Summary: Ms Z complains on behalf of Mr X that the Council has failed to provide care services; not taken account of his views when producing care plans; failed to provide large print copies of documents and sent invoices when he should not pay for his care. Mr X, until recently, was receiving direct payments and so he had the ability to source his own carers to meet his needs. The information provided shows that Mr X’s views were sought as part of the care planning process. The issues regarding large print copies and incorrect invoices have been acknowledged and action taken to resolve them.

The complaint

1. Ms Z, on behalf of Mr X, complains the Council has:

1. failed to provide care services which he has been assessed as needing;
2. produced care plans and needs assessments which have not taken account of his views;
3. failed to provide him with large print copies of documents relevant to his care;
4. sent him invoices when he should not pay for his care.

2. Ms Z says Mr X has felt socially isolated, neglected and unable to leave his house. Mr X says the failure to provide care is a form of abuse and caused a deterioration in his health.

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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. 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

5. As part of the investigation, I have:
• considered the complaint and the documents provided by the complainant’s representative;
• made enquiries of the Council and considered the comments and documents the Council provided;
• sent my draft decision to both the Council and the complainant and taken account of their comments in reaching my final decision.

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What I found

6. Mr X made a self referral for support with care needs in July 2015. The Council provided some help and support via enablement services but it was not until September 2018 that a care assessment was successfully completed and a personal budget of £91 a week was agreed. Mr X chose to have direct payments and used a brokerage service to help with recruiting a personal assistant.
7. The direct payments were agreed in October 2018 but as a personal assistant had not been recruited, the Council arranged for a 30 min call each day provided by a care agency. The service was suspended in January 2019 following complaints made by Mr X.
8. The Council arranged for another agency to provide the care. This lasted only five days before it was ended due to Mr X verbally abusing the care worker. A referral made to the mental health enablement team was declined as it had previously tried to work with Mr X without success.
9. A personal assistant began working for Mr X on 6 March 2019. However, the assistant went on holiday after five days, went off sick after 10 days and then did not return. The Council says that while attempts were made to find another personal assistant, it offered to provide five hours of care per week via another agency in April. The Council says Mr X recruited another personal assistant and so the agency was not used. The personal assistant went on sick leave in June.
10. Following complaints from Mr X about his care assessment, the Council agreed to undertake a re-assessment which it would carry out in short bursts to ensure Mr X was not over-fatigued by the process. The first appointment was made for 25 July. Mr X’s mother notified the Council on 5 August that the personal assistant was no longer supporting Mr X and hadn’t done so for a number of weeks. Mr X’s mother agreed to ring an agency to request support to recruit a new personal assistant.
11. The social worker visited Mr X at home on 15 August to continue with the re-assessment. The Council says the situation deteriorated to the point the social worker felt he had no choice but to leave Mr X’s home. The Council agreed Mr X could review the assessment with his advocate.
12. The social worker visited Mr X at home again on 18 September with the advocate. The Council says Mr X became angry quickly after they arrived. The notes state they were unable to calm him down and so they left.
13. In November, the Council received an email saying the personal assistant did not want to continue to work for Mr X because of his behaviour including shouting and swearing.
14. The Council contacted Mr X on 6 November in order to visit him with regard to sourcing a new personal assistant. Mr X said he did not want more than two people to visit and that the Council was abusing him. The Council says it was unable to arrange a visit because Mr X would not calm down.
15. In November the social worker contacted Mr X as the agency helping to find a new personal assistant had raised concerns about an angry phone call. Mr X said there were problems with the advert for the new personal assistant. He said his anger was due to frustration because he was not getting the help he needed and he felt social care was being abusive.
16. A referral was made for a short term assessment and plan for enablement in January 2020 but Mr X did not accept the offer of support. On 14 January the Council decided to suspend Mr X’s direct payment because of the problems sourcing a personal assistant and so the money was not being used. Mr X’s new social worker telephoned Mr X on 16 January to discuss the offer of enablement. The Council offered to provide Mr X 10 hours of support per week from a care provider while looking for a new personal assistant. Mr X declined the offer.
17. On 27 January Mr X said he had found a new personal assistant but refused to disclose the identity.
18. On 17 March Mr X’s mother requested interim support saying the personal assistant was on holiday. After Mr X’s mother visited him she spoke again with the social worker. The Council checked whether Mr X required extra support due to Covid 19. Mr X’s response did not answer the questions about his support needs but accused the social worker of being a criminal. Mr X declined an offer to interim support to cover the period his personal assistant was self isolating.
19. On 15 April the Council again offered support through a care agency while the personal assistant was on sick leave. However, when the social worker subsequently contacted the agency, it said it would not support Mr X because of his behaviour towards the care worker.
20. The social worker spoke to Mr X’s mother who confirmed the personal assistant was still on sick leave and so she was helping with Mr X’s shopping. She told the social worker that Mr X was able to prepare food and drinks for himself.
21. The Council wrote to Mr X’s GP on 22 April setting out its concerns and that Mr X was not engaging in any meaningful way. The Council confirmed it had a duty of care and was concerned about Mr X’s health and wellbeing. The Council it intended to carry out an unannounced visit to check if Mr X was safe and well and to try to engage with him. The GP confirmed Mr X’s main health problem was chronic fatigue syndrome and anxiety.
22. The Council carried out the unannounced visit on 24 April 2020. The social worker was accompanied by a support worker who would be able to offer immediate practical assistance if required. Mr X answered the door but would not let them into his property. The Council says he became verbally aggressive and despite trying to calm the situation, the workers were forced to leave when Mr X picked up a broom and began waving it at them in an aggressive manner.
23. The social worker contacted the GP again on 27 April. Mr X had continued to tell the social worker he was suffering from internal bleeding, daily falls, broken toes, sprained limbs, torn hip, groin and pelvis. The social worker asked the GP to let Mr X know it could arrange a package of care with another private agency to support him immediately.
24. On 27 April to provider of Mr X’s direct payment managed account served notice on Mr X due to his repeated abusive telephone calls. On 29 April Mr X’s mother confirmed the personal assistant was back at work. The Council notified Mr X on 1 May that he would need to find another managed account provider.
25. On 19 May an alternative account provider confirmed they did not want to manage M’ X's account due to receiving disturbing emails. The Council notified Mr X of this decision.
26. A multi-disciplinary meeting was held on 29 May to try to establish a way to work with Mr X in light of his behaviour. It was decided to start the safeguarding procedure. The first meeting was held on 11 June and involved Mr X’s GP, safeguarding officers, adult care mental health team, the direct payments service manager, NHS healthcare trust and the CCG. A second meeting was held immediately afterwards and included adult care mental health, the direct payments manager and Mr X and his mother. The meeting was curtailed due to Mr X’s verbal abuse.
27. A new package of care was due to start on 15 July comprising of two hours a day Monday to Friday. Mr X’s mother then cancelled this care package.
28. On 12 August the Council emailed information to Mr X’s mother about another package of care which would be four hours a day on Monday, Wednesday, Friday and Sunday. The Council says it has not received any response to this offer.

Analysis

29. Ms Z has made several specific complaints on behalf of Mr X. I will deal with each one in turn.

Failed to provide care services which he has been assessed as needing

30. Mr X says he first requested assistance in 2013. However, he was not assessed as having eligible care needs until September 2018. Mr X has been assessed as requiring help with shopping, cleaning, personal care and to reduce social isolation. Mr X chose to have direct payments and employ his own personal assistant. Mr X uses a direct payment service to help with recruitment and payroll. By providing direct payments as requested by Mr X, the Council has in effect met Mr X’s eligible needs.
31. It is clear that since October 2018, Mr X has not had continuous support and has not used the full 10 hours per week. I do not consider this is due to fault by the Council. There have been periods when Mr X’s personal assistants have been unable to provide a service due to sickness, holiday or because they were socially isolating. There have also been gaps during the recruitment processes for a new personal assistant.
32. The Council has regularly offered to provide a service through care agencies until the new personal assistant was in post. The Council cannot force Mr X to accept a direct service and Mr X routinely declined to accept it. I cannot say that is fault by the Council.
33. I am satisfied the Council was active in dealing with Mr X’s complaints and tried to find solutions. It made referrals to enablement services, offered services from different care agencies, contacted the GP and visited Mr X. Unfortunately, this has not resulted in Mr X receiving the care he is assessed as requiring but there is no fault by the Council.
34. I note the Council recently offered Mr X an improved direct service of 16 hours per week. Neither Mr X nor his mother have responded to this offer. I would suggest they contact the Council if they are interested in discussing this further.

Produced care plans and needs assessments which have not taken account of his views

35. An assessment of Mr X’s care needs was carried out in 2018. Visits took place on 30 May, 5 June, 20 August, 6, 9 and 18 September to complete the assessment. The assessment was carried out in small bursts at Mr X’s request because of his medical condition. Mr X also completed a self assessment and this was used to identify his care needs. The Council says that during a home visit on 1 October 2018 Mr X agreed the assessment reflected his needs.
36. In her complaint letter dated 21 November 2019, Ms Z says Mr X is of the opinion his care plan does not represent his needs or address his social exclusion. In its response, the Council said the social worker would look again at the care plan and assessment of needs to make it more in line with Mr X’s wishes.
37. I have not seen any evidence to show that this has taken place. It also seems to me that the Council could have taken a view on whether to amend the care plan itself and did not need Mr X to suggest a way to achieve this. However, even if re-consideration of the care plan did not take place, I am not persuaded this caused Mr X a significant enough injustice to warrant further investigation.
38. The Council has been in contact with Mr X throughout 2020. It has taken action to try to ensure care is available to Mr X. As explained above, for reasons not within the Council’s control, Mr X did not receive the level of care every week that he had been assessed as needed. Mr X’s failure to engage with the help offered is Mr X’s choice. It is possible Mr X would not have engaged in any process to make amendments to the care plan.

Failed to provide him with large print copies of documents relevant to his care

39. The Council says it provided a large print copy of Mr X’s care plan after Ms Z made a request in November 2019. It says Mr X had not previously requested large print copies. The Council also sent copies in large print flowing a subject access request in April 2020.
40. The information suggests large print copies have been provided when requested. I am sure the Council will continue to make this reasonable adjustment for documents in the future.

Sent him invoices when he should not pay for his care

41. Mr X was sent invoices in respect of his contribution for the care provided. The Council re-assessed Mr X’s contribution, taking account of housing related costs, and Mr X now has a nil assessment and so all invoices have been cancelled.

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Final decision

42. I will now complete my investigation as there is no evidence of fault causing a significant injustice.

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Investigator's decision on behalf of the Ombudsman