Summary: Mrs B complains the Council wrongly removed her care package. She says she had a fall due to the lack of support. Mrs B says the Council then delayed in arranging a new package of care and has not considered direct payments. At this stage, the Ombudsman finds fault in the way the Council completed a review in July 2018 and for not considering a carers assessment. We also find fault in the Council stopping Mrs B’s care, delays in completing a new needs assessment and for not making attempts to arrange a new financial assessment in 2019.

The complaint

1. The complainant, who I refer to as Mrs B, complains the Council removed her package of care. She says the Council was going door to door stopping care for anyone who received three hours or less a week in support. Mrs B says that during the time she did not receive support for shopping, she fell while carrying heavy bags. She says the Council then delayed for several months in re-starting her care package.
2. Mrs B says the Council has not considered her request for direct payments and will not consider her disability related expenditure.

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The Ombudsman’s role and powers

3. 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)
4. 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)
5. 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

6. I considered the information Mrs B provided and spoke to her about her complaint. I then made enquiries of the Council. I sent a copy of my draft decision to Mrs B and the Council for their comments.

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What I found

Legislation and Guidance

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. The Council must carry out the assessment over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Local authorities should tell the individual when their assessment will take place and keep the person informed throughout the assessment.
9. Where an individual provides or intends to provide care for another adult and it appears the carer may have any needs for support, local authorities must carry out a carer’s assessment. Carers’ assessments must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
10. If the Council identifies a person has eligible needs for support, it has a duty to meet these needs. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs.
11. Direct payments are monetary payments made to individuals who ask for one to meet some or all of their eligible care and support needs. They provide independence, choice and control by enabling people to commission their own care and support to meet their eligible needs.
12. After considering the suitability of the person requesting direct payments against the conditions in the Care Act 2014, the local authority must decide whether to provide a direct payment. In all cases, the local authority should consider the request in as timely a manner as possible.
13. The care act statutory guidance says the Council must leave people with enough money ‘to pay for necessary disability-related expenditure to meet any needs which are not being met by the local authority’. People may have to spend money on items and services that help them manage or cope with their disability, impairment or long-term health condition. These costs are called disability related expenditure. The Council may deduct disability related expenditure from a person’s contribution to their care fees.
14. The Care Act and Care and Support Statutory Guidance set out clear guidelines for council’s in recovering debt for social care fees. The Guidance says Council’s should consider all options for recovery.

Background

15. Mrs B has received a package of care from the Council for several years. The Council has made changes to the care package at various points, and in December 2018 stopped the care due to arrears. The care did not restart until September 2019.
16. I have investigated what took place from July 2018 to September 2019. In the following paragraphs I set out the background and timeline of events.

July 2018

17. Before July 2018, Mrs B received 3.5 hours of support per week. This included 1.5 hours for help with shopping and 2 hours for domestic tasks.
18. In July 2018, the Council reviewed Mrs B’s care package. It identified Mrs B had eligible needs in respect of:
• Maintaining a habitable home
• Managing and maintaining nutrition
• Maintaining personal hygiene
19. In the review it says Mrs B’s 18-year-old daughter lives with her, and she has three other children that live elsewhere. It says her daughter helps with personal care and meal preparation.
20. The review says the daughter’s mental health service had asked for her to take a reduced role in caring for her mother, as she had been a young carer for a long time.
21. The review says that Mrs B no longer has a child living with her. It therefore recommends it can meet her needs with a reduction in her care to 3 hours. The review does not go into further explanation but in the Council’s chronology it says this is because she is no longer caring for her daughter. I can only take from this, the Council meant because her daughter had reached the age of 18 and was no longer a child.
22. The Council produced a support plan, which provided for 2 hours of help with shopping and 1 hour of help with domestic tasks. The Council wrote to tell Mrs B about the reduction in August 2018.

October to November 2018

23. In October 2018, the Council chased Mrs B for her outstanding contribution to her care fees. The Council said Mrs B had not paid her assessed contribution since her care first started and she now owed more than £15,000. The Council wrote to Mrs B and tried to telephone her several times, leaving answerphone messages. It also tried to visit her at home, but she did not answer the door. The Council records that it believes Mrs B was at home due to factors such as her turning off the intercom buzzer steam coming from an external pipe.
24. The Council wrote to Mrs B again in November 2018 and said it would cancel her care package if she did not respond within 10 working days. Mrs B did not respond.
25. The Council completed a risk assessment and found Mrs B was at a low risk if it cancelled the care. It noted she had previously indicated she could manage her risk of falls by having a telephone and her daughter could help with shopping and domestic tasks. It said she received Disability Living Allowance, which could help her to pay for care privately. It said it would send Mrs B information about private care agencies she could contact and council services that might help her with shopping.
26. I cannot see any record the Council wrote to Mrs B to say her care had ended, or to provide the information suggested in its risk assessment.
27. Mrs B telephoned the Council on the day it ended the care asking about her carers. The Council said it had ended the care. Mrs B said it did not inform her.
28. Mrs B says a council officer came to her house and told her it was cutting care for anyone who received 3 hours or less a week. The Council says it does not have any policy to cut care for those receiving 3 hours or less, and does not know why Mrs B has this impression.

December 2018 to May 2019

29. Mrs B referred herself for a care assessment again in December 2018. The Council placed her in low priority for an assessment as it said she was largely independent.
30. In late January 2019 Mrs B told the Council she had fallen while shopping and suffered an injury. The Council contacted Mrs B three days later to arrange an assessment but received no response. It contacted her again in early February 2019 and arranged an assessment to take place a few days later.
31. The assessment identified Mrs B would benefit from support with personal care and practical tasks. The social worker asked if Mrs B could order shopping online. She said companies would not deliver to her because she was on the fifth floor with no lift. She said it was not feasible for family to support with shopping.
32. There were some delays in completing the assessment, partly due to waiting for medical information from Mrs B’s GP. The Council sent the final assessment document to Mrs B at the start of April 2019. It recommended 2 hours per week of practical support for shopping and laundry and 1.5 hours for personal care.
33. The Council’s records suggest Mrs B did not wish to pay her contribution towards the care package as she was on a low income. I cannot see any record the Council tried to arrange a fresh financial assessment. The Council seems to have based any assessment of Mrs B’s finances on her details from 2018. There is no indication Mrs B’s income had changed.
34. The Council records that it tried to contact Mrs B several times in April 2019 to discuss and finalise her care package but did not receive a response.
35. Mrs B sent a letter of complaint to the Council at the end of April 2019. She complained the Council removed her care package, which impacted on her health and caused her to fall when having to carry shopping. She complained the Council had not yet restarted her care package and had not responded to correspondence from her.
36. In the Council’s response it says it reduced her care package in July 2018 based on information from Mrs B that her daughter supported her with personal care and meal preparation. It said it then cancelled her care having tried to contact her several times about the arrears and receiving no response. It accepts there was some delay in progressing her new assessment to the care planning stage but says the Council has tried to contact Mrs B to obtain her views. It says the Council accepts her needs could have changed since the assessment and will offer her another assessment with a different worker.

June to September 2019

37. In June 2019 the Council conducted another assessment of Mrs B. It finalised the assessment document in July 2019. It produced a new support plan, which provided for 2 hours of personal care and 2 hours of practical tasks per week. The practical tasks included shopping and light housework.
38. Mrs B contacted the social worker to discuss the package in late July 2019. The social worker was on annual leave so her manager responded to clarify the points Mrs B raised. She told Mrs B the social worker would return in early August 2019.
39. Around a week after the social worker was due to return, Mrs B’s representative chased the Council for an update, as the care package had not yet started. The social worker responded around two weeks later, to say that she had returned a few days later than expected and had to deal with urgent cases.
40. The care package started in early September 2019.

Direct Payments and Disability Related Expenditure

41. Mrs B says she asked the Council to consider setting up direct payments rather than arranging her care itself. She also says she has sent the Council invoices for expenditures such as acupuncture, therapeutic massages and physiotherapy, which she asked the Council to deduct as disability related expenditure. She says the Council has not responded.
42. The Council says it does not have any record of Mrs B asking for direct payments or sending invoices for disability related expenditure. It says it would be unlikely to consider Mrs B for direct payments given the still outstanding arrears for her care.

I asked Mrs B to provide any evidence she has of the invoices she sent to the Council and any emails or other correspondence in which she might have asked for direct payments. Mrs B has not responded.

Findings

43. I have investigated and made findings on several matters, including:
• The review in July 2018
• The decision to stop Mrs B’s care package in November 2018
• The assessments and care planning in 2019, and the Council’s communication with Mrs B during this period
• The Council’s financial assessment of Mrs B and whether it properly considered direct payments and disability related expenditure

Review in July 2018

44. I find fault in the way the review took place in July 2018.
45. The review reduces Mrs B’s care package by 0.5 hours a week but does not clearly explain why. It says this is because she is no longer caring for a child but does not say if this means because her daughter is now 18. It also does not explain in what way that changes Mrs B’s needs, or how it can now meet her needs with the reduced hours.
46. The review says her daughter will assist with personal care. However, I note that in the same review it says the daughter’s mental health service has asked her to take a reduced caring role. There is no record the Council considered whether this had any impact on the daughter, or Mrs B’s needs. There is no evidence it considered whether to conduct a carer’s assessment for the daughter, or that it obtained her views.
47. The Council’s letter to Mrs B, simply says it is reducing her hours as she is no longer caring for a child. It provides no further explanation.

Ceased care package in November 2018

48. I find fault in the Council stopping Mrs B’s care package.
49. The Council assessed Mrs B as having eligible needs for support. It therefore had a duty to meet those needs. The fact Mrs B did not pay her contribution did not end this duty. The Council was entitled to take action for debt recovery, but not to stop her care.
50. I note in the Council’s risk assessment it says Mrs B is at a low risk and it is questionable whether she would be assessed as having eligible needs now anyway. I cannot follow the Council’s rationale here.
51. The Council reviewed Mrs B’s care plan only three months before. At that review it found she continued to have eligible needs. It was not for the Council to say that her eligibility for care was questionable when it had recently assessed her as eligible. The Council can only find a person has eligible needs if it identifies:
• as a result of their needs they cannot achieve specified outcomes; and
• as a consequence there is, or is likely to be, a significant impact on their well-being.
52. This means that, if the Council has identified someone has eligible needs, then without support that person’s wellbeing is at risk.
53. There is nothing in the Care Act or statutory guidance that says a Council’s duty to meet eligible needs stops if the person does not pay their contribution. There are whole sections on how the Council should go about debt recovery, if a person gets into arrears. It says the Council should consider all options for debt recovery, court action being a last resort.
54. I understand Mrs B did not respond to several attempts by the Council to contact her about the debt. However, this is a separate matter for the Council to pursue in line with its debt recovery procedures.
55. I can see no evidence in the information available, that the Council considered any debt recovery alternatives. I understand the debt accrued over a long period of time. There may be questions about why the Council allowed the debt to reach £15,000 without it taking any debt recovery action. I have not looked into this further, as it does not change the fact the Council should not have stopped Mrs B’s care. I have not investigated the Council’s original financial assessment, and any concerns about this or the amount of the debt would be a separate complaint.
56. If the Council had reviewed Mrs B and found she had no eligible needs, it might have been justified in stopping her care. However, it did not. It stopped it because she was in arrears. This is fault. It meant Mrs B went for 10 months without support the Council had identified she needed.
57. I also note, one of the reasons the Council gives in the risk assessment is that Mrs B can apply for a new assessment of needs if she wishes. It seems a futile exercise for the Council to stop Mrs B’s care, in the knowledge that if she applies again it will assess her again, and likely put in place a new package of care. Again, it meant Mrs B went for 10 months without care she needed, without in any way resolving the issue of the outstanding debt.

Assessments, care plans and communication in 2019

58. I find fault in how the Council progressed the assessments in 2019.
59. The Council placed Mrs B in a low risk category to begin with. It was therefore more than a month before it contacted her about the assessment. Normally, I would accept that based on Mrs B’s needs the Council was entitled to decide she was in the lower risk category for an assessment. We would normally expect assessments to take place within four to six weeks of the application. Therefore, the timeframe in which the Council contacted Mrs B is not outside what we would normally expect to see.
60. The issue in this case is that the Council should not have stopped Mrs B’s care in the first instance. This placed a greater level of urgency on the Council to assess her again. However, the fault is with stopping the care so I have not made a finding on this timeframe specifically. The Council did contact Mrs B more urgently, after it found out she had fallen.
61. There were more delays going forward, however. For instance, it was more than six weeks between the assessment and the Council producing an assessment document. Some of this delay was caused by waiting for medical information. However, it still took the Council a month after receiving this information to produce the assessment document.
62. The Council then tried to obtain Mrs B’s views. I understand Mrs B did not respond to the Council, which may have contributed to delays. She then sent in a complaint letter. However, it is difficult to understand why the Council’s response to that complaint was to conduct a fresh assessment.
63. Mrs B does not complain about the findings of her most recent assessment in her letter. Her complaint is primarily about the Council stopping her care and its communication with her. These complaints could have been dealt with separately to the ongoing care assessment.
64. The Council could have dealt any concerns Mrs B might have had about her assessment, or any recent changes in her needs, when finalising the current assessment. Starting the assessment procedure all over again, inevitably led to more delays. The new assessment did not take place until June 2019 and, due to more minor delays, around annual leave for instance, was not finalised until September 2019.
65. All these delays added up, so it was nine months between Mrs B applying for care and the Council putting in place a care package. It is my view there is fault in how long it took the Council to assess and put in place a care package for Mrs B, arising from a cumulation of avoidable delays.
66. I note the new assessment does not identify Mrs B’s daughter as a carer and provides support for personal care, which is what her daughter used to assist with.

Financial assessment, direct payments and disability related expenditure

67. I find some fault in how the Council has managed the financial elements of Mrs B’s care package.
68. I do not find fault in respect of direct payments or disability related expenditure. The Council has no record of these requests from Mrs B. I have asked Mrs B to provide evidence, but she has not responded. Therefore, I have no evidence the Council should have considered any such requests. I note that disability related expenditure would normally only be considered as part of a financial assessment or review.
69. I understand Mrs B did not cooperate with the Council’s attempts to review her financial circumstances in 2018. As already outlined, this was a matter for the Council’s debt recovery procedures. I can also see that in April 2019 Mrs B suggested she would not pay her contribution.
70. However, I can see no evidence the Council tried to arrange a financial assessment in 2019. While I do appreciate the history of the case, if the Council was starting again with a care assessment for Mrs B, it also needed to try and arrange a financial assessment. If Mrs B refused, the Council might have been entitled to say she was liable for the full cost of her care. Any such decision being limited by the fact it should not have stopped the care in the first place.
71. There is no evidence the Council tried to complete an up to date financial assessment and this is fault. The financial assessment, if Mrs B chose to engage, would have been a platform for her to request direct payments or disability related expenditure. It would then have been the Council’s decision whether to accept these requests.

Consideration of Remedy

72. I have identified fault in the following areas:
• The Council reduced Mrs B’s care in July 2018 without evidence it properly considered the relevant factors or explained why
• The Council did not complete a carers assessment for Mrs B’s daughter or obtain her views
• The Council stopped Mrs B’s care because of arrears
• There were delays in the Council assessing Mrs B’s needs in 2019
• The Council did not attempt to arrange a financial assessment in 2019
73. In terms of the July 2018 assessment, the injustice to Mrs B is distress in the form of uncertainty. I cannot say Mrs B should have continued to receive the same hours. The Council might have had good reason to think she could manage with less. However, there is no evidence it properly explained this or considered relevant factors. This causes uncertainty about what decision it would have reached but for the fault.
74. The injustice is limited as it was only small reduction of 0.5 hours per week and the care package stopped completely around three months later.
75. The lack of a carer’s assessment or consideration of the daughter’s views also causes uncertainty. The uncertainty is whether, but for the fault, the Council would have provided some support to the daughter, or if it would have impacted on the care plan it gave the Mrs B. Again, this is limited by the short amount of time the care plan remained in place.
76. I will not recommend the Council now complete a carers assessment as does not identify her as a carer in the new plan, which provides separate support for personal care. However, if Mrs B does raise any concerns that her daughter is taking on a caring role for her, and needs support, the Council should consider whether there are grounds to complete a carers assessment.
77. The main injustice to Mrs B is that she went for 10 months without care she should have received. It meant she had to do shopping by herself, when the Council’s assessments say she has difficulty carrying and lifting heavy items. Mrs B says she had a fall during this time, while carrying shopping. There is no evidence of further harm and Mrs B appears to have been able to access shopping over the 10 months.
78. Stopping Mrs B’s care package caused her significant distress, which continued for nearly a year due to the delays in completing a new assessment.
79. The fault in not contacting Mrs B about a financial assessment causes some uncertainty about whether the Council would have considered direct payments or disability related expenditure. However, this is limited again as Mrs B has not engaged with previous requests for a financial review there is no evidence she requested direct payments or disability related expenditure outside of any financial assessment.
80. Much of the fault caused limited distress to Mrs B, but the main injustice is substantial and caused significant distress. I therefore recommend the Council apologise to Mrs B and pay her £350 to recognise the distress caused.
81. I also recommend the Council attempt to arrange a fresh financial assessment for Mrs B. In the course of this assessment the Council can consider any requests by Mrs B for direct payments or disability related expenditure. However, I accept that if Mrs B does not engage with the financial assessment the Council can only go on the information it has available.

Recommended action

82. I recommend that, within a month of this decision, the Council:
• Apologise to Mrs B for the fault in her July 2018 review, for not considering a carers assessment, for stopping her care and the delay in completing a new assessment, and for not trying to arrange an updated financial assessment in 2019
• Pay Mrs B £350 to acknowledge the distress this caused
• Provide evidence it has contacted Mrs B to arrange an updated financial assessment

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Draft decision

83. Subject to further comments by Mrs B and the Council, I intend to close this case on the basis the Council is at fault in the way it completed a review in July 2018 and for not considering a carers assessment. It is also at fault for stopping Mrs B’s care, delays in completing a new needs assessment and for not making attempts to arrange a new financial assessment in 2019.

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Investigator's decision on behalf of the Ombudsman