Decision : Upheld
Decision date : 12 Sep 2019
The Ombudsman's final decision:
Summary: The Council failed to carry out a social care assessment and draw up a care and support plan before Mr F was discharged from a rehabilitation unit. This was not in line with Sections 9, 24 and 25 of the Care Act 2014 and was fault which caused avoidable distress. The Council will apologise and pay Mr F and his mother Mrs E £250 each to reflect their avoidable distress.
- Mrs E complains for her son Mr F about Kent County Council (the Council). She says he has not been receiving an appropriate level of care and support. She also says the Council’s response to her complaint was poor.
The Ombudsman’s role and powers
- 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)
- 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)
How I considered this complaint
- I considered Mrs E’s complaint, the Council’s response to her complaint and documents described later in this statement. A colleague discussed Mrs E’s complaint with her by phone. Both parties received a draft of this statement and I took comments into account.
What I found
- A council must carry out an assessment for any adult with an appearance of need for care and support. The assessment must be of the adult’s needs and how they impact on their wellbeing and the outcomes they want to achieve. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9)
- The Care Act spells out the duty to meet eligible needs (needs which meet the eligibility criteria). (Care Act 2014, section 18)
- An adult’s needs meet the eligibility criteria if they arise from or are related to a physical or mental impairment or illness and as a result the adult cannot achieve two or more of the following outcomes and as a result there is or is likely to be a significant impact on well-being:
- Managing and maintaining nutrition
- Maintaining personal hygiene
- Managing toilet needs
- Being appropriately clothed
- Making use of the home safely
- Maintaining a habitable home environment
- Accessing work, training, education
- Making use of facilities or services in the community
- Carrying out caring responsibilities.
(Care and Support (Eligibility Criteria) Regulations 2014, Regulation 2)
- The Care Act explains the different ways a council can meet eligible needs by giving examples of services that may be provided:
- Accommodation in a care home or other premises
- Care and support at home
- Counselling and social work
- Information, advice and advocacy.
(Care Act 2014, section 8)
- If a council decides a person is eligible for care, it should prepare a care and support plan which specifies the needs identified in the assessment, says whether and to what extent the needs meet the eligibility criteria and specifies the needs the council is going to meet and how this will be done. The council should give a copy of the care and support plan to the person. (Care Act 2014, sections 24 and 25)
- Statutory Guidance explains a council should review a care and support plan at least every year, upon request or in response to a change in circumstances. (Care and Support Statutory Guidance, Paragraphs 13.32 and 13.13)
- Mrs E wrote to the Council’s mental health social care team at the end of September 2018 when Mr F was in a drug and alcohol recovery unit. She asked what the plans were for Mr F’s discharge. There was no written reply to Mrs E’s letter.
- Mrs E complained to the Council at the end of October 2018. She was concerned because Mr F’s placement in the drug and alcohol recovery unit was ending the following week. Mrs E said she was not aware of any plans for Mr F’s care and support when he left the unit. She said she had left messages with the office and no-one had returned her calls.
- Mr F returned to his supported housing placement when his recovery unit placement ended.
- The Council responded to Mrs E’s complaint in November saying:
- The Council had allocated a different social worker and her concerns about the previous social worker speaking about her own stress were being addressed in supervision
- It was sorry no-one responded to her phone calls and the manager apologised for this
- Mr F should have had a discharge plan before he was discharged. The Council was sorry for the poor contact and planning and the stress and anxiety this caused
- In future, the Council would ensure discharge planning took place and a care and support plan was in place
- Staff were being spoken to in supervision and meetings about how to manage work load.
- Social activities and relationships: he wanted support to integrate when he moved. He wanted to attend a music group;
- Finances: he wanted help to budget; and
- Emotional wellbeing and mental health: he wanted more visits from mental health services.
The case manager gave Mr F information about a service which would help with budgeting and referred him to the community mental health team’s enablement service for support.
- The case manager drew up a care and support plan for Mr F in February 2019. It described Mr F’s needs and how these were going to be met. There was a review of the care and support plan in May. I have summarised the plan and the review below:
- Managing and maintaining nutrition: Mr F needed support with cooking and eating when depressed. When well, he was independent in this area. His family and a charity provided support with this when necessary. He attended a cooking club, could shop for himself or his family brought him food;
- Maintaining personal hygiene and being appropriately dressed: Mr F was independent unless her was severely depressed. He was not currently self-neglecting. The mental health team and a support worker from the enablement service would provide support when needed;
- Accessing work, training and education: Mr F could not do this at the moment. The mental health team would refer him to services when he felt ready;
- Making use of facilities in the community: Mr F was supported to access a music group and a charity. He had a bus pass and could use the bus independently. This need was met; and
- Carrying out caring responsibilities, maintaining and developing relationships, maintaining a habitable home, using the home safely and managing toilet needs: Mr F had no needs identified in these areas.
Events since Mrs E’s complaint to us
- Mrs E complained to us in February 2019. She said she was not happy with her son’s care and support. Mrs E said Mr F was not receiving any support apart from seeing a psychiatrist. She said she had been to a meeting at the end of January where support was promised and a care plan had been completed but there was no action since.
- Kent and Medway NHS Partnership Trust allocated Mr F a psychiatric nurse in February 2019.
- The Council told me Mr F’s support worker had drawn up a plan with him which included: applying for a bus pass, visiting the town to use facilities, introducing him to a local mental health project and completing a budgeting plan. The Council told me this support had been successful.
- The Council also told me a social worker had reviewed the care and support plan in May and concluded Mr F’s needs had been met and so no further involvement from social care was necessary. However, Mrs E wanted support to continue and so there was due to be a further social care assessment/review because Mr F appeared to be struggling to open his mail and pay bills.
Was there fault?
- The Council should have assessed Mr F’s needs to determine his eligibility for care and support before he was discharged from the drug and alcohol unit. It should have drawn up a care and support plan if the outcome of that assessment was he had eligible unmet needs. The Council failed to act in line with sections 9, 24 and 25 of the Care Act 2014. The fault caused Mrs E and Mr F avoidable distress.
- I am satisfied the Council acted in line with the Care Act since February 2019. It completed an assessment and care and support plan, identified Mr F’s eligible unmet needs and delivered the care and support identified in the plan.
- I note the Council is carrying out a further review/social care assessment in light of concerns from his psychiatric nurse about Mr F not coping with maintaining the home environment (paying bills, managing finances). This action is appropriate and in line with paragraphs 13.13 and 13.23 of Care and Support Statutory Guidance and section 9 of the Care Act 2014.
- The Council’s complaint response in November 2018 identified the same fault I have found. It apologised for the avoidable distress and set out actions including allocating a different social worker a and addressing concerns with the previous social worker in supervision. This was a partial remedy. The Council should also have considered whether a symbolic payment was appropriate in the circumstances of the case. The failure to consider a financial remedy was fault.
- Our published Guidance on Remedies suggests a symbolic financial payment may be appropriate to recognise avoidable distress caused by failings in care assessment and care and support planning. In this case, I recommend and the the Council has agreed to pay Mrs E and Mr F £250 each to reflect the distress caused at a time when Mr F was particularly vulnerable (he was receiving treatment for addiction). The Council will also apologise again to Mrs E and Mr F. It should so within one month of my decision.
- The Council failed to carry out a social care assessment and draw up a care and support plan before Mr F was discharged from a rehabilitation unit. This was not in line with Sections 9, 24 and 25 of the Care Act 2014 and was fault which caused avoidable distress. The Council will, within one month, apologise and pay Mr F and his mother Mrs E £250 each to reflect their avoidable distress.
- I have completed my investigation.
Parts of the complaint that I did not investigate
- I have not investigated the NHS mental health services provided to Mr F by Kent and Medway Partnership NHS Trust. NHS services are not within our remit. Mrs E needs to use the NHS complaints procedure and complain to the Parliamentary and Health Service Ombudsman if she is not happy with the Trust’s final response to her complaint.
Investigator's decision on behalf of the Ombudsman