Summary: The Council failed to act in accordance with the law during an assessment of Ms X’s care needs in 2018/19. It failed to consult her about changes to her care package, failed to consider her views and failed to consider the impact of reduced social support hours. This meant she missed out on services. She has suffered avoidable stress and worry. Decisions taken about Ms X’s care package appear to have been financially motivated.

The complaint

1. Ms X complains the Council changed her care arrangements without consulting her, failed to properly manage the change and failed to make timely provision for the continuation of ‘community hours’. She says the changes to her care package were substantial and caused her worry and stress.
2. She also complains the Council delayed in authorising direct payments. It was not authorised until February 2019. Consequently, she has missed out on support to access social and leisure activities.

Back to top

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. 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)

Back to top

How I considered this complaint

5. I have:

• considered the complaint and discussed it with Ms X;
• considered the correspondence between Ms X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation.

Back to top

What I found

Relevant legislation

6. The Care Act 2014 introduced a requirement that local authorities should promote ‘wellbeing’ and signifies a shift from existing duties on local authorities to provide particular services, to the concept of ‘meeting needs’. The concept of meeting needs recognises that everyone’s needs are different and personal to them. Local authorities must consider how to meet each person’s specific needs rather than simply considering what service they will fit into. (Care and Support Statutory Guidance, Ch1)
7. A council must carry out an assessment of any adult who seems to need care and support. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9). Having identified eligible needs through a needs assessment, the council has a duty to meet those needs. (Care Act 2014, section 18)
8. If a council decides a person is eligible for care, it must prepare a care and support plan. This must set out the needs identified in the assessment. It must say whether and to what extent, the needs meet the eligibility criteria. It must specify the needs the council intends to meet and how it intends to meet them. (Care Act 2014, ss 24 and 25)
9. The care and support plan must set out a personal budget which specifies the cost to the local authority of meeting eligible needs, the amount a person must contribute and the amount the council must contribute. (Care Act 2014, s 26)
10. Where the council is meeting some needs, but not others, the care and support plan should clearly set out which needs it will meet and which ones it will not. It should explain this decision.
11. A person with eligible care needs can have a council arrange their care or, if they wish, they can arrange their own care using a direct payment. (Care Act 2014, s 31)

What happened

12. Ms X is in her thirties. She has progressive multiple sclerosis which has deteriorated since 2014. She moved into the Council’s area in August 2018. Her live-in care package, arranged and funded jointly by the previous Council and the NHS, was carried over with continuation of funding for six weeks post move. Ms X cannot recall any previous joint funding arrangements
13. The Council received a referral letter from the previous Council in June 2018. The letter, from an Occupational Therapist (OT) confirmed Ms X would be moving into the Council’s area. It explained Ms X’s condition had rapidly deteriorated, that “she has extreme weakness in all limbs and poor postural tone… she has very little functional ability”, that she used an electric wheelchair, and that it would forward a manual handling assessment. It explained it had funded a 24/7 live-in carer “due to the level of support required”. Ms X was said to have an active social life, seeing friends and going to the pub, and that she saw her sister regularly.
14. The OT made recommendations going forward, saying:

• [Ms X] needs a very high level of support on a day to day basis and it is OT’s belief that her care needs cannot be met without the assistance of a live-in carer.
• It has been agreed that [Ms X] can take all the equipment with her with the possible exception of bathing equipment which will need to be re-assessed in the new place.
• It is recommended that West Berks OT assess, ideally prior to her move, whether the swivel bather can continue to be used in the new property.
• It is recommended that West Berks OT assess, ideally prior to her move, for level access shower and Automatic toilet washing facility. Other adaptations may be required such as door widening. OT has requested a Test of Resources for DFG but results not yet received.
• It is recommended that West Berks OT refer to Oxford Centre of Enablement to look at possible Environmental Control, Mobile Arm support and computer adaptations. This subject has not been explored with [Ms X] yet due to other higher priorities to manage her needs.
• It is recommended that West Berks OT review the Riser/recliner chair to see if a more comfortable chair can be sourced.

15. The OT enclosed a copy of Ms X’s previous care plan, completed by the previous Council in June 2018, eight weeks before Ms X’s move. I have seen a copy of this document. It shows Ms X to have complex needs and require full support in all aspects of daily living and “Participation in recreation, Social and economic wellbeing, Domestic, family and personal relationships”
16. The care plan recorded Ms X had had several different carers because she wanted to do as much for herself as possible and some carers found this challenging. A recently employed carer reported difficulty managing Ms X’s personal care and bed transfers alone so a second carer attended for morning and evening care on a temporary basis until a specialist hoist was installed. It is clear from the care plan managing Ms X’s complex needs was challenging for Ms X and carers.. An OT described it as “exhausting”.
17. The Council made initial contact with Ms X in June 2018 and made a referral to an OT, at its equipment store on 16 July 2018 for an assessment of aids and adaptions in her new home. An OT did a joint home visit with the OT from the previous Council on 26 July 2018 and confirmed adaptions were needed to the property. The work would be funded by a disabled facilities grant (DFG)
18. Ms X moved into her new home, within the Council’s area on 7 August 2018. Officers from the Council social services met with officers from the previous Council the same day to discuss Ms X’s care needs.
19. The Council allocated an OT on 13 August 2018.
20. A social care assessor visited Ms X at home on 17 August 2018 and completed an initial contact and assessment form, and a detailed care plan. I have seen a copy of this document. It records Ms X’s needs not to have changed from the assessment completed in June 2018. Ms X said she did not feel the live-in carer arrangement was working but she could not see any other way to manage her high care needs and remain at home. She said the agency was sending a different live-in carer every two weeks and she was fed up with having to familiarise new carers with her routine.
21. The assessor offered Ms X the option of direct payments to allow her to purchase services. Ms X declined the offer saying she would be unable to manage her responsibility as an employer, and she had concerns about how she would cover sickness and holidays. The assessor discussed the option of domiciliary care. Ms X said she needed the flexibility of live in care as no two days were the same because her health and routine fluctuated.
22. The assessor recorded Ms X enjoyed an active social life during the day and at night. Ms X’s carer did not always accompany her but was at home to assist her when she returned. On occasions the carer accompanied Ms X into town and sat in a cafe or met her own friends and attended Ms X if she required support with toileting.
23. At the beginning of September 2018, the records show the live-in carer was struggling to manage transferring Ms X alone. The Council commissioned a domiciliary care agency to provide a carer to double-up with the live-in carer starting 6 November 2018 on a short-term basis “whilst the care package settles down and equipment provided”. The domiciliary care agency recorded the time it took Ms X to complete some aspects of personal care herself and reported this to the Council. It reported Ms X took 7.5 minutes to brush her teeth, 30 seconds to rinse her mouth and five minutes to reverse her wheelchair back into the bedroom reporting “The whole process took 30mins”, and that if the tooth brushing been completed before the arrival of the second carer the double-up call would have actually taken only 90 minutes”.
24. The domiciliary care agency and Ms X reported concerns with the quality of the care being provided by some of the live-in carers. Live-in carers were changing weekly, so familiarity was never established. The domiciliary care agency was concerned about a lack of professional communication and co-working during the double-up calls.
25. On 7 September 2018, the care provider supplying the live-in carers wanted to give three days’ notice to terminate the service. Officers from social services had numerous discussions with its commissioning team, the previous Council and other care providers to secure live-in care services for Ms X with immediate effect. The Council says officers contacted Ms X “at least once”, to ask if a new care provider could assess her the same day. Ms X was not available that day because she had a medical appointment.
26. The Council offered Ms X a residential nursing placement. Ms X went to the view the proposed facility. After asking staff about social activities she was told the activities on offer were more suitable for older residents. Ms X did not feel the placement was suitable for her age or needs and declined it, but said she was not averse to the principle of her care being met in a residential nursing setting if an appropriate placement could be found. The Council recorded Ms X’s views and said, “We are therefore in the position of continuing to support her in her own home but with a PB likely to be limited to the cost of a residential nursing bed. The role of appropriate equipment and adaptations in reducing the time and thus cost of the calls is therefore now back on the priority list”.
27. A new Care Provider visited Ms X on 11 September 2018 and a new live-in carer arrived that day.
28. The ‘Tier 2 Plan was updated on 14 September 2018 to record care visits were taking longer than initially planned. The Council commissioned a second double-up carer on a short-term basis “…whilst care package settles down and equipment provided”.
29. On 19 September 2018, the domiciliary care agency providing the double-up carer contacted the Council again to say it could not sustain the calls because the calls were running over the allotted time as Ms X did not want to keep to a routine. It reported concerns with the quality of the care being provided by the live-in carers.
30. On 17 October 2018, the Council identified a new home care agency to provide a double-up carer to support the live-in carer. The Council increased the visit time by 4.5 hours per day. On 23 October 2018, the Council recorded “problems with having two agencies involved (ie live-in plus 1 carer for transfers from another agency)”. A council officer contacted Ms X on 24 October 2018 to advise her of the future care options:

• Res care trial with view to long term placement
• DP set at same rate as Res placement cost

31. A multidisciplinary meeting was held on 8 November 2018. Ms X and her sister were present, along with the care agency providing live-in carers, and the domiciliary care agency providing the double up-carer. The Council says the purpose of the meeting was to discuss care arrangements “…including outline of possible care plan without live-in that would enable [Ms X] to live within the PB once further equipment in situ and adaption to property completed”. The Council said the current care package was unsustainable. The home care agency providing the double up carer said care visits were exceeding the allotted time because Ms X wanted personal care completed in a specific way and wanted to complete some tasks herself. It said its carers were struggling to work with the live-in carer. Ms X reported some difficulty communicating with the live-in carer in place at the time but says this was because the agency was sending different live-in carers and she was unable to develop working relationships.
32. Ms X says it was at this meeting that officers told her it was ending the live-in care arrangement. She says the news was a bombshell and she was very anxious about the changes. She felt the change had been imposed on her without any discussion or consultation. She says officers said the new arrangement would bring her into line with other service users in a similar position.
33. An officer explained to Ms X that she was on a ‘Tier 2’ temporary support plan and that it was the Council’s intention to introduce assistive technology and moving and handling equipment over the following two weeks which would enable Ms X to live supported with a domiciliary care package, rather than a live-in carer. The proposed support hours were:

• am x 2 - Carers 2.5 hours x 7 days [dom care agency]
• lunch x 1 Carer 30 Mins x 7 days
• teatime x 1 Carer 30 Mins x 7 days
• pm x 2 - Carers 2 hours x 7 days
• 6 hours per week to access the community to be used how [Ms X] wishes

34. The Council reminded Ms X of the option to receive direct payments which would allow her to purchase services. Ms X again declined. The Council recorded, “We are therefore in the position of continuing to support her in her own home but with a PB likely to be limited to the cost of a residential nursing bed. The role of appropriate equipment and adaptations in reducing the time and thus cost of the calls is therefore now back on the priority list”.
35. The following day Ms X sent an email to the Council asking for a further discussion about the proposed changes to her care and requested written information.
36. On 14 November 2018 the agency providing the live-in carers contacted the Council to ask about payment of invoices, saying it had “repeatedly ask for confirmation that our additional hours would be paid and we were then offered additional hours to continue the domiciliary calls, which we refused as we felt they still didn't give enough time. As you were aware that the calls were overrunning”.
37. On 15 November 2018 at 13.05pm the Council sent an email to the agency providing the live-in carers saying, “due to poor quality of care, we would like to end care services for this client at “…11:00am on 26th November”. The agency responded asking the Council “…exactly what these concerns were as we were not aware that any concerns, of such great degree had been raised, and we would like the opportunity to address these concerns in an effort to improve our ongoing service for future service users please”. The Council responded saying poor standards of care had been raised at its MDT meeting.
38. At 3.15pm the same day the Council received a call from the home care agency providing the double-up carer with an update on the care arrangements. The agency said the arrangement was going well and the new live-in carer, “has a good rapport with PA and consequently the atmosphere in the house is relaxed and much more conducive to efficient care delivery”. She also wanted to give a good report of [W] (a previous live-in carer) who although inexperienced was a quick learner and after a steep learning curve began to know instinctively what [Ms X] needed. Consequently, her relationship with [Ms X] was good”.
39. Ms X requires support with a bowel evacuation process. The domiciliary care agency told the Council that when the live-in-care arrangement ended its care staff would not be able to support Ms X with the bowel evacuation process, saying It’s “not that they don't want to be helpful but simply they do not have staff who want to do it”. The officer said the Council was trying to establish what the NHS continence service could offer. The officer went on to say he was drawing up a draft support plan of essential tasks, and said, “I advised we would be distinguishing between 2 carer and 1 carer tasks in order to keep costs low”.
40. A social care assessor visited Ms X on 19 November 2018, along with an officer for the direct payments team. The aim was to explain direct payments in detail. The social care officer reminded Ms X she had sent her and her sister an email about this previously, which Ms X acknowledged. Ms X could not readily recall the information, saying, she received a lot of emails. She said she was doubtful she would be able to manage the administrative aspect of direct payments. She expressed concern about her reduced care package and said she assumed the removal of her live-in care to be a decision based on costs. The assessor said the domiciliary care package was 79 hours per week, and this was “a very large care package” The assessor said she was not able to discuss the cost of the care as she had not received authorisation for the funding from the Council’s funding panel. Ms X says visiting officers failed to enquire about any reasonable adjustments/support she would need during visits/meetings and to consider/complete any paperwork.
41. The assessor recorded she had requested an NHS CHC checklist be completed. I have seen no evidence to show this was completed.
42. The Council contacted the district nursing service to ask if it could assist with the bowel evacuation process. It said it could not. The Council then contacted Ms X’s GP on 23 November 2018 to establish the need for the process. The GP expressed concern about the Council “drastically reducing the care package she has”.
43. The Council also contacted a specialist nurse regarding the bowel evacuation process used by Ms X. The nurse said the system Ms X used “is a very useful tool to achieve this with the appropriate client”, that carers could be trained to use the system and the training was straightforward.
44. The Council’s funding panel approved 79.5 support hours per week support for Ms X for three months. It allocated £18.95 per hour. It included six hours per week for “community access”. Following this the live-in care arrangement ended.
45. The changes to Ms X’s care package took effect from 26 November 2018. Ms X says she was “all over the place” because live-in care was all she had ever known.
46. The Council commissioned the domiciliary care agency to provide all Ms X’s care from 26 November 2018. Ms X received four visits a day with two carers am and pm for transfers.
47. A hoist was installed in Ms X’s home in November 2018.
48. On 26 November 2018 Ms X’s sister contacted the Council to express concern about the proposed new domiciliary care plan, and that the am visit was being reduced to two hours. She was also concerned about Ms X being isolated between care visits. The council officer recorded the visit was for five hours am support, “two carers x 2.5 hours”. It appears the carers would be doubling up not visiting Ms X separately and the length of care visit was 2.5 hours.
49. In December 2018 council officers visited Ms X again to discuss the care plan, and how Ms X could utilise the six hours allocated for community support. Ms X said she preferred the Council commission the community support hours. The Council says took steps to “…identify an agency to commission the 6 hrs community access”.
50. On 2 January 2019 the domiciliary care agency contacted the Council to give notice on Ms X’s care package, saying it was unable to work with Ms X. Ms X says the carers usually worked with older people and were not experienced in supporting a younger person and this led to difficulty.
51. Ms X’s sister submitted a complaint to the Council saying changes to Ms X’s care plan were cost based. The Council met with Ms X and her sister on 17 January 2019 to discuss the complaint. A team leader from social services, an investigating officer and an officer from the complaints team were present. I have seen the notes of this meeting. Ms X’s sister reiterated her view, that the reduction in Ms X’s care package was financially motivated. Ms X said she had not been consulted about the changes; it had been imposed on her. The Council said it had to take account of its finances, but this had not been the primary reason for the changes. It could not sustain the live-in carer arrangement with double up carers from separate care agencies four times a day, this was not sustainable so it had to consider other options, one which had been an offer of a residential care placement. Ms X said she had considered the placement, but it was unsuitable for someone her age. Ms X’s sister said Ms X’s social needs were unmet and she had not received any community support hours since November 2018, the Council said any unused hours could not be accumulated and used later. The Council acknowledged this saying it needed to be more flexible. Ms X said she was interested in direct payments for the community hours and knew someone who may be interested but she did not know how to explain the process. Ms X’s sister said Ms X “had just been left”. Issues relating to Ms X’s personal care were discussed. The Council said most visits were over-running and merging into one. The Council offered Ms X the following options:

• The option of a live-in carer with no double up care
• A care home placement
• A direct payment, with a maximum payment of £1400 per week.

52. Ms X felt she needed more information about some of the options.
53. There were numerous visits from OTs to identify aids and adaptations and to address arising difficulties with moving and positioning, and aids and adaptations. An OT met with Ms X on 22 January 2019 to discuss the options in more detail. This process is ongoing.
54. The Council commissioned a new agency to provide home care on 25 January 2019. It arranged a period of shadowing between the existing and new agency.
55. Ms X decided she wanted to receive a direct payment for the six hours community support. The Council made a referral to its direct payments team.
56. On 23 April 2019, the home care agency contacted the Council to give three days’ notice on Ms X’s care package citing Ms X’s attitude towards carers as the reasons. Ms X says the carers were more used to working with older people and were not sensitive to her needs.
57. The Council was unable to source a replacement within the timescale. Ms X accepted a temporary placement in a residential care home on 25 April 2019, whilst an alternative home care agency could be found.
58. The records show the Council contacted a care agency on 25 April 2019 that provided support workers, rather than carers, and this would “bring a fresh approach to working with [Ms X]”. Two care agencies visited Ms X at the residential care home on 6 May 2019. Ms X chose her preferred agency.
59. During May/June 2019 the care agency staff were trained. They also visited Ms X at the care home to observe her daily routine.
60. Ms X returned home from care home on 8 July 2019. The Council says it provided eight days intensive support to the new support workers whilst a routine was established.
61. On 19 July 2019, concerns were raised by the OT, that one of the carers attending Ms X was struggling to manage the care single handed because she had a problem with her shoulder. The OT completed a revised Moving and Positioning Risk Assessment. A copy was sent to Ms X and the Care Provider on 25 July 2019. The OT also sent Ms X information about portable hair wash basins. The OT completed a ‘handover note’ which set out aids and adaptations outstanding, including tracks hoists to bedroom and bathroom.
62. I have had sight of an email an OT sent to an NHS professional about issues relating to a bed provided to Ms X. The OT said “Could we please discuss this case to try and come to some agreement as we have worked hard to get this care to a single carer and I am concerned that if we can’t rectify this and the care requires double handed care then [Ms X] does not have a large enough personal budget to cover this and may need to be placed in a nursing home which no-one wants”.

Current situation

63. The Council says, after some initial issues with equipment, Ms X has been successfully supported at home. She receives a direct payment for six hours community support.
64. Ms X says she is fairly satisfied with current care package. She has support workers who are more experienced in working with younger people. She has six hours support (8am to 2pm) and four and a half hours in the evening (5.30pm to10pm). She receives a direct payment receipt for six hours weekly support with socialising. She says this is not enough for a young person her age. She says she is denied social opportunities which she previously enjoyed, and the Council has not properly considered her social/recreational needs.

Analysis

65. It is not the Ombudsman’s role to decide if a person has social care needs, or if they are entitled to receive services from the Council. The Ombudsman’s role is to establish if the Council assessed a person’s needs properly and acted in accordance with the law.
66. In this case the Council failed to do so.
67. The Care Act requires Councils to promote the wellbeing of adults, and to do so in a way that satisfies certain underpinning principles, which includes the assumption that an individual is best placed to judge their wellbeing. This should be central to the care planning process. That is not what happened here. The Council imposed its decisions on Ms X and had little or no regard for her views and preferences. This is fault. Ms X says she felt powerless over her destiny. This is not the spirit of the Care Act.
68. The Care Act refers to the concept of meeting needs as opposed to providing services. If, as a result of a reassessment, a care package is reduced or changed in a significant way, then the law requires that the Council provides a detailed explanation why. This did not happen in this case. The Council was aware that prior to her moving into its area Ms X had an active social life. The Council does not appear to have properly considered this. It implemented a reduction in community support hours which resulted in a significant reduction in the social life Ms X had previously enjoyed. This has caused her increased isolation and impacted on her mental health.
69. The Council appears to have focused on costs not Ms X’s wellbeing. Throughout the care planning the Council seems to have been focused on reducing costs. Although cost can be a relevant factor in deciding between suitable alternative options for meeting needs that does not mean choosing the cheapest option. The Council can consider best value, but it cannot make decisions based only on financial considerations as it appears to have done in this case.
70. Throughout the care planning process, the Council set arbitrary limits on the budget for Ms X’s care. It capped the available budget for domiciliary care at that of a residential placement. Blanket policies of this nature are unlawful. It amounts to a fettering of the Council’s duty to meet an assessed need. Councils cannot simply take the cost of a residential care home as the benchmark figure for other care packages. In this case, such an approach left Ms X with little option of accepting residential care, or a reduced care package.
71. The Care and support statutory guidance says, “In determining how to meet needs, the local authority may also take into reasonable consideration its own finances and budgetary position, and must comply with its related public law duties… The local authority may reasonably consider how to balance that requirement with the duty to meet the eligible needs of an individual in determining how an individual’s needs should be met (but not whether those needs are met). However, the local authority should not set arbitrary upper limits on the costs it is willing to pay to meet needs through certain routes – doing so would not deliver an approach that is person-centred or compatible with public law principles”.
72. The Council told Ms X that unused social support hours could not be used at a later date. This is not helpful to Ms X, not person centred, and contrary to Statutory Guidance.
73. Ms X told the Council on several occasions she had reservations about managing direct payments, and that she preferred a council commissioned service. Despite this the Council continued to promote direct payments as a solution to the issues Ms X was facing. This placed unnecessary pressure on her. The Council offered no real alternative, so Ms X accepted. As it stands this has had a positive outcome, but that it more good luck than good management by the Council.
74. Direct payments are designed to give people more choice and control over the care and support services they are assessed as needing. The Care and Support Statutory Guidance 12.35 - says “The direct payment is designed to be used flexibly and innovatively and there should be no unreasonable restriction placed on the use of the payment, as long as it is being used to meet eligible care and support need”.

Summary

75. Had Ms X not pursued her complaint with the Ombudsman I have no doubt she would have been left with an unsuitable support package that did not genuinely involve her views on what is needed, and is clearly not the person-centred model that is required by the Care Act.
76. Ms X has understandably lost confidence in the Council’s ability and willingness to assess her in line with the Care Act.
77. The most appropriate way to resolve this concern is for there to be an independent assessment of Ms X’s needs carried out by an assessor who has experience of working with people who have complex needs.
78. Ms X has been put to significant time and trouble pursuing this complaint with the Council and the Ombudsman. This has added to her stress.

Recommended action

79. In considering the remedy I have taken account of the Ombudsman’s ‘guidance on remedies. This says a remedy needs to reflect all the circumstances including:

• the severity of the distress;
• the length of time involved;
• the number of people affected (for example, members of the complainant’s family as well as the complainant);
• whether the person affected is vulnerable and affected by distress more severely than most people;

80. The Council should

• provide Ms X with an apology for the failures set out above;
• commission an independent assessment of Ms X’s care needs from a suitably qualified professional, including the views of significant others in Ms X’s life;
• draw up a support plan from the assessment, and take all reasonable steps to reach agreement Ms X, and provide this office with a copy;
• make a symbolic payment of £750 to Ms X to acknowledge her stress, worry and loss of services as a result of the Council’s failure to properly consider her needs.
• pay Ms X £250 to acknowledge the time and trouble she has been put to pursuing this complaint with the Council, and the Ombudsman

81. Within three months the Council should:

• consider if other service users may have been affected by arbitrary upper limits and take any necessary action to address this:
• consider any training needs of officers completing or overseeing needs assessments under the Care Act
• ensure officers act in accordance with the Care Act.

82. Provide this office with evidence of the above.

Back to top

Final decision

83. There is evidence of fault by the Council in this complaint. The above recommendations are a suitable way to remedy the injustice caused.
84. It is on this basis; I intend to close the complaint.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman