Summary: There is evidence of some fault by the Council, in that it failed to provide support during a short period Mrs Y was without a second personal assistant. This placed additional stress on Ms X. On all other matters there is no fault by the Council.

The complaint

1. Ms X complains the Council has not provided a suitable level of care for her mother, Mrs Y.

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The Ombudsman’s role and powers

2. 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)
3. 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

4. I have:

• considered the complaint and discussed it with Ms X;
• considered the correspondence between Ms X and the Council, including the Council’s response to her complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Ms X and the Council an opportunity to comment on a draft of this statement, and considered the comments and information submitted by Ms X.

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What I found

Relevant legislation

5. The Care Act 2014 and the Care and Support Statutory Guidance 2014 (updated 2017) set out the Council’s duties towards adults who require care and support.
6. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs.
7. The Care Act 2014 says a council has a duty to safeguard adults. Section 42 of the Act says a council must make necessary enquiries if:

• it has reason to think a person may be at risk of abuse or neglect and
• the person has needs for care and support which mean he or she cannot protect himself or herself.

8. It must also decide whether it or another person or agency should take any action to protect the person from abuse or risk.
9. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. The Act (and the Code of Practice 2007) describes the steps a person should take when dealing with someone who may lack capacity to make decisions for themselves. It describes when to assess a person’s capacity to make a decision, how to do this, and how to make a decision on behalf of somebody who cannot do so themselves.
10. A key principle of the Mental Capacity Act 2005 is that any act done for, or any decision made on behalf of a person who lacks capacity must be in that person’s best interests. Section 4 of the Act provides a checklist of steps that decision makers must follow to determine what is in a person’s best interests. The decision maker also has to consider if there is a less restrictive choice available that can achieve the same outcome.
11. If there is a conflict about what is in a person’s best interests, and all efforts to resolve the dispute have failed, the Court of Protection might need to decide what is in the person’s best interests.

Background

12. This statement is not an exhaustive description of all the events that occurred in relation to this case, but an outline of the key issues as a background to the investigation’s findings.
13. Ms X first submitted a complaint to this office in March 2020 when all investigative work was suspended due to the pandemic. As time progressed matters evolved and Ms X contacted this office submitting further complaints about events beyond March 2020. We have exercised discretion to include these matters within the scope of the complaint.
14. Mrs Y is in her eighties and lives with her daughter Ms X. Mrs Y has dementia and needs full assistance with daily living activities. At the time of the events Ms X provided 22.5 hours formal support funded by a direct payment with the remaining care provided on an informal basis. Ms X herself has health problems.
15. At the time of the events complained about Mrs Y had a necrotic foot and was awaiting surgery. She received regular visits from a district nurse and an NHS podiatrist from the ‘High Risk Foot Team’ (HRFT).
16. Ms X says she expressed concern about Mrs Y’s leg to the district nurse and asked if she could take Mrs Y away on holiday to the south coast. She says the district nurse agreed a plan for Ms X to dress Mrs Y’s leg whilst on holiday. Ms X provided reports from the district nurse which support her claim. There is no evidence to show the district nurse advised against Mrs Y going on holiday.
17. The Council received a safeguarding alert on 21 July 2020 from the podiatrist attending Mrs Y. She expressed concern that Ms X may not be acting in Mrs Y’s best interest and that Ms X had been obstructive during her visit to Mrs Y on 17 July 2020. The podiatrist believed that Ms X was changing the dressing on Mrs Y’s leg against medical advice. She also reported that Ms X was planning to take Mrs Y on holiday to the south coast, which involved a long drive, and this was a cause for concern as Mrs Y’s leg needed to be elevated and she required pressure relief. She said the journey was likely to cause Mrs Y discomfort and that it appeared Mrs Y lacked capacity to advocate for herself. The podiatrist also discussed the concerns with Mrs Y’s GP
18. The Council held a safeguarding strategy meeting on 21 July 2020. The podiatrist’s concerns were recorded. The district nurse’s view differed from that of the podiatrist. She (district nurse) reported Ms X to be somewhat chaotic in her approach, but not obstructive, and that her behaviour during the podiatrist’s visit on 17 July 2020 was borne out of frustration as Mrs Y had not been issued with a specialist walker recommended by a vascular surgeon overseeing her care. The district nurse did not believe Ms X was changing Mrs Y’s dressings and said she had witnessed Mrs Y trying to scratch the wound which may have caused the dressing to come loose.
19. The Council arranged to visit Mrs Y on 27 July 2020 with the district nurse. Ms X took Mrs Y away on holiday before the visit could take place. The Council believed Mrs Y “… was not at immediate risk from [Ms X] and that an MDT would be arranged on [Mrs Y’s] return from holiday”.
20. Whilst on holiday Mrs Y’s foot became infected and she was admitted to a hospital on the south coast on 14 August 2020 where she underwent an amputation of her lower leg the following day.
21. On 17 August 2020 a hospital coordinator contacted the Council to express concern about Mrs Y and enquired if there were any open safeguarding concerns. The Council confirmed there was not but said concerns had been raised by the HRFT prior to Mrs Y going on holiday. The hospital coordinator said it was her belief that Mrs Y lacked capacity to be involved in conversations about her care needs and/or discharge destination. She said the hospital would be transferring Mrs Y to a hospital in her home area and the Council said it would reassess her needs from there.
22. Ms X contacted the Council on 18 August 2020 to confirm Mrs Y would be transferred back to a hospital in her home area. She requested a second person to provide 24hr support on Mrs Y’s discharge home. The Council said Mrs Y’s care needs would be reassessed and a discharge planning meeting would be arranged at the point she was deemed fit for discharge.
