Summary: Mr C complains about the way in which the Council has dealt with his request for adaptations to his house and his request to provide ongoing support to him at home. The Ombudsman found fault with the way the Council assessed Mr C’s needs, for which the Council has agreed to apologise.

The complaint

1. The complainant, whom I shall call Mr C, complains the Council failed to provide the adaptations and the homecare support he says he needs.
2. Furthermore, he says the Council has failed to carry out its financial assessment in line with the Care Act:
• It carried out his financial assessment before his needs assessment.
• It failed to consider some of his expenses as Disability Related Expenses.
• It failed to look into his concern that he is unable to afford his contribution of £97.68

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What I have investigated

3. I investigated Mr C’s complaint that the Council failed to provide the adaptations and homecare support he says he needs. I also investigated Mr C’s complaint about the timing of the financial assessment.

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The Ombudsman’s role and powers

4. 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)
5. 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)
6. If the Ombudsman is satisfied with a council’s actions or proposed actions, she can complete her investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i))

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How I considered this complaint

7. I considered the information Mr C and the Council provided to me. I shared a copy of my draft decision statement with Mr C and the Council and considered any comments I received, before I made my final decision.

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What I found

Relevant legislation and guidance

Needs assessment

8. The Care and Support Act Guidance says that:
• A care assessment must be of the adult’s needs and establish how they impact on their wellbeing and the outcomes they want to achieve. The assessment will help determine if needs are eligible for care and support from the Council and understand how the provision of care and support may assist the adult in achieving their desired outcomes.
• When determining if a person has eligible needs, a Council must consider if the person is unable to achieve two or more outcomes, and if that has a significant impact on their wellbeing.
• An ‘assessment’ must always be appropriate and proportionate. It may come in different formats and can be carried out in various ways. The process is flexible and can be adapted to best fit with the person’s circumstances.
• During the assessment, the council can identify needs that could be reduced, and help people improve their wellbeing, by providing specific preventive services or directing them to voluntary services that are available in the local community and can meet or reduce the eligible need.

Financial assessment

9. The Care and Support Act Guidance sets out the steps a council must take, in the following order, to:
• assess a person’s needs for care and support
• decide what needs are eligible for council support
• assess the person’s financial resources
10. The financial assessment may in practice run parallel to the needs assessment, but it must never influence an assessment of needs.

Disability Facility Grand / Adaptations

11. Providing adaptations may be a way of meeting a person’s assessed eligible needs. A person may be eligible for a Disabled Facilities Grants (DFG) to carry out such adaptations. DFGs are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996. Councils have a statutory duty to provide grant aid to disabled people for certain adaptations. Before approving a grant, it must be determined if the work is “necessary and suitable” to meet the disabled person’s needs and also if it is “reasonable and practicable”.
12. In this case, West Sussex County Council is the “social services authority” and a district council is the “housing authority”. The housing authority is responsible for deciding, in the end, if a person gets a DFG. After the social care authority determines if proposed adaptations are ‘necessary and appropriate’ (this is often done by an OT), the housing authority determines if they are ‘reasonable and practicable’, in relation to things such as the age and condition of the property.
13. If the client lives in a property owned by a housing association, permission is needed from the housing association before any adaptations can go ahead. If a complaint is about a housing association who has refused or delayed permission for an adaptation, a complaint about this and the correctness of the reasons for the refusal should be addressed to the housing association and thereafter (if needed) to the Housing Ombudsman.

What happened

14. Mr C is in his 60s and lives alone in a rented housing association property. Mr C asked the Council for support at the end of November 2018, after which it carried out an initial assessment three weeks later. The assessment form states that Mr C:
• Has an advocate who he wants to be present at all assessments.
• Has a toilet upstairs, which he finds difficult to access. He goes up and down the stairs one step at a time.
• Can mobilise on the ground floor and sometimes uses a walking stick.
• Sleeps on his sofa downstairs at times. 
• Can dress himself.
• Finds it difficult to do domestic tasks.
• Can do his own shopping by car. There is a possibility to receive help from store support staff, but he finds this takes too long.
• Has a shower seat fitted to the wall, but refuses to use it because he felt it was fitted in an unsafe manner.
• Said he could not stand in the kitchen to cook a whole meal and would eat ready meals instead.
15. The outcome of the assessment was a referral to one of the Council’s local social care teams, to make recommendations to meet his needs.
16. A Council record from January 2019 states that Mr C has a diagnosed kidney problem. He reported he had to go to the toilet every five minutes, but sometimes would not get to the toilet on time, resulting in accidents. He used a milk bottle instead of a urine bottle.
17. Mr C’s GP sent an email to the Council in mid-January 2019. It said that, due to Mr C’s deteriorating back condition, he was struggling to carry out Activities of Daily Living and with the general upkeep of his house. The GP said Mr C would like to be assessed for any support he may be able to receive.
18. The Council asked one of its Occupational Therapists (OTs) to carry out an OT assessment and an assessment of Mr C’s needs. The record of this assessment states that:
• Mr C said it was painful and difficult to use the stairs. As such, he would never go upstairs during the day, and was only able to sleep upstairs about twice a week. On the other nights he would sleep downstairs on his settee. Mr C declined to demonstrate climbing the stairs during the visit.
• Mr C reported that he only gets a few seconds warning when he needs to pass urine or open his bowels. As he said that he was unable to get to the upstairs toilet (on time) he used a plastic milk carton. The OT offered Mr C a commode, which he declined.
• Mr C said he did not use the shower and felt the shower seat was installed unsafely. Mr C said the chair has been checked, but he did still not believe it was safe.
• Mr C said he did not want to consider a stairlift. Instead, he wanted an extension to provide a ground floor toilet and shower. The OT advised that a ground floor toilet and shower would not solve the problem of accessing his bedroom. Mr C said he did not want to consider a stairlift and wanted to deal with one issue at a time. As such, he currently only wanted to deal with his access to toilet facilities. Mr C did also not want to consider rehousing at this time.
• Mr C was able to drive his car to the supermarket and walk around to do his shopping. However, he said this was not easy and usually took him three hours to complete. Mr C said he tried internet shopping but did not find it satisfactory.
• Mr C carried out very little housework / cleaning and was unable to use a vacuum cleaner.
• Mr C said he was still awaiting a needs assessment to see if he would be eligible for support by carers.
19. Mr C told me that:
• He did not decline to try and use the stairs. Instead, the OT said ‘don’t worry about it’.
• Some of the information included in the OT assessment, were things he did not discuss with the OT. They were actually from a previous discussion with the Council’s Prevention Assessment Team (PAT)
• He did not refuse a stair lift but has always said throughout that ‘he would think about it’.
20. The OT concluded that Mr C:
• Had eligible needs related to not being able to access his toilet, bedroom and shower, which affected his personal dignity as well as his physical and emotional wellbeing. These needs could be met through adaptations.
• Did not have eligible needs in the outcome areas of: developing and maintaining relationships; accessing / engaging in work/training; maintaining a habitable home environment, nutrition (cooking/shopping). As such, Mr C was not eligible for a package of homecare support through the Council.
21. The OT failed to record how he arrived at this decision. Furthermore, there is no evidence the OT discussed the outcome, and the reasons for the decisions, with Mr C at the time.

Adaptations

22. The OT advised Mr C that he would first need to obtain further information from his GP to determine whether the health conditions Mr C reported around toileting (his kidney etc) could be improved medically.
23. The OT contacted Mr C’s Housing Association at the end of January 2019, who said that, although Mr C was under-occupying the property, they may allow an adaptation if it would be a benefit to future tenants. However, it said it would unlikely approve a ground floor bathroom as there was already a bathroom at the property.
24. The GP reported in February 2019, that he did not know why Mr C had an urgency with his bowel and bladder movements. As such, all parties agreed to refer Mr C to a Gastroenterologist for investigation. Once the OT would receive the outcome of this, the Council would be in a position to make a decision about the suitability of any adaptations.
25. The Council received the Gastroenterology report mid-April 2019. It said that Mr C reported he opens his bowls every three or four days. But when he goes, it takes him a long time to get upstairs and he would therefore occasionally soil himself. Mr C denied the offer of a further internal investigation. His condition could not be improved through medication. As such, the OT concluded that:
• It would be necessary and appropriate for Mr C to have a toilet on the ground floor.
• It would not be necessary and appropriate to provide a downstairs shower, because this (and his bedroom) could be accessed by installing a stairlift.
26. At a joint visit at the end of April 2019, Mr C said he was only interested in having a ground floor toilet. He again did not agree to install a stairlift. It has since taken a long time to progress the adaptations:
• The Housing Association told Mr C in May 2019 that it would not agree to a ground floor extension. Instead, it offered to move Mr C to a retirement bungalow. This was eventually deemed unsuitable because it only had one bedroom, and Mr C’s son would return to live with him again after university. Mr C said he did not want to consider any alternative housing option offers and said he would continue to challenge the Housing Association’s decision, with support from his advocate.
• In June 2019, the Housing Association said it was “willing to look at alternative options” with regards to the location of the ground floor toilet. However, the Housing Association said in mid-July 2019 that it would not agree to an extension nor did it think it was practical to install a toilet within the existing ground floor footprint. The Housing Association said it was keen to move Mr C to a suitable property, but Mr C was unwilling to do so. Mr C told the OT that he would challenge the Housing Association’s decision, before considering alternative options.
• The OT advised Mr C again in mid-August 2019 that, because the Housing Association would not agree to a downstairs toilet, the OT was unable to do anything further, without the landlord’s consent.
• The Housing Association changed its mind and agreed in mid-October 2020 that it would agree to an extension for a toilet. The Housing Association would get a plan for a proposed toilet adaption and send it to the OT to review.

Analysis

27. I did not find fault with regards to the way in which the Council dealt with Mr C’s request for adaptations. The Council established early on that Mr C’s needs for adaptations could be met by a ground floor toilet and a stairlift to his bedroom and bathroom. However, according to the records, Mr C turned down the offer of a stairlift and said he only wanted a ground floor toilet.
28. Mr C lived in a property owned by a housing association. This meant the housing association would have to agree to any adaptations taking place. Mr C’s case did not progress further between May and October 2019, because the Housing Association did not agree at the time with installing a toilet downstairs.
29. If Mr C is unhappy about the time it took for the Housing Association to agree to an extension, or the way in which the Housing Association has developed the extension plans since October 2019, then he should first make a complaint about this to the Housing Association. If he is unhappy with the response he receives, he can subsequently refer that complaint to the Housing Ombudsman.

Homecare Support

30. Mr C told the Council again in May 2019 that he wanted an assessment for social care support, because of his difficulties with managing shopping and housework. The GP supported Mr C’s request for a reassessment of his needs. Mr C told the Council he needed support with shopping, cleaning and gardening:
• Mr C said he wanted someone to take him shopping.
• He declined the Council’s suggestions to do the shopping online.
• Mr C said that a volunteer provided by a local charity to do his shopping, would be at a cost of £10/hour.
• Mr C said he wanted to go and do the shopping himself.
• Mr C also turned down the option of Community Transport to take him to the shops and back, because he said he needed support while shopping. He declined the option of staff in the shop helping him with this.
31. Mr C has since told me that he did not refuse online shopping, but he could not do this online because he does not have internet or a smart phone. However, there is no evidence in the records of any of the assessments that he said this at the time. All assessments state he refused the suggestion.
32. There was a delay in carrying out the needs assessment, because the Council decided to first carry out a financial assessment to see if it may be more affordable for Mr C to meet his needs privately (without the Council arranging it). It told Mr C on 20 June and 2 July 2019 that it was still waiting for the financial assessment to take place first.
33. The financial assessment concluded that, if Mr C would be eligible for a homecare package, he would have to contribute up to a maximum of £97.68 per week.
34. The Council’s PAT team eventually carried out Mr C’s reassessment in mid-July 2020, two months after he and his GP had asked for it. The assessment form said:
• Mr C reported his health had further declined after a recent fall and he wanted support with shopping and cleaning his home.
• Mr C reported he was unable to carry out general housework due to his poor mobility and right-sided weakness. He said he could not afford to pay for a cleaner. Mr C was also unable to maintain his garden and depended on a neighbour to cut his grass. The assessor recorded that Mr C could not achieve the outcome of having a Habitable home environment.
• He struggled to carry his shopping bags from his car to his home.
• The assessor identified that Mr C was unable to achieve the following outcomes, and concluded they have a significant impact on his well-being:
1. Managing and maintaining nutrition
2. Being appropriately clothed
3. Being able to make use of the adult’s home safely
4. Maintaining a habitable home environment
• His need for support with shopping could be met via a volunteer who could help Mr C to take the shopping from his car into his house.
35. After the assessment, the PAT team referred Mr C’s case to a Local Community Team, because Mr C had unmet eligible needs that the assessor had been unable to meet by simply providing information and advice.

36. Mr C called the Council a week later to say that a lot changed since his last assessment. He said a fractur in his femur was diagnosed and he was now using clutches for his mobility. He said that, as a result, it now took a very long time to wash and dress himself. He also said he was not supposed to drive to the shops, but nobody was helping him. In response, the PAT Team Leader contacted Mr C and offered him a joint reassessment home visit within the next 5-10 working days, by a PAT Nurse advisor and a social care worker. The Care Act assessment on 13 August 2019 states that Mr C said that:
• He had to use crutches and was not able to carry food shopping. He again refused the suggestion of online shopping.
• He would like someone to help him as an "extra set of hands". He said he wanted his house redecorated and support to remove items he no longer needs.
• Mr C could heat microwave meals but was unable to prepare meals from scratch. The social worker suggested a ‘meals on wheels’ service if he wanted a different type of dinner.

37. The assessment lasted 2 hours and 20 minutes. Mr C said the next day that he had been happy with the assessment. After the reassessment, the Council explained it could provide some reablement support to him, which Mr C initially felt would be suitable for him. The reablement team visited Mr C in October 2019. The assessment form states:
• The hospital has disputed that Mr C has a stress fracture. Since July 2019, he has been using elbow crutches to mobilise. This has made many tasks more difficult, such as: domestic tasks, moving food / drinks from the kitchen to the dining area / lounge, his use of the stairs and shopping.
• The OT explained to Mr C that crutches should normally only be used for a short time. The OT suggested different mobility aids that would enable Mr C to complete various activities much easier. However, Mr C became agitated and dismissed all suggestions saying they were rubbish.
• The OT said Mr C could mobilise unaided once strength / muscle is rebuilt in legs. However, Mr C dismissed this. The OT told Mr C that the physiotherapist at the clinic Mr C had stopped going to, would be able to review his use of the crutches if Mr C started to go there again.
• Mr C wanted an extra pair of hands to support him with shopping and hovering. “We then discussed the reablement options and Mr C reported it was a waste of time”.
• The assessor advised Mr C that he did not currently meet the eligible criteria for funding, and suggested a volunteer from Age UK to provide him with support with his shopping and hovering. Alternatively, he could approach a care provider agency privately.
• The OT advised Mr C that the Community Reablement Service could not support him, because it would be unlikely that he would engage with them and their suggestions.
• Despite difficulties reported by Mr C, he has been managing unsupported since his reported injury to femur.
38. After the assessment, the OT told Mr C’s GP that many of Mr C’s reported difficulties were related to his use of elbow crutches. The OT told the GP he tried to discuss alternate mobility aids that would make activities of daily living easier. However, Mr C dismissed these and said he would only use crutches. The OT strongly recommended to Mr C that he should visit the clinic again, because a review of his mobility from Physiotherapy would be of great benefit to increase his independence and reduce the need for external support.
39. Mr C has since told me that he had tried the mobility aids suggested by the OT, but they were unsuitable for him and his property was too small. He also said he had stopped going to the physiotherapy clinic as it had become too slippery to leave his property.
40. Mr C’s GP sent another letter to the Council on 23 October 2019, asking for a review. The GP did not raise any new concerns but added that he was wondering whether a nursing home might be more suitable for him.
41. The Council sent a letter to Mr C on 18 November 2019, in which it advised him of:
• The contact details of a local charity who could support him with shopping and domestic chores
• Community transport contact details
• Patient transport contact details
• Care guide: A list of care providers who could offer help with domestic chores.
42. The Council sent a copy of the above letter to Mr C’s GP and added that the recent care act assessment found that Mr C is not eligible for Council funded care.

Analysis

43. I found that the needs assessment in January 2019, was not carried out in line with the Care Act:
• It appears from the records that Mr C was unaware that, part of the purpose of the visit in January 2019, was for the Council to assess his eligibility for care support. This means the Council failed to explain this to him before, and during, the assessment, which is fault.
• The form the Council used to complete the needs assessment did not include sections where an assessor could record, for each outcome area: what Mr C’s unmet needs were; what impact this was having on his wellbeing; and its decision and explanation if and why this was (not) an eligible need. This is fault.
• The Council failed to explain to Mr C, after the assessment, why it decided that he did not meet the eligibility criteria to receive a package of homecare via the Council. This is fault.
44. The support that Mr C asked for in 2019 was focussed on shopping and cleaning. I did not find fault with the way the Council considered whether he was eligible for this:
• The Council made several reasonable suggestions to meet this need, including online shopping and having volunteers from a charity or at the shop, support him to do the shopping for him or with him. However, Mr C turned these down. The Council concluded it had made reasonable suggestions to meet Mr C’s needs, and there was therefore no need to have a paid care worker to support Mr C in this area.
• Although the Council identified that Mr C had an eligible need to keep his house clean, this was the only eligible need he had with regards to homecare support. A council will only provide support if a person has two or more eligible needs. The Council recommended that Mr C could meet this need by hiring a cleaner for one or two hours a week.
45. The Council has acknowledged that it should not have carried out a financial assessment in July 2019, before it started a needs assessment, and that it was wrong to delay the needs assessment until the financial assessment was completed. It has also said that it has withdrawn the type of form used by the OT in the January 2019 assessment.

Agreed action

46. I recommended that, within four weeks of my decision, the Council should:
• Apologise to Mr C for any faults identified above and any distress this may have cause him.
• Remind all staff involved in carrying out adult social care needs assessments, that they should:
1. Use forms for needs assessments that are care act compliant
2. Clearly document for each of the outcome areas: what the clients (unmet) needs are, what impact any unmet needs have on their wellbeing, and if (as such) the person has an eligible need in that specific area.
3. Explain the decision reached to the client in each outcome area and record evidence this was done.
47. The Council has told me it has accepted my recommendations.

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Final decision

48. For reasons explained above, I found some fault with regards to the actions complained of. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.

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Parts of the complaint that I did not investigate

49. A letter from the Council dated 5 August 2019 says that Mr C should provide any information and evidence he has about the costs he wants the Council to treat as DRE. However, Mr C has since told me he has not done this yet.
50. Furthermore, as Mr C has not been eligible for a council funded care support package, he has not suffered an injustice with regards to the way in which the Council concluded that he should pay a contribution.
51. I have therefore decided to discontinue my investigation into Mr C’s complaint about DRE and affordability.

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Investigator's decision on behalf of the Ombudsman