visit where the social worker witnessed the carer arrive late and leave early having not completed the required support, there is no evidence of a proper investigation. The Council appears to have accepted the care providers explanation of a misunderstanding with the care to be provided. However, there is no record of any review of the care provider’s understanding of how the plan should be implemented or of any follow up visits or review of the care records to ensure the correct support was provided. Nor have I received evidence of any attempts to verify whether carers attended and stayed for the full visits.
41. There have also been periods when Mr Y did not receive the agreed care package at all as the Council had not identified a suitable provider.
42. The Council’s repeated failure to ensure Mr Y received the care and support required to meet his assessed needs is fault.
43. The Council has agreed a nursing placement needs to be found to promote both Mr Y and Miss X’s welfare and safety. However I have not received any evidence the Council has taken any action to facilitate this. Miss X says the Council has given an indicative budget of just over £1000 and told she is responsible for finding a suitable placement. This is clearly unacceptable and we would expect the Council to proactively assist in sourcing a suitable placement. And where one cannot be found within the Council’s usual terms and conditions, including fees, alternatives must be considered.
44. In response to the draft decision the Council as confirmed it has allocated a new social worker who will work with Mr Y and Miss X to assess Mr Y’s care needs. Based on the outcome of this assessment it will arrange appropriate care in the least restrictive environment.
45. Having identified fault I must consider whether this has caused Mr Y and Miss X an injustice. Where carers missed calls or did not complete the care duties in full Miss X and her family have had to step into care for Mr Y. It is clear from the documentation, and I have no doubt the Council is aware of, the difficulty this causes Miss X and the impact this has on Mr Y and Miss X’s relationship and their wellbeing.

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Agreed action

46. The Council has agreed to:
• Apologise to Mr Y and Miss X for the failure to ensure Mr Y consistently received the care and support required to meet his assessed needs and the difficulties this caused them. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• Pay Mr Y £500 to recognise the distress and difficulties he experienced as a result of the fault identified;
• Pay Miss X £700 to recognise the distress and difficulties she experienced and time and trouble she was put to as a result of the fault identified;
• Review the support in place to ensure the current care provider is meeting Mr Y’s care needs;
• Assist Miss X and Mr Y in arranging appropriate care for Mr Y and, if appropriate, in identifying a suitable nursing placement;
47. The Council should take this action within eight weeks of the final decision on this complaint and provide us with evidence it has complied with the above actions.

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Final decision

48. The Council’s repeated failure to ensure Mr Y received the care and support required to meet his assessed needs is fault. This fault has caused Mr Y and Miss X an injustice.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman