Summary: Mrs B complained the Council failed to provide satisfactory care to her uncle, Mr C. The Council’s safeguarding enquiry found that acts of neglect and omission had occurred in Mr C’s care. This is fault, which caused Mr C injustice. We found the Council has not properly addressed the injustice caused to Mr C and Mrs B. The Council has agreed to our recommendations to remedy the injustice caused to Mr C and Mrs B.

The complaint

1. Mrs B complained the Council failed to provide satisfactory care to her uncle, Mr C. Mrs B says this has caused Mr C physical harm and his mental and physical health have declined which has impacted his ability to live semi-independently. Mrs B would like the Council to provide:
• Compensation for the loss and replacement of Mr C’s belongings.
• Compensation for the inadequate care Mr C received.
• An updated care plan.
• An apology.

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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 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)
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)
4. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

5. I have discussed the complaint with Mrs B and considered the information she provided. I also considered the information the Council provided in response to my enquiries.
6. Mrs B and the Council had the opportunity to comment on a draft version of this decision. I considered any comments I received before making a final decision.

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What I found

Legal and administrative background

7. 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.
8. Once a council has determined a person is eligible, it must set out the person’s needs and how the council will meet those needs in a Care and Support Plan. The council must meet those identified eligible needs.
9. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards. These include:
• Regulation 9 of the 2014 Regulations requires care providers to work in partnership with the person, make any reasonable adjustments and provide support to help them understand and make informed decisions about their care and treatment options, including the extent to which they may wish to manage these options themselves.
• Regulation 12 of the 2014 Regulations requires care providers to assess the risks to people’s health and safety during any care or treatment and make sure that staff have the qualifications, competence, skills and experience to keep people safe.
• Regulation 13 of the 2014 Regulations requires providers to have a zero tolerance approach to abuse, unlawful discrimination and restraint. This includes neglect, subjecting people to degrading treatment, unnecessary or disproportionate restraint and deprivation of liberty. Where any form of abuse is suspected, occurs, is discovered, or reported by a third party, the provider must take appropriate action without delay. This includes investigation and/or referral to the appropriate body.
• Regulation 17 of the 2014 Regulations requires a care provider to keep accurate, complete and contemporaneous records of care and treatment.
10. Providers must do all that is reasonably practicable to mitigate risks. Incidents that affect the health, safety and welfare of people using services must be reported internally and to relevant external authorities.
11. Section 42 of the Care Act 2014 says a safeguarding duty applies where an adult:
• Has needs for care and support;
• Is experiencing, or at risk of, abuse or neglect; and
• As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.
12. If the section 42 threshold is met, then the Council must make enquiries or cause others to do so. An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect and if so, by whom.

Safeguarding

13. 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)

Background

14. Mr C was diagnosed with a traumatic brain injury following an accident. Mr C’s care needs assessment found him to be at risk of self-neglect due to this injury.
15. Mr C’s care plan, dated September 2022, states he should have received 8 hours of support per week. While residing at Park Lodge extra sheltered accommodation between October 2022 and July 2023, Mr C should have received the following support:
• Two 30 minute visits per day, AM and PM, to ensure that he was taking his medication, eating and drinking properly, washing and changing his clothes, had adequate food stock and was keeping his flat clean and tidy.
• One additional hour of support on Tuesdays to change Mr C’s bedding and supervise him doing his laundry.
16. Mr C paid care contributions based on him receiving 8 hours of care per week.

What Happened

17. This section sets out the key events in this case and is not intended to be a detailed chronology.
18. Care records show, between the months of October 2022 and July 2023, Mr C consistently received less than a total of 8 hours of support per month, with many of his support visits lasting between 1 and 5 minutes or not taking place at all. Mr C did not receive the support detailed in his care plan to ensure that he was:
• taking his medication twice a day,
• eating properly and had adequate food stock,
• washing and cleaning his clothes and bedding,
• keeping his flat clean and tidy.
19. In July 2023, Mrs B raised a safeguarding concern during a visit to Mr C’s flat. Mrs B had found Mr C’s flat infested with bedbugs and Mr C had suffered a number of bites which caused a rash for which Mr C required medical treatment. Mrs B removed Mr C from the home, and he lived with her for 7 months while alternative care was arranged.
20. The Council completed a safeguarding enquiry which determined it was more likely than not that neglect and/or acts of omission took place. It also found evidence to suggest the Care Provider did not advise Social Services of instances when Mr C refused his care. The Council set the following actions at a safeguarding outcomes meeting:
• Ensure Mr C’s personal property is returned to him after treatment.
• Add checking for bedbugs to property checklist.
• Request allocated social worker to conduct six-week care review with Mr C at his new accommodation.
• Update Mrs B and advise of safeguarding outcome within a week.
• Circulate outcome meeting minutes to all parties, once approved.
21. Mrs B sent a stage one complaint to the Council in August 2023 about the Council’s failure to keep Mr C safe from harm. As part of the complaint Mrs B asked the Council for the following:
• A swift relocation for Mr C to be closer to his support network. Mrs B requested this be a transfer to an assisted living accommodation with extra care and support.
• For Mr C’s care bill to be written off due to him not receiving good quality care for several years.
• For the contents of Mr C’s flat to be replaced in full.
22. The Council partially upheld Mrs B’s complaint but it did not apologise or explain which parts of the complaint it upheld. The Council could not complete a quick transfer for Mr C and did not agree to writing off or refunding any of Mr C’s care costs. The Council did seek information to show which of Mr C’s belongings had been replaced because of the bed bug infestation. Mrs B has told us she has not received any financial refund from the Council for Mr C’s destroyed belongings.
23. The Council has updated Mr C’s care plan which is now in place with a new care provider.

Analysis

24. The Council commissioned the Care Provider to deliver services to Mr C on its behalf to discharge its duty to meet Mr C’s eligible social care needs. The Council remains responsible for those services and for the actions of the Care Provider.
25. Between October 2022 and July 2023, the Council failed to ensure Mr C received the level of care and support which was detailed in his support plan. This put Mr C at risk of harm and caused distress and uncertainty for Mr C and Mrs B.
26. The outcome of the safeguarding enquiry determined it was more likely than not there had been neglect and/or acts of omission in Mr C’s care. This outcome is not disputed by Mrs B. The Council identified a significant injustice to Mr C which it has not effectively addressed or remedied through the safeguarding enquiry or complaints process.
27. The Council has also failed to address the impact on Mrs B, who has experienced avoidable frustration and distress because of the faults the Council identified.

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Agreed action

28. Within one month of my final decision the Council should:
• Provide a written apology to Mr C and Mrs B following the LGO’s effective apology guidance. Guidance on making an effective apology can be found here Guidance on remedies - Local Government and Social Care Ombudsman.
• Refund Mr C’s care contributions from October 2022 – July 2023.
• Pay Mr C an additional £1,000 to recognise the distress and risk of harm caused by the faults identified.
• Pay Mrs B £500 to recognise the distress, uncertainty and impact caused by the faults identified.
• Contact Mrs B to request a list of contents which needed to be replaced due to the infestation at Mr C’s flat and consider which of these items should be refunded.
29. Within three months of my final decision the Council should:
• Ensure the Care Provider has adequate health and safety checks in place to prevent a reoccurrence of the faults identified in this case.
• Work with the Care Provider to ensure it has a process in place to inform Social Services when residents refuse care.
• Remind its staff to consider personal remedies where it identifies, in the course of its safeguarding or complaints process, a person has experienced an injustice. Guidance on remedies can be found here Guidance on remedies - Local Government and Social Care Ombudsman
   
30. The Council should provide us with evidence it has complied with the above actions.

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Final decision

31. We uphold this complaint. There was fault by the Council, which caused an injustice. The Council has agreed to remedy the injustice caused.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman