Suffolk County Council failed to provide adequate care based on an assessment, or to communicate its reasoning for decisions, or to support a carer adequately

Decision Date:   21 Jan 2022

What happened

Mrs X complained about the care Mr Y received from a care provider which had been commissioned by the Council. She said that:

1. Mr Y’s provider’s care plan did not address his complex needs; it merely commented on his hoarding and home maintenance, but did not address them.
2. Mr Y needed routine – this was not provided by the staff arrival times which differed each day. 
3. Mr Y requested that a particular carer not be assigned to him and not enter his home. This was ignored. 
4. The carers’ notes showed they did not know him well.
5. There was an outstanding invoice of £515.91 for Mr Y’s care: this was unsatisfactory as the Council had offered to reduce the charge by 50%. The Council did not acknowledge this mistake, nor did it apologise. 
6. Communication with Mr Y was poor.
7. When Mrs X stepped in as an informal carer, she received no handover notes and became concerned about the lack of support provided to Mr Y by the Council.

Mrs X requested an apology and explanation to Mr Y, preferably face to face or by video. Mr Y requested that the outstanding care charges be waived and he asked for a full refund of the £1091.88 he paid for care between July 2019 and January 2020.

Some elements of the complaint dated back to 2016 but because of the legal restriction on the Ombudsman’s power to investigate complaints, and the complaint being made in May 2021, the Ombudsman used discretion to investigate from July 2019, this being a material point in the complaint. Anything prior to this was considered as background.

Prior to July 2019, Mrs X contacted the Council to complain about the social worker assigned to Mr Y and the domiciliary care Mr Y received. The care provider had concerns about Mr Y’s hoarding as well as his conduct with carers. The Council had concerns about Mr Y’s mental health and had considered Mr Y’s case as a safeguarding matter.

A financial assessment conducted in July 2019 led to Mr Y being asked to make a financial contribution towards his care costs. Mr Y was unhappy with the cost of the domiciliary care he was receiving.

Prior to July 2019, Mr Y had received six hours a week of care. He asked for this to be reduced and, from July 2019, his care was reduced to three visits a week. Mr Y had quickly signalled that even this was too much and was clear he did not want even the reduced amount of help. 

Given the difficulties its carers were experiencing with Mr Y, the care provider requested that it stop providing Mr Y’s care; however, the Council insisted the three weekly visits should continue and Mr Y should pay his contribution. The care provider requested for Mr Y’s care to be assigned to the Council’s complex needs team. This was declined after the complex needs team initially accepted the transfer; the report says that there was no explanation for this change. 

The situation continued until 2020, when Mr Y refused the domiciliary care service and Mrs X took on the role of his carer. Mr Y refused to pay the outstanding care charges; he requested a refund of the contributions he’d made.

What was found

Although Mrs X had wanted the Council to respond to all the complaints she’d made (as set out above), the Council did not expressly address all her criticisms. The Council referred ONLY to the complaint about the care provider and not to any of the other complaints relating to its own role in the matter.

The Council was found at fault for its lack of action in circumstances in which it had identified the difficulties in dealing with Mr Y well prior to 2019, concerns about Mr Y’s mental health and known significant breakdowns in the relationship between Mr Y and his care provider. The Council chose not to do anything about this and even when there was a proposal to refer the case to its complex needs team, this was not pursued (without explanation).

The LGSCO found that the Council had not properly explained its role to Mrs X – including information regarding the support that she may be entitled to as a carer. This was fault. The LGSCO recommended that the outstanding care charge be waived by the Council and that a partial refund of half the £1091.88 to Mr Y (ie £545.94) was issued. The LGSCO also recommended that Council officers should offer both Mr Y and Mrs X an explanation of any support that could be offered to them both as well as formally apologise to Mr Y in writing.

Points to note for councils, professionals, people using services and their carers, advocacy groups, members of the public

We can’t work out why the Ombudsman doesn’t focus on the need for the council’s own care plan to address what was needed. It is not enough to purchase a service without setting out what it should do; it can’t just be left to the provider under the Care Act, even if the issue is specialist, which with hoarding cases is often the case.  

We can’t understand how it was not commented on by the LGSCO investigator that the Council cherry picked from the original complaint and left other bits out with no explanation. 

In this case, the Council’s duties included taking professionals’ opinions into account regarding the deterioration of the situation: the complex needs team would not have been referred to without the home care company having serious concerns. Public law says that all relevant considerations must be taken into account; to our minds, this is a breach of the duty to meet needs through straightforward omission to engage. It seems obvious to us that skill and sensitivity were required to overcome a deteriorating relationship and difficult history. 

It is also clear that continuing to provide a person with a service and charging them for it after it has been declined amounts to a stance on the person’s incapacity and the need for intervention in self-neglect, but nothing is said about that in this report other than that Mr Y may have been autistic but not definitively diagnosed.

So this is an example of a rather poor LGSCO report, as well as an apparently inadequate grasp of the Care Act on the part of the council, we have to say. 

The full Local Government Ombudsman report on the actions of Suffolk County Council can be found here: https://www.lgo.org.uk/decisions/adult-care-services/domiciliary-care/21-002-572