What Happened
Ms C complained on behalf of herself, and her son Mr D.
Mr D had a Council funded care package arranged by the Council at a supported living setting run by Affinity Trust.
This placement was by no means ideal for Mr D as he was the only young adult living in the scheme and had differing needs from the other residents. This was a fact that the Council was aware of.
Towards the end of 2017 Affinity Trust served notice on Mr D’s package as the relationship between them, Mr D and Ms C had broken down (unexplained in the report). But it continued to support Mr D until the Council found a new vacancy for a tenant elsewhere in April 2019.
Mr D spent a large amount of time away from his original home during the wait for another, and Ms C provided him with lots of extra support – he was in need of support with personal care and cleaning and could easily neglect himself without. Ms C did what was required, taking him to all of his appointments as well; and she picked up her son and dropped him off outside the accommodation, due to the relationship breakdown with staff.
Ms C complained to the Council about:
- Debt and finances.
- A lack of support from Affinity Trust in supporting Mr D with medication.
- Issues around Safeguarding
- How staff at Affinity Trust blamed her for the relationship breakdown and the way the staff treated her after that.
After one round of investigations and recommendations to the provider, the council and the Care Provider helped Ms C in a benefits application for Mr D. The Care Provider wrote off debts Mr D had accrued and the council paid Mr D money he had previously lost out on in benefits to which he would have been entitled.
At the start of 2019, the care provider contacted Ms C to raise concerns about Mr D’s room. Staff had noticed flies coming from the room and Mr D had refused to let staff enter.
Ms C went into the room and found mouldy fruit and empty sausage packets. There was a difference of recollection as to whether sausages had been eaten raw or were pre-cooked and simply eaten cold.
The Council stated that because Mr D was now out for a lot of the day, the Care Provider was finding it hard to provide the one to one support hours to him and therefore couldn’t prompt him to clean his room. It did however accept that there was little flexibility in the timetable, so did not allow Mr D choice on when to receive the necessary support.
Mr D later agreed that a staff member could access his room without him present, so they could check on cleanliness.
The Care Provider deemed that Mr D had capacity to make decisions about not cleaning his room, even if those decisions were considered unwise by others. It did however accept that its lack of awareness about Mr D’s health condition may have affected how they supported him.
Ms C told the LGO that because Mr D appears very capable, people would tend to assume he did not need help, but that he still required a lot of prompting to complete tasks and to look after himself and his environment. She said that the relationship between the care provider, herself and Mr D had not improved, and that there was still a lot of tension and a negative atmosphere.
Ms C remained unhappy with the Council’s response, so complained to the LGO.
- She said that the constant negative atmosphere led Mr D to suffer more regular absence seizures than usual, because of stress.
- Mr D did not receive his support hours from the Care Provider because of the time Mr D felt better remaining off the premises as a result and lost out on communal time with other residents.
- Mr D was home in the evenings, but the care provider’s rota was not flexible enough to provide him his one-to-one support then, which might have benefited him.
- Mr D took to eating alone in his room at times and had possibly consumed raw sausages.
What was found
In summarising its conclusions, the LGO did not explicitly write that the Council was ‘at fault’, simply that the care provider ‘may have been in breach of a fundamental standard’.
The LGO highlighted that the care provider accepted that it had a lack of awareness of Mr D’s condition and abilities and said that this ‘may’ have been in breach of CQC’s fundamental standard that care providers should provide care or treatment that is bespoke and meets personal needs and preferences.
The LGO also pointed out that the CQC requires care providers to treat people with dignity and respect, including giving adequate support to someone so they remain independent and involved in the local community. The Care Provider accepted it was not always providing adequate support, so the LGO again stated it ‘may’ have been in breach of this fundamental standard.
In addition, the LGO stated that the CQC requires care providers to keep people safe. The care or treatment given must not be unsafe and a person should not be put at risk of harm that could be avoided. Care providers must assess the risks to health and safety during any care or treatment and make sure their staff have the qualifications, competence, skills and experience to keep clients safe. The LGO stated that the Care Provider ‘may be in breach of this fundamental standard’.
Ms C had to reduce her work hours to support Mr D. However, the LGO said that it could not make a direct link that this was a result of the issues she complained of. Council records suggested that she reduced her hours in 2015, before the issues complained of, and that she reduced her hours to care for an elderly neighbour. However, the LGO did accept that Ms C had to take time off work for the year being investigated (2018-2019) due to stress and that she had had suicidal thoughts.
The LGO also found that the Council should have offered or given Ms C a Carer’s Assessment.
As a result of the investigation, the Council offered to pay Ms C the equivalent of Mr D’s support hours from March 2018, when she first made a complaint, until April 2019 when Mr D moved out, amounting to £4,100. The LGO considered this sufficient to recognise the impact of Ms C giving up her spare time to support Mr D.
The Council also offered £500 as sufficient recompense to Ms C in recognition of the distress caused. The Council also offered a payment of £250 to Mr D for the distress caused to him; however the LGO recommended that £500 would be a more appropriate sum.
Points to note for councils, professionals, people who use services and their carers, advocacy providers and members of the public
This complaint makes little reference to the options councils need to keep in mind to review whether a care plan is meeting the person’s needs and promoting their wellbeing to a sufficient degree to manage the impact of their difficulties.
Using this process, a proper complaints process internal to the company, a safeguarding referral or a service review – any of these steps could have enabled the Council to act sooner and consider whether the care and support it had commissioned was falling below the expected standard in a way that could have been improved.
The Care Provider readily admitted that it had not understood Mr D’s condition and abilities, yet had continued to assume he ‘had capacity to make unwise choices about cleaning his room’.
This, in our view, is where the Care Provider and Council ought to have been found at fault. A person’s capacity, whether impaired cognitively or affected by motivation issues, or executive capacity to sequence steps without supervision, are part and parcel of shaping a care plan so that it DOES meet needs. The care and support on offer to him in this ‘supported living’ setting may have been too rigid in terms of its availability to be flexible to Mr D as an individual. Or it may merely have been prompting – and yet more prompting, but NO supervision, which would have enabled registration to be avoided.
Had this Council acted properly and used good provider monitoring and care plan reviews as a mechanism to consider how Mr D’s needs were being met through his care and support plan, this complaint could have been avoided. When a care plan is not ideal, interim arrangements can and should be made to make up for that, and this is not mentioned in the report.
The remedy provided here, in terms of quantifying it, was offered in parallel to a legal development called restitution, in adult social care cases: effectively, reimbursement when someone who shouldn’t have had to take on a load, either steps up and not as a volunteer, informally, or spends money on doing something that the council should have been able to secure through ordinary channels. Here, the reimbursement at the rate equivalent to the support hours in lieu of what should have been being done by the provider, was noteworthy, because (we presume) the care package had had to be paid for in any event.
It is common for councils to make care and support arrangements with providers who have really no length or breadth of experience in creating a positive culture in a supported living setting. Once on the framework, a provider is rarely thrown off, and performance management in some councils is regarded as unnecessary because of the mere existence of the CQC, which is a recipe for disaster, in our view.
The LGO is a valuable resource for those finding themselves in a position of needing to raise concerns beyond ineffectual council complaint procedures, in order to achieve a better outcome. But this report shows that the LGO cannot make formal findings about things that are for the CQC, as regulator.
The full Local Government Ombudsman report of Leeds City Council’s actions can be found here https://www.lgo.org.uk/decisions/adult-care-services/other/19-011-131