The Ombudsman's final decision
Summary: Mr and Mrs B say the Council failed to arrange accommodation for their son and unnecessarily delayed making the required arrangements to allow a suitable placement to go ahead. The Council was not at fault for delays in the process to allow an identified placement to go ahead. However, the Council’s communications with Mr and Mrs B were at times overoptimistic and at other times did not provide sufficient information. An apology to Mr and Mrs B, payment to reflect their raised expectations and time and trouble and arrangement of a meeting with them to discuss options going forward is satisfactory remedy.
The complaint
The complainants, whom I shall refer to as Mr and Mrs B, complained the Council: failed to arrange accommodation for their son despite him having been assessed as requiring residential care; and delayed making the required arrangements to allow the only suitable placement to go ahead. I will refer to that placement as Care Provider A.
Mr and Mrs B say fault by the Council has led to their son having to move back to the family home for the last three years which has put a significant strain on Mrs B as the main carer and has led to their son losing some of his skills.
The Ombudsman’s role and powers
We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, sections 26(1), 26A(1), as amended and 34(3), as amended).
If we are satisfied with a Council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
How I considered this complaint
As part of the investigation, I have: considered the complaint and Mr and Mrs B's comments; made enquiries of the Council and considered the comments and documents the Council provided.
Mr and Mrs B and the organisation had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
What I found
What should have happened The Council’s procedure to commission care (the procedure) sets out the procedure for commissioning of a new package with a new service. This involves: the officer completing a general contract queries form and sending it to the procurement and contracts team; the procurement and contracts team undertaking the necessary vetting and price agreement; once a price has been agreed with the provider procurement will notify the officer of the price so the care plan can be sent to the quality assurance panel for authorisation.
What happened Mr and Mrs B’s son has learning disabilities, autism and diabetes. Until July 2019 he was living at a residential college. The intention was for him to move into a residential home at the end of his college course. However, due to issues with non-qualified staff administering insulin the placement secured fell through. Mr and Mrs B’s son therefore moved back to live with Mr and Mrs B in July 2019. A package was in place to provide six hours support for Mr and Mrs B’s son to access the community until restrictions were introduced with COVID-19 in April 2020.
The Council began seeking alternative care providers for Mr and Mrs B’s son. Identifying a suitable provider was made more difficult by the need for the provider to have staff who were qualified to administer insulin, which is why the previous placement fell through. The Council identified a possible provider in February 2020, although that provider did not have any placements available immediately. The Council also sought advice from the diabetes specialist nurse about seeking a suitable placement but that did not provide any further assistance in identifying a placement.
Mr and Mrs B identified a possible placement in May 2020 and told the Council about it. I will refer to that care provider as Care Provider B. The Council contacted Care Provider B which told the Council it would check whether its staff could be trained to administer insulin. At the same time Mr and Mrs B told the Council about a potential new property being developed by Care Provider A. The Council’s social worker also made enquiries about that provider. At that point there were therefore three potential providers.
In May 2020 the Council asked Care Provider A to provide more information about its charges. In response Care Provider A provided some details about costings for outreach support, proposing to provide four hours support per day Monday to Friday with a view to that leading to Care Provider A providing Mr and Mrs B’s son with accommodation. At that point Care Provider A had not purchased a property.
In June 2020 Care Provider B told the Council its staff could be trained to administer insulin. Care Provider B told the Council it would contact Mr and Mrs B to arrange an assessment.
The Council discussed the options of Care Provider A and Care Provider B with Mr and Mrs B. Mr and Mrs B told the Council they wanted to go ahead with Care Provider A. The Council’s social worker therefore asked Care Provider A to provide a breakdown of what its residential service would cost.
Later in June 2020 the Council’s social worker contacted Mr and Mrs B to discuss the two options. The social worker pointed out that Care Provider B had provided details of costings and could be referred to the Council’s contract department to request funding. The social worker explained that Care Provider A had not yet purchased a property and the Council could not commission a service unless it went to tender. At the same time the Council contacted an alternative provider to see whether it had staff trained in administering insulin due to the problems finding a provider.
At the end of June 2020 Care Provider A told the Council it had put in an offer on a property and had recruited an outreach support worker for Mr and Mrs B’s son. The Council again asked Care Provider A to provide costings for the residential option for Mr and Mrs B son.
In July 2020 Care Provider A told the Council the home it was purchasing was new and therefore not registered with CQC until an application had been completed. Care Provider A suggested outreach support could be commissioned in the interim to cover what was expected to be a six month period before the home was ready to open. The Council told Care Provider A it could not complete its vetting process until the accommodation had been registered with CQC. The Council provided Care Provider A with the information and documentation for it to begin the process of contracting with the Council.
The Council identified the possibility of a placement with a different care provider in October 2020. The Council told Mr and Mrs B about that. Mr and Mrs B declined the option as they considered Care Provider A the best fit.
In October 2020 Care Provider A contacted the Council to advise it expected to complete on the property within three weeks. Care Provider A told the Council the property should be ready to move into in January 2021. The Council reminded Care Provider A it would need to register with CQC before the Council could carry out vetting. The outreach package was agreed later in October. The Council could agree that as Care Provider A had CQC registration for its domiciliary care service. It needed a separate CQC registration for the residential home.
The Council’s social worker contacted Mr and Mrs B in November 2020 to tell them about the funding for outreach support. The social worker told Mr and Mrs B this would help Care Provider A’s staff to get to know Mr and Mrs B’s son and understand his needs before he moved into residential accommodation early the following year.
Mr and Mrs B contacted the Council in January 2021 to say it would likely be April before the property would be ready to move into due to the need for planning permission and renovations. That was then delayed further by the planning department at the Council.
In May 2021 Care Provider A contacted the Council to say it intended for refurbishment work to start on the property in June and the work would take eight weeks. Care Provider A told the Council it hoped to open in August 2021.
At the end of June 2021 the Council’s social worker told Mr and Mrs B once the property was ready the Council could have a meeting with Care Provider A to discuss what support Mr and Mrs B’s son needed and once it was registered with CQC the Council could update the care plan so support was ready for him to move in.
Care Provider A contacted the Council again in September 2021 to report it had not yet obtained CQC registration.
The Council held a virtual meeting with Care Provider A on 1 November 2021 and asked it to provide costings. Care Provider A submitted those costings to the Council on 9 November. The Council raised concerns about how those costings had been reached and whether they reflected the care Mr and Mrs B’s son needed. In response Care Provider A asked the Council for a copy of the needs assessment with a breakdown of support hours required for Mr and Mrs B’s son so it could reconsider its costings.
Mr and Mrs B asked the Council for an update on 19 November. The Council suggested looking at an alternative placement in tandem with considering Care Provider A in case there was another service available that could meet Mr and Mrs B’s son’s needs.
Care Provider A completed its CQC registration on 2 December.
The Council sent a placement enquiry to 12 other providers on 8 December.
In December 2021 the Council exchanged emails with Care Provider A, during which it explained what the process for setting up a care home would normally involve. The Council told Care Provider A once it had completed the vetting process the Council could look to progress a contract if they could agree on costings.
Following a complaint from Mr and Mrs B the Council apologised if Mr and Mrs B had been given the impression there were no barriers to prevent the placement going ahead when there were significant issues. The Council agreed to write to Care Provider A to set out the Council’s position and requirements to progress the matter further. The Council also recommended the social worker attend a briefing on the Council’s procurement processes so expectations could be managed in future.
On 23 December 2021 Care Provider A invited the Council to visit the accommodation and said it would review its costings if the Council could provide an up-to-date care assessment. The Council sent Care Provider A a copy of the care assessment at the end of December. The Council then visited the accommodation on 25 January 2022. The Council identified some issues with the property and fed those back to Care Provider A.
Mr and Mrs B chased the Council at the end of January 2022. The Council told Mr and Mrs B it did not have a contract with Care Provider A and therefore it was not an available option to pursue. The Council then told Mr and Mrs B about two potential vacancies with a different care provider in February 2022. At the same time the Council consulted 11 further providers about the possibility of a placement.
In March, May and June 2022 the Council contacted Care Provider A on several occasions to ask it for the outstanding information on costings. Care Provider A has not yet provided the information the Council has asked for.
The Council identified another placement in March 2022. This was a placement with Care Provider B. Mr and Mrs B visited that placement at the end of May 2022 but did not consider it a suitable option.
Analysis Mr and Mrs B say the Council has failed to arrange accommodation for their son since July 2019. Mr and Mrs B say that is despite the fact the Council had identified a suitable provision at Care Provider A, which is the only suitable provision, and has delayed making the required arrangements to allow that placement to go forward. I understand Mr and Mrs B frustration given the length of time matters have taken. However, the evidence I have seen satisfies me Care Provider A would not have been able to provide a residential service to Mr and Mrs B’s son until at least December 2021 given it needed to purchase the property, seek planning permission, carry out renovations and then register with CQC. That process was not completed until December 2021. The Council had no control over those delays and I therefore cannot criticise it for them. I am satisfied though the Council offered Mr and Mrs B an alternative care provider, which they declined. I am also satisfied the Council agreed funding for outreach support from Care Provider A in the interim.
Having considered the documentary evidence though, I am concerned about some of the information given to Mr and Mrs B by the social worker when discussing the option of accommodation at Care Provider A between 2020 and 2021. In some of those communications the social worker spoke as if it was already agreed that Mr and Mrs B’s son would move into the property once Care Provider A had purchased the property and renovated it. Certainly the way in which the social worker’s communications were worded would likely have given Mr and Mrs B the impression this was the case. It is clear though that alongside the social worker’s discussions with Mr and Mrs B the Council’s procurement department also had some involvement with Care Provider A and had concerns about both the failure to follow the normal process and the information provided by Care Provider A about the likely charge for Mr and Mrs B’s son to move into the property. I am also concerned that when responding to Mr and Mrs B’s complaint the Council did not clearly tell them about the issues that were preventing it agreeing a contract with Care Provider A. Because the Council has not fully explained the issues with the pricing structure provided by Care Provider A I can understand why Mr and Mrs B believe the issue lies with delay by the Council and the Council refusing to consider the cost presented by Care Provider A without reasonable excuse.
The evidence I have seen satisfies me though that irrespective of whether Care Provider A followed the procurement process, the outstanding issue is how much the service will cost to enable Mr and Mrs B’s son to move in. I have received copies of communications between the Council and Care Provider A about the costings. The costings provided by Care Provider A refer to the staffing ratio during the day being one member of staff to three residents. There is no breakdown in the costings provided to show how many 2:1 hours are allocated each week and how much that will cost and nor is there any information to show how many 1:1 hours are allocated each week and how much that will cost. In addition, there is no information about the staffing provision during weekends or what the charges cover and whether it includes food. Mr and Mrs B’s son requires 1:1 support during the day and 2:1 when in the community. As it stands the quotation provided by Care Provider A does not reflect the level of support Mr and Mrs B’s son will need and is therefore not reflective of the cost to the Council of the service. In those circumstances I cannot criticise the Council for raising concerns with Care Provider A or for deciding it is not in a position to agree a contract.
The Council has a responsibility to source suitable accommodation for Mr and Mrs B’s son. However, the Council also has a responsibility to use public money wisely. In the absence of detailed costings to reflect the care package required by Mr and Mrs B’s son I cannot criticise the Council for refusing to sign a contract at this stage. The Council simply does not have sufficient information from Care Provider A about the cost of the accommodation and what that will include to enable it to make a decision. I am satisfied though the Council has communicated those concerns to Care Provider A and asked it to provide the more detailed information to enable the Council to calculate how much the service will cost for Mr and Mrs B’s son. The evidence I have seen satisfies me that despite chasing Care Provider A the Council still does not have the information required. As I am satisfied the Council does not have the information it needs to establish the cost of the service and whether that is something the Council can fund I have no grounds to criticise it for not agreeing a contract to allow Mr and Mrs B son to move in.
I recognise this will be frustrating for Mr and Mrs B as their son has now been living at home with them for three years when he should have been in residential accommodation. I am satisfied though the Council has identified alternative providers for Mr and Mrs B son, albeit I recognise there was a significant gap between a provider being offered in 2020 and a provider being offered in 2022. During that period though there were delays as a result of Covid 19 restrictions. There was also the complicating factor of requiring a residential provision which could administer insulin to Mr and Mrs B’s son. It is clear that has significantly reduced the options the Council is able to consider. I understand Mr and Mrs B’s frustration about that. However, that is a matter which is beyond the Council’s control and I therefore cannot criticise it when there is evidence it has made attempts to identify alternative providers in 2020, 2021 and 2022. In addition, I do not criticise the Council for seeking to resolve the issues with Care Provider A initially given this was the care provider Mr and Mrs B had chosen. I also recognise Care Provider A remains Mr and Mrs B chosen option. However, as I have made clear, the evidence I have seen satisfies me the delays now are down to Care Provider A not providing the information the Council has asked for, rather than due to any fault on the part of the Council.
Mr and Mrs B have raised an issue about why the Council will fund Care Provider A to provide outreach support to their son when it will not agree a contract for him to move into the property run by Care Provider A. I consider this relates to the Council not sharing information with Mr and Mrs B about the specific issues with the pricing structure provided by Care Provider A. As I said earlier, the information Care Provider A has provided to the Council about the costs of the residential service do not reflect the level of care Mr and Mrs B’s son requires and the cost quoted is therefore not accurate. So, the Council is not saying that Care Provider A cannot provide satisfactory care to Mr and Mrs B’s son. The issue is how much that care is going to cost and whether Care Provider A has provided a cost which reflects Mr and Mrs B’s son’s needs. That is not an issue with the outreach service because Care Provider A provided a specific quotation in relation to the hourly cost for outreach support. So, the cost quoted by Care Provider A reflected the outreach provision it intended to put into place for Mr and Mrs B’s son. That is not the case for the residential option. I therefore see no contradiction in the Council agreeing to fund outreach hours by Care Provider A but not agreeing a contract for the residential service.
As I said earlier though, I am concerned the Council’s approach to Mr and Mrs B has raised their expectations and failing to share with them the issues with the pricing details it has been provided with has caused them significant frustration. That has also contributed to their time and trouble in pursuing the complaint and may have affected their willingness to consider alternative care providers. As remedy I recommended the Council apologise to Mr and Mrs B and their son and pay them £500 to reflect the time and trouble, frustration and raised expectations. I cannot make any recommendations around resolving the contract issues with Care Provider A because resolution of that issue lies with Care Provider A providing the information the Council has asked for. Given the length of time this has been going on though, and the possibility the costs for the accommodation at Care Provider A will be higher than the Council can consider, I recommended the Council arrange a meeting with Mr and Mrs B to discuss the option of the alternative provision the Council has already discussed with them or any other provision that has since become available. The Council has agreed to my recommendations.
Agreed action
Within one month of my decision the Council should: apologise to Mr and Mrs B and their son; pay Mr and Mrs B £500; and arrange a meeting with Mr and Mrs B to discuss residential options should Care Provider A not provide the Council with the information it requires or where the costings put forward are too high for the Council to consider.
Final decision
I have completed my investigation and found fault by the Council in part of the complaint which caused Mr and Mrs B an injustice. I am satisfied the action the Council will take is sufficient to remedy that injustice.
Investigator's decision on behalf of the Ombudsman