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 However, NHS funding for the £800-a-week nursing home placement was withdrawn in October 2011, making Mr F’s care the responsibility of Worcestershire council.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.
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.”