Summary: We have not found fault in the occupational therapist’s and the Council’s housing team’s support of Ms B. However, there was a substantial delay in the Council’s assessment of Ms B’s needs for care and support, its care plan and its provision of support. This meant that Ms B was without care and support for a long time. The Council has agreed to apologise to Ms B and pay her £1,000 for the distress and lack of service during that time.

The complaint

1. Ms B says that the Council delayed assessing her needs for care and support and she says there are failures in its assessment to decide whether she needs adaptations to her home. She also says the Council did not have the right to ask for certain information in its welfare assessment to decide her housing priority.

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What I have investigated

2. I have investigated Ms B’s complaint about the occupational therapist report and the delay in her adult social care assessment. Paragraph 66 explains why I have not investigated the care plan.

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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. The law says that, before investigating a complaint, we must normally be satisfied the council knows about the complaint and has had an opportunity to investigate and to reply. Usually, we expect people to have the exhausted the complaints procedure before we consider whether to investigate their complaint.
5. 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)
6. 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

7. I have discussed the complaint with Ms B. I have considered the documents she and the Council have sent, the relevant law, guidance and the Council’s policies and both sides’ comments on the draft decision.

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What I found

Law, guidance and policies

Care Act 2014

8. The Care Act 2014 and the Care and Support Statutory Guidance 2014 (updated 2017) set out the Council’s duties towards adults who require care and support. The Council also has its own policies.

Assessment of needs and care plan

9. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan which outlines what services are required to meet the needs and a personal budget which sets out the costs to meet the needs.
10. The Guidance says local authorities must undertake an assessment for any adult with an appearance of need for care and support, regardless of whether or not the local authority thinks the individual has eligible needs or of their financial situation.
11. An assessment should be carried out over an appropriate and reasonable timescale taking into account the urgency of needs and a consideration of any fluctuation in those needs. Local authorities should inform the individual of an indicative timescale over which their assessment will be conducted and keep the person informed throughout the assessment process.

Threshold for eligibility

12. The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Council must consider whether:
• The adult’s needs arise from a physical or mental impairment or illness.
• As a result of the adult’s needs the adult is unable to achieve two or more of the specified outcomes.
• As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.
13. The outcomes are:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Being able to make use of the home safely
• Maintaining a habitable home environment
• Developing and maintaining family or other personal relationships
• Accessing and engaging in work, training, education or
• Making use of necessary facilities or services in the local community
• Carrying out caring responsibilities for a child.

Housing

14. The government has published guidance for local authorities on the allocation of accommodation. This says that all local housing authorities must have a published allocation scheme which sets out how they assess and prioritise applications for housing.  Local housing authorities are required to give ‘reasonable preference’ to certain categories of people.
15. The Council’s allocation policy says that, if an applicant has a medical or welfare need (including grounds relating to disability) that makes living in their current accommodation unsuitable, they can require a welfare assessment. The process is:
• The applicant completes a welfare assessment form and provides supporting information, for example, from a social worker, health professional, GP, consultant or health visitor.
• The Welfare panel assesses the application and the supporting evidence and decides whether to award priority to the application for (re)housing.

Disabled adaptations

16. Disabled Facilities Grants (DFG) are provided under the terms of the Housing Grants, Construction and Regeneration Act 1996.
17. Councils have a statutory duty to provide grant aid to disabled people for certain adaptations.
18. The Council will need to check that the proposed works are:
• necessary and appropriate to meet the disabled person’s needs.
• reasonable and practicable depending on the age and condition of the property.
19. Councils will often consult an occupational therapist (OT) from the social services department to carry out the assessments.
20. The maximum grant that can be paid in England is £30,000 and the grant is means tested.

What happened

Adult social care

21. Ms B and her son live in a two bedroomed property which they rent from a housing association. Ms B has medical conditions which mean she has a need for care and support.
22. The Council’s adult social care team received a referral to assess Ms B in March 2019. The Council contacted Ms B in December 2019. The Council said this delay was ‘due to volume and urgency with allocations being based on priority.’
23. The social worker spoke to Ms B on the telephone on 13 December 2019. The social worker said Ms B had crumbling bones in her ankles so she had to wear high heels. Ms B also had very heavy periods every two weeks so she would be in bed for two to three days. The social worker noted that Ms B prepared meals in advance and was independent in her personal care needs.
24. The social worker concluded that ‘from information provided [Ms B] had no eligible care needs.’ The social worker cancelled the assessment of Ms B’s needs as she felt that an occupational therapist’s assessment was more appropriate.
25. Ms B contacted the Council in January 2020 to ask for a copy of the assessment of her needs. The manager noted that an assessment had not been carried out and agreed that a new referral would be made for allocation for an assessment.

Needs assessment – August 2020

26. Ms B’s case was allocated to a social worker in the adult social care team in July 2020 and the social worker carried out an assessment of Ms B’s needs on 4 August 2020.
27. The assessment of needs and care plan said:
• The social worker identified that Ms B had underlying conditions which would affect her ability to meet her needs. Ms B had chronic fatigue syndrome. She had menorrhagia (abnormally heavy periods) and was bedbound for four days every two weeks. Ms B had crumbling bones in her ankles which were deteriorating and she would need a wheelchair in the future, after she had surgery. Ms B had post-traumatic stress disorder and dyslexia.
• The social worker concluded that Ms B had eligible fluctuating needs for care and support relating to managing nutrition, personal care, being appropriately clothed, being able to make use of the home safely, maintaining a habitable home environment and child-care.
• The social worker recommended five hours support a week, split over three sessions.
• The plan was for Ms B to receive direct payments so that she could use these to pay for the care and support she needed. The personal budget was £102.70 per week.
28. The Council’s chronology says: ‘Care and support plan commended August 2020 with input and advice being requested from Direct Payments team. Direct Payments Officer allocated December 2020.’
29. The Council sent the care plan to Ms B on 25 January 2021. It said this recommended a ‘commissioned service pending direct payments due to change in plan for relative to be personal assistant.’
30. Ms B sent a nine-page email to the Council on the day she received her care plan. She said there were a lot of inaccuracies in the plan and it did not meet her needs.
31. Following this complaint, the Council agreed to re-assess Ms B’s needs and it is my understanding that this assessment has been started recently.

Occupational therapy and housing

32. The Council received a referral on 21 October 2019. This said Ms B was mobile and used a walking stick, but wanted to ‘plan for the future’.
33. Ms B’s case was placed on the waiting list and was allocated to an occupational therapist (OT) on 3 July 2020.

Occupational therapist’s report – July 2020

34. The OT assessed Ms B on 16 July 2020. She said in her report:
• Ms B had chronic fatigue syndrome and had problems with her ankles giving way.
• Ms B said she may have surgery to fuse the ankles, but that would be in the future as her son was young. Ms B said if the ankles were fused she would have to use a wheelchair and would not able to walk.
• Ms B showed the OT that she mobilised within the property without aids. She was independent with sit/stand from dining chair and sofa.
• Ms B said she used a walking stick when needed and had access to a wheelchair.
• Ms B said her main concerns were the internal stairs and access outside to the property. She wanted a stair lift for the stairs and a ramp to the outside. Ms B said she wanted to stay in the property as she had lived there for 20 years.
35. The OT agreed to:
• Make a referral to the housing association for the grab rails the front and rear of the property and the bathroom.
• Make a referral for a disabled facilities grant for a stair lift.
• Look at options for the front access. The OT advised Ms B that ‘it may not be possible to adapt the front access with a ramp due to the physical environment and a surveyor visit would be prudent to investigate options’.
36. The OT sent a letter to the housing association on 22 July 2020 to request ‘minor works’ (rails to the bathroom, front and rear access) to be carried out.
37. The OT sent a letter to the Home Solutions Team to request ‘major works’ (ramps and stair lift). The Home Solutions Team assists people with disabilities and older people with housing support and adaptations.
38. On 11 August 2020, the stairlift company confirmed to the OT that it had carried out the stairlift survey.
39. The OT planned to visit Ms B’s property with a keyworker from the Home Solutions Team to assess the front access to determine whether adaptation was possible.
40. On 14 September 2020 the Home Solutions Team said they had contacted Ms B but Ms B said she was reconsidering the works as she wanted to explore relocation.
41. On 1 October 2020, it was agreed that an officer of the Home Solutions Team would support Ms B with her application to Homechoice. This was an application for a welfare assessment to be considered for a higher priority band based on her disability. The OT wrote a Homechoice supporting letter on 1 October 2020.
42. The Home Solutions officer sent a draft welfare assessment form to Ms B on 9 December 2020. She asked Ms B to check the form and also to provide details of her medication as she was worried she may have written it down wrongly.
43. Ms B responded to the officer that she did not agree with providing the medication details as she thought it violated data protection law.

Complaints process

44. Ms B complained to the Ombudsman on 3 August 2020. As Ms B had not made a formal complaint to the Council yet, the Ombudsman referred the complaint back to the Council for a response on 8 August 2020.
45. The Council wrote its complaint plan on 7 December 2020. Ms B’s complaints were:
• There were inaccuracies in the OT report.
• The report did not properly reflect the adaptations that would be needed to fit the stairlift.
• There was a lack of communication from the OT as she had not discussed the service costs of the stairlift.
• She would need a wheelchair in the future. The OT had not taken into account the fact that her front door was too narrow for a wheelchair and the fact that the door led into the living room which meant she would have to roll the dirty wheelchair into the living room.
• The OT had not properly communicated with other departments about the works.
• She needed adult social care support and had not received any.
• Homechoice had no right to ask for her medical records and this request was a breach of her human rights.
• She questioned whether the Homechoice employees were DBS checked.
46. The Council responded to Ms B’s complaint on 21 January 2021 and said:

Occupational therapist

• The role of the OT was to make recommendations for adaptations based on an assessment of Ms B. The OT would not address the technical specification of the works as this would be done by the stairlift surveyor.
• The OT had explained that the stairlift would be funded by a disabled facilities grant. She did not go into detail about the service costs of the lift but had explained that the housing association may not take these costs on, in which case they became Ms B’s responsibility.
• The OT had sent the request for minor works to the housing association on 22 July 2020, but the housing association did not respond and the OT did not follow this up. The rails were then installed by the housing association, but not at the request of the OT.
• The OT explained in her report that it may not be possible to adapt the front access and that the doorframe dimensions would be considered in a joint survey visit.

Adult social care

• Ms B had now been offered a direct payment to pay for her care and support package.

Housing

• The Home Solutions officer was assisting Ms B in her application for higher priority for rehousing due to difficulties in her current home. Homechoice asked for this information to be included in the form as it was part of the welfare assessment process. The form had not been sent off yet as the Home Solutions officer was waiting for Ms B’s consent to send off the application to Homechoice.
• All Homechoice staff were DBS checked.

Analysis

Occupational therapist and housing

47. I find no fault in the way the Council assessed Ms B’s needs for aids and adaptations to her home. The Council instructed the appropriate professional which was the OT to assess Ms B.
48. The OT carried out the assessment of Ms B’s needs and made recommendations based on that assessment.
49. I agree with the Council that it would not be the role of the OT to address any technical issues relating to the property. It is normal practice for the OT to recommend the adaptations and for a surveyor to then assess the property to see what is possible.
50. I do not uphold the complaint that the OT did not consider the width of the door in her considerations relating to the wheelchair access. The OT said in the assessment that a visit with a surveyor was needed to decide what was possible in terms of wheelchair access. This visit then did not take place, partly because Ms B said she was not sure whether she wanted the adaptations as she wanted to move to a property that better suited her needs.
51. I also find no fault in the actions relating to the housing application. The Home Solutions officer was assisting Ms B in her welfare assessment application and the information was needed as part of that application.

Adult social care

52. There was fault in the way the Council considered Ms B’s request for an assessment of her needs for care and support.
53. The Council initially received the referral for an assessment in March 2019. However, the social worker did not contact Ms B until December 2019.
54. I appreciate that the Care and Support Statutory Guidance does not set a time limit for the assessment. Generally speaking, though, we would expect these assessments to be carried out in four weeks. A delay of 10 months between the request of an assessment and the social worker contacting Ms B is clearly far too long and is fault.
55. The social worker then failed to carry out a full assessment of Ms B in December 2019 and made the decision that Ms B did not need an assessment based on very little information. That was further fault.
56. It appears the Council agreed that this was fault as in January 2020 the manager agreed that Ms B needed an assessment of her needs. However, Ms B should have been prioritised at this stage, considering she had already waited for 10 months. Instead she was put back on the waiting list and had to wait a further eight months for an assessment. That delay was further fault.
57. I do not understand why, as the assessment and care plan were completed in August 2020, the Council did not send these documents to Ms B until January 2021, but this was fault. I understand that Ms B said, at one point, that she wanted a relative to be her personal assistant, but that would not change the care plan as such and does not explain a delay of a further six months in sending the documents to Ms B or in providing support.
58. I have considered whether Ms B has suffered an injustice as a result of this fault and, if so, what the remedy would be.
59. The Council has recommended a care package of five hours support a week although I understand that Ms B disputes this package.
60. I cannot say, with certainty, what Ms B’s care plan would have been if the Council had assessed her needs properly in March 2019 or in January 2020. However, as far as I am aware, there have not been any significant changes in Ms B’s needs since March 2019, except maybe that her condition with the ankles deteriorated a bit further.
61. Therefore, it is very possible that Ms B would have been offered a care plan if the Council had properly assessed her needs in March 2019 or in January 2020. Certainly, Ms B was eligible for support from August 2020.
62. Therefore, I conclude that Ms B has suffered a substantial injustice by the Council’s delay in assessing her needs and preparing a care plan. The injustice is the lack of service and the distress caused by this.

Agreed action

63. The Council has agreed the following actions within one month of the final decision.
64. The Council will:
• Write to Ms B and acknowledge the errors it made and apologise.
• Pay Ms B £1,000 to reflect the distress and lack of service suffered by the delay.
• Re-assess Ms B’s needs and provide her with an updated care plan.
• Provide Ms B with the direct payments or, if Ms B prefers a direct service, with five hours of support a week as set out in her current care plan, until it has put in place the revised care plan.

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Final decision

65. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

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Parts of the complaint that I did not investigate

66. Ms B received the Council’s adult social care plan on 25 January 2021 and sent a complaint to the Council as she disagreed with the content of the plan. I have not investigated this complaint as it has not gone through the Council’s complaints process yet. Also, the Council has agreed to re-assess Ms B’s needs which is an appropriate remedy if there is a disagreement about the content of the care plan.

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Investigator's decision on behalf of the Ombudsman