Summary: Mrs D complains about a lack of social care support from the Council. The Ombudsman has found fault causing injustice. The Council has agreed to assess Mrs D’s care and support needs.

The complaint

1. Mrs D complains about a lack of social care support from the Council. In particular she complains her previous social worker failed to contact her and she had to wait for six months for support. Mrs D says her health has deteriorated as a result.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), 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 to Mrs D about her complaint and considered the Council’s response to my enquiries and:
• The Care Act 2014
• The Care and Support Guidance
5. I sent Mrs D and the Council my draft decision and considered the comments I received.

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What I found

Care and support needs assessment

6. 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.

Eligibility for care and support

7. 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 this 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:
1. Managing and maintaining nutrition;
2. Maintaining personal hygiene;
3. Managing toilet needs;
4. Being appropriately clothed;
5. Being able to make use of the adult’s home safely;
6. Maintaining a habitable home environment;
7. Developing and maintaining family or other personal relationships;
8. Accessing and engaging in work, training, education or volunteering;
9. Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
10. 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.
8. 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.

What happened

9. Mrs D has epilepsy, anxiety and memory problems. She says she needs support from a key worker to help her with daily tasks and that she is vulnerable to abuse.
10. In March 2018, Mrs D asked the Council for support and to provide a key worker. It agreed to assess her needs.
11. A social worker visited Mrs D at home in May 2018. The social worker suggested support could be provided to encourage Mrs D’s confidence and reduce anxiety. She made a referral to the Council’s reablement team and a housing support service in June 2018. But it was then agreed with Mrs D that these services would not be helpful. The Council agreed to make a referral for telecare, but this was not progressed as Mrs D could not find someone to be a key holder.
12. In July 2018 the social worker went on sick leave. The Council says Mrs D was aware she could contact the duty social work team or the social worker’s manager, who called her twice in August.
13. On her return, the social worker visited Mrs D at home on 13 September 2018. Unfortunately, she was late for the meeting due to problems accessing the property. The social worker considered there were no other services that could be offered to Mrs D which had not already been discussed with her.
14. Mrs D was dissatisfied and approached the Ombudsman, she said she had complained to the Council in June 2018 but had received no response. It was too soon for us to consider her complaint as she had not yet completed the Council’s complaint procedure.
15. Mrs D complained to the Council that she had not received any support. The Council responded on 19 October 2018. It apologised for any lack of support whilst the social worker was off sick. It set out the services that had been offered but had been unable to be taken up. The Council suggested Mrs D contact community mental health services, her neurologist and a community support group. Mrs D complained about the social worker arriving late. The Council apologised for this.
16. In January 2019 a mental health social worker started to visit Mrs D. Mrs D again requested a key worker, but the Council considered Mrs D did not have any needs that could be met by adult social care. The Council closed the case in March 2019.

My findings

17. Mrs D complains the Council has not provided her with the support she needs. It is not the Ombudsman’s role to decide what, if any, care and support a person needs. That is the Council’s role. The Ombudsman’s role is to consider if the Council has followed the correct process to establish a person’s needs.
18. The Ombudsman cannot question the outcome of a care and support needs assessment that has not been affected by administrative fault. The Council says Mrs D has been assessed as not having eligible care and support needs, but I have seen no evidence of this assessment.
19. Whilst there is evidence the Council tried to find services to support Mrs D, it is not clear how the Council knew what her needs were, how it decided she was not eligible for support, or how it determined what care and support she may need to meet her needs.
20. I therefore find there is fault in the way Mrs D’s needs were assessed. This has caused injustice to Mrs D as she does not know what support she may be eligible to receive or how her needs may be met.

Agreed action

21. The Council has agreed to assess Mrs D’s care and support needs within a month of my final decision.

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Final decision

22. There was fault by the Council. The actions the Council has agreed to take remedy the injustice caused. I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman