A service user was put at “risk of harm” and her daughter pushed to “breaking point” after a local authority failed to make alternative care arrangements when an agency ended its contract, the local government and social care ombudsman has found.
Hertfordshire council did not step in when Mrs C, an older woman with physical and mental health needs, was left without home care support after a care agency stopped providing services.
Nor did the local authority carry out a reassessment of Mrs C’s needs to see if they had changed and whether her current financial package was still appropriate, the ombudsman found.
This left her daughter, Mrs B, struggling to pay for the care of her mother, which caused strain on their relationship.
Hertfordshire also failed to follow safeguarding procedures after Mrs C told her daughter a care worker had been excessively “affectionate” towards her, and did not communicate the investigation results clearly.
Cancelled care package
Mrs C requires help with some personal care, such as preparing food and prompting to take her medication. She received a home care package from a care agency commissioned by Hertfordshire, comprising four calls a day and other services, totalling 15.5 hours of care per week.
In addition, Mrs C received a direct payment of £541.52 per week from the council, enabling her to employ her daughter for a further 34 hours a week as a personal assistant.
The money also funded two hours a week at a mental health charity befriending service.
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On 29 April 2016, the care agency decided to end the commissioned service that had been set up for Mrs C through the council.
At a professionals’ meeting earlier on in the week, records showed, the last day of agency care had been noted by the council. Social workers were to consider an alternative care package for Mrs C and then speak to Mrs B.
But there was a delay in the council being able to commission another care agency. It was not until July that, according to the council’s records, an assessment by a social worker was carried out.
This showed Mrs C needed a high level of support, yet the council failed to increase the direct payments made to her beyond what she already received – despite the loss of provision from the first care agency that had ended in April.
Daughter finds new carers
By November 2016, Mrs B had recruited carers to take over some of her mother’s care calls but was having to meet the cost of this from the direct payments, which had not been increased.
A social worker visited Mrs C around the same time and, despite learning about the new charges, noted the payments to Mrs C as being good enough to meet her needs and “almost the rate of residential care”.
When Mrs B asked the social worker about increasing the sum given to Mrs C, the social worker said she should ideally use the money Mrs C already received from the direct payments. All the while, there had been no proper assessment of how the amount could meet all Mrs C’s assessed needs.
The council’s records also included comments from the deputy team manager to the effect that the direct payments package was “too substantial and reflects residential care rather than home care, therefore it needs to be cut back significantly”.
On 14 December 2016, Mrs B telephoned the council after she found her mother crawling on the floor to get to the toilet, with notes reporting the daughter was “at breaking point”.
At this point, Hertfordshire agreed, without reassessment, to increase the direct payment rate to £626.99 per week from 20 December 2016.
Service users potentially put at ‘risk of harm’
The ombudsman concluded Hertfordshire was at fault as it caused Mrs C distress by the “difficulties presented by the reduced care package”. It said this strained her relationship with her daughter and, potentially, put her “at risk of harm”.
It added Mrs C’s care package was “effectively cut” without proper reassessment to find out if her needs had changed and could be met with the existing direct payment amount.
The watchdog also found that Mrs B was caused “considerable distress” by the council, after it failed to find alternative care arrangements when the agency ended its service and she had to find care for her mother.
It said the council should have made arrangements to commission an alternative home care provider “as soon as possible” after the care provider stopped providing the service, and was at fault for not doing so.
Regarding the deputy team manger’s comments that the direct payments were “too substantial”, the ombudsman said such remarks “may be indicative of attempts to inappropriately ration limited resources”.
It reminded councils that care provision should be based on assessed needs and, “where there is no evidence of appropriate assessment such remarks may be indicative of attempts to inappropriately ration resources”.
In addition to failing to properly assesses the needs of Mrs C and find a replacement home care provider, the ombudsman found fault in how Hertfordshire followed safeguarding procedures.
On February 2016, Mrs C told her daughter that a social worker had been excessively “affectionate” towards her, which resulted in Mrs C slapping the worker after pushing her away.
The following day Mrs C took a fall, but the care worker, who had been struck previously, refused to see to see her.
Following a safeguarding investigation, the council decided no wrongdoing was committed by the care worker and, after carrying out further enquiries, it concluded no further action was needed, and closed the case.
Yet, in its investigations, the ombudsman found that the council had failed to “properly communicate” to Mrs C and her daughter about the outcome of the investigation. It added the local authority “should have been clear” as to the reasons why it decided the matter had not met the threshold criteria for a full investigation.
The ombudsman recommended that, within four weeks of the decision, the local authority issue Mrs B and Mrs C with a formal written apology and pay a combined total of £3,250 to Mrs B and Mrs C.
The ombudsman additionally recommended that, within three months of the decision, the council formally review the learning from the complaint, focusing on the requirement to properly review or reassess care needs before the imposition of changes to care packages.
Hertfordshire council also accepted the safeguarding investigation should have been properly recorded under its safeguarding adults at risk procedure and has reopened the enquiry.
It said it has carried out practice audits of safeguarding on a regular basis, as well as training record audits, to ensure that all staff have received mandatory training in safeguarding.