London Borough of Richmond upon Thames (20 003 344)

Category : Adult care services > Assessment and care plan

Decision : Upheld

Decision date : 29 Mar 2021

The Ombudsman's final decision:

Summary: There was a delay in the provision of emergency support for Mr B when he moved to a new flat. The Council has agreed to pay £200 to Mr B to remedy the injustice he suffered.

The complaint

  1. Mr B complains that the Council delayed assessing his needs for care and support and delayed providing the support. He also says that there was a delay in the Council providing orientation training.

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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. 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 have discussed the complaint with Mr B’s representative and I have considered the documents he and the Council have sent and the relevant law, guidance and policies.

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What I found

Law, guidance and policies

  1. The Care Act 2014, 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.

Duty to assess and meet needs

  1. Section 9 of the Care Act says councils have 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.
  2. Section 18 sets out the circumstances when councils have a duty to meet the eligible needs dependent on ordinary residence and financial assessment.

Timescale for assessment

  1. The Guidance does not specify a time scale for the council to complete the needs assessment. It says the 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’.

Urgent needs

  1. The Care Act Section 19 provides councils with the powers to meet urgent needs where they have not completed an assessment. Where an individual with urgent needs approaches or is referred to the local authority, the local authority should provide an immediate response and meet the individual’s care and support needs. For example, where an individual’s condition deteriorates rapidly or they have an accident, they will need a swift response to ensure their needs are met. Following this initial response, the individual should be informed that a more detailed needs assessment, and any subsequent processes, will follow.

Needs met by a carer

  1. Local authorities are not under a duty to meet any needs that are being met by a carer, for so long as the carer continues to do so. The local authority should record in the care and support plan which needs are being met by a carer.

What happened

  1. This is a chronology of what happened from the Council’s records.
  2. Mr B first contacted the Council on 10 December 2019 for housing support. He said he was blind and that he would become homeless on 20 December 2019.
  3. The housing officer started Mr B’s housing application on 12 December 2019. Mr B said he had been living in a privately rented property. He had received a personal injury payout, related to his blindness, from court action against the NHS and he had used some of this money to pay the rent. The tenancy was coming to an end on 20 December 2019 and Mr B said he could no longer afford it.
  4. Mr B said he lived in a three-bedroom flat. He lived with his adult daughter but paid privately for a live-in carer to assist him. He would not give any details about this carer, but said he had dismissed the carer and their last day would be 14 December 2019. Mr B said he still had £40,000 from the personal injury claim.
  5. Mr B was not known to the Council as he had lived in a different area before. The housing officer told Mr B what documents he had to bring in so that he could make a housing application.

First contact assessment on 16 December 2018

  1. Mr B met with a social worker on 16 December 2018 and she carried out a ‘first contact assessment’ in relation to his adult social care needs.
  2. The assessment said:
    • Mr B was independent in his personal care needs and managed around the home.
    • In terms of nutrition, Mr B had been assessed by the Sensory Team who said Mr B was able to make snacks, meals and drinks, but Mr B disputed this and said he could not do this as he would get nervous and felt like he was going to drop things.
    • Mr B needed assistance to go out in the community and assistance in domestic tasks such as cleaning his home and doing his laundry.
  3. The social worker said Mr B would not share certain information with her such as details of his next of kin, details of the support he had received from his support worker and how he had managed without a support worker. She said Mr B seemed to be falling out with organisations and agencies which were trying to assist him.

23 December 2019

  1. On Mr B went to the Council’s civic centre to give the housing application documents to the housing officer. While he was there, he spoke to the social worker. He told the social worker he would not discuss his care provision. He said he could not think about that at the moment as he wanted his housing to be settled first.
  2. The social worker and Mr B had a short discussion about how independent Mr B could be, if he was shown how to do things, rather than rely on support workers. Mr B said he could never be totally independent as he would need support in areas such as his correspondence and cleaning.
  3. In terms of nutrition, Mr B said somebody had taught him how to do this, but he lost confidence as soon as the person left. He said his coordination was not good and he would drop things and could cut himself.
  4. Mr B was offered temporary accommodation which was a studio room in a hotel complex in Hounslow. He stayed there for one night, but said the accommodation was unsuitable for his needs.

24 December 2019

  1. On 24 December 2018 the Council found a different property for Mr B and offered him a studio flat in Hounslow, but Mr B refused this accommodation. Mr B became aggressive and accused the housing officer of racism. He refused to leave the building and the police had to be called and he was escorted off the building.

8 and 9 January 2020

  1. Mr B went to the Council’s civic centre on 8 January 2020 and was offered a different property in Hounslow.
  2. Mr B went to the Council’s civic centre on 9 January 2020 as he said the property was unsuitable. Mr B said he was feeling unwell and was taken to hospital where he became aggressive and would not leave, threatening to sue the doctors and nurses. The Council’s notes said the Council was becoming increasingly concerned about Mr B’s mental health and his aggressive behaviour towards staff.

10 January 2020

  1. Mr B went to the Council’s civic centre on 10 January 2020 at 10:00 am and waited to be allocated temporary housing. The Council found a ground floor studio flat for Mr B at 4pm. The Council’s social worker explained that there would be no care package in place over the weekend.
  2. The social worker took Mr B to the flat in her car. She and Mr B went to a small supermarket which was 100 m from the flat. The social worker bought Mr B bedding, laundry tablets, and some food and drinks.
  3. The flat was all on one level and the social worker showed Mr B where everything was, sockets, radiators, fridge, hob and so on. She put the washing machine on the correct setting and showed Mr B how to turn it on and off (one button). The social worker made Mr B’s bed and took his rubbish out.
  4. Mr B was described as very anxious about the security of the building and wanted to know whether it was in a good neighbourhood. He practised locking and unlocking the door and using the phone entry system.

13 January 2020

  1. Mr B spoke to the manager on 13 January 2020. He said he had been neglected and left in a strange place with no care and no money. He said he would sue the Council for neglect. The manager went to Mr B’s flat to provide him with food and drinks. She said they were in the process of finding an agency which could provide support to Mr B.

14 January 2020

  1. The service manager spoke to Mr B on the telephone to discuss the support on 14 January 2020. She explained that the minimum proposed package of support was:
    • Morning visit: to assist with breakfast and prepare lunch to be left out.
    • Evening visit: to assist with dinner.
    • Support workers to assist Mr B to go to the shops to do his weekly grocery shop.
    • A weekly visit to assist in domestic tasks.
  2. Mr B said that he needed assistance to go out daily to attend appointments and to socialise and that he was entitled to have a carer support him in the community.
  3. The manager acknowledged this but said the proposed support package was simply to meet his emergency care needs. She explained that the Sensory Team would also meet him this afternoon to discuss community access options.
  4. Mr B spoke to a senior rehabilitation officer later that day. He said he should have support every day to get to appointments and to socialise. The officer explained again that the interim package of care was only to meet his urgent needs and that she would arrange a full needs assessment for him. The needs assessment would determine Mr B’s full care plan, and this would also require the input of the Sensory Team. Mr B said he did not need to be assessed as he had been assessed by the manager and the social worker when he visited the Council offices last week.
  5. The senior rehabilitation officer obtained fast track funding for Mr B from the Council’s funding panel. The package was:
    • Two visits of 45 minutes each, in the morning and the evening – to provide support in domestic tasks and preparing meals and drinks.
    • Two additional community visits of two hours each – to allow community access for shopping, banking and appointments.
  6. The Council’s brokerage team tried to find an agency which could deliver the support package.
  7. The senior rehabilitation officer and an assessor from the Sensory Team visited Mr B on the same day (14 January 2020). Mr B was extremely angry as somebody (the landlord) had delivered a microwave and pots and pans while he was out, without his knowledge. This made him feel unsafe.
  8. The manager provided Mr B with food. The Sensory Team assessor started the assessment for sensory services. He measured for a bathboard, to assist Mr B with accessing the shower in the bath. The assessor said he would visit Mr B in two days’ time to provide him with a talking microwave, the bathboard and a hot water dispenser. Mr B was due to start training with a rehabilitation officer for the visually impaired (ROVI).

16 January 2020

  1. Mr B went to the Council’s civic centre on 16 January 2020 and said he would not leave until carers had been put in place and said the Council would have to call the police to remove him. The police were called and Mr B agreed to leave with the support of the social worker who bought him a fast food meal and other food and took him back to the flat.
  2. Later that day, the assessor from the Sensory Team delivered a hot water dispenser, bath board, liquid level indicator, measured up for grab rails in the bathroom and fitted bumpons on the microwave.
  3. The assessor showed Mr B how the use the bath board so that he could safely use the shower. He showed Mr B how to use the hot water dispenser so he could make a hot drink. He showed him how to use the microwave but there was a problem with the microwave. The officer said a talking microwave would be delivered in a few days’ time. The officer guided Mr B to the train station.

17 January 2020

  1. On 17 January 2020, the Council found an agency to provide support to Mr B. However the agency withdrew its offer to support as it said Mr B became confrontational after the agency worker said they could not take Mr B to Newham, only to local appointments.
  2. The social worker rang Mr B on 22 January to say that another agency had been identified to provide the care.

24 January 2020

  1. The assessor from the Sensory Team visited Mr B on 24 January 2020 to complete the assessment of his sensory needs. During the assessment Mr B became increasingly angry about the lack of support he had received to date and the officer was unable to complete the assessment. Mr B said he was going to sue social services.
  2. The manager from the support agency visited Mr B to discuss his support. Mr B said he wanted to combine his morning and evening calls so that the support worker could cook his choice of meals. The manager said the support workers would only heat up prepared meals. Mr B also wanted four hours to go into the community as and when he needed it and carry forward the hours to the following week if he did not use them. The manager said they could move the hours to suit Mr B if he gave them notice but the hours could not be carried forward to the following week.
  3. The social worker spoke to Mr B. She offered Mr B the option of meals on wheels but Mr B refused this. The social worker was not sure whether Mr B could use the hours of community support to go out of the borough and would need to check. Mr B became angry and said he would raise a complaint.

25 January 2020

  1. The agency support workers attended Mr B’s flat on 25 January, but he refused to let them in. Mr B said he did not want any assistance and was going to make a complaint to social services.

After 25 January 2020

  1. The social worker rang Mr B on 28 January 2020 to make an appointment for his needs assessment but the calls went to voicemail.
  2. On 29 January 2020 the assessor from the Sensory Team checked when the ROVI route training would start. The manager said the previous ROVI had left and the replacement ROVI would start next week and asked the assessor to inform Mr B of this. Mr B made his complaint on the same day.
  3. The social worker spoke to Mr B on 30 January 2020 and he said he wanted nothing to do with social services and was raising a complaint against them.
  4. The Sensory Team assessor spoke to Mr B on 5 February 2020 but Mr B said he had made a complaint against the team and wanted no services from the team.
  5. It is not known what support Mr B has received since then.

Assessment by the Sensory Team

  1. The Sensory Team was unable to complete the assessment that was started on 14 January 2020, but sent Mr B a copy of the assessment insofar as it was completed. The assessment said:
    • Mr B was able to orientate himself in the flat and showed that he knew where things were and was able to use them.
    • Mr B felt that he was unable to complete domestic tasks. It may be helpful if he had Kitchen Rehab Training by an ROVI which would give him more independence in preparing food and drinks.
    • Mr B was living in an unfamiliar area and the ROVI was due to start orientation and route training shortly. Mr B had shown that he was able to go to the local bus stop to go to the Council’s civic centre and was able to go to the tube station and use the tube.

Mr B’s complaint

  1. I have summarised Mr B’s complaints and the Council’s responses insofar as it is relevant to the complaint that I am investigating.
  2. Mr B said:
    • The Council had a duty to assess his needs and to meet his needs.
    • He presented to the Council on 10 December 2019, but the Council did not progress his assessment until 13 January 2020.
    • The Council did not offer him interim care until 25 January 2020.
    • The Council failed to assess his needs and then meet his needs between 10 December 2019 and 25 January 2020.
    • A referral was made to the Council’s Sensory Team. Mr B received home orientation visits, but he requested local area orientation on 20 January 2020. The Council did not organise this and Mr B withdrew his request on 5 February 2020.
  3. The Council said:
    • Mr B’s case should have been passed to the locality social work team in December to ensure that a full needs assessment took place in a timely manner. It apologised for the delay in the needs assessment.
    • There were delays in finding a local agency, once Mr B moved into his property in Hounslow on 10 January 2020. Members of the team visited Mr B daily to ensure he was ok and had access to food until the care package started.
    • There was a delay in finding the ROVI to carry out the orientation training. This was not communicated to Mr B until 5 February 2020 and this was poor communication.
    • The Council had taken actions to learn from the complaint and to improve its service. It said referrals into the access team had to be transferred to the locality team in a timelier manner and it had reminded staff of the importance of good communication.
  4. In its response to the Ombudsman the Council said:
    • Although Mr B approached the Council on 10 December 2019, he said he did not want to discuss his care needs until he was in a more settled setting. Therefore, the Council gathered as much information as possible to inform its emergency response to Mr B’s care needs.
    • It acknowledged the shortcomings and apologised to Mr B.

Analysis

  1. In considering Mr B’s complaint it is helpful, in my view, to distinguish between the Council’s general duty to assess and meet Mr B’s needs (sections 9 and 18) and its duties to meet urgent needs (section 19).
  2. In response to the complaint about the delay in the assessment, the Council said that it should have referred Mr B to its locality team earlier so that there was no delay in the needs assessment. I agree an earlier referral should have happened, but this was only relevant in the Council’s general duty to assess his needs (section 9).
  3. The injustice of this failure is limited. Even if a referral had happened, the Council explained that it could not have carried out a full needs assessment until Mr B had been provided with housing. The assessment would have had to consider the property Mr B was living in, the amenities and support available in the local area and would have required the input from the Sensory Team who would have advised on what support they could provide to increase Mr B’s independence.
  4. Also, it may well be that, even if the Council had tried to carry out some of the needs assessment before Mr B moved to his flat, Mr B may not have cooperated with the assessment as he said he wanted to wait until he had moved into his new flat.
  5. I think the more important complaint, for Mr B, was not the delay in the general needs assessment (section 9), but more the delay in the provision of the emergency support which was needed to meet his urgent needs (section 19) after he moved into his flat on 10 January 2020. The Council has upheld the complaint that there was a delay in the provision of emergency support and I agree there was fault.
  6. Mr B also complained that the Council delayed his ROVI orientation training to go into the community. The Council did not uphold this complaint as it said this type of training was normally delivered within eight weeks, but it said there was fault in its communication about when the training would be delivered.
  7. I accept that, in itself, the delay in the ROVI training may not have been fault, but it should be considered as part of the more general delay in the Council’s duty to meet Mr B’s urgent needs. The Council knew Mr B had not received ROVI orientation training so that made it even more important that the Council put in the emergency support to ensure Mr B’s urgent needs were met.
  8. I have considered the injustice Mr B has suffered as a result of the delay in the emergency support. I accept Mr B suffered an injustice but it is difficult to assess the level of injustice as I can only consider the information that I have which is limited.
  9. The Council has not completed a full assessment of Mr B’s needs so his needs are not entirely known. Mr B has never received a support package from the Council. I have focussed on the emergency needs the social worker identified on 16 December 2019 which were that Mr B needed support to go into the community to shop for food, support to prepare meals and to carry out domestic tasks.
  10. I note the social worker took Mr B to the local supermarket when he moved in and bought him food for the weekend and that there were further social work visits on later days to provide Mr B with food and essentials. There was also input from the Sensory Team which provided Mr B with equipment and training so that he was more independent in his flat. Those were positive actions which aimed to partly mitigate the lack of support but they were not the same as having a support package in place.
  11. I also note Mr B could have started receiving support from 17 January 2020 but the agency withdrew the offer of support as Mr B was not satisfied with the proposed package. Mr B then refused any support after 25 January 2020 and it is not known how he has supported himself since that date.
  12. The aim of the Ombudsman’s remedy is to put the complainant in the position that he would have been in if the fault had not happened. If there is no direct financial loss as a result of the fault, the Ombudsman may still recommend a financial remedy but this will be symbolic to reflect the loss.
  13. In a case such as this one, the Ombudsman would normally recommend the Council assesses Mr B and provides him with a care plan and the provision of the support, but Mr B has said he does not want this. Mr B has not suffered a direct financial loss as a result of the delay. I therefore recommend the Council pays Mr B £200 to reflect the distress caused by the lack of service during the 10 days.

Agreed action

  1. The Council has agreed to pay Mr B £200 within one month of the final decision.

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Final decision

  1. 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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Investigator's decision on behalf of the Ombudsman

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