Summary: Miss X complains about the Council’s decision not to complete a care assessment when she asked for one in 2018. Miss X also complains about the Council’s complaint handling. I find fault with the Council for failing to complete a care assessment. I also find fault with the Council’s complaint handling. I have recommended the Council apologise, pay Miss X a financial remedy, and remind staff of the requirements of the Care Act 2014.

The complaint

1. Miss X complains about the Council’s decision not to complete a care assessment when she asked for one in 2018. Miss X says the Council told her she was not eligible for an assessment because she did not have any physical issues. Miss X first complained to us about the matter in August 2018. We asked the Council to investigate her complaint. Miss X says the Council never responded to her complaint.

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The Ombudsman’s role and powers

2. 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. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. 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)

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How I considered this complaint

4. I spoke with Ms X and considered the information she provided.
5. I made enquiries with the Council and considered the information it provided.
6. I sent two draft decision to Ms X and the Council and considered their comments.

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What I found

Legislation

7. Sections 9 and 10 of the Care Act 2014 require local authorities to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to all people regardless of their finances or whether the local authority thinks an individual has eligible needs.
8. The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs and their carers. The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how a person’s needs affect their ability to achieve relevant outcomes, and how these impacts on their wellbeing. To have needs which are eligible for support, the following must apply:
1. The needs must arise from, or be related to, a physical or mental impairment or illness.
2. Because of the needs, the adult must be unable to achieve two or more of the following:

• Managing and maintaining nutrition;
• Maintaining personal hygiene;
• Managing toilet needs;
• Being appropriately clothed;
• Being able to make sure of the adult’s home safely;
• Maintaining a habitable home environment;
• Developing and maintaining family or other personal relationships;
• Accessing and engaging in work, training, education or volunteering;
• Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
• Carrying out any caring responsibilities the adult has for a child.
3. Because of not achieving these outcomes, there is likely to be, a significant impact on the adult’s well-being.

What happened

9. In July 2018, Miss X contacted the Council and asked to speak with someone regarding her mental health. Miss X told the Council she had an appointment with mental health services in September 2018 but could not wait for their help. As Miss X was known to the Community Mental Health Team (CMHT), the Council provided her with contact details for the Mental Health Crisis team.
10. In August 2018, Miss X contacted the Council twice and asked for a care needs assessment. Miss X said the Council told her she was not eligible for an assessment because she had mental health issues rather than physical issues.
11. The Council said it did not complete a care needs assessment because the Council felt Miss X’s needs arose as a result of her mental health issues. The Council also said it had not identified any health and care needs during their phone conversations and so signposted her to the mental health services and mental health crisis team instead.
12. In August 2018. Miss X made a complaint to the Ombudsman about the Council’s decision to not complete a care assessment. We asked the Council to respond to her complaint as it had not yet had the opportunity to investigate Miss X's complaint.
13. In August 2019, Miss X returned to the Ombudsman. The Council explained it had not investigated Miss X’s complaint and said it had instead asked the NHS to investigate her complaint under its complaint procedure. The Council said this was because Miss X’s complaint was about mental health services, which is an NHS service. 
14. The Council completed a care assessment for Miss X in October 2019.

Analysis

Care assessment

15. The evidence shows Miss X asked the Council for a social care assessment in August 2018. The Council did not complete one because it did not think Miss X had any health and care needs.
16. The Care Act 2014 sets out the Council’s duty to complete an assessment for any adult with an appearance of need for care and support. It must provide an assessment regardless of whether it thinks an individual has eligible needs. This is a low threshold. As Miss X asked for an assessment, this suggests she felt she had a need for care and support.
17. Further, the evidence suggests the Council did recognise Miss X had needs. It said it “felt Miss X’s needs were arising as a result of her mental health issues”. Therefore, as this is an appearance of need for care and support, the Council should have completed a care assessment.
18. The Council also seems to suggest it did not have to complete a care assessment because Miss X’s needs were a result of her mental health issues. However, the law is clear that needs can arise from, or be related to, a mental impairment or illness. This means Miss X’s could still have had eligible needs even though she did not have any physical issues. The Council could not have known whether Miss X had any eligible needs until it completed a care assessment.
19. Therefore, I find the Council was at fault for not completing a care assessment for Miss X in 2018. The fault identified caused Miss X an injustice because there is uncertainty as to what the outcome of the care assessment would have been.

Complaint handling

20. We asked the Council to investigate Miss X’s complaint in August 2018. The Council asked the NHS to consider it instead.
21. Miss X’s complaint was about the Council’s decision not to complete a care assessment. This is not a service provided by the NHS. Therefore, the Council was the appropriate body to respond to the complaint. Therefore, I find fault with the Council for its complaint handling.
22. The fault identified caused Miss X an injustice because she did not get a timely response to her complaint. Miss X was also caused time and trouble as she had to pursue her complaint with the Ombudsman to get a response.

Agreed action

23. To remedy the injustice caused by the faults identified, the Council has agreed to complete the following:

• Write to Miss X and apologise for the faults and injustice caused.
• Pay Miss X £150 to recognise the uncertainty and time and trouble caused.
• Write to all relevant staff to remind them of the Council’s duties as set out within the Care Act 2014. The Council should remind staff that a care assessment must be completed for any adult with an appearance of need for care and support. The Council should also highlight that needs can arise from a mental impairment or illness.

24. The Council should complete the above remedy within four weeks of the final decision.

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Final decision

25. I find fault with the Council for failing to complete a care assessment in 2018. I also find fault with the Council’s complaint handling. The Council has agreed to my recommendations, therefore, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman