Service user’s wife caused ‘frustration, distress and anxiety’ after safeguarding referral left open for 15 months, ombudsman finds

A service user’s wife was caused “frustration, distress and anxiety” after a council failed to carry out a safeguarding investigation in a timely manner, the Local Government and Social Care Ombudsman has found.

Bromley council failed to meet a number of its own targets when investigating safeguarding concerns made about the wellbeing of Mrs B’s husband, Mr B, who had Parkinson’s disease.

The ombudsman found that one safeguarding referral was left open for 15 months, following the council’s failure to produce an enquiry report. This was “much longer” than set out in the council’s procedures, the ombudsman said.

Bromley council was also at fault for failing to carry out a further occupational therapy assessment after a referral, to decide if Mr B required further equipment.

Struggling to cope

Mr B had Parkinson’s disease, Lewy Body dementia and other health conditions, which caused urinary incontinence and made him more prone to falling. He lived with his wife, the primary carer, who had also privately arranged for a live-in carer to assist with her husband’s care.

In July 2015, Bromley council received two safeguarding referrals that Mrs B was struggling to cope with caring for Mr B, and a safeguarding case was opened. A social worker was concerned that Mrs B was unable to care for Mr B when the live-in carer was not there and asked for emergency respite care to be provided.

However, Mr B’s family refused this on the advice of a consultant and said their father would need a full-time care home placement instead.

The council held a strategy discussion in October, 59 working days after the referrals had been received, in which it was decided a social worker should visit Mr B at home. The social worker spoke to Mrs B on the phone in November, with the case record stating Mrs B did not think social care could help Mr B. She refused to pay the council for any care services.

New safeguarding referral

In January 2016, Mrs B contacted the council asking for grab rails to be fitted in the toilet in their home and a referral was made to an occupational therapist (OT). The OT was unable to contact Mrs B but arranged for the rail to be installed in February.

Mr B’s case was then allocated to a new social worker, who carried out a joint visit with the OT in July 2016. Mrs B explained she had a live-in carer for three weeks at a time, asked for a second hand rail and insisted she was “coping well”.

After a social worker spoke to the GP and district nurses, who reported no concerns, the council intended to close the safeguarding case. However, two months later, the local authority received another safeguarding referral that Mrs B was not coping, and the live-in carer was considering leaving. There were also concerns she had pushed her husband.

The council called Mrs B in September, with the social worker suggesting Mr B needed to go into a care home after Mrs B said she could no longer care for her husband. Despite refusing an emergency respite placement, she agreed to the social worker calling a care home she had considered. But she denied she wanted to put her husband in a care home when speaking with a different social worker.

Mrs B’s GP wrote to Bromley council, explaining Mr B’s needs had increased and she was concerned that Mrs B was struggling to cope. The GP advised the council should offer more support to Mrs B, which the council treated as a safeguarding referral.

Concerns substantiated

The council completed the safeguarding enquiry report in October, 42 working days from the August referral. It said that Mr B had fallen and did not have the capacity to understand risks. Mrs B had said she felt unable to care for him and there were concerns she had pushed him in the past. It had been reported Mrs B had refused to allow Mr B to take anti-psychotic medication.

The report found the concerns about neglect, emotional and physical abuse had been substantiated, and it was agreed Mr B needed 24-hour care that he was not getting at home.

A case conference was held in November 2016, 40 working days after the enquiry report had been completed. The outcome was a protection plan, which said Mr B needed two care workers at all times to be arranged by Mrs B. Mr B would also have a mental health assessment.

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Following a succession of falls, Mr B was admitted to a hospice following treatment in hospital. On the same day, the council received another safeguarding referral which said Mr B had frequent falls and bruising. The ambulance service also made a safeguarding referral about Mr B’s bruising in February 2017.

While Mr B remained in the hospice, the council emailed Mrs B two days later to notify her of a meeting to review the protection plan 11 weeks after the case conference.

At the meeting, all professionals agreed Mr B would be best cared for in a care home, rather than at home. But Mrs B disagreed, saying her husband had deteriorated since going into the hospice.

Mental capacity assessment

A mental capacity assessment carried out later that month found Mr B did not have capacity to decide where he should live, and concluded it was in Mr B’s best interest to move into a care home, with Mrs B agreeing to search for a suitable placement.

Mrs B found a care home, but there is a dispute over funding, with Mrs B understanding she would be part funding the placement. However, Mrs B had to pay privately for her husband’s care as Mr B had capital of more than £23,500.

Significant delays

The ombudsman found delay in processing the safeguarding investigation around Mr B’s case. It said the enquiry report should have been completed by the end of August, but instead was completed in early October, 22 working days late.

Following the offer of emergency respite, the watchdog said the council did not have a strategy discussion until October 2015, highlighting this was 59 working days after the council had received the safeguarding referral, when the council’s target is five working days.

The enquiry report was completed 15 months after the July 2015 referral.

While the ombudsman found the case conference was forty working days after the enquiry report had been completed and the review of the protection plan took 11 weeks, not 6 weeks.

The ombudsman concluded Mrs B, once aware of the investigation, would have been caused “frustration, distress and anxiety”, and said there should have been a further OT assessment after the January 2016 referral. It said the council was aware Mr B’s condition had changed and that Mrs B had said she was struggling to cope.

Bromley council has agreed to apologise to Mrs B for the delays identified in progressing the safeguarding case and for not carrying out a further OT assessment after the January 2016 referral. It has also agreed to remind managers to monitor safeguarding cases in “robust supervisions” to avoid drift and ensure they are closed when appropriate.