Summary: The Council is at fault as it carried out an inadequate Care Act assessment for Ms Y so it did not have a complete picture of her needs. The Council also delayed in arranging the installation of an intercom system following the assessment. The Council has agreed to remedy Ms Y’s injustice by carrying out a new Care Act assessment for Ms Y and by making a payment of £250 to her to acknowledge the distress caused.

The complaint

1. Mr X is Ms Y’s representative. He complains that the Council:
1. Failed to respond to his request of 19 August 2019 for a Care Act assessment for Ms Y.
2. Retrospectively converted a sensory impairment assessment into a Care Act assessment. Mr X considers the assessment to be inadequate as it does not consider the cumulative impact of Ms Y’s disabilities and health conditions on her ability to achieve outcomes. The assessor also did not have the required skills and knowledge of Ms Y’s disabilities and health conditions. As a result, Ms Y’s care and support needs have not been properly identified and the Council has not provided support to meet her needs.
3. An occupational therapist told Ms Y the Council does not provide personal assistants.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. We must also consider whether any fault has had an adverse impact on the person making the complaint. I refer to this as ‘injustice’. If there has been fault which has caused an injustice, we may suggest a remedy. (Local Government Act 1974, sections 26(1) and 26A(1), as amended)
3. If we are satisfied with a council’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)

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How I considered this complaint

4. I have:

• Considered the complaint and the information provided by Mr X;
• Made enquiries of the Council and considered the information provided;
• Invited Mr X and the Council to comment on the draft decision. I considered any comments received before making a final decision.

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What I found

5. 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.
6. 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.
7. 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
10. Carrying out any caring responsibilities the adult has for a child.

8. Because of not achieving these outcomes, there is likely to be, a significant impact on the adult’s well-being.
9. Where local authorities have determined that a person has any eligible needs, they must meet these needs. When a local authority has decided a person is or is not eligible for support it must provide the person to whom the determination relates (the adult or carer) with a copy of its decision.
10. Paragraph 5.3 of the Council’s procedures state that the purpose of an assessment is to establish a complete picture of the individual’s needs, what outcomes they want to achieve in their day to day life and what impact this has on their well being.

What happened

11. Ms Y has a visual impairment and physical and mental health conditions. The Council’s records show that in August 2019, officer A, a visual impairment officer, contacted Ms Y to arrange a visual impairment assessment. A few days later Mr X wrote to the Council requesting a Care Act assessment for Ms X. In this letter Mr X set out Ms Y’s health conditions.
12. In late August 2019 officer A carried out an assessment. His entry in the records state it was a visual impairment assessment. The assessment shows officer A noted all Ms Y’s health conditions. He recorded Ms Y’s presenting situation as her visual impairment and need to declutter her property. The assessment records that the Council would assist Ms Y with the installation of lighting to meet her needs and it would order an intercom for her.
13. The assessment also records Ms Y’s needs against the outcomes but did not indicate if they had a significant impact on her wellbeing for all outcomes. There is no reference to how Ms Y’s other health conditions could affect her ability to meet her outcomes. The assessment did not say if Ms Y was eligible for care and support.
14. The Council’s records show Mr X contacted the Council to ask for a care needs assessment for Ms Y in mid-September 2019. Officer A’s records also note he sent the visual impairment assessment to Ms Y.
15. Officer A visited Ms Y in early October 2019 to discuss the assessment. Officer A’s record of the visit notes Ms Y had read the assessment and not made any significant alterations. The record of the visit also notes Ms Y’s primary needs being a door entry system and improved lighting. Ms Y has said that at this visit officer A told her he had been instructed to convert the visual impairment assessment into a care act assessment. There is no record to show officer A made this statement.
16. In November 2019 Mr X made a complaint that the Council was delaying in carrying out a care act assessment for Ms Y. The Council’s records show Ms Y also contacted the Council to ask for a care act assessment. Officer B, a manager, sent an email to officer A stating if Ms Y was able to say the reason why she requires a care assessment it will help identify how they proceed. Officer A explained this to Ms Y in telephone call.
17. In response to Mr X’s complaint the Council said an assessment had been carried out and Ms Y agreed the assessment and outcomes at the home visit of early October 2019.
18. Mr X contacted officer A in early December 2019. He said he and Ms Y thought the assessment carried out in August 2019 was a sensory impairment assessment, not a care needs assessment. Mr X said due to Ms Y’s mental and physical health conditions she required a personal assistant in relation to a number of outcomes, including preparing food and accessing the community.
19. Officer A sent an email to Mr X detailing a visit he made to Ms Y in mid-December 2019. He set out a number of actions taken relating to Ms Y’s visual impairment. He then set out the reasons why Ms Y wanted a personal assistant to achieve her outcomes. The Council has said officer A had not identified these needs in his assessment and did not refer Ms Y for further social work intervention so a further assessment did not take place.
20. The Council’s records show it agreed to review Ms Y’s care needs in May 2020. Officer C, a social worker, sent an internal email stating Ms Y had several mental health diagnoses that were impacting on her ability to attend to her daily living. Officer C stated she has identified care and support needs that would require a six week reablement package until mental health intervention started. The Council has acknowledged it failed to refer Ms Y for reablement. It has said it will explore with Ms Y whether it is still appropriate to pursue the reablement referral.
21. Following the review of her care needs, the Council considered Ms Y did not have eligible care and support needs. I understand Ms Y disagrees with the outcome of this assessment.
22. In response to my enquiries the Council has said:

• It carried out a proportionate Care Act assessment for Ms Y in August 2019. At the time of the assessment Ms Y was independent with her physical needs and was signposted to various health care professions and local services:
• Ms Y advised officer A she was under the Mental Health Team to support her with her anxiety with accessing the community and engaging in employment.
• All assessments are carried out using the care act assessment form.
• Officer A was unable to process the request for additional lighting and the intercom before he left the Council. It has now provided the intercom and identified that lighting was no longer needed.

My assessment

Assessment of August 2019

23. It is not our role to determine whether Ms Y is eligible for care and support form the Council. Our role is to examine how the Council carried out the assessment and reached its decision about eligibility.
24. The Council has said the assessment of August 2019 was a Care Act assessment. Mr X disputes the Council carried out such an assessment. The assessment includes information about Ms Y against the outcomes so appears to be a Care Act Assessment. However, officer A’s reference to the assessment as being a visual impairment assessment when he contacted Ms Y to arrange the assessment calls into question whether he intended to carry out a Care Act assessment. But, even if the assessment was a Care Act assessment, I consider it was inadequate as it did not establish a complete picture of Ms Y’s needs in accordance with the Council’s own guidance and the Care and Support Guidance.
25. The assessment lists Ms Y’s physical and mental health conditions. There is no evidence to show officer A explored with Ms Y whether she had needs arising from her physical and mental health conditions, the impact of those conditions on her well being and ability to meet her outcomes. The assessment considers Ms Y’s visual impairment but, again, it does not consider if she has care and support needs arising from her visual impairment, the effect on her wellbeing and ability to achieve her outcomes. As a result, the Council did not establish a complete picture of Ms Y’s needs. This is fault.
26. There is no evidence to show the Council made a decision on whether Ms Y had eligible needs following the August 2019. In any event the Council was not in a position to make an informed decision on Ms Y’s eligibility as it did not have a complete picture of her needs due to the inadequate assessment. This is fault.
27. The Council’s communication with Ms Y and Mr X lacked clarity. There is no evidence to show officer A explained to Ms Y in advance of the assessment that it would be a Care Act assessment. Officer A’s record of his call to Ms Y to arrange the assessment refers to it as a visual impairment assessment. I am therefore not persuaded the Council properly informed Ms Y it would be carrying out a Care Act assessment and what the assessment would cover. So, Ms Y would not have been prepared for a Care Act assessment and be able to fully participate in it.
28. The Council did not inform Mr X in August 2019 that it had carried out the requested Care Act assessment and did not do so until he made the complaint on behalf of Ms Y. The Council did not explain to Ms Y that it had already carried out a Care Act assessment when she requested one in November 2019. This lack of clarity meant Ms Y was unaware the Council considered it had carried out a Care Act assessment.
29. Ms Y informed officer A that she considered she had eligible needs in December 2019 and he reported this to Mr X. It is not clear why officer A did not consider if he should review Ms Y’s Care Act assessment in light of the information she had provided as this was not covered in the assessment of August 2019. This is fault.
30. There is no evidence to support Ms Y’s complaints that officer A was instructed to convert a visual impairment assessment to a Care Act assessment or that the Council would never provide personal assistants.
31. The Council has acknowledged the recommendations to install an intercom and lighting were not pursued when officer A left the Council. This is fault which left Ms Y without an intercom for longer than necessary. I understand the Council now considers Ms Y does not require additional lighting. This is a new issue which has arisen since Mr X made the complaint to us so I cannot consider this matter at this time. Mr X and Ms Y will need to make a complaint to the Council if they disagree with its decision not to install the lighting. It is open to them to make a further complaint to the Ombudsman if they are unhappy with the Council’s response to the complaint.

Injustice to Ms Y

32. The inadequate assessment carried out in August 2019 meant the Council did not have a complete picture of Ms Y’s needs. I am mindful that the Council carried out a review of Ms Y’s care and support needs in May 2020 and decided Ms Y is not eligible for care and support. I have not come to a view on the adequacy of that assessment as it was carried out after Mr X made the complaint to us. But the inadequate assessment of August 2019 means Ms Y cannot be satisfied that the Council has a complete picture of her needs and this could have compromised the Council’s review of her needs in May 2020. Ms Y is also disputing the assessment of May 2020 and has lost confidence in the process. I therefore consider it would be appropriate and proportionate for the Council to carry out a new Care Act assessment for Ms Y which fully considers if she has needs arising from her physical and mental health conditions which impact on her wellbeing and ability to achieve the outcomes.
33. The Council’s fault in not carrying out an adequate assessment in August 2019, its poor communication and delay in installing the intercom will have caused distress and inconvenience to Ms Y. The Council should remedy this injustice.

Agreed action

34. That the Council will:
1. Send a written apology and make a payment of £250 to acknowledge the distress and inconvenience caused to Ms Y by its failure to carry out an adequate Care Act assessment in August 2019, poor communication and delay in installing the intercom.
2. Carry out a new Care Act assessment for Ms Y to fully consider if she has needs arising from her physical and mental health conditions which impact on her wellbeing and ability to meet the outcomes. If the Council considers Ms Y is eligible for care and support and would have been from August 2019, it should then consider an appropriate remedy to acknowledge this.
35. The Council should take the action at a) within one month of my final decision and the action at b) within six weeks and provide evidence to the Ombudsman of the action taken.

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Final decision

36. The Council is at fault as it carried out an inadequate Care Act assessment for Ms Y so it did not have a complete picture of her needs. The Council also delayed in arranging the installation of an intercom system following the assessment. The Council has agreed to carry out a new Care Act assessment for Ms Y and make a payment of £250 to her to acknowledge the distress caused. This is a reasonable and proportionate remedy for Ms Y’s injustice so I have competed my investigation.

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Investigator's decision on behalf of the Ombudsman