Summary: Mrs B complained the Council failed to take adequate action to address her care and support needs. She says the Council delayed providing care and support, it failed to complete and record assessments and it failed to ensure she has adaptations to her house so she can live independently. We find the Council was at fault for how it handled Mrs B’s care and support needs. The Council has agreed to our recommendations to address the injustice caused by fault.

The complaint

1. Mrs B complained the Council failed to take adequate action to address her care and support needs. She says the Council delayed providing care and support, it failed to complete and record assessments and it failed to ensure she has adaptations to her house so she can live independently. Mrs B also says the support services the Council commissioned did not meet her needs and the Council failed to appropriately deal with her concerns about it.
2. Mrs B says the matter has caused significant distress and upset.

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The Ombudsman’s role and powers

3. 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 significant injustice, or that could cause injustice to others in the future we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
4. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
5. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, section 25(7), as amended)
6. If we are satisfied with an organisation’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)
7. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

8. I considered information from Mrs B. I made written enquiries of the Council and considered information it sent in response.
9. Mrs B and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Assessments

10. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person has eligible needs. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve.
11. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.

Care and support plan

12. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. 

Direct payments

13. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.

Care services regulation and guidance

14. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers which meet the fundamental standards of care, inspects care services, and reports its findings. It can also enforce against breaches of fundamental care standards and prosecute offences.
15. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The CQC has guidance on how to meet the fundamental standards.
16. Regulation 17 says care providers should “maintain securely” records and should have “an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided”.

What happened

17. This chronology provides an overview of key events and does not detail everything that happened.
18. Mrs B has care and support needs. Her husband supported her before he sadly passed away in July 2021.
19. Mrs B’s daughter (Ms C) contacted the Council the same month. She said Mrs B needed support. She explained the family was supporting Mrs B, but it was not a long-term plan as they did not live close by.
20. The Council contacted Mrs B the following day to complete an assessment. Mrs B explained she could not make meals independently, and she needed help with household chores and encouragement to take her medication. The Council suggested reablement care. Reablement is a type of care that helps people relearn how to do daily activities. Mrs B accepted the Council’s offer.
21. The Council made a referral for reablement care. The team responded and said they did not have the capacity to pick up care. The Council therefore decided to source a long-term care package which would include carers providing support three times a day.
22. The Council commissioned a care agency, Hands in Harmony (the care agency), to provide Mrs B with a care package in August. Mrs B cancelled the care package after one week. She said it was not working and she was stressed and in pain.
23. The Council visited Mrs B in September. Mrs B said a personal assistant through a direct payments package was more suitable than a care agency. Mrs B also said she needed support to move around her house safely. The Council agreed to complete an occupational therapy referral. It also told Mrs B to consider accepting an agency because it was difficult to employ a personal assistant for 12 hours a week.
24. Ms C contacted the Council at the end of October. She said she was concerned about Mrs B’s mental state. She said Mrs B needed more than 12 hours of support a week. The Council explained Mrs B was on the waiting list for a specialist assessment from the occupational therapy team. It also explained the only way it could meet Mrs B’s care and support needs was through a care agency or if Mrs B employed a personal assistant through a direct payments package.
25. An occupational therapist (OT) visited Mrs B at her home in February 2022. She recommended a powered door entry system to allow Mrs B to enter and leave her house independently. She also said Mrs B needed a reassessment of her care and support needs before she could finalise any other recommendations.
26. Mrs B contacted the OT in March and said she had not considered her needs fully. Ms C also emailed the OT with concerns that she had misunderstood Mrs B’s needs. The OT responded and said she would revisit the matter once a social worker had reassessed Mrs B’s care and support needs.
27. The Council reassessed Mrs B’s care and support needs and sent her the assessment in May. Mrs B and the Council exchanged emails about the content of her assessment in June, July and August.
28. Mrs B sent a detailed complaint to the Council in August about how it had handled her care and support needs. She said it had failed to provide her with adequate help and there had been significant delays in completing assessments and answering her questions. She said she had tried to complain to the social worker, but she had refused to progress her complaint. She also provided a detailed account of her experience with the care agency.
29. The Council upheld Mrs B’s complaints about its social work team and the occupational therapy team. It said:

• It delayed completing assessments.
• There was poor communication and poor record keeping.
• The social worker failed to make a referral to the direct payments team.
• Her assessment from July 2021 said she needed support with picking up shopping and housework. However, her care and support plan did not reflect this and therefore it did not provide her with the support she needed.
• The social worker should have advised her of the complaints procedure.
• It should have done more to ensure the OT and social worker worked closely together.
• The OT should have considered other options to help her.

30. The Council apologised to Mrs B for the distress caused. It said it would assign a new worker to visit her and start the process for direct payments. It also said it would forward details of her complaint about the care agency to its care standards team. The team is responsible for monitoring the quality of care provided by all care agencies in the area.
31. Mrs B emailed the Council. She accepted its apologies. However, she said she was still suffering, and it had not addressed this. She also asked whether its care standards team would contact her about the care agency. The Council responded and said it had contacted the care standards team and raised concerns with the manager about the care agency. The manager said the care agency did not get a lot of complaints and it had a good CQC rating. It told her to contact the CQC if she remained unhappy.
32. The Council assigned a support worker to Mrs B’s case in October and a new OT in November. The OT and support worker visited Mrs B. The OT assessed Mrs B. She suggested a front door opening system, a drop-down basket and oven housing unit in the kitchen and window openers in the bedroom and lounge. She also said she would explore whether a grab rail could be installed. Mrs B said she wanted to consider the options. The support worker left Mrs B with information about direct payments and the financial assessment process.
33. The OT chased Mrs B for a response to the proposed adaptations to her house.
34. The support worker spoke to Mrs B about her care and support options and the possibility of direct payments the following week. Mrs B said she was not sure how she wanted to proceed until it had completed the adaptations to her house. She also said she was concerned about how much she would have to contribute financially to her care. The support worker agreed to send Mrs B a pre-service financial assessment. The finance team sent this the following week.
35. The OT sent further chasers to Mrs B. Mrs B responded and said she could not consider the proposed adaptations as the OT had not answered her questions.
36. Mrs B emailed the Council’s complaints department in December and said she was still unhappy with the occupational therapy department. She said the OT had not answered her questions and her needs were still being ignored. She also said she was unhappy it had not dealt with her complaint about the care agency. The Council emailed Mrs B and said it would respond by early February 2023.
37. The OT responded to Mrs B’s questions in January 2023. She asked Mrs B further questions on why the proposed adaptations would not meet her needs.
38. The Council sent Mrs B a copy of her needs assessment in January. It asked her to contact it by the end of the month if she wanted to progress with direct payments. It closed the case in February after it did not hear anything further.
39. Mrs B chased for a response to her complaint in March.
40. The Council issued its final response to Mrs B’s complaint in mid-March. It apologised for the delay in responding. It said the delays she experienced during the assessment process were unacceptable. It offered her £350 in recognition of her frustration, uncertainty, and distress. It said it had reassessed her needs, and if she still wanted support, she should engage with the occupational therapy and social work teams. It also said its care standards team provided a proportionate response to her concerns about the care agency.
41. The Council sent Mrs B a further email the following week and offered her support to address her ongoing questions and concerns about her assessments.
42. Mrs B emailed the Council at the end of May and said £350 was not sufficient to remedy her injustice. She said she wanted it to address her needs and not close her case.
43. The Council emailed Mrs B at the beginning of June. It said it was still happy to meet her and resolve the issues with the assessments.

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Analysis

44. The Ombudsman cannot investigate late complaints unless there are good reasons to. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. Mrs B complains about issues from July 2021, but she did not refer her complaint to us until June 2023. Mrs B explained she was unwell during some of this time and the issues were ongoing. She also said when she initially tried to complain, the social worker did not progress her concerns. I consider these are good reasons why Mrs B did not contact us sooner, and therefore I have exercised discretion to investigate her complaint from July 2021.
45. The Council upheld Mrs B’s complaints. It accepts it delayed completing assessments, it did not arrange care and support in line with Mrs B’s needs, its communication was poor, and it did not consider enough different solutions to adapt her home. I agree with the Council’s findings. These faults have caused Mrs B distress, frustration, and uncertainty at a difficult time.
46. Mrs B says the care agency did not meet her needs and the Council failed to appropriately deal with her concerns about it. As the Council commissioned the care, it has the overall responsibility to address any complaints about the care agency. Mrs B raised detailed concerns about the care agency in her complaint in August 2022.The Council passed the matter to its care standards team but failed to address any of Mrs B’s detailed points. The Council said it in its final response to Mrs B’s complaint its care standards team provided a proportionate response to her concerns about the care agency. This is not correct as the care standards team did not address Mrs B’s complaint at all. The Council’s failure to conduct a detailed investigation has caused Mrs B further frustration.
47. I have investigated Mrs B’s core issues about the care agency. She says its record keeping was poor and some events in the daily notes are inaccurate and contradict what happened.
48. I agree with Mrs B that the care agency was at fault for its record keeping. Accurate record keeping is vital for the safe delivery of care. I have received two different care plans from the care agency. One is a care plan that Mrs B signed, and another is a care plan she did not sign. In the care plan that Mrs B signed, some sections are blank, including whether Mrs B needed help washing herself and what tasks and domestic duties carers had to complete. Although it states in the care plan Mrs B needed prompting to take medication, this action is not always recorded in the daily notes. There are also some inconsistencies in the records about Mrs B’s needs. These faults have caused Mrs B frustration and uncertainty about whether the care agency fully understood her needs.
49. The Council has apologised to Mrs B and offered her £350 for her injustice. Given the further faults I have identified in my investigation, I do not consider this is sufficient to remedy her injustice. I also do not consider £350 is sufficient to address the number of faults identified and the length of time they went on for. I recommend the Council makes an increased payment to Mrs B.
50. The Council said in response to Mrs B’s complaint it has introduced monitoring procedures within its social work team to ensure it addresses any failures in case recording in a timely manner. While I welcome this, I recommend the Council makes further service improvements to prevent a recurrence of the faults.
51. It is for the Council, not the Ombudsman, to decide what care and support a person needs. Councils must involve the individual and consider their views. It is clear Mrs B is unhappy with the Council’s reassessments of her needs. She still has questions she says the Council has not answered. As a resolution to her complaint, she wants the Council to provide her with a suitable care package and adaptations to her house to meet her needs. The Council offered to meet with Mrs B in its emails from March and June 2023 to resolve her outstanding concerns with her assessments. This is an appropriate way forward. Mrs B will need to respond to the Council if she wishes to progress this matter.

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Agreed action

52. When a council commissions another organisation to provide services on its behalf it remains responsible for those services and for the actions of the organisation providing them. So, although I found some fault with the service of the care agency, I have made recommendations to the Council.
53. By 22 December 2023 the Council has agreed to:

• Apologise to Mrs B for the frustration and uncertainty caused by the further faults identified.
• Pay Mrs B £500 to reflect the frustration, distress and uncertainty from how it handled her care and support needs.
• Pay Mrs B a further £150 to reflect the frustration caused by not dealing with her complaint about the care agency.

54. By 25 January 2024 the Council has agreed to:

• Remind relevant staff that they must fully investigate complaints about a care agency the Council has commissioned.
• Remind relevant staff they must complete assessments of a service user’s care and support needs/occupational therapy needs without unnecessary delay. The needs identified in any assessments must also reflect what it is the care and support plan.
• Remind all care and support staff at the care agency the importance of maintaining complete and accurate care records.

55. The Council should provide us with evidence it has complied with the above actions.

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Final decision

56. There was fault by the Council, which caused Mrs B an injustice. The Council has agreed to my recommendations and so I have completed my investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman