Summary: Ms X complained the Council delayed in assessing her care and support needs and then delayed in providing the care to meet those needs. She said this caused her child harm and her distress. She also said Council departments failed to work together effectively. The Council was at fault, as there was a three-month delay in assessing her needs and it did not appropriately consider the need for an emergency care package. This did not cause her child harm but did cause her frustration and distress. Council departments did communicate but the Council did not consider more integrated care planning and documentation provided to Ms X was unclear. The Council has agreed to apologise to Ms X and pay her £200 to acknowledge the distress caused. It will also take action to improve its services.

The complaint

1. Ms X complained the Council delayed in assessing her care and support needs and then delayed in providing the care to meet those needs. She says the delays left her child at risk of harm, caused actual harm and have caused her distress. She also said Council departments have failed to work together effectively leading to poor care planning, inaccurate and incomplete records and further delays. She wants the Council to apologise, pay compensation for the putting her child at increased risk of harm and the distress caused, provide her with a clear and accurate care and support plan and review its procedures.

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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 read Ms X’s complaint and discussed it with her representative over the phone.
5. I made enquiries of the Council and considered the information it sent me. I also considered information sent to me by Ms X’s representative.
6. Ms X and the Council had the opportunity to comment on the draft decision. I considered their comments before making my final decision.

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What I found

Legal and administrative background

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. 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.
8. Whilst the law does not define a timescale for a council to complete an assessment, the statutory guidance says it should be carried out “over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs.”
9. 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 be eligible for Council support:

1. The needs must arise from or be related to a physical or mental impairment or illness.
2. The adult must be unable to achieve two or more of the following outcomes:
• Managing and maintaining nutrition;
• Managing personal hygiene;
• Managing toilet needs;
• Being appropriately clothed;
• Being able to make use of the home safely;
• Maintaining a habitable home environment;
• Developing or managing 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 for a child.
3. Being unable to meet these outcomes is likely to have a significant impact on the adult’s wellbeing.

10. Where a council identifies a person has eligible needs, it has a duty to meet those needs.
11. The Care Act also give councils powers to meet urgent needs before they have completed their assessment, should the circumstances require it.
12. Statutory guidance says where a person has needs that can be met by various services, a council should not develop plans in isolation from other plans and should take a holistic approach. It says councils should have regard to all the persons needs and outcomes and seek to combine or integrate assessment and care plans, if appropriate. It says a council should consider a potential need to combine or integrate assessment or care planning early in the planning process.

