Decision Date: 19 Nov 2024
Summary
The LGSCO found fault with Croydon’s failure properly to assess, plan and review the care needs of Mr Y; further fault in its poor communication from substantial delay in sharing the Council’s decisions was found.
What happened
Mr Y, an adult with autism and learning difficulties, was regarded as presenting significant behavioural issues affecting the chances of caring for him at home. His behaviour escalated in early 2022, leading to hospitalisation.
Prior to moving to Croydon, his care had come from a different council, which had assessed that he needed significant support, including 15 hours per week of two-to-one care, to help manage his needs at home.
When Mr Y was taken to hospital his mother, Mrs X, told the Council that the family was unable to meet his needs and keep him safe at home.
As part of Mr Y’s discharge plan, the Council held a best interests meeting to discuss how to best support him. Attendees included Mrs X, Mr Y’s sibling, his social worker (Officer 1), Officer 2 (the social worker’s manager), but nobody documented details of this meeting.
During the best interests meeting, Mrs X made it clear that Mr Y required two-to-one care. Officer 2 acknowledged this need saying that that would be ‘fine’ and that it ‘would have to do that anyway’ (this was on a recording taken by Mrs X).
However, after the meeting, the Council sought to reduce the care provision based on cost concerns, despite agreeing verbally that Mr Y would require two-to-one care.
Officer 1 provided the cost of two-to-one care for eight hours a day and one-to-one care for the rest of the time to Officer 2.
Officer 2 (the manager) stated it was too expensive and would need to be reduced; otherwise it would be a temporary placement while it sought an alternative.
When he moved into a supported living placement in March 2022, it was described as temporary, and he was initially provided with two-to-one care during the day and one-to-one care at night.
A formal care needs assessment documented Mr Y’s ongoing need for constant support due to his behavioural challenges. The care plan however suggested that he could manage with one-to-one care for his daily personal needs.
This care plan was not shared with Mrs X. [We expect it was the care provider’s internal plan but the investigator does not say…]
In April 2023, after 18 months or so, the care provider informed Mrs X that the Council had not paid for the full care package Mr Y required. It said the Council had told it that Mr Y could receive shared care with other residents at night and only one-to-one support for eight hours a day.
It said that in its view Mr Y needed extra support for his safety and wellbeing and reducing his support was not a risk it was willing to take. It told Mrs X it could not continue to support Mr Y without payment, and could not reduce the support, due to the risks. So the care provider felt it had no choice but to carry on providing the care.
Mrs X raised concerns with the Council, emphasising that the care package of two-on-one care, agreed upon at the best interests meeting, for day time risks, had not been fully funded.
In July 2023, Mrs X formally complained to the Council, providing an audio recording of the best interests meeting where all parties had agreed that Mr Y required two-to-one care.
The Council responded at the end of September 2023, apologising for the delay in responding but also stating that there was no evidence to support that Mr Y required two-to-one care. The Council suggested that it would be willing to review the care package to determine if more support was needed.
In response to the LGSCO’s enquiries, the Council said it ‘did not have a contract with the provider’. It said Mr Y’s placement was still temporary, and that contact with Mrs X had been complicated due to the financial dispute with the provider.
What was found
Care assessment and plans
The Council’s omission in keeping a written record of the best interests meeting caused uncertainty and was fault. Its conclusion that one carer was sufficient during the day time was inconsistent with its own knowledge of the man’s history. Particularly, the Council had failed to explain:
- how one-to-one care would meet Mr Y’s needs and mitigate the risk he was to himself, and to others, identified in its own assessment;
- in what way Mr Y’s needs had reduced from the previous formal assessment identifying 15 hours of two-to-one care as necessary (and especially given Mr Y had been in education full time and so not even at home);
- in what way Mr Y’s needs had reduced given that his behaviour had escalated so significantly that he had been admitted to hospital and his parents were no longer able to care for him at home;
- in what way Mr Y’s needs had reduced since the best interests meeting.
While it is for the Council to decide what care an individual needs, the LGSCO noted that it had failed properly to consider Mr Y’s needs and how it would meet those needs through its care plan.
Additionally, the Council had placed Mr Y in a temporary placement in April 2022, yet failed to provide a permanent placement as promised by June 2022, with the placement still temporary as of September 2024, which was another fault.
The Council failed to review Mr Y’s care assessment or plan between May 2022 and June 2024, despite Mrs X’s raising concerns and the care provider expressing difficulty in meeting Mr Y’s needs without two-to-one support. The LGSCO thus found fault in the Council’s failure further to reassess Mr Y’s needs.
Although the Council’s failures did not affect the level of care Mr Y received, which remained two-to-one care from the conscientious provider, they caused Mrs X significant distress and uncertainty about whether his needs were properly assessed, planned for and met.
The LGSCO also noted that the issue of payment for the care was a separate matter between the Council and the provider, and was thus not investigated.
Communication
The LGSCO found that the Council’s communication with Mrs X was inadequate, as it failed to share Mr Y’s care assessment and plan. Mrs X only learned of these decisions a year later from the provider. When she raised concerns and complaints, the Council did not respond for five months, causing Mrs X significant frustration and distress, fearing Mr Y’s care would be reduced or cancelled.
Accordingly, the LGSCO recommended that the Council:
- Apologise and pay Mrs X £500 to acknowledge the distress caused to her by the identified faults.
- Complete a reassessment of Mr Y, ensuring adequate consideration of the views of the care provider and Mrs X, and its rationale for how Mr Y’s needs can be sufficiently met by one-to-one support.
- Decide whether Mr Y’s placement should become permanent, identifying a suitable alternative permanent placement if not.
- Remind staff of the importance in keeping clear, complete and contemporaneous records of best interests meetings, its decision-making process, outcomes and actions.
Points to note for councils, professionals, people using services and their carers, advocacy groups and members of the public
It was clear the Council discussed the cost of Mr Y’s care after the best interests meeting and that is not unlawful, in and of itself, but it was clear to the Ombudsman that this may have overly influenced the decision-making about the contents of the subsequent needs assessment and plan.
It’s a frustration for us that the report doesn’t say whether the gentleman was sectioned into a psychiatric hospital or an ordinary acute general hospital, and if the former, whether there was a Care and Treatment Review before that was decided upon as the only possible option.
It’s also frustrating that one cannot tell whether the provider was being paid directly for the accommodation as well as the care, or just the care. The Investigator just doesn’t deal with that point – but it was called an emergency placement, which is the kind of situation where the payment is sometimes made directly and there is not even a purported tenancy.
The significance of this is that this man needed personal care, and the provider may have been providing both the accommodation and the personal care without any separation by way of a valid tenancy agreement for the housing. If the provider and the house owner were in a contract with each other or associated or otherwise working interdependently, that is very much the sort of situation in which CQC should be investigating whether what was being provided was in fact a registerable care home, although this is not something that is attractive to CQC, given the very common occurrence of that situation, these days.
That is not to say that this was a bad provider; quite the opposite, in fact: in a very telling point, the ombudsman’s investigator said there was no actual injustice – as Mr Y had received two-to-one care from the provider, even though the Council had tried to impose its opinion that he did not require it.
It is of course ridiculous to say that there was ‘no contract’ with the provider. Croydon was taking the benefit of the provider and paying something – and the very conscientious provider was shouldering the risk that Croydon had a mandatory duty to manage under either s117 Mental Health Act or s18 of the Care Act.
If it was a Care Act placement or care plan, section 27 of the Care Act 2014 requires councils to review care and support plans regularly, and the Guidance says that this means not less than once every 12 months, and within six to eight weeks after the plan is finalised.
Care Act reviews should also occur if reasonably requested by the individual or their representative.
The Ombudsman did not investigate the issue of the transfer of care from one council to another because that would have been a late complaint.
Please use the following link if you want to read the original Local Government and Social Care Ombudsman’s London Borough of Croydon (24 001 238) report.
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