Plymouth City Council (19 019 289)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 22 Feb 2021

The Ombudsman's final decision:

Summary: Mr C complained about the Council’s decision to reduce his homecare support, which he says prevents him from doing things in the community that he would like to do. We found there was fault with regards to some aspects of the care review process. The Council has agreed to apologise to Mr C and pay a financial remedy for any distress it has caused him. It will also arrange an independent care review of Mr C.

The complaint

  1. Mr C complains about the Council’s decision to reduce his care support. He says that, as a result, he is no longer able to go to the cinema, theatre and football matches between April and September each year.
  2. Mr C also complains that, even though his hours have been reduced, the contribution he has to pay towards his support has not reduced.

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The Ombudsman’s role and powers

  1. 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)
  2. We investigate complaints of injustice caused by 'maladministration' and 'service failure'. I have used the word 'fault' to refer to these. 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)
  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

  1. I considered the information Mr C and the Council provided to me. I also interviewed the social worker who was involved in the case. 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

  1. Mr C is in his late 30s, lives alone and provides support to his mother during the day. The Council said that Mr C can access the community independently during the day when it is light outside, he will avoid the dark which makes him anxious. The care support plan that Mr C had in place before May 2018 consisted of support from 4pm until 9am the next morning, which was 17 hours per day. The Council paid for support until 8am, with the additional hour from 8 till 9am provided by the care provider. It said that:
    • Mr C had autism, anxiety, and struggles with social interaction.
    • When slight changes are made in his life, or even suggested, this could result in agitated behaviours and anxiety.
    • He had good practical skills to carry out daily living tasks. However, many areas where he was usually independent could be affected during times of heightened anxiety. The support in place was mainly to manage his anxieties and support him with encouragement and reassurance,
    • He needed some support with his dinner preparation.
    • Independent with personal care and needed verbal direction only. However, self-neglect could occur during periods of high anxiety.
    • He had a high level of independence in terms of community access but had anxieties around crowded places and the dark.
    • A change in his routine would result in Mr C spending more time with his mother when her support workers are not present. This would put increased pressure on her to manage his anxieties and associated aggressive outburst, putting her at increased risk. All multi agency professionals agreed this would not be sustainable due to her own ill health.
    • Community care need: support to maintain emotional/mental health, which in turn impacts on daily functioning in terms of personal care / domestic tasks and safety.
  2. The Council was unable to confirm why the decision had been made in 2006, and had not been changed since, that Mr C’s support should start at 4pm, or finish at 9am.
  3. In 2018, Mr C moved property. Based on previous assessments, this was likely going to result in significant anxiety for him. There would therefore likely be an increased need for his support workers to manage this. However, at the same time, the Council agreed with the care provider to introduce two changes in his support plan: to start his support at 6pm instead of 4pm, and finish at 8am instead of 9am. This was an overall reduction of 21 hours per week. The reduction started mid-May 2018, immediately after Mr C moved to his new accommodation. Mr C told us that, as a result of the later start, he was no longer able to do the following activities, between April and September:
    • Go to the Cinema / Theatre: Mr C said: he goes (on average) twice a month with his mother to the cinema and twice a month to the theatre. He says his mother is Diabetic and has to eat before the show starts. As such, they would go for a meal at 4.45pm and then to the cinema or the theatre. However, he was not able to do this anymore when the support worker would only start at 6pm.
    • Football matches: Mr C said he is a season ticket holder with his local football team. He said: the home games finish at 4.45pm, which meant there was no longer a support worker to walk him home, as he was nervous walking home. His friends don’t take him home.
  4. The Council told me that:
    • Theatre/Cinema: During the summer, Mr C did not need a support worker to take him to the theatre or cinema. It would still be light outside, and Mr C would access such activities with his mother and her friends without needing any formal support. If ever he wanted to attend such an activity with a support worker, the care provider would have been flexible with his hours. In January 2019, following Mr C’s request, it brought forward the start time during the winter to 4.30pm, because this would be the time it would be dark.
    • Football: Following Mr C’s request, it brought forward the start time during the winter to 4.30pm, which enabled staff to pick hum up after a football game.
  5. Mr C told us the Council did not properly explain why it made these decisions. He also said he did not agree but was simply told that this would be all the Council would offer.
  6. The social worker told me that the support was reduced from:
    • A 6pm start to a 4pm start, because Mr C would regularly return from his mother late. This meant his support worker would have to wait at his property. As such the carers were already not providing any support to him between 4 and 6pm. The social worker also told me that Mr C wanted it to be changed to 6pm as he wanted to stay longer with his mother. The care provider told me that Mr C would arrive late (around 5.15pm) approximately 2 or 3 times a week. It also said that Mr C did not want the hours to be changed from 4 to 6pm. I have not seen any evidence that this was mentioned in discussions between the Council and the care provider during March and April 2018, or that this was discussed with Mr C at the time of his care review in April/May 2018.
    • A 9am to 8am finish. The Council decided to reduce this in May 2018, because on most occasions Mr C was still in bed by the time the carers left. As such, the carers were already not providing any support to him in the morning between 8 and 9am. The care provider confirmed that this was correct. However, I have not seen any evidence that this was actually mentioned in any discussions between the Council and the care provider during March and April 2018, or that this was discussed with Mr C at the time of his review in April/May 2018.
  7. The records state there were several discussions between the social worker and the care provider during March and April 2018 about how the support hours could be reduced. Several different start and finishes times were proposed at different stages, but it was never clear from the records how these proposed changes in times related to Mr C’s needs.
  8. A record provided by the Council from 13 April 2029, states the social worker said: “I am visiting Mr C tonight just to catch up about his week (…), she asked if I would mention changes tonight as she is not back in work until next Tuesday”. However, there is no further record made immediately after the meeting that shows what was subsequently actually discussed and agreed at the visit that night.
  9. The Care Review form dated 24 April 2018 states:
        1. Mr C is supported by staff with managing a main meal at night, prompts to have a shower and carry out household tasks & administer medication. However, the Council has since told me that he is independent with showering, managing daily living tasks and managing his medication, and care workers only prompt/supervise with preparing a main meal.
        2. He is able to independently access the community by foot or by bus but avoids the bus at times when it is crowded.
        3. He visits his mother daily as part of his routine. He stays with his mother until he catches a bus home for his care.
        4. He is afraid of the dark and gets highly anxious at night.
  10. On 10 May 2018, the social worker carried out a home visit with the care provider. At the meeting, the social worker gave a copy of Mr C’s care review to him. The records state the social worker advised Mr C that she would reduce his hours. The social worker suggested that a later start time would be better for Mr C, as he would not have to rush home. However, the social worker did not realise at the time that this would mean that Mr C would have to come back from his mother in the dark during the winter.
  11. The records state that Mr C told the social worker two weeks later, that he needed his hours to be reinstated again, because he could not wait at his mother’s until 6pm every day. Rather than discussing this further, the record states the social worker said these were the hours following his review and the old hours would not be put back in again. However, the social worker did suggest that staff could perhaps come one hour earlier, but this would mean the night staff would also have to leave an hour earlier to compensate for that. It is not clear (or recorded in the records) on what basis the social worker felt that Mr C’s morning hours could be reduced by a further hour. The social worker spoke to Mr C’s mother the same day, who agreed that the hours should not have been reduced.
  12. There was a meeting in July 2018 to review how Mr C’s revised support plan was working. However, the Council has told me there are no notes from this meeting that show what was discussed.
  13. Mr C told the Council in October 2018 that he was struggling to manage his hours, because of the darker mornings and nights. The social worker did again not ask Mr C to explain what he was struggling with. Following a subsequent request, the social worker did agree to meet with him and the care provider. The meeting took place on 11 October 2018, but the social worker again failed to ensure there was a record of what was discussed.
  14. Mr C made a complaint about the changes to his support, which resulted in a meeting on 19 November 2018. The record states that:
    • Mr C said he could no longer attend football matches, because home games would finish at 4.45pm but his support worker would only start at 6pm.
    • Mr C also explained he would often go out to the theatre and cinema with his support workers, but all this stopped now. He provided a list of all activities he did in the past. He said he was afraid of the dark, which impacts his ability to do things and socialise during the winter months. It was agreed that Mr C was still young and should be enabled to do more.
    • Mr C agreed to consider a compromise of having less hours in the summer and more hours in the winter, keeping the total hours per year the same (at the reduced level). Mr C’s social worker would work on a plan with Mr C to enable this. It was clear that any solution should not include any increase in hours.
  15. Mr C had a meeting with his social worker in January 2019. According to the records, Mr C said he would be able to leave his mother’s house earlier in the winter and he was very happy with his social worker. Following the meeting the hours were changed to:
    • October to March: 4.30pm – 7.30am (15 hours).
    • April to September: 6pm – 7am (13 hours).
  16. The Council says that: if Mr C has a planned activity, he can approach his care agency to change their rota time. However, in my view, it had become more difficult to ‘save hours’ to attend a planned activity after his care had been reduced by 7 hours a week during the winter and 21 hours during the summer.
  17. The records indicate that Mr C used to go with a support worker to the theatre and cinema. But this stopped when he did not have enough money to pay for the ticket of the carer. Mr C says he also used to go with his mother.
  18. Mr C told me he did not mind the reduction in the morning from 9 to 8am but needs to have his support start at 4pm all year through. However, the Council says there is no need to start the support at 4pm in the summer as it is not dark then, which means Mr C can be out and about on his own.

Analysis

  1. The assessment and support plans from before 2018 clearly stated that even a small change in Mr C’s routine, would result in an increase in his anxieties, which would result in an increase in the support and assurance he would need from his support workers to manage this. They also stated that any change in his routine, would result in Mr C spending more time with his vulnerable mother, which would potentially put her at risk. All multi agency professionals had agreed that this would not be sustainable due to her own ill health.
  2. There is insufficient evidence in the records, that these issues were sufficiently considered / risk assessed when the Council decided to reduce Mr C’s hours in the afternoon, as well as in the morning, and do this at the same time when he already had to cope with the major change of moving property and the associated anxiety and increase in support / reassurance he would need from support workers with that. This is fault.
  3. I have seen insufficient evidence to be able to conclude that Mr C was sufficiently involved in discussions in April and May 2018, as to why his care should be reduced now and how this would take place. This is fault and not in light with the Care Act, which says the client should be actively involved in the care review. Mr C rightfully felt that he was not sufficiently listened to in May 2018 or given a fair opportunity to discuss the possible impact any proposed changes may have on him. As such, issues such as the impact the changes could have on potential social activities (attending football matches) or the fact Mr C wanted to be back home before dark in the winter (4.30pm) were not even discussed or considered during the review in April / May 2018. Mr C did not agree to the changes.
  4. I have also not seen evidence in the records, that the Council sufficiently explained to Mr C in April / May 2018 why it now believed he no longer needed support between 4pm and 6pm, or between 8am and 9am. This is fault. The reasons provided were vague and did not always correlate with the actual situation, as Mr C was back by 4pm on most occasions and did not say at the time of the cut, that he wanted to stay longer with his mother.
  5. The Council also failed to record what was discussed at the important care review meetings in July and October 2018, which is fault.
  6. Since then, the Council has only been willing to discuss how to change the start and finish time, as long as it does not increase the total number of the reduced hours. This is an unusual approach to determining what support a person needs to meet his needs.
  7. Although the Council agreed on 19 November 2018 that “Mr C is still young and should be enabled to do more”, I have not seen evidence in the records that there was subsequently a sufficient discussion with him about what (social) activities he wanted to do in the evening, how often and how to facilitate this. As such, the Council has failed to sufficiently support this aspect of Mr C’s care support. The Council has since told me it will consider making an application to the Cinema Exhibitors Association for providing a free cinema ticket for one carer.
  8. However, I did not find that the reduction in hours had a significant negative impact on Mr C attending the theatre, cinema, or matches. During the summer it is still light outside at 6pm, and (after January 2019) the Council brought forward the winter period start time to 4.30pm. This enabled Mr C to continue with these activities throughout the year.
  9. Mr C has proposed several changes to his start and finish times. It is clear from the records that, since May 2018, he has struggled to find a way to use the reduced hours to meet his needs as best as possible.
  10. Taking Mr C’s condition into account (anxiety etc) the above will have had a significant impact on him since May 2018.
  11. There was no fault with the fact that Mr C’s contribution to his care package did not reduce after his hours reduced. The total cost of the reduced care package is still more than the Council has assessed him as being able to contribute. He therefore needs to continue to pay this full contribution.

Agreed action

  1. I recommended the Council should, within four weeks of my decision:
    • Provide an apology to Mr C for the faults identified above and the distress these have caused him.
    • It should pay Mr C £500 for the distress the faults have caused him and the lack of sufficient / active support to try and enable him to do more social activities in the evening.
    • Carry out an independent care review that addresses the shortfalls identified above.
    • Discuss with him what additional (social) activities he would like to pursue during the day / evening.
    • Share the lessons learned with all adult social care staff involved with needs assessments and care reviews.
  2. The Council told me it has accepted my recommendations.

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Final decision

  1. For reasons explained above, I decided to uphold Mr C’s complaint.
  2. 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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Investigator's decision on behalf of the Ombudsman

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