Ombudsman’s findings against the London Borough of Ealing (12 012 697)

Ms Y was admitted to hospital in August 2011, prior to which she lived at home alone (with assistance from daily visits by home carers). After concerns were raised by one of Ms Y’s relatives and Ms Y’s psychiatrist regarding Ms Y’s failure to take her medication and her frequent admittances to A&E, a care manager approved funding for a four-week placement in a care home for Ms Y. A senior care manager then contacted Ms X, Ms Y’s niece, to inform her that Ms Y was being assessed with a view to offering her a place in a care home, which Ms X supported. The ‘First Care Home’ then offered Ms Y a place, with Ms Y later leaving hospital to move there on 17th August. A placement agreement for Ms Y was later signed by a member of staff at the care home which stipulated that Ms Y’s placement was ‘short stay residential’. Ms X was later informed of the charging structure for Ms Y’s care, and her required contribution.

After carrying out an assessment on Ms Y’s needs, the care manager at the First Care Home highlighted Ms Y’s needs and the risks to her independence, before concluding that she required ongoing 24-hour care. Ms X’s views were also included on the form, with her agreeing to the need for 24-hour care, before her view that Ms Y should be moved to the ‘Second Care Home’. However, the Council’s adult social care department’s panel of senior officers later approved permanent funding for Ms Y’s placement at the First Care Home from 16th September. A care manager then allegedly informed Ms X of the arrangements 11 days later (which Ms X strongly denied).

Ms Y’s case then went to a different care manager, who completed a second assessment during the following month. Ms X was not present during this, and the assessment identified that Ms Y’s needs had not changed. The care manager recommended 24-hour care for Ms Y, and no record was made of a discussion about Ms Y’s placement formally being made permanent. Rather, a note was made that indicated that the care manager recommended a long-term placement.

The care manager later spoke to Ms X, who again requested that Ms Y be moved to the Second Care Home, which she considered to be more suitable for Ms Y, given Ms Y’s continuing negative impression of the First Care Home. The care manager’s supervision record, dated 20th October, said ‘client allocated for long term plan for permanent placement, yet client appears from case notes to be already permanent’. Ms X later had her request to move Ms Y to the Second Care Home rejected due to a recent poor CQC inspection. As a result, Ms X complained to the Director of Services that Ms Y’s placement had been made permanent without her consent and she made the following complaints:

–           the standard of care in the First Care Home was inadequate;

–           the First Care Home changed Ms Y’s GP without informing her;

–           despite the fact that she had repeatedly outlined Ms Y’s dissatisfaction with the First Care Home, she was nonetheless informed that Ms Y’s placement at the care home had been made permanent in September;

–           she was told that the Council could not place Ms Y at the Second Care Home because of a poor CQC inspection report, despite her having undertaken research independently and having found it to be suitable for Ms Y; and

–           Ms Y had suffered neglect at the First Care Home, with the care home failing to adequately wash and change Ms Y, control her medication appropriately and inform Ms X after changing Ms Y’s GP.

A third assessment in January 2012 detailed how Ms Y wanted to move to the Second Care Home as it was closer to her friends, and it recorded that her niece said that she had suffered neglect at the First Care Home. The assessment summarised the incidents of the alleged neglect, and summarised Ms Y’s care needs and the risks to her independence.

Findings

In relation to the permanent status of Ms Y’s placement, the Ombudsman made a finding of maladministration, given the failure to reach an agreement on this point.  As stipulated by the CRAG (‘Charging for Residential Accommodation Guide’), decisions on the temporary or permanent status of a residence must have been agreed with the resident and/or their representative and included in a written care plan. There was no record of a discussion with Ms Y about whether she agreed to the placement in the First Care Home becoming permanent, and it was evident that Ms X did not agree with these arrangements. Despite the fact that the care manager noted that he had ‘informed’ Ms X of the Council’s decision that the placement was to become permanent, the Ombudsman held that informing was not the same as seeking another person’s agreement.

Regarding the allegations of neglect at the First Care Home, the Ombudsman once more held that maladministration had occurred. As the Council had made arrangements for Ms Y to go into residential care through its powers and duties under Part III of the National Assistance Act 1948, the care home’s actions in carrying out that arrangement were treated as if they were the Council’s actions. In making arrangements to place someone in residential care under the National Assistance Act 1948, whether in one of its own care homes or with a third party care provider, local authorities were under a continuing responsibility to ensure the quality of care. The Ombudsman made a finding of maladministration because the services provided by the First Care Home did not meet the applicable regulatory standards in Ms Y’s case. The Ombudsman found that the First Care Home did not comply with the 2010 Regulations and CQC Guidance.

In relation to the delay in informing Ms X about and invoicing her for the contribution, the Council had written to Ms X in August 2011 with an explanation of how it calculated Ms Y’s contribution, and there was no delay in telling Ms X about the charge. As a result, the Ombudsman did not uphold this part of the complaint. However, as the Council did not send a first invoice until March 2012, with good administration requiring it to send regular invoices from August 2011 every four weeks, the Ombudsman made a finding of maladministration.

Finally, regarding the long period of time taken to move Ms Y to the care home of her choice, a delay was found in acting on Ms Y and Ms X’s request to change care homes, which the Council should have agreed to have done in September 2011. This was because the conditions set out in the Choice of Accommodation Directions were satisfied. As a result, maladministration was found by not acting promptly on Ms X’s request to move Ms Y. But once the Council became aware of the CQC’s poor inspection report, it was not at fault in refusing to place Ms Y at the Second Care Home until the CQC was satisfied that it complied with all of the necessary standards.  This was because the Choice of Accommodation Directions stipulated that a council should be satisfied that a placement was suitable. Therefore no finding of maladministration was found in the decision that Ms Y could not move to the Second Care Home in December 2011. Once the Council re-inspected the Second Care Home and found that it complied with the 2010 Regulations, it placed Ms Y in the Second Care Home after giving the required contractual notice to the First Care Home. As this was undertaken within an acceptable timeframe, no maladministration was found.

Remedy

The Ombudsman recommended that the Council should:

–           apologise to Ms X and Ms Y for the aforementioned failings;

–           pay Ms X £500 to reflect the distress, unnecessary time and trouble in bringing the complaint;

–           reduce Ms Y’s contribution by £2350 to reflect the poor service received; and

–           review its contracting arrangements and ensure that the risk of the aforementioned failings are reduced in the future.

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