Leicester City Council (18 009 875)

Category : Adult care services > Assessment and care plan

Decision : Not upheld

Decision date : 27 Mar 2019

The Ombudsman's final decision:

Summary: Ms X complains about the way the Council carried out a review of her care needs and reduced the hours of support she previously received. The Ombudsman has found no evidence of fault in the way the Council considered these matters.

The complaint

  1. The complainant whom I shall refer to as Ms X complains about the way the Council carried out a review of her assessed care needs and reduced the hours of support she has previously received. Ms X says this caused her distress and significantly reduced her physical, emotional, mental health and wellbeing. Ms X complains the decrease in her support places greater responsibility on her son to provide her care.

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The Ombudsman’s role and powers

  1. 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)
  2. 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

  1. I have read the papers provided by Ms X and spoken to her about the complaint. I considered the Council’s comments on the complaint and the supporting documents it has provided. I have explained my draft decision to Ms X and the Council and considered the comments received.

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What I found

  1. 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. The assessment must be of the adult’s needs and how they impact on their wellbeing and the results they want to achieve. It must also involve the individual and where suitable their carer or any other person they might want involved.
  2. Where local authorities have determined that a person has any eligible needs, they must meet these needs. When a local authority has decided a person is or is not eligible for support it must provide the person to whom the determination relates (the adult or carer) with a copy of its decision.

Care Plan

  1. The Care Act 2014 gives local authorities 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 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. When preparing a care and support plan the local authority must involve any carer the adult has. The support plan may include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person.

Reviews

  1. Section 27 of the Care Act 2014 gives an expectation that local authorities should conduct a review of a care and support plan at least every 12 months. The authority should consider a light touch review six to eight weeks after agreement and signing off the plan and personal budget. It should carry out the review as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. As well as the duty to keep plans under review generally, the Act puts a duty on the local authority to conduct a review if the adult or a person acting on the adult’s behalf asks for one.

Background to the complaint

  1. Ms X lives with her adult son. From 2013 to 2016 the Council assessed her as needing a care package of 10.5 hours a week due to her medical conditions and personal circumstances. And then from 2016 to 2018 the Council assessed Ms X as needing 12 hours of care a week. The care was to provide support with personal care, domestic tasks and social inclusion including accessing therapy sessions. Ms X used a care agency to provide the support she needed and her son also provided some support.
  2. The Council allocated Ms X a social worker in October 2017 to carry out an annual review of her care needs. The review took place in November 2017 at Ms X’s home with her son and advocate present. The Council’s records say the social worker stopped the assessment after Ms X became upset discussing matters.
  3. Ms X complained to the Council after the meeting about the procedure, discussions and the social worker’s behaviour. The Council responded to Ms X’s complaint and referred to the issues raised by Ms X. But Ms X’s advocate said it had not addressed all the concerns about the social worker’s approach and consideration given to the wellbeing of both Ms X and her son.
  4. The Council offered to meet with Ms X but she declined asking for a written response. The Council refused saying it considered its previous response dealt with Ms X’s concerns. The Council allocated a new social worker to Ms X who continued with the review until March 2018. Ms X said she did not wish to continue with the social worker and asked for a new officer to carry out the assessment.
  5. The Council noted Ms X’s dissatisfaction but continued with the assessment and drew up a support plan for her. This reduced the care and support she received to five hours a week from June 2018. It reduced the social support Ms X received from seven hours 15 minutes to one hour 30 minutes. With personal support reduced to three hours 30 minutes. The Council recommended Ms X needed the care agency to provide rehabilitation from her trusted carers to become more independent and prepare meals for herself.
  6. Ms X met with two social workers to discuss the care assessment and support plan and submitted her comments on the document with her disagreement to its contents. The social workers considered Ms X’s comments but did not consider they changed the view of the assessment.
  7. The Council issued the support plan to Ms X and advised the support was a short-term measure designed to help her overcome and manage the difficult situation she found herself in. The Council said it would review the plan after three months from the start of the new package of care. It explained the community services she could use to help her and continue to build her own independence.
  8. The Council says the care agency delivering the support consider it is working now. It says it mainly provides support by giving Ms X lifts in cars to visit friends or to shop. The care agency says it is not providing the physical care as listed in Ms X’s assessed need. And the Council will consider this at the next reassessment.

Ms X’s complaints

  1. Ms X complained about;
    • The Council’s decision to reduce her care to five hours a week and says this goes against the medical evidence and personal reports provided. And the health problems she has. Ms X also complains about the Council’s decision for her to use a reablement agency to become more independent. Ms X wants the Council to return her support hours to 12 hours a week with her chosen care agency and not use the rehabilitaition services.
    • The Council’s reference to information in her assessment could only be gained from third parties who Ms X did not want any involvement from. Ms X says the Council’s contact with these third parties has caused her distress.
    • The attitude of the social workers carrying out the assessment in 2017/18 who she considered were rude and hostile to her and failed to understand PTSD, a medical condition she suffers from. Ms X says the officers omitted information from the assessment and kept in factual errors.
    • The Council expecting her son to act as her carer and take on more responsibility for her so affecting his educational plans.
    • The level of her financial contribution she is expected to make towards her care. Ms X says she has paid £54 a week towards her care since 2013. The Council is still needing her to pay this amount even though her care hours have reduced to five a week.
    • The way the Council dealt with a safeguarding referral in August 2018. And arranged a visit from her GP without her knowledge when she was attending an event. Ms X says the Council knew about the event and this caused her problems with the surgery as she was out at the time of the call. Ms X says the fact she was out at the time of the visit is being used unreasonably as evidence to support a decrease in her care hours.

The Council’s response to Ms X’s complaints

  1. The Council considers the support offered to Ms X suitable to meet her identified eligible needs and promote her independence under the requirements of the Care Act 2014. It says officers have considered how she can enhance her existing techniques and abilities. And how she can use these to help her integrate into the community. The Council says Ms X, her son and advocate participated in the assessment. It sought medical information for Ms X’s GP and from her care agency during the procedure to inform its decision on the care offered.
  2. The Council said it recognised Ms X’s concerns about the review procedure and tried to carry out the assessment as fairly and flexibly as it could in response to her complaints. It says it has acted to address the concerns she raised and appointed new social workers to assess her.
  3. The Council considers the assessment looked at Ms X’s needs and how she would be able to improve her overall independence in the future. It says Ms X chose not to engage in the community based services offered and considered to be able to help her improve the overall quality of her life. But it is aware Ms X has positively taken up some community based activities she has chosen to do.
  4. The Council says it gathered information and considered it as part of the care assessment and this has appropriately informed the level of support identified to meet Ms X’s care needs. It says it is aware of Ms X’s views disagreeing with the assessment and taken account of her concerns. It has noted Ms X’s views as an addendum to the assessment document. The Council says officers are aware Ms X receives support from other agencies and health services. Officers have directed her when appropriate or offered to refer her to services outside Adult Social Care that may offer her additional or alternative support.
  5. The Council says that matters about Ms X’s health are managed through appropriate services by her GP. Although the social workers do consider an individual’s cognitive and emotional health conditions and the person’s own abilities. The Council is satisfied the officers considered these issues when visiting Ms X. It acknowledges PTSD is a complex condition. But it expects this to be addressed by professional services provided by health services with appropriate therapies and approaches identified. The Council says officers understood health services had made appropriate arrangements for this condition for Ms X.
  6. The Council says the information Ms X considers was provided by third parties was in fact given by Ms X in 2013 and during the assessment in 2017. The Council says its clearly documented in the assessment. It says it does not hold contact details of the third parties Ms X mentions and it has not made any contact with them.
  7. The Council acknowledges that Ms X holds a different view about the proposal to use reablement services. But the Council regularly considers such services for those with potential to improve their life and wellbeing using trained workers to help at first. Officers proposed using the services to encourage Ms X to develop techniques and gain confidence in her own abilities. But as Ms X declined to use reablement services the Council says it did not take more action to engage the service.
  8. The Council says it has financially assessed Ms X according to Care Act legislation in May 2018 and she needs to pay £54.51 a week towards her care.
  9. The Council says the safeguarding referral happened following an incident involving Ms X. The Council considered the referral but found it did not meet the safeguarding investigation threshold for any action. This was due to the Council establishing there were appropriate services in place via health services to support Ms X.
  10. The Council says it does not hold any information about Ms X’s attendance at the event she referred to. The Council says it asked the GP to visit Ms X’s home after one of Ms X’s support workers contacted it a month later to express concern about Ms X’s low mood at the time. The GP confirmed Ms X contacted the surgery to say she was well and did not need a GP visit.
  11. The Council says it does not have any expectations Ms X’s son should be supporting her with care tasks. Social workers found during the assessment that Ms X was managing her own personal care, able to make her own food and drinks as well as some light domestic chores. It has however assessed Ms X as needing support with heavier domestic chores and shopping and have actively considered these should avoid relying on relatives or other carers. The Council says it offered Ms X’s son a separate carer’s assessment but this was declined. The option remains open to Ms X’s son should he wish for an assessment.
  12. In commenting on the draft decision Ms X says her son did accept having a carers assessment but is yet to submit the relevant forms.

My assessment

  1. The documents provided by the Council of Ms X’s assessment and case records, show the Council considered the information it received from medical professionals and Ms X about her health and personal information. This is according to the requirements of the Care Act 2014.
  2. Ms X disagrees with the Council’s decision on the package of care needed to support her eligible assessed needs. This decision is a matter of the officers’ professional judgement. The Ombudsman cannot question the merits of the decision itself without evidence of fault in the way it was made. I do not consider there was fault in this case.
  3. This is because from the documents I have seen I am satisfied the officers met with Ms X and considered the information she provided. The officers considered documents from Ms X’s GP and other health professionals with information from her care agency. From this information officers identified a package of care it considered suitable to meet her identified eligible needs to help Ms X to become more independent. This is decision the Council was entitled to make. There is no evidence of fault in the way the Council reached its decision.
  4. The Council has confirmed it had no contact from the third parties Ms X refers to. And it was Ms X who provided the information in 2013 and during the assessment in November 2017. This is confirmed in the documents provided by the Council.
  5. Ms X complained about the attitude of the social workers when carrying out the assessment. The documents show the Council responded to Ms X’s concerns and appointed new social workers to continue with her assessment. The Council has confirmed that while the social workers were aware of Ms X’s PTSD it was for health services to provide suitable support to her for this condition.
  6. The Council’s documents show Mrs X’s financial assessment form and the Council’s calculations carried out to assess her financial contribution towards her care needs. I appreciate Ms X may be unhappy with the outcome but I have no evidence of fault in the way the Council has carried out the assessment.
  7. The Council has explained how it consider the safeguarding referral in August 2018. It decided that it did not meet the safeguarding threshold for action and Ms X had suitable services in place provided by health services. This is a decision the Council is entitled to make. There is no evidence of administrative fault in the way the decision was reached from the documents I have seen. The Council has explained its involvement in the decision to ask Ms X’s GP to visit her due to concerns about her mental health following contact from her support worker a month later. It is unfortunate that Ms X was not at home at the time of the call. But I do not consider it was due to any fault by the Council.
  8. The Council confirmed it does not expect Ms X’s son to take on most of her care needs. The documents show officers considered the impact onto Ms X’s son as he was present at the assessments. And offered him a carer’s assessment which would take account of any care he provides, the impact of this and whether he needs any support. It is unfortunate the Council’s offer of an assessment has been declined and it may be an option for Ms X and her son to consider.
  9. If Ms X ‘s son has submitted the relevant documents and consider the Council failed to follow this up then it is open to him to submit his own complaint to the Council about the matter.

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Final decision

  1. I am completing my investigation. I have found no evidence of fault in the way the Council carried out a review of Ms X’s care needs and produced a support plan reducing her care hours.

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Investigator's decision on behalf of the Ombudsman

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