23. Mrs Y was transferred to a hospital in her home area on the 20 August 2020. An Occupational Therapist from the hospital contacted the Council to enquire about the layout of Mrs Y’s home and to say a gantry hoist installed in her home needed servicing as Mrs Y had been knocking her legs against it.
24. Ms X contacted the Council to confirm the date the hoist would be serviced. She said family members could support her to care for Mrs Y for a short period after she was discharged from hospital.
25. The hospital contacted the Council on 3 September 2020 to report concerns about Ms X’s behaviour on the ward. It said similar concerns had been reported by the hospital on the south coast. The Council says it had not received such concerns from the hospital on the south coast.
26. The Council arranged a meeting at the hospital for 8 September 2020. It informed Ms X about the concerns and said Mrs Y would remain in hospital until the meeting had taken place.
27. Ms X contacted the Council’s out-of-hours team on 6 September 2020 to ask for help arranging Mrs Y’s discharge from hospital. She said she believed Mrs Y had been hurt in the hospital and that she was being held against her will. The same day Ms X took Mrs Y from the ward and returned home without the knowledge or consent of the nursing staff. The hospital informed the Council’s out-of-hours team, who in turn telephoned Ms X to ask that she return Mrs Y to hospital. Ms X refused and the hospital contacted the police, who assisted in returning Mrs Y to the ward.
28. The hospital suspended Ms X’s visits until the meeting on 8 September 2020 had been held.
29. The Council made a referral for an Independent Mental Capacity Advocate (IMCA) for Mrs Y on 7 September 2020.
30. The meeting on the 8 September 2020 concluded Ms X’s visiting rights would be reinstated as per the hospital visiting policy, one hour per day. It was agreed that Mrs Y would remain in hospital until an Independent IMCA had been in contact and Mrs Y’s best interests were established. It said a discharge planning meeting would then be held.
31. The Council chased the agency responsible for allocating the IMCA referral on 10 and 12 September 2020. It said the referral was not considered a priority. It was informed on 22 September 2020 that an IMCA had been allocated. The Council was unable to contact the IMCA, so it contacted a manager at the agency. The manager confirmed the IMCA was on leave and the referral was reallocated to an available IMCA. The agency apologised. A Best Interest Meeting was arranged for 25 September 2020.
32. The Council assessed Mrs Y’s mental capacity on 11 September 2020 to establish if she was able to make decisions about where she should live and how her care needs should be met. This concluded Mrs Y’s “…cognitive state has restricted her ability to make any decisions”.
33. Ms X believed Mrs Y’s discharge from hospital was being delayed and that she was being deprived of her liberty.
34. Ms X submitted an application to the Court of Protection (COP) on 7 September 2020. I have had sight of the application. On 18 September 2020 the Court issued a COP1 form to the NHS and the Council’s deprivation of liberty safeguarding team (DOLS) instructing both parties to respond to the application with all relevant documentation within 14 days.
35. Ms X says the COP ordered that Mrs Y should be discharged home within two weeks and that care should be ‘organised’. I have seen no evidence which supports this. The evidence shows the COP considered the application on 2 December 2020, and the judge noted Mrs Y had been discharged from hospital on 30 September 2020 and proceedings were discontinued.
36. A ‘Best Interest’ meeting was held on 25 September 2020. Ms X was present and had support from a legal representative. All care and accommodation options were considered for Mrs Y’s discharge from hospital. The notes from the meeting record officers had “…already had a professionals meeting about this prior to [Mrs Y] requiring a foot amputation and the clinical professionals involved did not feel that [Mrs Y] was placed at risk by being taken away, nor did they feel that there was any evidence of skin damage as a result of poor care. District Nurses had overseen [Ms X] doing the dressings and were satisfied that whilst this is not the way they would do it, it was sufficient for [Mrs Y’s] needs. All parties acknowledged the importance of Mrs Y’s relationship with Ms X and agreed it was in Mrs Y’s best interest to return home with four care visits per day. Mrs Y was deemed to need two carers to support with transfers. Ms X would continue to provide 22.5 hours per week paid support and a second personal assistant would be sourced. The Council says Ms X agreed to provide care on an informal basis outside that of the formal care arrangements, and that family would assist where necessary.
37. A personal assistant was identified but the individual decided not to take up the role.
38. Mrs Y was discharged from hospital on the evening of 30 September 2020 and the Council’s re-ablement service commenced on 1 October 2020.
39. Ms X was dissatisfied with the care provided by the re-ablement service. She alleged carers had injured Mrs Y whilst transferring her in a hoist and that Mrs Y had sustained bruising & torn tendons.
40. The emails exchanged between Ms X and the Council in October 2020 show she was satisfied with some of the carers, describing them as ‘very good’ but was dissatisfied with others, and believed they were not caring for Mrs Y properly, and were ‘doing nothing’.
41. The Council says Ms X refused the re-ablement team access on numerous occasions. She was unhappy with the times of the visits and repeatedly cancelled visits. When carers were given access Ms X asked them to move Mrs Y in a way which contravened moving and handling guidelines.
42. A social worker and an assessor from the moving & handling team visited Mrs Y to review the situation. Ms X showed the officers CCTV footage of carers transferring Mrs Y. This confirmed the carers had not hurt Mrs Y. In an email to Ms X the officer acknowledges there “…had been difficulties in fitting the sling and we have requested that [officer A] and [officer b] attend the home to regularly review the moving and handling plan”.
43. An email sent by the Council to Ms X on 21 October 2020 says hoisting of Mrs Y was unsafe, and Mrs Y was to be cared for in bed until an appropriate sling could be found. The officer said neither Ms X nor her family should transfer Mrs Y until appropriate equipment was in place.
44. On 11 November 2020 Ms X informed the re-ablement team that she was taking Mrs Y on holiday and that they would return on 2 December 2020. The re-ablement team ceased its involvement.
45. Ms X contacted the Council on 13 November 2020 to say she was not going on holiday as planned and requested a sitting service. The Council commissioned an agency to provide a sitting service six hours per week, commencing on the 18 November 2020.
46. The re-ablement service was not reinstated, instead the Council reinstated the direct payment for 45 hours per week. Ms X was paid 22.5 hours as a formal carer and the remaining 22.5 hours were to fund a personal assistant.
47. A personal assistant was not recruited. The Council says there were difficulties with recruitment. Ms X asked that her son be appointed as second personal assistant. The Council refused. Ms X reported she was struggling with transferring Mrs Y and that she had hurt her back in the process. She says the Council then agreed to provide care for Mrs Y, but it failed to do so. It is not clear what action the Council took to ensure Ms X was supported by a second carer when transferring Mrs Y whilst a second personal assistant was recruited.
48. Ms X says the Council refused her request for respite care at home for Mrs Y and that it said respite care could only be offered in a residential care home, which Ms X says would have been a frightening environment for Mrs Y. Ms X says she asked the Council for a night-sit carer and two days sit-in support to allow her time off from her caring role. She says this was refused.
49. Ms X contacted the Council on the morning of 28 November 2020 to say her son had been involved in a road traffic accident. She asked that the sitting service be increased. The Council increased the service and arranged a sitter to attend later the same day, from 3pm until 10pm. The sitter returned the following day from 9.30am until 9.30pm. A sitting service was also agreed for the following week:

• Monday 9am to 3pm
• Tuesday 9am to 3pm
• Wednesday 9am to 3pm
• Thursday 9am to 3pm

50. Ms X asked that these times be changed to 12-6pm, the Council agreed. The service was extended to 10 December 2020, following which it was reduced to three days a week for six hours each day.
51. A needs assessment of Mrs Y completed by the Council in January 2021 records Ms X to be struggling in her caring role because of her own ill-health, that she was considered at risk of ‘carer breakdown’. The assessor recorded Ms X provided round the clock support to Mrs Y, partly on formal paid basis with the remaining care on an informal basis. And, that Mrs Y needed “...2:1 for all transfers. [Ms X] transfers her on her own as an informal carer and our OT Team are satisfied that although this method cannot be used by formal carers, it is adequate and not placing [Mrs Y] at risk”.
52. The outcome concluded Council commissioned services would be provided for Mrs Y, along with a sitting service and respite. It is not clear if, and when commissioned support commenced.
53. I have had sight of a carers assessment the Council completed in January 2021 in which Ms X sets outs her wishes and feelings and the impact of her caring role. It is clear Ms X was in difficult circumstances, that she was finding her caring role demanding and that it was impacting on her health. She reported she could not continue without support. At this point Ms X had support from the sit & support service three times a week.
54. In mid- January 2021 the care agency providing the sitting & support service reported Ms X was asking carers to use, what they believed to be unsafe transfer techniques. It was reported that carers had moved Mrs Y without a hoist. Ms X also asked carers to remove their footwear. Concern was expressed about carers transferring Mrs Y in socks on a tiled floor. A manager from the care agency was asked to investigate.
55. The investigation concluded carers had used the equipment incorrectly and that this had caused redness and shearing to Mrs Y’s hip which lasted for two days. Officers completed a “protection plan for all carers to read the moving and handling plan and also for carers to be refreshed on moving and handling”.
56. A surveyor contacted the Council’s OT to report several missed and cancelled visits to Mrs Y in relation to a ceiling track hoist, and when the surveyor telephoned Ms X she said the hoist was no longer needed.
57. In February 2021 carers reported that Mrs Y had swelling to her lip and bruising to both knees. Ms X said the injuries had been sustained when Mrs Y fell out of her wheelchair. Ms X contacted the Council to report Mrs Y had been hurt by carers during transfers using the standing hoist. The officer taking the call advised Ms X that the hoist should not be used until a social worker had been involved. The same day a social worker made three attempts to contact Ms X without success. The social worker contacted the care agency, and it reported a red mark to Mrs Y’s hip. It said carers had used the hoist as advised in the moving & handling plan. Ms X had advised carers not to use the hoist when moving Mrs Y.
58. The social worker recorded a discussion with managers, and that Ms X had declined the proposed ceiling track hoist. A meeting between officers was convened four days later.
59. The records show contact between Ms X and the social worker. Ms X confirmed carers were manually moving Mrs Y, that she requested a revised care plan, and that she wanted the social worker to amend the care & support plan to reflect how she (Ms X) wished to transfer Mrs Y. She also requested an advocate. The social worker added Ms X to the waiting list for a manual handling course.
60. An OT and a manager visited Mrs Y the same day. The notes of the visit show a discussion about a commode and carers incorrect use of a sling, which had caused the red mark to Mrs Y’s hip. Ms X reported carers were not adhering to the moving & handling plan. Ms X said she did not want a permanent ceiling hoist. Mrs Y’s sitting and sleeping arrangements were also discussed. It was agreed that carers transfer techniques would be reviewed.
61. Ms X later supplied the OT with a video clip showing Mrs Y being transferred. The OT offered to visit Ms X in March 2021 to review all transfers and provide training to Ms X in the use of the sling and hoist. Ms X said Mrs Y was much stronger and asked the OT about standing transfers. The OT said a full review would be needed before any changes were made to the moving & handling plan. Ms X asked that this be done as soon as possible.
62. The OT completed the review on 3 March 2021. Care staff were also present. Records show Ms X was satisfied with the outcome of the review and that everyone was ‘happier’.
63. On some occasions during March 2021 the care agency were unable to provide a sitting service for Mrs Y because of staffing difficulties due to Covid. The Council commissioned another care agency to provide support. Ms X said she wanted the temporary care agency to provide the sit & support service permanently. The agency was unable to take on the service on a permanent basis but agreed to cover the visits until a new care agency could be found. However, it was unable to guarantee set days and did not provide a sitting service on bank holidays.
64. In March 2021 Ms X enquired about a direct payment. She said a carer known to the family had become available. The Council reminded Ms X this worker had been previously unreliable and that the new arrangements were working well. Ms X agreed. Ms X later contacted the direct payment service to make the request again. The social worker informed the direct payments team that Mrs Y required 2:1 with transfers and the options need to be discussed further with Ms X. The records show some disagreement between Ms X and the social worker about the proposed support hours Mrs Y needed.
65. Ms X reported some deterioration in Mrs Y’s health and that she needed hoisting in the afternoons, that she (Ms X) was tired and that she had still not received hoist training.
66. On 31 March 2021 carers reported an incident at Mrs Y’s home involving Ms X’s son. Carers reported feeling unsafe and expressed concern for Ms X. The social worker contacted Ms X who said she was struggling with her son as he was recovering from a road traffic accident, and he was taking strong prescription drugs for pain. Ms X said she was taking Mrs Y to stay in their holiday home in another county.
67. The Council authorised the fitting of a ceiling hoist in March 2021.
68. In April 2021 the OT made several unsuccessful attempts to contact Ms X to arrange visits to discuss a ramp and repair, and repositioning of the hoist because Ms X had moved Mrs Y’s bed to another part of the room.
69. The Council approved a direct payment to fund Ms X’s daughter as Mrs Y’s personal assistant. Ms X said both she and her daughter needed training to use the hoist.
70. The OT contacted Ms X again in early May 2021 to discuss issues relating to a ramp and the repositioning of the gantry hoist, which required authorisation from the OT. The records show a delay in the installation of the ceiling hoist because of a delay with paperwork.
71. Ms X informed the Council the ceiling hoist fitted would be installed in July 2021 so repair and repositing of the gantry hoist was unnecessary.
72. The records show the Council responded to Ms X’s request for additional sit & support in May and June 2021. On occasions Ms X requested a change of dates, and on each occasion the Council contacted the care agency to rearrange dates. Where this was not possible it sourced the service from different providers.
73. Ms X contacted the Council again in July 2021 to say the second personal assistant (Ms X’s daughter) was not present and that she was struggling to transfer Mrs Y. She said Mrs Y’s ability to transfer had recently deteriorated and the officer advised Ms X to seek advice from Mrs Y’s GP. Ms X said her brother had assisted with Mrs Y’s transfer into bed, but Ms X was concerned she would be unable to manage the following morning. She said she was without adequate support and intended to contact a solicitor.
74. The Council requested a physiotherapist visit Mrs Y the following morning. The records of this visit show Ms X and her daughter to be present and that Ms X’s daughter could no longer undertake her duty as Mrs Y’s personal assistant. Ms X’s daughter reported the ceiling hoist to be broken. Ms X was advised to contact the company responsible for repair of the hoist. The physiotherapist recorded a disagreement with Ms X’s daughter about the arrangement of repair and use of the hoist.
75. Ms X contacted the Council again later the same day to say she would contact the hoist repair company and to complain about the attitude of the physiotherapist. She asked that the urgent care team provide support to transfer Mrs Y.
76. The urgent care team contacted Ms X the same day. A portable hoist was offered. Ms X again refused saying it would frighten Mrs Y and said she usually transferred Mrs Y without a hoist. The officer asked to visit Ms X to develop a plan. Ms agreed to a visit later that evening. The notes of the officer’s visit show that Mrs Y was already in bed when she (officer) arrived, and that no assistance was required. The officer offered to visit the following morning and Ms X agreed.
77. An officer from the urgent care team attended Mrs Y’s home the following morning. Ms X did not answer the door. The officer followed up with a telephone call to Ms X to ask if Mrs Y would need care that evening. Ms X said not.
78. On 23 July 2021 the care agency providing the sitting & support service contacted the Council to say it could no longer provide the service. The Council informed Ms X and said it may not be able to source another agency immediately as care agencies were having staffing difficulties. The Council arranged manual handling training for Ms X at the end of July 2021.
79. Ms X contacted the Council in a distressed state the following day to say she needed to go shopping and could not leave Mrs Y alone. The Council contacted two agencies to ask if they had capacity to provide a sit & support service that day. Both agencies said no. The Council contacted Ms X to say the only available option for Mrs Y was a temporary residential care placement.
80. Two days later an OT visited and sat with Mrs Y whilst Ms X attended a manual handling course.
81. On 29 July 2021 Ms X informed the Council she had sourced another personal assistant for Mrs Y and that she wanted the individual to start work on 6 August 2021. The Council arranged for the individual to have manual handling training.
82. The Council increased Mrs Y’s support hours to 18 per week. Ms X informed the Council she had possibly sourced another personal assistant to provide support on weekends.
83. An OT visited Mrs Y on 12 August 2021 to say the new ceiling track hoist would be installed on 20 August 2021. Ms X said she had agreed the end of August 2021 with the installation company. The OT contacted the company to confirm the arrangements and was told a further survey was needed as Ms X had moved Mrs Y’s bed. The company said Ms X had contacted it the previous month to ask that it remove the gantry hoist as it was not in use. Ms X asked that the gantry hoist be repositioned urgently. The OT advised this would need to be arranged with the maintenance company. The OT arranged for the gantry hoist to be serviced and repositioned on 20 August 2021.
84. The OT later confirmed Mrs Y’s bed would need to be positioned back to its original position and the gantry hoist would be serviced and ready for use. The OT telephoned Ms X to confirm access for the following day. Ms X told the officer she did not want the hoist serviced and only wanted it moved. The OT said the hoist required maintenance and without it was not under warranty. Ms X disconnected the call.
85. The maintenance company reported it had been unable to access the property to service the hoist.
86. The OT made serval attempts to agree dates to visit Mrs Y. Ms X was not available on any of the dates suggested.
87. The records show the OT’s concern about Mrs Y’s home situation, that the ceiling track hoist had not been installed because Mrs Y’s bed had been moved, the gantry hoist had not been serviced and Ms X’s lack of engagement in dealing with these issues. The OT reported Ms X refused to explain to the OT how she was managing to get Mrs Y in and out of the property.
88. Ms X contacted the Council on 20 October 2021 to say she and Mrs Y were intending to move to the south coast later that month or the beginning of the following month. The Council advised Ms X to contact social services in the area she was moving to.
89. On 22 October 2021 the police alerted the Council to an incident at Ms X’s home between Ms X and her son. A social worker completed a welfare visit the same day. The officer said Mrs Y lacked capacity to decide where she should live and that such a decision needed to take via a best interest decision. She said Mrs Y required an advocate. Ms X was unhappy with this as she did not feel it was necessary.
90. Following the visit, the Council referred the matter to its legal team. It contacted Mrs Y’s GP and contacted social services in the area Ms X intended to relocate. It made a referral for an advocate for Mrs Y.
91. On 28 October 2021, the Council received a telephone call from the social services team in the area Ms X was moving to, to say Ms X had contacted it to say she was moving that day. It said it had strongly advised Ms X not to move that day as it was experiencing a care crisis and did not have capacity to provide support to Mrs Y, and because there was no aids and adaptions installed at the new property.
92. The Council contacted Ms X and agreed a date to visit Mrs Y to assess Mrs Y’s capacity to decide where she should live.
93. The visit took place on 17 November 2021. During the visit officer established Mrs Y did not have capacity to decide where she should live. Officers reported Ms X to be extremely agitated throughout the visit and the situation to be volatile. A decision was taken to leave the property.
94. Following the visit, the Council submitted an application to the Court of Protection on 26 November 2021 seeking an order allowing it to obtain access to Mrs Y. It was concerned access to Mrs Y may be restricted and that this would prevent the completion of necessary assessments.
95. Paperwork from the Court of Protection dated 25 January 2022 shows the Council was liaising with the council in which Ms was relocating to support Mrs Y’s transition to the new area.
96. However, as it no longer had any statutory responsibility for Mrs Y it sought permission from the Court to withdraw its application. This was granted and the proceedings were discontinued.
97. Mrs Y continues to live outside of the Council’s area.

Analysis

98. It is not the Ombudsman’s role to determine a person’s care and support needs, that is the Council’s role. It also not the Ombudsman’s role to direct the Council in its day-to-day decision making. It is the Ombudsman’s role to consider if there was maladministration (fault) by the Council in how it made its decisions.
99. It is clear the situation in which Ms X found herself was complex and that she was a carer under stress. It is also clear Ms X was concerned for Mrs Y’s wellbeing, and she believed she knew what was best for her. Whilst I have no reason to doubt Ms X’s good intentions, my role is to consider if there was fault in the Council actions or in the way it made decisions. If there was not, then I cannot question/criticise the decisions it made.
100. I note the difference of opinion between the district nurse and the podiatrist about Ms X’s attitude towards professionals dressing Mrs Y’s foot. Information provided by Ms X shows the district nurse was aware Mrs Y was going on holiday and that she (district nurse) did not advise against it.
101. The podiatrist expressed concern about the proposed holiday to the Council. Councils have a duty to instigate safeguarding enquiries if it believes an adult in need of care and support to be at risk. The purpose of a safeguarding enquiry is to clarify matters and then decide on what course of action, if any, is required.
102. Ms X and Mrs Y left for their holiday before enquiries were underway. As the Council considered Mrs Y not to be at any immediate risk it suspended its enquiries. It came to this decision after considering all available information. There is no fault by the Council here.
103. Following Mrs Y’s emergency admission to hospital whilst on holiday, staff at the hospital contacted the Council to raise concerns about Mrs Y, and the behaviour of Ms X on the ward. The Council planned to reassess Mrs Y’s care needs following her repatriation to a hospital near her home.
104. After repatriation Ms X removed Mrs Y from hospital without notice or consent of the ward, the Council instigated immediate safeguarding procedures and arranged a best interest meeting. Its actions were proportionate and in accordance with the law. I find no fault by the Council.
105. Ms X was suspended from visiting Mrs Y in hospital. This action was taken by the NHS, not the Council and so I cannot say there was fault by the Council here.
106. There is evidence of some delay in the involvement of an IMCA for Mrs Y which resulted in a delay holding a best interest meeting. The agency responsible for appointing the IMCA was responsible for the delay, not the Council. The records show the Council contacted the agency to query the delay and chase the appointment of an available advocate.
107. I have seen all the documents associated with the assessment of Mrs Y’s capacity to make decisions about where she should live, and documents relating to the subsequent best interest decisions taken. There is no evidence of fault by the Council in this process. It acted proportionally and in accordance with the law.
108. In respect of Ms X’s application to the Court of Protection. The Court documents show proceedings were discontinued because Mrs Y had been discharged from hospital. There is no evidence to support Ms X’s claims that the Court made any direction to the Council in respect of Mrs Y’s care needs. There is no fault by the Council here.
109. There is no evidence to support Ms X’s claim that Council delayed Mrs Y’s discharge from hospital or that it delayed providing domiciliary care following her discharge. Mrs Y was discharged from hospital early evening and care commenced the following morning. The Council endeavoured to meet Ms X’s requests where possible, sometimes with very little notice. There is no fault by the Council here.
110. Some of the care Ms X provided to Mrs Y was on a formal paid basis. The Council says Ms X agreed to undertake the remaining care on an informal basis. The evidence I have seen upholds the Council’s claim, that Ms X was happy to care for Mrs Y formally and informally with support.
111. Ms X was dissatisfied with the care provided, saying incorrect use of a gantry hoist had caused Mrs Y to sustain injuries. Whilst the evidence shows some incorrect use of a sling there is no evidence which shows Mrs Y had been injured by use of the gantry hoist. Mrs Y did sustain chaffing to her thighs as a direct result of carers incorrect use of the sling. The Council investigated the matter properly and took appropriate action to prevent a recurrence.
112. The reablement team ceased its involvement with Mrs Y after Ms X said she was taking Mrs Y on holiday in November 2020. Three days later Ms X informed the Council that her plans had changed and that she required a sitting service. The Council responded and commissioned an agency to provide a sitting service, starting five days later. Given the last-minute change of plan, and that there was no emergency, I consider the timeframe acceptable. There is no fault by the Council here.
113. Following the cessation of reablement care the Council increased Mrs Y’s direct payment to fund a second personal assistant. At the time there was no second personal assistant employed. This left Ms X caring for Mrs Y alone. The Council refused Ms X’s request that her son be a formal personal assistant for Mrs Y. Legislation allows a council discretion to decide such requests. In this case the Council deemed Ms X’s son not to be an appropriate carer. Whilst Ms X may have disagreed with the Council’s decision I have seen no fault in the decision-making process which would lead me to question or criticise the decision.
114. However, the Council’s decision left Ms X as the only carer until her daughter was appointed as a second personal assistant. By the Council’s own admission Mrs Y needed two carers for transfers. It appears no arrangements were in place to support Ms X with transfers until Ms X’s daughter was in post. This placed Ms X additional stress and strain and impacted on her wellbeing. This is fault by the Council.
115. When Ms X asked the Council for respite care it said this could only be provided in a residential care setting, which Ms X refused. Ms X was a carer under stress and her request appears to be less about respite care and more about needing more support at home. This should have alerted the Council to the fact Ms X was struggling as a sole carer. The sit & support service provided Ms X with relief from her caring role, it was not a substitute for a second personal assistant.
116. The formal support provided by Ms X’s daughter appears to have been somewhat chaotic and the Council offered additional support where needed. There is no evidence of fault by the Council here.
117. There were numerous issues relating to the assessment and fitting of a ceiling hoist. Although there was some delay in completing the paperwork for the ceiling hoist I consider this had little impact on the fitting of the hoist. Ms X’s lack of cooperation was the primary cause of the delay. Had she not relocated Mrs Y’s bed to another part of the room then the existing hoist could have been used. This would have alleviated some of the issues of transferring Mrs Y.
118. Whilst there is some evidence to suggest the Council delayed in arranging training for to use the hoist. I do not consider this caused any significant injustice because of the reasons set out in the paragraph above.
119. There is no evidence of fault by the Council in its application to the Court of Protection. The Council was concerned for Mrs Y’s wellbeing and staff had no legal of power to enter her home. It was concerned Ms X may deny access and it sought legal intervention to ensure unimpeded access to Mrs Y. It acted proportionally and in accordance with the law. Proceedings ended because Ms X & Mrs Y made a permanent move to another part of the country. There is no fault by the Council here. 

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Final decision

120. There is evidence of some fault by the Council. The Council failed to provide support during a short period Mrs Y was without a second personal assistant. This placed additional stress on Ms X for which the Council should apologise. Given the short timeframe I do not consider the level of injustice warrants any further remedy.
121. On all other matters, there is no evidence of fault by the Council.
122. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman