Summary: Mr X complained the Council reassessed his care needs and reduced his personal budget. The Council was not at fault for the way in which it assessed Mr X’s needs. It was at fault for allowing the situation to drift when Mr X refused to cooperate in developing a revised support plan. This did not cause Mr X an injustice as his personal budget was not reduced.

The complaint

1. Mr X complains the Council reassessed his care needs and reduced his personal budget when his needs have not changed. He says the revised budget will not meet his needs.
2. Mr X also complains the Council has failed to take appropriate action or reassess his needs after he and other agencies, including the police and fire brigade, raised safeguarding alerts. This has left Mr X at risk of harm.

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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 have considered the information provided by Mr X and have discussed his complaint with him on the telephone. I have considered the Council’s response to my enquiries and the relevant law and guidance.
7. I gave Mr X and the Council the opportunity to comment on a draft of this decision and considered the comments I received in reaching a final decision.

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What I found

The relevant law and guidance

8. 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. 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.
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 have needs which are eligible for support, the following must apply:
• The needs must arise from or be related to a physical or mental impairment or illness.
• 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.
• Because of not achieving these outcomes, there is likely to be a significant impact on the adult’s well-being.
10. The care and support plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. The support plan should include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person.
11. The Care Act says that where an adult refuses a needs assessment, the council concerned is not required to carry one out. If however the adult changes their mind, the council must then carry out an assessment.
12. The care and support statutory guidance says, if an adult refuses a needs assessment and the council identifies the adult lacks mental capacity and that carrying out a needs assessment would be in the person’s best interest then the council is required to do so. The same applies where the council identifies that an adult is experiencing, or is at risk of experiencing, abuse or neglect. Where the adult who is a risk of abuse or neglect has capacity and is still refusing an assessment, councils must undertake an assessment so far as possible and document this.
13. The Care and Support Statutory Guidance states ‘the local authority must take all reasonable steps to reach agreement with the person for whom the plan is being prepared’. It goes on to say ‘in the event the plan cannot be agreed with the person, or any other person involved, the local authority should state the reasons for this and the steps which must be taken to ensure the plan is signed off…..If a dispute still remains, and the local authority feels that it has taken all reasonable steps to address the situation, it should direct the person to the local complaints procedure’.
14. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the care and support plan.
15. 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.

What happened

16. The following is a summary of what happened and does not reflect every event that occurred in the period.
17. Mr X has physical disabilities, is visually impaired and he uses a wheelchair. Since March 2013, Mr X received 45 hours of support per week. Mr X employs a personal assistant (PA) using direct payments, to meet his care needs. Mr X has a hoist which he can use independently to transfer in and out of bed and can use his wheelchair move round his home. He is unable to wash or dress himself independently, or make a meal though he could access snacks and drinks. Mr X wants to move to a different council area (Council A).
18. In March 2020 a relative of Mr X’s contacted the Council to advise Mr X’s carer was in hospital with COVID19 and so he had no support. The Council called Mr X and suggested a care package of three visits a day. Mr X’s relative arranged for meals on wheels to be delivered to Mr X. However, Mr X said he had a cough. As he was symptomatic, the Council proposed one visit a day to help him shower and prepare a sandwich for lunch. He would then receive a hot meal in the evening via meals on wheels. The notes record Mr X agreed to this. The Council provided Mr X with details of local shops doing deliveries.
19. The Council tried to source care provider however they required Mr X to have a negative covid-test, which Mr X was unable to get, or to self -isolate before providing support. The Council tried repeatedly to call Mr X but he did not answer the phone. It spoke to his relative who said the meals on wheels were working well. The Council explained it needed Mr X to confirm if he wanted a package of care. Mr X’s relative was unable to contact him. Mr X telephoned the Council and was verbally aggressive and unhappy the Council had contacted his relative and said he did not want contact. The Council cancelled the requested care package.
20. Mr X attended the hospital emergency department in mid-April 2020. The hospital contacted the Council. The notes record Mr X expressed he was suicidal and had poor mental health but the hospital did not identify any mental health issues. A Council officer spoke to Mr X who did not want to return home. The officer explained Mr X should return home with crisis care if required. Mr X was discharged from hospital. The Council wrote to Mr X advising him of his options regarding care and made a referral to mental health. Mental health cancelled the referral as the Council did not have Mr X’s consent and it felt his issues related to social care and accommodation.
21. In late April 2020, Mr X’s case was allocated to social worker Y who tried unsuccessfully to contact Mr X. They noted his direct payments had not been reviewed for over a year due to difficulties in contacting Mr X. In early May 2020 Mr X contacted the Council and said he was okay.
22. Later in May 2020 the police contacted the Council as Mr X had contacted them to say he had received no care and support since he was discharged from hospital. The Council advised Mr X had direct payments so could arrange his own care and could contact the Council if he required support but was blocking its calls. The Council also left Mr X a message offering support. Mr X texted social worker Y’s line manager asking for help. The Council asked the police to carry out a welfare check.
23. The police advised they had visited Mr X as he was alleged to have threatened a supermarket delivery driver. They found him still wearing a hospital gown and, due to the threats, he had not received his shopping. The Council contacted mental health services due to Mr X’s self-neglect and behaviour. The mental health practitioner noted Mr X had no GP. They contacted the on-call consultant who felt Mr X had capacity and did not need a mental health act assessment but required social care interventions. They later visited Mr X.
24. At the visit Mr X said his PA may be back at work later that week. He expressed his frustration about not being able to move to a property in Council A’s area. Mr X reported he was willing to engage with anyone to assist him in moving forward. They noted Mr X was able to keep himself safe and they had no concerns about his mental health.
25. Social worker Y decided to visit Mr X in mid May 2020 as Mr X was not returning their calls. At the visit they told Mr X they needed to arrange to review his needs which Mr X agreed to. They also assisted Mr X with a shower and change of clothes. Mr X said he did not need carers as his PA was returning shortly.
26. Later that week social worker Y called Mr X. They noted Mr X’s PA was still self isolating. Social worker Y offered an urgent care package and offered to help Mr X register with a GP. The notes record Mr X verbally consented to this and social worker Y arranged an urgent care package for Mr X.
27. Mr X contacted the Council to complain carers were sent to his property without his permission. He refused the carers access and asked for the care to be cancelled. Social worker Y spoke to Mr X who denied agreeing to the urgent support. Mr X reiterated his need to move house.
28. In late May 2020 social worker Y reassessed Mr X’s needs over several visits and telephone calls. They also spoke to Mr X’s PA. They went through the assessment with Mr X who verbally agreed it was a full and fair representation of his care needs.
29. They noted Mr X refused to use a care agency. He had a PA but had not been able to employ a second one. He needed assistance with:
• shopping and preparing meals,
• reading correspondence,
• maintaining his home in a sufficiently clean and safe condition,
• shopping and meal preparation,
• showering and a whole body wash,
• dressing.
30. It recommended a formal package of care but if Mr X chose to continue to employ PAs using direct payments. It recommended he receive assistance in employing more PAs.
31. The indicative budget was based on Mr X receiving 25.75 hours of support a week. This would comprise 9.75 hours a week for daily living tasks, 1 hour a week for household tasks and 15 hours a week of 1:1 social activities. The social worker recommended Mr X’s budget remain at its current level for four weeks to assess Mr X’ ability to manage with a reduced budget. Mr X submitted a formal complaint to the Council.
32. Following the assessment social worker Y contacted the mental health practitioner as they were concerned about Mr X’s threats to self harm. The mental health practitioner phoned Mr X who was in hospital having taken an overdose. The hospital made a safeguarding referral to the Council. It was concerned Mr X was at home with no care and support. The referral was closed at Mr X’s request. It noted he was in hospital and able to request support.
33. Social worker Y’s manager spoke to Mr X. The notes record Mr X said ‘he took the overdose as a way to force the hand of [Council A] into offering him accommodation’. The manager explained Mr X’s behaviour was unlikely to have an impact on his rehousing. Mr X confirmed he knew social worker Y would support him with care If he needed it.
34. Mr X remained in hospital as he refused to be discharged and threatened to self harm. The Council arranged for an Occupational Therapist to assess Mr X’s housing needs and for Mr X to complete a housing application for Council A. Around this time Mr X’s PA handed in their notice. Mr X attended the assessment in mid-June 2020. The OT assessed the property as functionally suitable for Mr X and identified no occupational therapy need for a move. Mr X was able to hoist himself on and off the bed and could use the toilet independently. He also had a rise and fall sink. The OT noted the kitchen could possibly be adapted and the property was cluttered. Mr X returned to hospital.
35. Social worker Y telephoned Mr X in late June 2020 and discussed the needs assessment with him which Mr X agreed to. The social worker explained the indicative budget had decreased which was a true reflection of Mr X’s needs. Mr X did not want to discuss his personal budget or support provision for leaving hospital and was abusive. He then refused to speak to anyone from the Council.
36. Social worker Y discussed Mr X’s discharge with the hospital. They advised Mr X had a direct payment and if he could not manage the Council would provide support through its Crisis care team. Mr X was evicted from hospital in early July 2020. Mr X said he did not want Crisis care involved.
37. The police carried out a welfare check after Mr X made threats to self harm. The police contacted the Council as Mr X was at home but said he could not cook or care for himself. The Council explained Mr X had direct payments and had refused Crisis care. The police called an ambulance and Mr X was readmitted to hospital. Following this Mr X agreed to access crisis care however none was immediately available. So the Council looked for an urgent interim care package. It identified a firm who could visit twice a day with two carers. Mr X refused to accept this as his housing association had now turned off his gas. The Council contacted the housing association who agreed to turn the gas on when Mr X returned home.
38. Mr X’s former PA agreed to visit his property so the gas could be turned on. Mr X told the Council he did not want the care package as his former PA was returning to work for him.
39. Mr X self-discharged from hospital later that week. He telephoned social worker Y and advised Council A said he did not meet the criteria to move there. Social worker Y spoke to Council A which confirmed Mr X did not have any housing needs so did not meet the criteria. Social worker Y asked to discuss Mr X’s support plan but Mr X refused. Social worker Y referred Mr X for a mental health act assessment due to his threats to self-harm.
40. A mental health practitioner spoke to Mr X. They noted Mr X’s distress related to his housing rather than a mental disorder and so would not accept a referral. Social worker Y visited Mr X and agreed to assist him with applying to housing associations and to look at properties to rent in Council A’s area. Mr X also consented to a referral to the home treatment team (who assist those living in the community with mental health problems). After the visit Mr X contacted the police and threatened self-harm. He was taken to hospital but discharged shortly after.
41. Following this, in early July, the Ambulance Service raised concerns with the Council that Mr X’s property did not meet his needs. It submitted a safeguarding referral as Mr X was threatening self harm, he was discharged from hospital with a large amount of painkillers and the property was cluttered and unkempt and Mr X was discharged from hospital with no care and support. The Council advised it was trying to assist Mr X with moving and it would note the concerns raised. It closed the safeguarding as partially substantiated. It noted intensive work was ongoing including liaison with mental health services and referrals for the necessary assessments
42. In late July 2020 social worker Y explored whether Council A would accept a social care referral from Mr X. Council A advised Mr X required an address in its area before it would accept this. Social worker Y wrote to Mr X explaining this and that it required a support plan to be completed so a review date could be set to assess whether the budget was sufficient to meet his needs. The letter asked Mr X to contact the support worker and advised without this it would complete a support plan without his input and his updated budget would be actioned. Mr X submitted a safeguarding referral that he was not getting the support he needed.
43. Mr X called the Council to advise he had self-harmed and had contacted the police. Mr X was admitted to hospital. Mr X was discharged from hospital a week later. Social worker Y left Mr X a message requesting he contact him. Mr X spoke with a senior manager and requested a new social worker. The manager refused and due to Mr X’s abusive behaviour they requested a communication plan be developed for Mr X.
44. The Council responded to Mr X’s safeguarding referral in early August 2020. It wrote to Mr X and explained it had sent Mr X a letter setting out the steps to take to transfer his care to Council A and advised him to raise a complaint if he remained dissatisfied with the service adult social care had provided. It closed the referral as unsubstantiated due to the ongoing work by adult social care to support Mr X.
45. In early September the mental health practitioner contacted the Council as Mr X was threatening self-harm or to burn his house down. The Council advised the mental health practitioner that Mr X was provided with appropriate advice about contacting Council A regarding moving properties. The mental health practitioner advised there was little they could do as Mr X’s issues related to his accommodation. They arranged to assess Mr X’s mental health.
46. The Council wrote to Mr X in September 2020 setting out its communication plan. In the letter it advised Mr X he had 28 days to engage in his support planning. If not, it would take steps to reduce his social care budget to reflect his current assessed social care needs.
47. The Council responded to Mr X’s complaint in mid-October 2020. It did not uphold Mr X’s concerns.

Findings

48. It is not for the Ombudsman to say what level of care is appropriate to meet Mr X’s needs. We can only look at how the Council made its decisions and whether there was fault in the process it used to make those decisions.
49. The Council assessed Mr X’s needs, Mr X participated in the assessment and agreed with its content. This produced a lower indicative budget than Mr X had previously received. There is no evidence of fault in the way the Council carried this out. The assessment suggested Mr X could manage with a reduced amount of support. Mr X did not agree and refused to cooperate with the production of a support plan. In July 2020 the Council told Mr X if he would not cooperate with producing a support plan it would produce one without his input and reduce his budget. It then wrote in September 2020 giving Mr X 28 days to engage in support planning.
50. The Care and Support Statutory Guidance sets out that councils should refer people to the complaints procedure if support plans are not agreed. Mr X would not discuss or agree to a support plan with a reduced number of hours and the Council allowed the situation to drift. It should have referred Mr X to the complaints procedure or issued Mr X with a draft support plan and did not do so. This is fault. However, this did not cause Mr X an injustice as Mr X continued to receive the same personal budget he had received previously.
51. Given Mr X’s lack of cooperation it remains open to the Council to produce a support plan for Mr X in line with his assessed needs and the proposed budget. Mr X was satisfied the assessment accurately represented his needs and has not provided evidence to show why he considered the revised budget would not meet his needs. In any case, we would expect the Council to review the support plan after six to eight weeks to ensure it was sufficient.
52. Mr X has not used all his direct payments but that was not due to fault by the Council. It was open to Mr X to use his direct payments to pay for additional support and the Council also offered to commission care for Mr X. It was Mr X’s choice not to pursue these options.
53. Mr X had a difficult relationship with the Council and displayed challenging behaviour when he disagreed with the Council’s actions. The Council tried to provide a care package to meet his needs and offered emergency help appropriately following Mr X’s hospital admissions. The Council was not at fault. It was Mr X’s choice to refuse to accept this support.
54. The Council assessed Mr X’s housing needs. It found his current accommodation was suitable to meet his health needs. There is no evidence of fault in the way it considered this. Council A refused to accept a housing application from Mr X because his current accommodation meets his health needs. However, this is not due to fault by this Council.

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Final decision

55. I have completed the investigation. There is no evidence of fault in the way the Council assessed Mr X’s needs. There was fault when it did not refer Mr X to the complaints procedure or issue a draft plan when he refused to progress the support plan but this did not cause an injustice.

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Investigator's decision on behalf of the Ombudsman