Summary: The Council is at fault at it failed to make reasonable adjustments to help Mr Z to complete his housing application and the care workers were late to Mr Z’s scheduled care calls which will have caused distress to him. The injustice to Mr Z cannot be remedied. The care provider is also at fault as it did not follow its procedure when Mr Z could not be contacted. This caused distress and uncertainty to Ms Y which the Council has agreed to remedy by apologising and making a payment of £250 to her.

The complaint

1. Mrs X and Ms Y complains on behalf of the late Mr Z. They complain:
1. The Council failed to make appropriate adaptations or provide Mr Z with suitable equipment which would meet his mobility and visual impairment needs when discharged from hospital. As a result Mr Z could not use his bathroom, leave his property to meet friends or make himself a drink in his kitchen.
2. The Council failed to understand the combined impact of Mr Z visual impairment and mobility needs when carrying out the occupational therapy assessment and care act assessments. As a result Mr Z mobility needs were not met and his care package was insufficient to meet his needs.
3. The Council did not provide adequate assistance to Mr Z with making an application for the housing register so it took him a long time to complete the application due to his visual impairment.
4. The Council did not provide adequate assistance to Mr Z to make bids on properties as his social worker failed to bid on a property he had high priority for while his housing support officer was on leave. As a result Mr Z was unable to move to more suitable accommodation.
5. The care provider did not meet Mr Z needs as carers did not visit him at the required times so he missed meals. Carers also did not understand the combined impact of his visual impairment and mobility needs which caused frustration to him.
6. Carers did not attend the morning visit on 1 October 2020 or did not seek timely assistance when Mr Z did not answer the door on that day. This was despite knowing Mr Z had been unwell the previous day. As a result Mr Z family have some uncertainty as to whether carers could have assisted Mr Z.

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The Ombudsman’s role and powers

2. 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)
3. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
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. I have:

• Considered the complaint and the information provided by Mrs X and Ms Y;
• Discussed the issues with Mrs X and Ms Y;
• Made enquiries of the Council and considered the information provided;
• Invited the Council and Mrs X and Ms Y to comment on the draft decision. I considered any comments received before making a final decision.

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What I found

6. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
7. The care provider has a procedure to follow for when a service user cannot be contacted. This provides the care worker should check the property to see if they can see the service user, check with neighbours, wardens and key holders. If there is still no sign then they should inform the office. The office should then ring the service user. If they still can’t be contacted they should ring the next of kin or keyholder or emergency contact. If the service user is still not contactable the office should ring the social work team and police.
8. Councils have a duty under the Equality Act 2010 to ensure a disabled person can use a service as close as it is reasonably possible to the standard offered to non-disabled people. If a disabled person requests an adjustment, the Council must make it if it is reasonable.

What happened

9. Mrs X was Mr Z’s advocate and Ms Y was his partner. A hospital discharged Mr Z following surgery for a below knee amputation. Mr Z needed to use a wheel chair and also had a visual impairment. The Council provided reablement for six weeks to support Mr Z with his personal care when he was discharged.

Occupational therapy and Care Act assessments and care

10. The Council’s records note an occupational therapist (OT) carried out a joint assessment with therapists from the hospital at Mr Z’s home on the day he was discharged. The OT found the doorways in Mr Z’s property needed widening to accommodate his wheelchair and he could not access his kitchen, bathroom, front door and communal front door in his wheelchair. Major works were required to make the property fully wheelchair accessible and would need to be funded by a disabled facilities grant so the OT considered rehousing may be a better option. The OT’s assessment notes her assessment of Mr Z’s mobility and recommended some initial equipment would be provided. This included a ramp for the front door. The Council’s records note the OT raised the order for the ramp the following day.
11. The Council’s records note an OT and sensory rehabilitation officer visited Mr Z two weeks after his discharge to assess him for sight aids. The record notes that Mr Z declined sight aids for the kitchen but would contact the Council if he required any further equipment. The OT also assessed Mr Z use of his wheelchair around the flat and noted his difficulties in accessing the kitchen and bathroom. The record of the visit also notes the OT reviewed whether works could be carried out to make the flat wheel chair accessible and her view that it may not be possible. Mr Z agreed to consider rehousing rather than works to the flat. The OT referred Mr Z to housing for support.
12. The Council carried out a Care Act assessment for Mr Z to asses his need for support when reablement came to an end. Officer B, social worker, carried out the assessment with Mr Z by telephone, rather than face to face, due to the COVID19 pandemic. Officer B considered Mr Z was eligible for care and support and drew up a support plan and care package for Mr Z. This provided care workers would call in the morning and evening to assist Mr Z with meals and personal care
13. The Council’s records show Mrs X contacted the Council to raise that Mr Z urgently needed independent living equipment as he was finding it difficult to transfer from his wheelchair to access the kitchen. She also raised the provision of equipment, including the ramp, had been delayed. Officer B referred Mr Z for a review of his equipment. The Council records show an OT carried out a review for Mr Z and found he was managing with his equipment but he could not use the ramp. She also requested an additional care visit for Mr Z to help him manage in the kitchen.
14. Officer B discussed this with Mr Z and offered a further visit to allow Mr Z to access to community. Mr Z agreed the lunch time visit from care workers but declined the visit to access the community. In response to my enquiries the Council has said equipment was provided to support Mr Z with his mobility but both OTs were of the view they had reached the limits of what could be achieved within Mr Z’s property.
15. Mrs X raised concerns with officer B about care workers not attending the scheduled visits on time and on occasions missed a visit. Officer B contacted the care provider to stress the importance of visiting Mr Z in accordance with his support plan and the care provider undertook to raise this with the care workers. In response to my enquiries the Council has acknowledged that some visits were late and much later than planned. Mrs X said the timing of the visits had improved but later raised further concerns. Officer B intended to review Mr Z’s care with him and the care provider but Mr Z passed away before the review could take place.

Housing

16. Officer A made a referral to Bolton for Homes to support Mr Z with rehousing. Mr Z applied for the Council’s housing register which would enable him to bid on properties. Ms Y has said the Council did not provide any support to Mr Z to help him complete the application form which he required due to his visual impairment so it took him a long time to complete the form. In response to my enquiries the Council has said its housing options team can provide support but it did not receive a referral from the housing support team.
17. A housing support officer, officer C, placed bids on properties in consultation with officer A who assessed the suitability of the property for Mr Z. The Council has said four bids were placed by officer C and one bid placed by officer A. The bids were not successful as the properties were offered to other applicants or Mr Z considered them to be unsuitable.
18. The Council also later placed Mr Z on the adapted housing register for a wheelchair accessible property.
19. Mrs X and Ms Y has said officer B was required to place bids when officer C was on leave but failed to place a bid on time due to other commitments which meant Mr Z missed out on the property. The Council has said it is unclear which property Mrs X and Ms Y are referring to.

Care workers unable to contact Mr Z

20. A care worker visited Mr Z for the morning call as scheduled but Mr Z did not answer. The Council has said the care worker assumed Mr Z was still in bed as he had called earlier than usual. The care worker notified the on call service and intended to call back. Around lunchtime the care worker realised he had not returned to see Mr Z so a second care worker attended. She could not contact Mr Z but gained access to the building. She looked through Mr Z’s letterbox and saw he was unresponsive in his wheelchair and called the emergency services. Sadly Mr Z had passed away. The care provider notified the Council and the Care Quality Commission and took statements from the care workers who attended. The statements have not been provided.
21. Ms Y says the emergency services told her a care worker had not attended in the morning.
22. Mrs X and Ms Y consider the Council did not provide sufficient equipment to support Mr Z and failed to understand the combined effect of his visual impairment and mobility issues. The provision of the equipment, such as the ramp, was also delayed. Mr Z struggled to manage over time due to his health and he was unable to leave his property to meet friends.
23. In response to my enquiries the Council has said it does not agree it failed to understand the combined effect of Mr Z’s visual impairment and mobility issues. Officer B considered Mr Z’s visual impairment and mobility issues in the care act assessment and in the support plan which was agreed by Mr Z. Joint visits were also carried out by OTs and sensory rehabilitation officers.

Analysis

Occupational therapy and care act assessments

24. The OT, Care Act assessment and support plans refer to Mr Z’s visual impairment and mobility issues so I am satisfied these were considered. The Council also reviewed how Mr Z was managing with the equipment when Mrs X raised concerns. It also reviewed the support plan when an OT raised Mr Z required a lunchtime call.
25. Mrs X and Ms Y have raised concerns that the Council did not consider the combined effect of Mr Z’s visual impairment and mobility issues. Although an OT and sensory rehabilitation officer visited Mr Z, it is not clear from the assessments how the combined effect was considered. But it is not proportionate for me to investigate the matter further as any injustice is to Mr Z and that now cannot be remedied as he has passed away.