What happened

13. Ms X has a visual impairment and is registered blind. In 2018, Ms X lived with her mother. Her mother was elderly and received support from home carers. Ms X also provided her mother with daily support.
14. In July 2018, Ms X gave birth to a child, Y. Ms X was not in a relationship with the child’s father, Mr Z, but had arranged for Mr Z and her wider family to support her to care for the child 24 hours a day.
15. In August 2018, a visiting social worker had concerns about how Ms X was caring for Y and whether this care was meeting Y’s needs. They referred Y to Children’s Services for an assessment.
16. Later that month, Ms X contacted Adult Social Care and requested an assessment for care and support for herself.
17. In September 2018, Children’s Services visited Ms X and Y to start their assessment. Ms X said she currently had support from her family at least 23 hours a day to help her care for Y. She said she needed support to enable her to change Y’s nappies and to make up their bottles. Children’s Services decided Y may need support from the Council and this needed further assessment. They referred Ms X to the sensory team for assessment to increase her independence with tasks related to Y’s care.
18. In October 2018, Children’s Services visited Ms X and Y. Ms X told the Council there were gaps of up to an hour where she was alone with Y without support from relatives, but she was able to manage during these times.
19. Children’s Services offered Ms X a family group conference to clarify what long term support family members were willing to provide. Ms X declined this offer saying arrangements were in place.
20. In November 2018, Ms X rang Children’s Services to say Y had choked on some medicine. A family member was present during the incident and assisted Ms X and Y.
21. Children’s Services met with Adult Social Care and the Sensory Team to discuss Y’s case. They expressed concerns about Ms X’s willingness to engage with services and the potential impact of this on Y.
22. A Children’s social worker visited Ms X and completed a further assessment. The report said although Ms X had initially said her family were supporting her at least 23 hours a day, this support was getting less and less. It identified a gap where there appeared to be no family support between 7-10am, but said Ms X had declined a family group conference to clarify the family’s support. It said there were currently no health or other concerns reported about Y.
23. At the end of November, the Sensory Team assessed Ms X. The report said that due to Ms X’s sight loss, there was serious and imminent risk of harm when Ms X was left alone with Y. It recommended various aids and adaptations be supplied to Ms X and discussed with her the risks of changing the Y’s nappy on a bed or sofa. It identified there was a gap between 7-10am when Ms X regularly did not have any family support.
24. The next day, Ms X contacted the Council to report Y had fallen off the bed whilst she was changing their nappy. The Council provided parenting advice advising Ms X to change Y on the floor. It said this was a proportionate response and a family member was present at the time. Ms X says the only other person present was her mother, who was elderly and unable to help. Ms X says the Council’s failure to provide her with support caused her baby harm.
25. In December 2018, the Sensory Team met with Children’s Services to share the findings from their assessment. The team also referred Ms X to Adult Social Care for a needs assessment.
26. Ms X complained to the Council. She said there had been unacceptable delay in Adult Social Care assessing her needs. She said the Children’s Services assessment and the Sensory Team assessment had both identified risks when she was alone with Y, but the Council had not put any support in place. She asked the Council to provide immediate emergency support and to complete the needs assessment.
27. Adult Social Care, Children’s Services and the Sensory Team met to discuss Ms X and Y’s case. It noted Ms X had requested 7 hours per day of support. Children’s Services agreed to purchase a bottle making machine and said it had already provided stairgates and a cot. Adult Social Care agreed to start a needs assessment. The sensory team said it would continue to support her to use aids and device around the home.
28. On 20 December 2018, a social worker visited Ms X to start the needs assessment.
29. In January 2019, the Council continued its assessment of her needs. It requested Ms X complete an occupational therapy assessment, but Ms X declined this. It also contacted her GP for further information.
30. Adult social Care and Children’s Services met to discuss the case. The meeting record noted there was a three-hour period between 7am and 10am where Ms X did not have any family support to care for Y. The Council said it was unclear when family had stopped providing this support, but as Y was not currently mobile, they did not consider there to be an immediate risk. They accepted as Y was likely to soon become more mobile, there was an increasing need for 24-hour oversight of his care. It said Ms X had told them she currently had support from a family member at all other times, although the afternoon and evening support was unlikely to continue long-term. They agreed to work together and jointly commission services. The services expressed concerns that Ms X and her family were not prioritising Y’s needs. They agreed they needed to clarify what support the family was prepared to offer.
31. The Council responded to Ms X’s complaint. It said although it accepted Ms X had first requested an assessment of her care needs in August 2018, the Council had first concentrated on the needs of her child. It said she had been allocated a social worker in December 2018 who had visited Ms X to complete their assessment.
32. The Adult Social Care social worker completed the needs assessment and considered Ms X had eligible needs for care and support.
33. At the end of January 2019, Children’s Services offered Ms X 3-hours daily care support between 7am and 10am. Ms X accepted this and the care package started soon after.
34. The Adult Social Care social worker completed the care and support plan. This identified Ms X had eligible needs but did not clearly set out the support the Council would provide to meet those needs. The social worker contacted Ms X and offered her 27.5 hours care per week. This was in addition to the support offered by Children’s Services. The plan did not include or refer to the support hours being provided by Children’s Services or set out what support was to be provided or how the hours were to be used.
35. In February 2019, Ms X told Adult Social Care her mother had been admitted to hospital and asked for the 27.5 hours a week of care to be put on hold.
36. At the beginning of March 2019, Ms X contacted Adult Social Care to say she was ready for the care package to start. The Council arranged this.
37. In May 2019, the Council reviewed Ms X’s care and support plan. Ms X said she was not given a copy of the revised plan and said the Council had not provided her with clear information about what care it was providing and how it was meeting her needs.
38. In June 2019, Ms X brought her complaint to us. She complained about the Council’s delay between August and December 2018 in completing the assessment of her care needs. She said this led to delays in putting in services which put her child at risk of harm. She also said the Council had not involved her in the care planning process or provided her with clear documentation setting out all the care the Council was providing. It had not provided her with a copy of her care plan following a recent review. She said there had been a lack of co-ordination between Adult and Children’s services.
39. In its complaint response, the Council said it did not consider the 4-month delay between her request for assessment and the start of her needs assessment to be unreasonable. It disputed that there had been lack of co-ordination between Adult and Children’s services. It said the two services had met in December 2018 and January 2019 to discuss Ms X and Y’s needs. It said both services had agreed to commission care from the same agency to ensure continuity for Ms X and Y. It said before January 2019, the Council had not identified a need for emergency care as Mr Z and Ms X’s family were providing support. It acknowledged there were two incidents that raised safeguarding concerns but said these were dealt with proportionately at the time and on each occasion a family member was present.
40. It said Ms X’s eligible needs had not changed since January 2019, but the commissioned support had been reviewed and increased several times when family had reduced their support. It said it had communicated changes to Ms X but could not confirm she was sent a copy of the updated care and support plan after the review meeting in May 2019. It accepted there was inadequacies in the format of its records when multiple services are working together to meet identified needs.
41. It said it has since reviewed Ms X’s care package several times and made appropriate adjustments to the commissioned care to ensure her needs continue to be met. I have seen evidence of this.

Analysis

42. Ms X requested an assessment of her need for care and support in August 2018, but the Council did not start the assessment until 20 December 2018. The statutory guidance says once a council receives a referral, it must complete a needs assessment within a reasonable timescale. The Ombudsman considers four weeks to be a reasonable timescale, unless there are good reasons why it would take longer. During Autumn 2018 Children’s Services were involved with Ms X and Y, but this did not discharge the Council of its duty to assess her needs under the Care Act. I have seen no evidence of other good reason for the delay. The Council delayed assessing her needs and this is fault. This delay caused Ms X frustration and uncertainty. However, Ms X told the Council family members were supporting her to meet her needs, and to care for Y, during this time. So, even if the Council had assessed her needs earlier, I cannot say that it would have led to a care package or paid support.
43. There were two safeguarding incidents (where Ms X’s child rolled off the bed and choked) during this time period. I cannot say these would have been avoided had a care package been in place. The Council appropriately considered these incidents and provided advice to Ms X. The Council is not at fault.
44. Ms X said the Council should have provided emergency care to meet her needs in December 2018. The Council did meet and discuss her request for support, and three days after this meeting, adult services began the needs assessment. However, children’s services and the sensory team assessment had both identified there was a three-hour gap in her support between 7-10am. I have seen no evidence the Council properly considered this information at this time, or whether an emergency care package was needed to cover this identified gap in the family support. This is fault.
45. Despite the fault, I cannot say whether the Council would have put a care package in place, had it properly considered the matter at this time. The Council started providing support to cover this 3-hour period at the end of January 2019, a month later. There is no evidence the failure to properly consider whether an emergency care package was required in December 2018 caused Y harm.
46. Ms X said, after it had identified her eligible needs in January 2019, the Council delayed providing the care to meet those needs. The Council did provide some care, but Ms X asked for the additional hours commissioned by Adult Social Care to be put on hold. She did not agree for this care to start until March. The delay in starting the care was at Ms X’s request and this delay was not Council fault.
47. The evidence shows Adult and Children’s Services did communicate during the assessment process and met three times between November and January 2019 to discuss Ms X and Y’s case. The case notes record the Council had an awareness of the overlapping needs of Ms X and Y and the need for services to work together.
48. However, the Council could have considered closer integration of its care planning and documentation. The statutory guidance says councils should consider producing a combined plan, where two or more services are working together to meet needs. I have seen no evidence the Council considered this, despite Adult Social Care working with Children’s Services to meet her eligible need to carry out caring responsibilities for her child. The care and support plan produced in January 2019 did not clearly set out how the Council planned to meet her needs and did not include details of the care hours commissioned by Children’s services. The Council should have considered closer integration of its care planning and documentation. It did not do this and this is fault. This caused Ms X confusion about what care the Council was providing and how it was meeting her needs.
49. However, despite the unclear documentation, the Council was providing care and support. In its response to our enquiries, the Council said its Adult social care documentation did not allow officers to add information about other services. It accepted this could be improved. It has since provided Ms X with a clear timetable of the care commissioned by both Adults and Children’s Services.
50. Ms X says the Council did not include her in decision making but I have seen no evidence of this. Records show there were times Ms X was reluctant to engage with services and the Council was concerned about her lack of engagement and the potential impact of this on Y. However, records show the Council did visit Ms X as part of its assessment and the documentation clearly recorded her views. It has also since reviewed the care and support plan several times. It has increased its care provision in response to her requests and reductions in the support provided by her family.
51. The Council said its records could not confirm it sent Ms X a copy of the updated care and support plan after the review meeting in May 2019. The statutory guidance says councils must give a person a copy of a care plan once completed. The Council should have provided her with a copy of the revised plan and documented it had done so. This is fault. Despite this, the Council was providing the care during this time and meeting Ms X’s needs. It has since provided her with a clear timetable of its care provision. This fault did not cause Ms X a significant injustice.

Agreed action

52. Within one month of the final decision the Council will:
• Write to Ms X to apologise for the 3-month delay in completing the needs assessment;
• Pay Ms X £200 to acknowledge the frustration and distress caused by the delay and the confusion caused by her unclear care and support plan.
53. Within three months of the final decision the Council will:
• Remind its officers that, where appropriate, they should consider if there is a need for an emergency care package prior to completing the needs assessment, and to record its consideration of this;
• Remind its officers of the need to consider combined or integrated assessment and care planning, where more than one service is assessing or meeting a person’s needs;
• Review its documentation to consider enabling the recording of integrated care planning when appropriate;
• Remind its officers of the need to provide individuals with a copy of their care and support plan and any reviews of this plan.

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Final decision

54. I have completed my investigation. I have found fault causing injustice and the Council has agreed actions to remedy this and to improve Council services.

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Investigator's decision on behalf of the Ombudsman