Council rapped after social workers moved man to cheaper care home contrary to assessment recommendations

Health of resident declined and he later died after move to less suitable home, which was followed by inadequate safeguarding investigation, finds Local Government Ombudsman

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Worcestershire council has been heavily criticised for moving a man with dementia to a less suitable care home contrary to a social worker’s assessment recommendations that this would be detrimental to his health.

The man, Mr F, died in January 2012, two months after the move following a sharp decline in his health, and the evidence suggests this was caused by the impact of the move and the poor care he received at the second home, Grove House, found the Local Government Ombudsman (LGO).

Mr F, who also was doubly incontinent, needed help from two carers to mobilise and became agitated in noisy environments, was settled at the first home, Applewood House, where he had moved in February 2011, funded by NHS continuing healthcare. However, NHS funding for the £800-a-week nursing home placement was withdrawn in October 2011, making Mr F’s care the responsibility of Worcestershire council. At the time, the ‘usual rate’ that the council paid for nursing home care was £495 a week.

Move ‘would be detrimental’

He was assessed by a council social worker, Officer A, in September 2011, who found that his needs were being met at Applewood House, care staff knew how to prevent him from becoming agitated and that any move “would be detrimental to his health and wellbeing”.

Council records show that senior managers with budgetary responsibility did consider taking over funding the placement at Applewood House, but this option was not pursued despite Officer A’s conclusions.

“Worcestershire County Council’s social workers ignored their own recommendations which stated that any move would have a detrimental effect on the man’s health and wellbeing and should have considered if any move should take place in these circumstances,” said the ombudsman, Jane Martin.

Instead, Officer A first gave Mr F’s family the impression they would have to pay an unaffordable top-up of £300 for him to stay at Applewood House by telling Mr F’s son, Mr E, that the council would pay no more than its usual rate for a placement. This is contrary to the Choice of Accommodation Directions 1992, which states that a council could not seek a top-up if it could not identify a suitable placement at its usual rate.

Then, the council’s brokerage team asked several nursing homes whether they could meet Mr F’s needs and had vacancies, with only Grove Lodge saying that it met both criteria, at a rate £100 a week above the council’s usual rate. The council agreed to meet the cost, minus Mr F’s assessed contribution, and he moved there on 15 November 2011.

However, the ombudsman found that the council did not properly assess Mr F could be moved without detriment to his health or how Grove Lodge could meet his needs, particularly his agitation, relying instead on the provider’s assertions.

Complaint over care

On 9 December Mr E contacted Mr F’s new social worker, Officer C, to complain about the care he was receiving at Grove Lodge. He said Mr F had developed a pressure sore not referred to in his notes, was regularly being returned to his room for “shouting out” and was found in bed on one occasion, sweating, fully clothed and “with two pillows nearly covering his face”. Mr F was then admitted to hospital on 28 December 2011 and was dehydrated on admission, reported Mr E in an email to the NHS trust that was passed on to the council. Mr F died in hospital on 24 January 2012.

The LGO found that the council mishandled Mr E’s complaint, made on 9 December. Firstly it did not record it as a complaint under its adult social care complaints procedure despite it pertaining to care being provided on the council’s behalf.

Secondly, while Officer C asked Grove Lodge’s provider to investigate the complaint, the council did not monitor the adequacy of its handling of the complaint or challenge its failure to answer all of Mr E’s concerns.

Thirdly despite Mr E’s complaint including safeguarding issues, these were not immediately referred to the council’s adult protection chair for consideration under its safeguarding procedures. While a safeguarding investigation was later triggered in January 2012 it was closed in July 2012 because the provider had by then completed its complaint investigation. However, the LGO concluded that this was not an adequate explanation, as there had been no finding about why Mr F had been admitted to hospital with dehydration or about the incident when he was found in distress in his room.

Recommendations

On the recommendation of the LGO, the council has agreed to:

  • review social workers’ and other relevant staff’s knowledge of the Choice of Accommodation Directions 1992, which sets out the policy on top-ups to care home fees, and arrange training to correct any deficits;
  • introduce a procedure to manage cases where care home residents become eligible for council funding, including consideration of identified risks from moving and checks on the suitability of alternative accommodation;
  • review whether all all social care staff know how to identify a complaint and understand the council’s social care complaints procedure and its interaction with adult safeguarding procedures, and provide any training required;
  • review existing contracts with care providers to ensure council oversight of complaints against providers by or on behalf of residents whose care is paid for and commissioned by the council, and to ensure those service users have access to the council’s own complaints procedure;
  • brief all council staff involved in adult safeguarding on the LGO’s findings, in particular the need for a clear written audit trail of decisions and effective communication with those reporting concerns;
  • pay Mr E £1,500 in recognition of the distress caused to him and his mother.

“We are working on an agreed action plan to remedy the issues raised by the complaint and have apologised to the family, as well as offered them the payment recommended by the LGO,” said the council’s cabinet member for adult social care, Sheila Blagg. “Procedures at the county council are currently being reviewed and will be constantly assessed to ensure similar occurrences do not happen again.”

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8 Responses to Council rapped after social workers moved man to cheaper care home contrary to assessment recommendations

  1. Mark Highfield February 12, 2014 at 12:10 pm #

    While there were clear failings, i do not approve of the family being paid compensation for this. the idea is to learn lessons from such a case. I am suprised that family would even consider accepting compensation given that their relative had died.

  2. Mike Gimson February 12, 2014 at 3:08 pm #

    The action of this social worker is in our opinion a disgrace but I am sorry to say that local authorities are moving residents to cheaper option Care homes regardless of the impact this is having this is now becoming the norm. Our company has seen many examples of this practice and I’m afraid its money before care needs these days and no-one appears to care what is happening to our Elderly including CQC. Our system is broken and we can only expect more of the same in the future just look at the safe-guarding numbers they are going through the roof. Mike Gimson Chairman Moundsley healthcare group

  3. monty February 12, 2014 at 4:47 pm #

    mr highfield, the article does not say that Mr E or his mother away in any way related to Mr F, nor that they accepted the compensation which the council agreed to offer them

    “clear failings” rather understates the severity of the outcome, a person’s death, and I find it strange that you bother to post your disapproval of compensation in this context (although if the money suggested were compensation for a lost human life, it would of course be insultingly small)

  4. Andrew Reece February 12, 2014 at 6:07 pm #

    I am surprised that Community Care have not considered how the decsion by health to withdraw continuing health care funding both precipitated the action taken by Worcestershire and how this could potentially have lead to Mr F’s death. I am also concerned that as reported the Local Govt Ombudsman did not see fit to refer this to the Health Ombudsman.

    Finally I would like to know why Worcestershire did not consider that Mr F’s death met the criteria for a serious case review. Perhaps only a serious case review could properly consider the interations between the decisions taken by both Social Care and Health decision makers and ensure lessons are leant to ensure this does not happend again.

    • mithran samuel
      mithran samuel February 13, 2014 at 10:13 am #

      Thanks Andrew. I’m not sure if Worcestershire has ruled out an SCR in this case but can check with them. On the health issue, I’m not up on the criteria for LGO referral of cases to the health ombudsman. I guess there are lot of CHC reviews and decisions to withdraw funding going on a so perhaps the LGO didn’t see anything suspect in it.

  5. Philip Craig February 14, 2014 at 4:27 pm #

    Its yet another example of the poor state of social care to the elderly in particular the poor qaulity of care being provided in so many private profit making organisations who are clearly not in it because they care but only to make vast sums of money.
    The same could also be said of the childrens social care agenda.

    Why can’t govenment see that if you pay for low cost provision you will receive low cost care.
    the difference between council run care homes are clear to see compared to private run care homes.
    In council run and lead care homes you will even get the council own in-house regular monitoring which is far more robust that you will get in a private venture as well as the regulated inspection this is something that needs to be addressed.

    Are we really willing to continue to provide care to our most volunarable on the basis of the chepeast service or will someone stand up and be counted and make a serious challenged to the way this society shamefully gets away with this.

    Are we not soposed to be a leading nation one of the richest econamies in the world but yet we still place our priorities towards our own people at the bottom to feed of the scraps whilst all the other major significant investments are very really to do with supporting and developing our own.

    Its a disgrace and a shame that we all know what’s going on but everyone pretends to not see or be willing to stand up and teel it the way it really is.

  6. Martin Porter February 18, 2014 at 8:38 am #

    I’m not sure Worcester did anything different to how any other authority would have reacted.

    The fragmented nature of 24 hour care, with people moving from Continuing Health Care to private funding to council; funding, with providers also being able to increase fees whenever they want (and councils reduce them) leads to this issue cropping up all the time.

    NOBODY in 24 hour care in this country can be sure they can still afford their placement come April. That is scandalous.

  7. Alison Woolf February 20, 2014 at 4:48 pm #

    I agree with Andrew’s point, so often people have CHC funding withdrawn without Local Authorities having proper input into those reviews. I worked in one authority where we had a good relationship with the community matrons carrying out the CHC reviews, tried to attend as many as possible and this allowed for advocating on behalf of service user on the one hand, or enabling proper transition arrangements if there was no other choice than a move. In another local authority they dont want to get involved until they hear that CHC funding has gone, with all the attendant problems as has happened here. Often I have found that people will be funded out of hospital to free acute beds when they really shouldn’t have qualified in the first place, or seem to no longer meet the criteria because they are getting the level of care required (which is why a social worker at that review is a good idea). It’s a shame that the rules can’t be changed as CHC funding has to be agreed by an MDT including social care so it should be an MDT that agrees to withdraw it.