Summary: There were some faults by the Council, and the care provider in the way that they handled arrangements for Ms Y’s care package. The Council has agreed the recommended remedy.

The complaint

1. Mr X complains on behalf of Ms Y the care package the Council arranged was not sufficient to meet her needs. She says the Council ignored her concerns, discriminated against her and the care providers lied.
2. Mr X also complains that Ms Y was neglected in a Council commissioned care home.
3. Mr X complains the Council refused to provide copies of documents it held about Ms Y when she made a subject access request (SAR).

Back to top

What I have and have not investigated

4. I have investigated the complaints above in paragraphs 1 and 2.
5. We cannot investigate a complaint if someone has appealed to a tribunal about the same matter. (Local Government Act 1974, section 26(6)(a), as amended.)
6. We cannot investigate the complaint in paragraph 3 about Ms Y’s SAR because Ms Y has appealed to the ICO regarding this matter.

Back to top

The Ombudsman’s role and powers

7. 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.)
8. When considering a Council’s decisions, we consider whether there was fault in the way it 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)
9. 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)

Back to top

How I considered this complaint

10. I have discussed the complaint with Mr X and considered the complaint and the documents, correspondence and audio recordings he provided. I have made enquiries of the Council and considered the comments and documents the Council provided. Mr X and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

Back to top

What I found

Safeguarding

11. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014).

Assessment

12. 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.
13. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Care Plan

14. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan. The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.

What happened

15. What follows is a brief chronology, in which I have set out the key events. It is not necessary for me to detail everything that happened here.
16. Ms Y, who is blind and has other disabilities and health conditions lives in her own home. The Council had assessed that she had eligible needs which required care. The Council had been paying Ms Y direct payments to arrange her own care. Mr X, a friend of Ms Y also supported her.

Care Home A

17. In November 2020 Ms Y had a mental breakdown and went into Care Home A for respite care.
18. After seven weeks Ms Y discharged herself from Care Home A. She complained after she returned home about the care she received in the care home and said that it had affected her mental wellbeing. She said that:
• Staff had not taken her for regular walks to help build her strength.
• Staff did not offer her freshly squeezed juice.
• Staff had refused to give her medication to help pain relief when requested.
• She complained that several items of clothing had gone missing in the home.
19. The Council opened a safeguarding enquiry regarding Ms Y’s complaint. However, it closed this after considering its own records and comments and further information from the care home, including case notes and food and fluid charts. The care home said that:
• Ms Y would often refuse to go for a walk when carers suggested it.
• It would have provided fresh juice if Ms Y had requested it.
• It could not give the pain relief medication on one occasion because Ms Y had alcohol that day.
• It would discuss the missing items of clothing with Ms Y, and these would be returned when found.
20. The Council said the safeguarding alert failed to reach the threshold for a safeguarding enquiry under section 42 of the Care Act. The Council asked its contracts team to consider a monitoring visit to the home and consider its quality assurance framework.

Analysis

21. I have not seen evidence of fault in the way that the Council considered the safeguarding alert about Care Home A. The Council addressed the issues Ms Y raised with the care provider and considered its safeguarding policy. It decided the incidents did not meet the threshold for a safeguarding enquiry.
22. The Council considered the threshold criteria set out in the Leicester, Leicestershire and Rutland (LLR) Safeguarding Adults Thresholds Guidance 2018. This refers to concerns which are isolated incidents, or are not a regular occurrence, and which have not resulted in any harm. In my view the Council properly considered evidence it held, relevant information from other parties, its own policy and the Care Act 2014. Therefore, I have not found fault here.

Care provider B

23. The Council carried out an assessment of Ms Y’s needs before she left the care home. The Council arranged an independent advocate to support Ms Y during the assessment.
24. The Council’s support plan of January 2021 set out Ms Y’s eligible needs which included support with personal care, domestic tasks and preparing meals. The Council proposed four visits of one hour every day. The plan did not refer to assisting Ms Y with shopping for food, or assisting with daily walks. The Council says Ms Y agreed to the proposed plan.
25. After Ms Y left the care home the Council arranged for Care Provider B to assess Ms Y on 5 January 2021 for the proposed care package. But on the day of the assessment, Ms Y cancelled the appointment. She said she wanted her advocate to be there and that the amount of support was not enough.
26. The Council requested the advocate contact Ms Y. After discussing the Council’s needs assessment with Ms Y, the advocate reported that she asked for a reassessment because she had been mentally unwell in the care home at the time of its assessment. The Council called and agreed to hold a meeting the next day with Ms Y on 6 January 2021.
27. The Council also emailed Ms Y and suggested that she allowed the agreed care package to start. The Council would then arrange a review after two weeks.
28. The Council’s notes show a social worker called Ms Y as agreed on 6 January 2021. The social worker urged Ms Y to accept the package of care and repeated it could be reviewed after two weeks. Ms Y said she wanted to speak to her advocate and that she would not accept the care. The Council noted that Ms Y said she just wanted to go for walks. The social worker noted she suggested that Mr X and Ms Y walk together each day “ limiting contact in the current climate”. This was a reference to the COVID 19 restrictions at the time.
29. It appears that Ms Y agreed to the proposed care by Care Provider B because it completed a pre assessment at Ms Y’s home on 11 January 2021. Ms Y explained the tasks that she wanted the carers to do relating to personal care, domestic tasks. She also stated that she would like help to go for a walk at lunchtime. She said she needed to walk every day in order to get a guide dog, and if she was unable to get a guide dog, she would kill herself. The care provider noted that Ms Y repeated this several times.
30. Ms Y also said that
• she must complete her physiotherapy exercises every day to help her mobility due to a problem with her hip.
• carers needed to help her complete food shopping online.
31. However, before the care package started Care Provider B called the Council and said that that it could not meet Ms Y’s needs. The social worker noted this on the case notes, and did not record the care provider gave any reasons.
32. After Ms Y requested its reasons, Care Provider B sent her a copy of the preassessment adding that: “the time frame allocated is not suffice [sic] and, on the meeting, judging by what was seen and spoken about. We feel she will need a lot more support and increase in the times allocated to ensure her needs are met and we are not leaving her at risk. Judging by what we witnessed [Ms Y] is extremely vulnerable and need assistance will all aspects of her daily living needs.”
33. Later, Care Provider B advised the Council that because of Ms Y’s threat to kill herself and the panic attack it noted in its assessment, it could not provide the support she needed due to its duty of care to Ms Y.

Analysis

34. Mr X complains the Council cancelled the review meeting of 6 January 2021 without giving any reasons. However, I have not seen the evidence to support this as the Council made notes of a call. I have not seen that it was referred to as a review. I have not found fault here.
35. Mr X complained that the Council changed the reasons it gave for Care Provider B withdrawing the proposed the care provision. However, I have not seen evidence the provider explained its reasons to the Council initially. Care Provider B later explained it had concerns which included the time for completing all the tasks. But it was also concerned about Ms Y’s vulnerability and that it could not support her due to the risks to her as well as to its own carers. I have not found fault here.

Care Provider C

36. The Council arranged another company, Care Provider C, to provide the care package. Care provider C’s care coordinator visited Ms Y at home in February 2021 to assess her needs. Mr X was present and audio recorded the meeting.
37. During the meeting Mr X asked if the carers were Covid vaccinated. The care coordinator replied ”Yeah, yeah we’re on top of that”.
38. During the meeting Mr X and Ms Y referred to her needing assistance with shopping. They also referred to her wish to go for daily walks to build her strength and learning routes in order to get a guide dog. It does not appear the care coordinator agreed to either of these. However, at the end of the meeting she stated that it would be discussed in the review in two weeks and that she would mention it to the Council.
39. Care Provider C started the provision in March 2021. Ms Y said the carers were good but they could not complete all the tasks in the time. They took her for one walk, but then said they would not be able to do it again. The carers said that shopping was not included in the plan. Mr X emailed the Council to ask it about support with shopping and walks.
40. The Council’s notes show the care provider called the Council and advised that there was not enough time to complete the tasks. It gave details of the tasks it was able to complete in the time. The Council emailed Ms Y regarding arranging a review of the care plan in 10 days on 12 March 2021.
41. However, after four days Ms Y ended the care because she says a carer told her she had just had her first Covid vaccination. Ms Y said she could not accept unvaccinated carers as she was clinically vulnerable. She complained to the Council and the care provider that it had promised that carers were vaccinated. She said it had caused her much stress and anxiety, and she could have died.
42. The care provider rejected Ms Y’s complaint saying that the care coordinator had told her it was a matter of choice for the carers whether they were vaccinated.
43. The Council responded to Ms Y’s complaint that the care coordinator did not say that all carers were vaccinated but said that it was carers choice. It said carers were wearing full PPE and self tested regularly.

Analysis

44. I have listened to the recording of the care provider’s assessment and the care coordinator stated that carers were vaccinated. However, the carers were not vaccinated. I consider that the care coordinator gave incorrect information. This is fault. The care provider’s denial of this statement was also fault. It does not appear the provider or the Council listened to the recording. This is also fault. Ms Y was caused stress and anxiety due to the incorrect information. I have recommended a remedy in respect of this.
45. However, I must also take into account that the care provider was following government guidance to carers to wear PPE and self test regularly. Neither Ms Y nor the carers contracted Covid at that time. In addition, if the care provider had stated it was the carer’s choice to have the vaccination, or that she could not confirm this, Ms Y would not have taken up the package of care. It would have been unlikely that the care provider could have arranged other suitable vaccinated carers quickly or at all. Ms Y received care that she would not have received if it had not been for the fault.
46. I do not consider there is fault by the care provider in respect of Ms Y’s complaint that the care coordinator said she would contact the Council but did not do so. I can see that the care coordinator contacted the Council’s social worker about the tasks within the plan and the time for these. The Council arranged a review within 10 days which would have addressed this. But the review did not take place because Ms Y ended the care.

The Council’s responses to Ms Y’s complaints about its actions

47. In March 2021 the Council responded to Ms Y’s complaint that the care plan should include shopping and walks. The Council said that when it assessed Ms Y in the care home, she had stated that she used an app to order food. With regard to walks, the Council had referred Ms Y for a physiotherapy assessment. The Council stated that daily walks were not included on the care plan. Finally, the Council said that if Ms Y unreasonably declined care, the Council could “decline to provide any further services”.
48. Mr X and Ms Y complained to the Council in July 2021 that several social workers and the social work manager lied, neglected her and ignored her concerns. They complained the Council did not understand her complex medical conditions, and had not considered the evidence of her GP and others regarding the care she needed. As a result the Council wrongly reduced her care hours, leaving her without a suitable package of care to meet her needs.
49. The Council responded to Ms Y’s complaint in August 2021. It said it was not its social work manager’s intention to cause distress. She apologised for this. It explained that decisions regarding Ms Y’s care package were not solely the manager’s decision. The Council said:
• it had investigated Ms Y’s safeguarding concern regarding Care Home A. The Council noted further complaints which were not raised at the time. It said it could investigate further if Ms Y had concerns.
• it had responded to emails regarding contemporaneous care and support issues. But that due to the number of emails it received from various sources it had limited its responses. It apologised for not having advised Ms Y of this.
• It accepted it had not sent a breakdown of the care plan which Ms Y requested in March 2021. It apologised and had sent this in July 2021.
• Its social workers had considered the GP’s advice and other medical professionals’ information.
• It noted Ms Y did not consider the Council had responded to her concerns. It said it could see social workers had contacted her, but apologised that she felt this was insufficient.
• It had already responded regarding Care Provider C stating that carers were vaccinated.
• It noted Ms Y said she felt threatened by the Council and forced into accepting Care Provider C, even though the amount of care was not sufficient. It apologised Ms Y felt threatened, but said that it had proposed a review of the care after a few weeks so that it could assess whether her needs were being met. It said residents had a right to refuse care but the remaining option would be to arrange care privately.
50. Mr X and Ms Y remained dissatisfied with the Council’s response and complained to the Ombudsman.

Analysis

51. As I have set out in paragraph 44, I consider there was fault by the Council in not properly investigating Ms Y’s complaint that Care Provider C falsely promised carers would be vaccinated. The Council’s second response was also faulty because it accepted the initial finding. The Council should have considered the evidence it had.
52. I do not consider that there is sufficient evidence that the Council ignored Ms Y or neglected her concerns. There is evidence the Council made several referrals and proposed a review of her care shortly after it had started. This could not take place as planned because Ms Y ended the care.
53. A council can reduce care hours if it considers they are not necessary, or it can make provision differently. I consider the Council carried out an appropriate assessment in the care home with the aid of an advocate. When Ms Y raised concerns in 2021, the Council said it would review her care needs. I do not consider it was due to a fault by the Council that this review did not take place.
54. It appears the Council struggled to respond to all the contact regarding Ms Y. It has apologised that she felt ignored. However, I consider the Council responded to the main issues. I consider the Council’s apology is an appropriate remedy.
55. From June 2021 I can see the Council reviewed its assessment and that it has agreed a joint package of care with the health service. The Council has increased the number of care hours taking into account Ms Y’s needs.

Back to top

Agreed action

56. Within one month of my decision
• The Council should apologise for its failure to properly consider Ms Y’s complaint about Care Provider C promising carers would be vaccinated.
• Care Provider C should apologise that it did not properly consider the complaint about the care coordinator stating carers would be vaccinated.
57. The Council should provide us with evidence it has complied with the above actions.
58. The Council has agreed my recommendations

Back to top

Final decision

59. I have found fault and proposed a remedy to address the injustice caused. I have completed my investigation and closed the complaint.

Back to top

Investigator's decision on behalf of the Ombudsman