London Borough of Ealing (20 001 319)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 11 Feb 2021

The Ombudsman's final decision:

Summary: Mrs B complained the Council failed to assess Mrs C’s care needs properly and caused delays in her assessments. She said, as a result, Mrs C’s care plan was not meeting her needs and she experienced distress because of the delays. The Council was at fault for its failure to assess all of Mrs C’s care needs and some of the delay in assessing her needs. It has agreed to apologise and make payment to acknowledge her loss of care provision and the delays caused. It also agreed to reassess Mrs C’s care needs and ensure its staff are aware of its statutory responsibilities when carrying out care assessments.

The complaint

  1. The complainant, whom I shall refer to as Mrs B, complains on behalf of Mrs C. She says the Council:
    • failed to properly assess Mrs C’s care and support needs and wrongly decided to reduce her support hours from 47 hours to 27 hours; and
    • delayed completing Mr C’s needs assessments and care plans in 2019 and in 2020.
  2. Mrs B says, as a result, Mrs C’s care plan is not meeting her needs and she has experienced distress from the delays.

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What I have investigated

  1. I have considered all parts of Mrs C’s complaint, including the Council’s assessment of her care needs in January 2019.

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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 cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, 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. As part of the investigation, I have considered the following:
    • Mrs B’s complaint and the information she provided;
    • documents provided by the Council in response to our enquiries;
    • the Care Act 2014; and
    • the Care and Support (Eligibility Criteria) Regulations 2014.
  2. I gave Mrs C and the Council the opportunity to comment on a draft version of this decision and considered their comments.

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What I found

Care and support needs assessment

  1. The Act requires 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.
  2. The law does not set a timescale for local authorities to complete an assessment. However, statutory guidance says it should be carried out over an appropriate and reasonable timescale.
  3. The assessment determines what the person's needs are and whether the person has any needs which are eligible for support from the council. Where councils have determined that a person has any eligible needs, they must meet those needs.
  4. The person's needs and how they will be met must be set out in a care and support plan. The care and support plan should consider what needs the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area.
  5. Councils should conduct a review of a care and support plan at least every 12 months. The authority should consider a light touch review six to eight weeks after agreement and signing off the plan and personal budget. It should carry out the review as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if the person asks for one, unless the authority is reasonably satisfied that the plan remains sufficient, or the request is frivolous, or is made on the basis of inaccurate information, or is a complaint.

What happened

  1. Mrs C suffered a stroke in 2010 and has several medical conditions affecting her physical abilities to look after her own care and move around. She lives alone in her home.
  2. The Council funded Mrs C’s care and support package through direct payments. Mrs C has arranged for her own care through a care agency.

Mrs C’s care and support needs

  1. In Mrs C’s previous care and support plan from 2015, the Council decided she was entitled to support with all her care needs, with the exception of work and education. Mrs C received a care package based on 47 hours of support. The Plan was reviewed in 2017 with no changes in her care package.
  2. In early 2019 the Council reviewed Mrs C’s care and support plan again. It conducted a needs assessment and found her package of care should be reduced. It said this was because it had assessed Mrs C’s physical abilities had improved, including her mobility. And as a result, Mrs C needed less support from her carers. It also said the time her carers spent on certain tasks were unreasonable and could be completed quicker.
  3. The assessment found Mrs C had eligible care needs with:
    • Managing and maintaining nutrition;
    • Maintaining personal hygiene;
    • Managing toilet needs;
    • Being appropriately clothed;
    • Being able to make use of the home safely; and
    • Maintaining a habitable home environment.
  4. Mrs B disagreed with the assessment and said Mrs C had not improved. She said her needs were the same as before, if not greater. The Council said a further assessment was needed and an occupational therapist (OT) should be present to assess Mrs C physical needs.
  5. Five months later, the Council assessed Mrs C again and an OT was present to assess her needs. The OT report recommended a reduction in her care package to 23 hours and 45 minutes per week to help her with personal care. It said:
    • she could use her quad stick in her home to move around with minimal to moderate supervision from the carer.
    • it observed she could move from a seated position to standing with help from one carer.
    • she used an attendant propelled wheelchair and cannot use stairs.
    • no carers log was available, so it did not see evidence of the tasks her carers did.
    • the size of Mrs C’s bathroom limited the equipment or adaptations that it could provide. The OT also said Mrs C’s landlord had previously refused adaptations to the shower room and she had refused to move to a sheltered accommodation with a walk-in shower.
  6. Two months later, the Council provided a care and support plan for Mrs B with a support package based on 27 hours care support.
  7. Mrs B said Mrs C signed the plan to avoid her care payments being stopped, but she disagreed with the Council’s decision. So, Mrs C complained to the Council.
  8. In response, the Council said the reduction in Mrs B’s care package was justified because:
    • its assessments and the OT had found Mrs B’s mobility had improved;
    • her travel with support to GP and hospital appointment were the responsibility of the NHS;
    • her carers should do her shopping locally or use online shopping for her dietary needs. It said this could be done at affordable costs; and
    • it did not find flaws in how it had conducted the assessments.
  9. The Council did not uphold Mrs C’s complaint, but it apologised for an inappropriate term used by the Social Worker. It also said it would arrange a further assessment to ensure Mrs C felt supported and heard.
  10. In late 2019, Mrs C had a community advocate to support her with her care planning. The Council arranged for a reassessment of Mrs C’s needs, but her advocate could not attend. So, her carers and Mrs B supported Mrs C. The Council decided Mrs C needed a care package of 30 hours per week to meet her needs.
  11. Mrs C did not agree with the Council’s view on her care needs and refused to sign the assessment. And so, the Council agreed to contact her GP to discuss her incontinence and other health needs.
  12. In March 2020, Mrs C’s advocate disagreed with the Council’s assessment and provided a report to the Council. She said Mrs C’s care needs required more time for her carers to:
    • shop for food and other essentials;
    • support Mrs C with personal care;
    • cook the fresh food Mrs C prefers otherwise there was risk of her not eating and because her GP put her on a specific diet;
    • do laundry as no time had been allocated for this;
    • keep Mrs C’s home clean as no hours were allocated for this;
    • reduce Mrs C’s isolation by taking her to see friends and places in the community; and
    • support Mrs C during trips to medical appointments.

The Advocate also asked the Council to provide equipment to support the carers and Mrs C in her home.

  1. By May 2020, the Council had called and emailed Mrs C’s GP several times, but her GP had been unable to meet or discuss her care needs with the Council. And so, Mrs B asked the Council to complete its review of Mrs C’s care needs to avoid further delay.
  2. The Council says it considered the report and reviewed Mrs C’s needs, but it did not change it view. It said:
    • Mrs C’s medical history and previous assessments showed she was wheelchair bound in 2015, but her mobility had improved as she now could use quad sticks for small distances. It also said she could transfer to sit up on her bed aided by her quad sticks and one carer.
    • One hour of domestic cleaning had been considered in its the assessment.
    • Visits to GP and Hospital could be managed by the GP and using her taxi card.
    • It considered her dietary wishes but it did not agree she had a need for support to cook her meals from scratch.
    • It had offered Mrs C befriending services and a day care centre for her to access the community, but she had declined these.
    • It agreed to provide extra time for shopping during COVID-19. It also said it would discuss Mrs C’s care needs with her GP, when her GP responds to it.
  3. Mrs C remains unhappy about the Council’s assessment of her care needs and the reduction in her care package, and so she complained to the Ombudsman.

The complaint

  1. Mrs B complained the Council’s decisions for Mrs C’s care needs are wrong and contains false information. She says it:
    • was wrong to say Mrs C was wheelchair bound in her 2015 care plan but can now mobilise with a quad stick. She said the plan said she could mobilise with similar support. She also said Mrs C’s mobility had not improved but has become worse.
    • was wrong to decide Mrs C did not need help from her carers to attend medical appointments, as her travel with support could be arranged by the NHS. She said the Council did not properly consider her balance problems, fear of falling and incontinence. She also said the Council’s recommendation to refer Mrs C to her GP for pain management and incontinence support was not enough to support her with this, as she was already receiving such support from her GP.
    • failed to consider how Mrs C’s health was getting worse. She says this was shown in her medical evidence.
    • recommended day care services to reduce Mrs C’s isolation, but these were unsuitable due to language and cultural barriers, and so did not meet her needs. She also said no time was included in the care plan for her carers to take Mrs C out in the community, to the mosque or to see friends.
    • failed to consider Mrs C’s diet, the risk of her not eating and the costs of readymade food. She said Mrs C’s carers should be given time to cook fresh food from scratch.
  2. Mrs B also complained the Council caused a significant delay in completing Mrs C’s care assessments and care plans.
  3. In response to our enquiries the Council said the delays were because Mrs C’s assessments needed a multi-agency approach and several individuals, including a care advocate and translator had to be present. It said it took time to find a time that all relevant individuals were available. It also said there was delays by Mrs C’s care advocate and her GP.

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My findings

  1. Mrs B complained to us in July 2020 about the Council’s assessments and delays from January 2019. We expect complainants to bring complaints about what a council has done to our attention within 12 months, and so therefore parts of her complaint are late. However, Mrs B has continued to raise her concerns about Mrs C’s care assessments and care plans throughout the period. There have also been delays which was outside her control. I am therefore satisfied with the reasons given and I have exercised discretion to consider Mrs C’s complaint from January 2019.

Assessments of Mrs C’s care needs

  1. It is not the Ombudsman's role to decide what, if any, care and support a person needs. That is the Council's role. The Ombudsman's role is to consider if the Council has followed the correct process for establishing a person's needs and if it acted correctly when this process was complete.
  2. In doing so we look at what information the Council considered, and if it took account of the service user’s and carer’s wishes. If a council considers all this information properly the Ombudsman cannot find a council at fault just because a service user disagrees with its decision, or outcome of an assessment.
  3. The Council assessed Mrs C’s care needs in January 2019. It proposed a reduction in her care because it found her mobility had improved and she was able to do some personal hygiene tasks herself. However, it said it needed an OT to assess Mrs C’s mobility properly. And so, it arranged for another assessment. There is no fault by the Council on this matter. It decided it needed to assess Mrs C’s needs further before any changes could be made to her care plan.
  4. When the Council assessed Mrs C again, an OT was present to assess her mobility. The OT report said he considered Mrs C’s mobility, moving around within her home and the support provided by her carers in her home. The OT found Mrs C to need 23 hours and 45 minutes of support per week with personal care.
  5. The Council provided a care plan for Mrs C for 27 hours care support. It reduced her care because it found her mobility had improved compared to her 2015 assessment. It also reduced the time available for her carers to prepare her meals and for transfers to GP and hospital appointments.
  6. Based on the evidence available, there was fault in how the Council assessed Mrs C’s care needs, which resulted in a reduction in her care package. This is because:
    • Her 2015 care plan states she was wheelchair bound, but it also states she could mobilise using quad sticks with support from her carer. In addition, her medical evidence also did not show her mobility had improved, but she had new medical problems. I have therefore not seen any evidence her mobility had improved.
    • Mrs C told the Council she wished to participate in the local community, visit the mosque and her friends. In response the Council offered signposting to local day centres. I have seen no evidence the Council considered Mrs C’s personal wishes or whether the day centres were suitable for her. Nor did the Council allocate any time for her carers to support her to attend the community.
    • Mrs C can use her taxi card or GP transfer services to attend medical appointments. However, there is no evidence the Council considered Mrs C’s needs to be accompanied by a carer to attend to toilet needs, avoid falls or push her wheelchair.
    • The OT said Mrs C has personal care support needs of 23 hours and 45 minutes per week. The Council provided 27 hours total care support per week. I am not satisfied the Council properly considered the time it will take her carers to do her laundry, cleaning, preparing meals, shopping, collect medicine and other domestic tasks within 3 hours and 15 minutes per week. This is because when the Council assessed her needs again, it agreed she needed three more hours of support per week for cleaning and shopping. However, there is no evidence this was because her health had become worse or her circumstances had changed.
  7. When Mrs C complained to the Council, it did a review of her care needs. It said it considered her and her care advocate’s comments as part of its assessment. In May 2020, it gave Mrs C a care package of 30 hours per week, which consisted of:
    • Four one-hour visits seven days a week;
    • One domestic call for cleaning and shopping of two hours per week;
  8. Based on the evidence available, there was fault in how the Council assessed Mrs C’s care needs. As above, there is no evidence the Council considered her wishes to attend the community or her support needs during transfers to GP or hospital appointments. Nor is there any evidence her mobility has improved. However, the Council did consider Mrs C’s care needs for cleaning and shopping and increased the support for this.
  9. In addition, Mrs C also said the assessments failed to provide enough support for her carers to buy specific ingredients and cook fresh meals from scratch due to her dietary needs. While I understand Mrs C is overweight and has dietary wishes, she has not provided any evidence to the Council that this is medically or otherwise needed. The Council’s care assessments show it considered her wishes but disagreed with her view. I have therefore not found any fault by the Council on this matter.

Delays

  1. Mrs C complained the Council caused delays in assessing her needs and completing her care plan.
  2. The Council reassessed Mrs C’s care needs in January 2019 and proposed a reduction in Mrs C’s care needs. Mrs C disagreed and the Council agreed to do another assessment with an OT present. It took the Council six months to arrange for a re-assessment. The Council said this was because it was difficult to find a time that all the relevant individuals were available. It then took the Council a further two months to provide Mrs C with her care plan.
  3. The Care Act Statutory Guidance does not give a timescale for the Council to complete Mrs C’s care plan, but it says this should be done within a reasonable timescale. I acknowledge the Council’s difficulties in arranging the re-assessment, but I do not find it reasonable in the circumstances for the Council to take six months to do so. And so, this is fault. I am satisfied the delay caused Mrs C some distress due to the uncertainty. However, the Council did not change Mrs C’s care package during this period and so she did not experience any injustice from the proposed changes.
  4. There were further delays between September 2019 and May 2020 in assessing and completing Mrs C’s care plan. However, based on the evidence available, these delays were caused by Mrs C’s care advocate and her GP. I am therefore not satisfied the Council caused any delays in this period.

Agreed action

  1. To remedy the injustice the Council caused to Mrs C, the Council has agreed to, within one month of the final decision:
      1. Apologise to Mrs C in writing for its delays and failure to assess all of her care needs since January 2019;
      2. Pay £1,450 to remedy the injustice caused by the failure to meet her need for help with domestic tasks and external transfers from September 2019;
      3. Pay £300 to remedy the injustice caused by the failure to meet her need for participating in the local community from January 2019;
      4. Pay Mrs C a further £200 to acknowledge the delay and time and trouble it has put her to in pursuing her complaint.

In total the Council should pay Mrs C £1,950.

  1. Within three months of the final decision the Council should also:
      1. Reassess Mrs C’s care needs addressing the needs for help participating in the local community and transfers to medical appointments,
      2. Remind its staff of its statutory responsibilities when carrying out care assessments.

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Final decision

  1. There was fault leading to injustice. The Council has agreed to my recommendations. Therefore, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman

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