Cambridgeshire County Council (14 013 229)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 12 Jun 2015

The Ombudsman's final decision:

Summary: The complaint is upheld. The Council failed to provide some assessed needs and delayed in providing others. This failure contributed to Ms X’s decision to move out of the area.

The complaint

  1. Ms Y, a paralegal, complains on behalf of Ms X, the Council:
    • failed to provide an interim care package of three hours per week following the care assessment in April 2014. The Council later increased this to six hours per week but also failed to provide this;
    • delayed in providing the meal service identified in the care assessment;
    • failed to provide a suitably trained social worker;
    • failed to carry out a re-assessment following Ms X’s autism diagnosis;
    • failed to implement the 2010 statutory guidance “implementing fulfilling and rewarding lives” following the Autism Act 2009.

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The Ombudsman’s role and powers

  1. The Ombudsman investigates complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. She 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, she may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1))
  2. The Ombudsman cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. She must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3))

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How I considered this complaint

  1. As part of the investigation, I have:
    • considered the complaint and the documents provided by the complainant’s representative;
    • made enquiries of the Council and considered the comments and documents the Council provided;
    • discussed the issues with the complainant’s representative;
    • sent my draft decision to both the Council and the complainant’s representative and invited their comments.

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What I found

  1. The Council carried out a care assessment on Ms X in April 2014. It decided a formal diagnosis of Ms X’s condition would be helpful. The Council referred Ms X to CLASS (Cambridge Lifespan Asperger’s Syndrome Services).
  2. The Council agreed an interim care package for Ms X. This included three hours per week to be used flexibly to help Ms X manage mail, household activities, liaise with people and going out. It also offered to provide a meal delivery service and to seek funding for a freezer. I also agreed to make a referral to physiotherapy.
  3. The Council says it would expect contact to be made with suitable care providers and the food delivery service immediately but there is no evidence to show this happened. The case files do not show the exact start date of the food delivery service. There is some evidence of contact with the delivery service in June. A case note dated 1 August is the earliest entry confirming the service was in place.
  4. The Council identified a charity as a possible care provider. It said it would need to complete a joint assessment before providing services. This entry is in the case note dated 1 August, over three months after the Council carried out the care assessment. The joint assessment never took place and the charity did not provide any care.
  5. The CLASS assessment was completed in July 2014. The doctor wrote to the Council on 21 July confirming a diagnosis of high functioning autism. The Council took the view it should use a specialist autism care provider to meet Ms X’s assessed needs. Because of the diagnosis it also increased the care from three to six hours per week. Although the Council contacted the new charity, no care hours were ever provided to Ms X.
  6. Ms X told the Council she wanted to change social workers. She also had concerns about the meal delivery service. She did not have a freezer and so fortnightly deliveries were no good as the food did not keep. The Council says there is no evidence to the social worked made applications for funding help for a freezer. However, the situation resolved itself when weekly food deliveries were agreed.
  7. Following the CLASS assessment, the Council needed to complete a new care assessment for Ms X’s needs. The Council appointed a new social worker in August. The social worker spoke to Ms X by telephone on 12 August. During this call Ms X made comments about her possible behaviour that caused concern. The social worker discussed the call with her line manager and they made the decision to cancel a meeting with Ms X due to her history of risk.
  8. The Council did not carry out the reassessment of Ms X’s needs as it failed to find an appropriate venue. A police station was suggested by the Council as a possible venue but this was not acceptable to Ms X. The representative acting for Ms X suggested meeting at her office. The Council considered a venue within Cambridgeshire and Peterborough NHS Trust (CPFT) but this was not considered appropriate.
  9. Ms X’s representative wrote to CPFT on 10 August making a formal complaint. The Council said it would provide a response within 25 working days. On 16 September the representative wrote to CPFT again as no response had been provided. CPFT wrote to the representative on 31 October responding to the complaint.
  10. The complaint response said the Council was in the process of setting up a specialist team to work with people diagnosed with Autism and Asperger’s and that it may consider appointing a new social worker from that team to work with Ms X. It said that care agencies usually used felt they could not offer the necessary care for Ms X. It said it was now working with a national specialist charity to see if it could provide the assessed care. It acknowledged there was a gap in the specialist services available for people with autism and asperger’s. It was unable to say when it would be able to start providing services to Ms X or carry out the reassessment of her needs.
  11. Around November Ms X moved out of Cambridgeshire. She told her representative she could not stay because she needed help and the Council had failed to provide support. She hoped by moving to another area she would be able to get the help she needed.

Analysis

Failure to provide care package following care assessment in April 2014

  1. The Council completed a care assessment in April 2014. This identified a need for three hours of support per week. After her diagnosis in July, the Council increased this to six hours per week. No support hours have ever been provided to Ms X.
  2. The information provided does not persuade me the Council took appropriate steps to find a suitable carer for Ms X. There is no evidence of any action between 24 April and 1 August. Following the change of social worker another agency was approached but this did not result in any support hours actually being provided.
  3. I am not persuaded Ms X’s care needs were particularly specialised. She required help with managing mail, housework, going out and liaising with people. The delay in providing the assessed care is fault.

Delay in providing the meal service

  1. The care assessment completed by the Council in April 2014 identified the need for a meal delivery service for Ms X. It also stated a freezer would be required. The information provided does not clearly indicate when the deliveries actually began. A note dated 1 August confirms the deliveries have commenced. Other file notes show Ms X experienced problems with the deliveries which were cancelled on 24 September.
  2. The Council accepts it delayed in putting the meal delivery service in place. The problems experienced by Ms X with the service were added to by the Council’s failure to source a freezer. The failure to properly provide the meal delivery service is fault.

Failure to provide a suitably trained social worker

  1. There is nothing to suggest the social workers assigned to Ms X were not qualified. The Council allocated a new social worker to Ms X following her request in August 2014. Ms X made a request for a further change of social worker as she felt the second social worker was more focussed on her own personal safety than with assisting her. The Council began the phased development of a specialist Autism and Adult Support Team in October 2014. It said it would consider allocating a social worker from this new team.
  2. The Council responded to the requests to change social workers as Ms X had difficulties working with them. I cannot conclude the Council did not provide suitably trained social workers.

Failure to carry out a re-assessment following the autism diagnosis

  1. The CLASS assessment was completed in July 2014 and a diagnosis of high functioning autism was given. This information was passed to the Council and there was a slight delay in taking action due to the appointment of a new social worker.
  2. The file notes show a telephone conversation between Ms X and her new social worker in which Ms X said she may get physically aggressive. This resulted in the Council cancelling a planned meeting with Ms X and it trying to find a different venue for future meetings. The file notes indicate the Council was unsuccessful in finding another venue.
  3. The Council completed a care assessment of Ms X in April 2014. There is nothing to suggest any problems due to physical aggression. While Ms X said in a conversation she may become aggressive I am not persuaded there was significant new information to suggest it was not safe to meet with Ms X in the same way the Council had met with her in April. I appreciate the Council has a duty to ensure the safety of its staff but it also had a duty to assess Ms X and provide services. I consider the continued delay to carry out a reassessment was fault.

Failure to implement the 2010 statutory guidance “implementing fulfilling and rewarding lives” following the Autism Act 2009

  1. The Council has provided documents which show it was aware of the Autism Act statutory guidance. The Cambridgeshire Health and Wellbeing Board considered a report in October 2014 which detailed progress made on the autism strategy. It was also at the point of setting up a specialised team.
  2. I cannot conclude the Council failed to consider or take action in response to this statutory guidance. However, it seems that despite the Council being aware of and putting the statutory guidance in place, this did not prevent problems arising in Ms X’s case.
  3. The Council acted appropriately in referring Ms X for a specific diagnosis following the care assessment in April 2014. However, it then failed and/or delayed in providing all the identified needs. The failure to commission a suitable care provider frustrated Ms X and contributed to her decision to leave the area.

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Agreed action

  1. The Council should pay Ms X £2,500 to recognise the fault in this case. This recognises the cost of the services that were never provided to Ms X and an amount for the frustration and distress which contributed to Ms X’s decision to move out of the area.
  2. The Council should also consider why things went so wrong in this case and implement changes from any lessons learnt.

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Final decision

  1. My decision is the complaint is upheld.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman

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