Housing

26. The Council is at fault for not making reasonable adjustments for Mr Z when he applied for the housing register and it did not have sufficient regard to its duties under the Equality Act. The Council’s duty to make reasonable adjustments is anticipatory and it was aware Mr Z was visually impaired. So, the Council should have offered support to Mr Z in completing the application form. The form took Mr Z an excessive amount of time and effort to complete due to his visual impairment and caused exhaustion as he was recovering from his surgery. Ms Y also had to assist Mr Z which was caused unnecessary time and trouble to her as she has a visual impairment.
27. The Council’s records show officers placed bids on properties for Mr Z. I do not have sufficient information to know why officer B would be placing bids on properties for Mr Z when officer C was on leave, whether she missed bidding on a property or if Mr Z would have been offered the property. I am also not clear why the Council did not place Mr Z on the adapted housing register sooner. But I will not pursue these matters further as any injustice is to Mr Z and that cannot be remedied.

Provision of care

28. The Council has acknowledged the care provider did not always attend Mr Z at the appropriate times and some calls were missed. The Council took appropriate action to follow up the late and missed calls with the care provider. But the fact the calls were late and missed suggest the care provider did not always provide the care in accordance with the support plan. This is fault which will have caused some distress to Mr Z. Again, the injustice to Mr Z cannot be remedied.
29. Mrs X and Ms Y have raised issues about care workers not understanding the impact of Mr Z’s visual impairment, not cooking items properly or leaving items where he could not find or reach them. The Council has not been able to provide the records of Mr Z’s care as these were left at Mr Z’s property and the care provider has not retrieved them. So, I cannot know if the care provided by the care workers was in accordance with the support plan and further investigation will not achieve anything.
30. I am concerned that the care provider did not retrieve the care records from Mr Z’s property after he passed away. This is poor practice as these records contained Mr Z’s personal information. It also means the care provider has no audit trail of the care delivered to Mr Z so cannot know if it was adequate.
31. On balance, I consider a care worker attended Mr Z’s property on the morning he passed away. I acknowledge the emergency services told Ms Y that a care worker did not attend in the morning. But the Council’s account of what happened is detailed so I consider it is likely a care worker attended. However, the care provider did not follow its procedure when it could not contact Mr Z and this is fault. The care provider should have followed the various steps in the procedure which would ultimately have resulted in it calling the police when it could not contact Mr Z. It is possible Mr Z could have been found sooner if the care provider had followed its procedure. But I cannot know, on balance, if the outcome would have been different and Mr Z could have been assisted. Nevertheless, the fault will cause distress and uncertainty to Ms Y which should be remedied.

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Agreed action

32. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found fault with the actions of the care provider, I have made recommendations to the Council.
33. That the Council:
1. Sends a written apology and makes a payment of £250 to Ms Y to acknowledge the distress and uncertainty caused to her by the care provider’s failure to follow its procedure when it could not contact Mr Z and for the avoidable time and trouble she was put to in assisting Mr Z with his housing application as the Council did not make reasonable adjustments.
2. Reviews its procedures to ensure the Council makes reasonable adjustments for housing applicants with disabilities and complies with its duty under the Equality Act 2010.
3. Ensures the care provider reviews its procedures to retrieve care records from a service user’s property in the event they have passed away.
4. By training or other means, ensures the care provider’s staff are aware of its procedure in the event a service user cannot be contacted.
34. The Council should take the action at a) within one month of the final decision and the action at b) to d) within two months of the final decision.

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Final decision

35. The Council is at fault at it failed to make reasonable adjustments to help Mr Z to complete his housing application and the care workers were late to Mr Z’s scheduled care calls which will have caused distress to him. The injustice to Mr Z cannot be remedied. The care provider is also at fault as it did not follow its procedure when Mr Z could not be contacted. This caused distress and uncertainty to Ms Y which the Council has agreed to remedy in an appropriate and proportionate way.

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Investigator's decision on behalf of the Ombudsman