Summary: The Council reduced Mrs X’s package of care when it assessed that her needs were being met by other means. It reinstated care after Mrs X showed her needs had increased again. However, there was a failure to consider Mrs X’s circumstances which led to a period when her care was less than satisfactory. The Council agrees to apologise and offer a payment in recognition of the distress caused.

The complaint

1. Mrs X (as I shall call the complainant) complains the Council reduced her care package when she still had unmet needs.

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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 considered the information provided by the Council and by Mrs X. I spoke to Mrs X. Both Mrs X and the Council had an opportunity to comment on a draft of this statement and I considered their comments before I reached a final decision.

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What I found

Relevant law and guidance

5. 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:

1. The needs must arise from or be related to a physical or mental impairment or illness.

2. Because of the needs, the adult must be unable to achieve two or more of the following:

• Managing and maintaining nutrition;
• Maintaining personal hygiene;
• Managing toilet needs;
• Being appropriately clothed;
• Being able to make use of the adult’s home safely;
• Maintaining a habitable home environment;
• Developing and maintaining family or other personal relationships;
• Accessing and engaging in work, training, education or volunteering;
• Making use of necessary facilities or services in the local community including public transport, and recreational facilities or services; and
• Carrying out any caring responsibilities the adult has for a child.

3. Because of not achieving these outcomes, there is likely to be, a significant impact on the adult’s well-being.

6. 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.
7. Section 27 of the Care Act 2014 gives an expectation that local authorities should conduct a review of a care and support plan at least every 12 months. As well as the duty to keep plans under review generally, the Act puts a duty on the local authority to conduct a review if the adult or a person acting on the adult’s behalf asks for one.

What happened

8. Mrs X, who lives with her husband and adult daughter, has a visual impairment and other health-related conditions. The Council funded a package of care which included support from an agency care-worker to provide personal care and help with food preparation, and a Personal Assistant (PA) funded through Direct Payments who helped with shopping, social activities and accompanied Mrs X to a MIND day centre.
9. The Council reassessed Mrs X’s care package after contact from the care agency and from MIND. The care agency told the Council that when care-workers arrived to give personal care, Mrs X was either already up and dressed, or in bed and declined care: on those occasions care-workers were doing the family washing-up or preparing vegetables for the family’s meals. The MIND service said Mrs X telephoned to see what was for lunch and based her attendance on her preference for the meals available.
10. Mrs X says the agency care-workers did not understand if she stayed in bed with depression. She says sometimes she cancelled their calls when they told her they weren’t available until after 10am, as she needed her insulin administered before then, but the care agency just recorded a cancelled call. She says depression was frequently the cause of her missed attendance at MIND.
11. A social worker visited Mrs X in December 2019 to discuss the care package with her. He recorded Mrs X said she did not use the care agency fully but felt it was important to have freshly prepared vegetables for the family meal. The social worker discussed other ways in which this could be achieved: “(Mrs X) agreed that the support currently being provided by (the agency) was not necessary and agreed to this ceasing.” Mrs X’s PA would meet any needs which remained unmet after the assistance provided by Mrs X’s husband and daughter.
12. Mrs X says this misrepresented what she told the social worker. She explains her husband works long hours and her daughter is autistic and cannot provide care for her. She says she told the social worker she needed the agency care-workers to help her with her personal hygiene but he told her (incorrectly) the district nursing service would help. The social worker says this is not accurate:he discussed with her the administration of her insulin by the District Nurses but was aware they could not assist with her personal care.
13. The social worker also discussed with Mrs X her attendance at MIND. Mrs X agreed she was not using the service fully because of her depression but undertook to try and attend on a weekly basis going forward. It was agreed her PA would continue to support her to attend.
14. The social worker noted the additional £30 per week which was being paid to Mrs X for social activities would cease as she had used the money to pay for fuel for her PA’s car, which was not its intended purpose. Mrs X says this is not true. She says she always paid for fuel herself from her Personal Independence Payment (PIP). The social worker has a different recollection of the conversation.
15. The social worker says Mrs X did not mention at their meeting the assistance in blood glucose monitoring her PA was providing during the MIND sessions. He acknowledges he could have explored further the reasons for the PA’s attendance, but says he had no concerns Mrs X would be left without support. He adds that she was supported during the meeting by her mental health worker and her husband.

The complaint

16. Mrs X contacted the Council at the start of January 2020 concerned that her care package had been stopped, and that her family was unable to assist her properly with personal care. The social worker says he asked the interim team manager to contact Mrs X several times during January 2020 but says this did not appear to happen.
17. Mrs X complained to the Ombudsman in February as she had not had a response from the Council.
18. An officer responded to the complaint on 4 March. She said (in respect of the care agency) that while the care was available to Mrs X whether she used it or not, the Council was paying for it anyway so once it was clear that Mrs X was not using the service, it had no option but to cancel it. She said the team manager had agreed to putting a personal care call back on a weekly basis to enable Mrs X to manage her hygiene: she said the care agency would advise if more care was required. She also said while the PA hours (15 per week) remained available for support to and from the MIND service they were not to be used while Mrs X was in attendance at MIND as the Council would effectively be paying double for the same hours.
19. Mrs X telephoned the officer to discuss the response. As a result the officer wrote again on 9 March. She noted the following:
• Mrs X’s PA would support her with personal care 3 times a week;
• The Council would make a referral for an Occupational Therapy assessment;
• Mrs X would accept the offer of an agency care-worker to assist with showering once a week;
• Mrs X said the PA stayed at MIND with her to monitor her blood glucose as the MIND staff were unable to do so, and to assist with her insulin. The Council said it would consider reinstating the PA hours for this;
• There was confusion whether Mrs X had used her £30 a week activity payment to pay for her PA’s fuel or for social activities. The officer said the Council would continue to fund an identified social activity which met the outcomes specified on Mrs X’s care plan.
20. At the end of July 2020, the Council arranged for a sensory assessment, an assistive technology assessment and an occupational therapy assessment for Mrs X.
21. The Council undertook a reassessment with Mrs X on 13 August, after she indicated she was unable to meet her own personal care needs. The Council arranged a daily morning care call from a care agency to support her. Mrs X says the care-workers from the new agency have a better understanding of how to manage her care when she is depressed.
22. Mrs X says the social worker who assessed her in December 2019 did not fully consider her individual circumstances. She says as a result of only being able to shower once a week, and unable to have a proper wash otherwise, she was self-conscious about her personal hygiene which was compounded by comments from other people. She says she felt bullied by the social worker.

Analysis

23. The Council reassessed the package of care it funded for Mrs X when it was told she was not using the service appropriately. That was not fault. But it appears the assessing officer did not take into Mrs X’s individual circumstances as he should have done.
24. The Council responded appropriately to Mrs X’s complaint.
25. More recently the Council responded to Mrs X’s needs by undertaking a needs specific assessments and reinstating a daily care call for personal care.

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Agreed action

26. The Council agrees to apologise for a failure to consider Mrs X’s circumstances properly and offer £500 in recognition she was left without services to meet her needs.

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Final decision

27. I have completed the investigation as
• The Council reduced Mrs X’s care package when it assessed her needs were being met otherwise but reinstated it when she showed her needs had increased;
• there was a failure to consider all Mrs X’s circumstances and that led to a period when her care was less than satisfactory, which caused injustice to Mrs X:
• completion of the recommendation at paragraph 24 will remedy that injustice.

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Investigator's decision on behalf of the Ombudsman