Summary: Mrs X complained the Council did not adequately assess her care needs and failed to provide appropriate care and support between August 2018 and September 2020. The Council was not at fault.

The complaint

1. Mrs X complained the Council did not adequately assess her care needs and has failed to provide appropriate care and support between August 2018 and September 2020. She says she has had to fund her own care and adaptations and is unable to leave the house. She says the situation has caused deterioration in her mental health. She wants the Council to refund her costs, offer an advocacy service, complete a fresh care assessment and provide her with appropriate care and support to meet her 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.
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 read Mrs X’s complaint.
5. I made enquiries of the Council and considered information it sent me.
6. Mrs X and the Council had the opportunity to comment on the draft decision. I considered their comments before making a final decision.

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What I found

Legal and administrative background

Assessment and provision of care and support

7. The Care Act 2014 requires councils to carry out an assessment for any adult with an appearance of need for care and support. If a council decides a person has eligible needs, it must set out how it is going to meet these needs in a care and support plan.

Charging

8. Councils can make charges for care and support services they provide or arrange. Charges may only cover the cost the council incurs. (Care Act 2014, section 14).
9. Councils must complete a financial assessment to decide how much a person can afford to pay towards the cost of their care. How to do this is set out in the Care and Support Statutory Guidance (the Guidance).
10. The financial limit, known as the “upper capital limit”, exists for the purpose of the financial assessment. The upper capital limit is currently set at £23,250. If a person has more capital that the upper capital limit, the person is not entitled to any financial assistance from the council and is deemed to be able to afford the full cost of their care. Where a person’s needs are to be met in their own home, the council must meet the eligible needs but the person must pay the full cost of their care and support until their capital falls below the upper capital limit.
11. A council does not have to complete a full financial assessment if it is satisfied a person has sufficient capital above the capital limit to afford to pay for their care. Evidence that might satisfy a council of this include:
• property clearly worth more than the upper capital limit, where they are the sole owner or it is clear what their share is;
• savings clearly worth more than the upper capital limit; and
• sufficient income left following the charge due.
12. When assessing a person’s assets, a council must disregard the value of a property which a person lives in as their main or only home. It can take into account any other property the person owns but has discretion to disregard other property if it chooses to do so, depending on the circumstances. The Guidance says councils will need to balance this discretion with ensuring a person’s assets are not maintained at public expense.

Direct payments

13. A direct payment is a payment made to people with eligible care and support needs so they can arrange their own care, rather than the Council arranging it for them.

Disabled Facilities Grants

14. Disabled facilities grants (DFG) are grants awarded by councils to disabled people who need adaptations to help them remain in their home. They are subject to a means test. The council will assess a person’s income and calculate how much the applicant should contribute to the cost of the adaptations. This can vary from nil to requiring the applicant to pay the full costs.

Adult safeguarding

15. The Care Act 2014 sets out a council’s duty to investigate allegations that an adult is suffering or is at risk of suffering serious harm. When a council receives a safeguarding referral, it should make initial enquiries. Based on the outcome of these, it should decide whether to progress to a formal enquiry under Section 42 of the Care Act 2014. If it decides there is insufficient evidence, it can close the case.

What happened

16. This chronology does not list all the evidence considered but is a summary of key events relevant to the decision.
17. Mrs X has health conditions which affect her mobility and ability to live independently.
18. In August 2018, Mrs X lived alone in her own home. She also owned a second property which was occupied by a relative. The Council had completed a financial assessment but, as Mrs X owned a second property, concluded she was not eligible for financial support and should pay the full cost of any care. Mrs X arranged and paid privately for daily support from home carers to meet her needs.
19. The Council received a safeguarding alert. The referral said Mrs X had made allegations of abuse about her carers. The Council met with Mrs X to discuss the matters raised. Mrs X declined to discuss the allegations further. As it had no evidence to support the allegations and Mrs X did not want to discuss it further, the Council ensured Mrs X had contact details for the safeguarding team in case of further concerns and closed the case.
20. In September 2018, Mrs X was discharged home after a hospital admission. She contacted the Council to say she had been discharged without any support. The Council said it understood she had agreed to arrange her care privately. Mrs X said was unhappy with her previous care agency so had cancelled it and had not been able to find an alternative. She said she wanted the Council’s help to arrange her care and support. The Council agreed to this. It confirmed that she knew the Council assessed her as a full cost payer so she would have to pay the full cost of any care arranged.
21. The Council approached agencies on its approved provider list but was unable to find one with availability. In October 2018, it offered to help her arrange care through a private agency. Mrs X declined this as she said she could not afford it.
22. In October 2018, an occupational therapist (OT) and a physiotherapist assessed Mrs X in her home. They agreed to provide further physiotherapy and arrange some adaptations for her property.
23. Mrs X contacted the Council to say she could not afford to pay for care. The Council explained that as she owned a second property, the Council’s position was that she should pay the full cost of her care. Mrs X said the relative living in her second property was refusing to pay her any rent. The Council advised her to discuss this further with her relative and gain further advice should she want to take action to evict them.
24. In November 2018, Mrs X was admitted to hospital. A Council social worker visited her on the ward and discussed her needs. They discussed whether Mrs X wanted home care support on discharge, but as a full cost payer, Mrs X would have to pay for this. Mrs X said she could not afford to pay for any care. The social worker confirmed that Mrs X’s daughter would still be assisting with personal care and Mrs X was able to prepare meals. She would also have support from the therapy team. The social worker told Mrs X as she did not appear to have any outstanding needs, they would close the case.
25. In January 2019, Mrs X was admitted to hospital again. The Council visited Mrs X on the ward to complete a care needs assessment. Mrs X said she did not want a care package but could not go home as her property was uninhabitable. An OT completed a home visit to assess her property. The OT offered Mrs X a perching stool but she declined this. They arranged for new stair rails to be fitted and provided Mrs X with a kitchen trolley.
26. Mrs X self-discharged from hospital. She was not in receipt of any Council services, so the Council closed her case.
27. In March, Mrs X had a further hospital admission.
28. The Council visited Mrs X again in April to assess her care and support needs. It decided she had eligible needs and that these needs could be met with two care calls a day. It advised Mrs X that, as a full cost payer, she would have to pay for any support it arranged. Mrs X said her relative was still living in the second property but not paying any rent. Mrs X only agreed to the Council arranging one care call, as she said she could not afford any more. She told the Council she understood why she was assessed as a full cost payer.
29. The Council received two safeguarding referrals related to Mrs X. The first related to possible financial abuse by a family member and the second concern related to neglect. The Council considered the allegations and spoke with Mrs X about them. It decided the planned care support would reduce the risk of neglect. There was no evidence of financial abuse from her relative. It decided no further enquiries were needed at this time.
30. The Council discussed with Mrs X about her second property and the ongoing issue that her relative refused to move out or pay any rent. It advised her where she could get further legal advice.
31. In April, the Council arranged for a care agency who started providing care for Mrs X.
32. In May, the Council supported Mrs X to complete an application for sheltered housing. Mrs X later declined to progress with this option.
33. Mrs X was admitted to hospital. The Council social worker visited her on the ward. Mrs X told the social worker she did not think she had enough support at home but did not want carers as they just told her what to do. They discussed the situation with her second property, but Mrs X said the situation was unchanged and she did not want to start legal proceedings to evict her relative.
34. In June 2019, Mrs X was admitted to hospital again. The Council completed a needs assessment which showed she had eligible needs. Mrs X agreed to two care calls a day and support with shopping. The assessment said Mrs X was a full cost payer and understood what this meant.
35. The Council contacted several care agencies but was unable to find one to support Mrs X. The Council says all the agencies they worked with either had no capacity or would not support Mrs X due to previous concerns about her behaviour. The Council discussed the situation with Mrs X. They agreed she would go home with support from the Council’s reablement team for shopping and once home, she would arrange her own care privately. The reablement team supported the discharge and ensured Mrs X’s property was liveable once she was home.
36. Mrs X complained to the Council that it was not providing her with the care and support she needed. She said she could not afford to pay for care.
37. A week later, Mrs X contacted the Council again to say she was not managing at home and needed support. She said she had arranged a private carer but they could not start for 2 weeks. The Council provided her with advice and information and arranged to visit.
38. The Council responded to Mrs X’s complaint. It responded to each point of her complaint and set out what it had provided to support her and meet her needs. It said she owned a second property and the Council included it as an asset in the financial assessment. Because of this, it assessed her as being able to afford the full cost of her care. It said it understood she was looking to sell one of her properties, which may help her situation. It directed her to complain to us, if she remained unhappy.
39. Mrs X contacted the Council’s finance department. She asked for a review of her financial assessment and said her second property should not be counted as an asset because:
• her relative had lived in her second property for some time;
• her relative was refusing to move out or pay rent; and
• the property was in a poor state of repair and could not be sold.

The Council agreed to review its financial assessment.

40. In September, Mrs X asked the Council to arrange home carers for her. The Council identified an agency with availability. The agency agreed it would support her but said it would need two carers at each visit due to concerns about Mrs X’s behaviour. The social worker arranged a visit with the care agency and Mrs X to discuss her needs.
41. Mrs X cancelled this visit and told the Council she did not want the care support as she did not agree she needed two carers at each visit. She asked for an OT assessment. The social worker referred Mrs X to the community OT team.
42. In October, the Council completed its financial review and decided to use its discretion to disregard Mrs X’s second property from its financial assessment. It backdated this decision until December 2017 and cancelled all outstanding care charges on her account.
43. The Council social worker and OT visited Mrs X. She declined care support again. She declined a commode for downstairs. The OT recommended she apply for a Disabled Facilities Grant (DFG) to install a downstairs wet room and stairlift. Mrs X agreed to this and the OT submitted the application.
44. Mrs X was admitted to hospital but discharged shortly after. The Council social worker reviewed Mrs X’s needs and agreed she needed support. It approached several care agencies but could not find an agency to provide care for Mrs X. It discussed the option of direct payments with Mrs X to allow her to employ her own carers with Council funding. Mrs X agreed to this and the Council referred her to an external agency who could help her with the process.
45. The Council wrote to her with the outcome of the DFG assessment. It said the means test had calculated that she needed to contribute to the recommended adaptations. It set out her assessed contribution and asked her to confirm if she agreed to this and that she wanted to proceed with the application.
46. In December 2019, the Council identified a care agency who agreed to support Mrs X and visited her to discuss this option. Mrs X told the Council she had recently employed two personal assistants (PAs) and was paying them privately. The Council agreed to see if the PAs could be paid by the Council by direct payment. The Council told Mrs X what documents the Council needed her PAs to provide to arrange this. Mrs X said she would discuss this with her PAs and ask them to provide the paperwork.
47. At the end of January 2020, Mrs X contacted the Council to ask why it was not paying her PA’s. The Council told her it was because her PAs had not provided the required paperwork to enable them to be paid by the direct payment.
48. The Council re-assessed Mrs X’s care needs in February 2020. One of Mrs X’s PAs had provided the paperwork and was now being paid by the Council through the direct payment. The Council confirmed Mrs X had eligible needs and agreed an increased package of care with Mrs X. The care would be funded by a direct payment and provided jointly through a private care agency and Mrs X’s PA.
49. Mrs X declined to sign the direct payment agreement and she said she did not agree with it. She also confirmed she did not agree with the outcome of the DFG means test and did not agree to pay her assessed contribution. As she did not agree to pay her contribution, the OT team could not progress the DFG application. It advised her to get back in touch if she changed her mind.
50. In April 2020, Mrs X had still not signed the direct payment agreement. In order to prevent Mrs X’s care package breaking down, the Council arranged to pay the care agency directly.
51. In June 2020, the care agency was continuing to provide Mrs X with care. Mrs X raised several concerns with the Council. Mrs X said she had not received the letters about the DFG or the direct payment agreement, or a copy of her care assessment as she had requested. The Council told her it had sent these documents all recorded delivery and Royal Mail tracking had confirmed she had received them. It provided the tracking confirmations to Mrs X.
52. Mrs X continued to complain to the Council about poor care and said the Council had left her unsupported.
53. In September 2020, Mrs X remained dissatisfied and brought her complaint to us.

Analysis

54. The Care Act sets out that councils have a duty to assess people who appear to have needs for care and support. The evidence shows appropriately assessed Mrs X’s needs and set out how it would meet her needs in care and support plans. It helped her to arrange care when she requested this, either directly with care agencies and also through a direct payment arrangement. Mrs X did not always agree to the care offered but this was not Council fault.
55. Mrs X received three occupational therapy assessments. She was offered small aids such as a commode and perching stool which she declined. She agreed to the OT arranging for grab rails and new stair rails being fitted and this work was completed. She was offered a Disabled Facilities Grant for major adaptations but declined this as she did not agree to pay her assessed contribution calculated through the means test. The Council occupational therapy service assessed Mrs X appropriately. Mrs X did not always accept the OT recommendations. This was Mrs X’s choice to make and was not Council fault.
56. The Council received several safeguarding referrals for Mrs X. It discussed each concern raised with Mrs X and considered whether it needed to make further enquiries. It considered the referrals and made its decisions based on the evidence gathered. This is what we would expect. The Council was not at fault in how it responded to the safeguarding alerts received.
57. Between August 2018- October 2019, the Council’s financial assessment concluded Mrs X was eligible for the full cost of her care. Mrs X owned two properties and the Guidance allows Councils to take account of any other property apart from the one the person lives in as their main or only home as part of its financial assessments. The Council was not at fault for including the second property in its calculations. In any case, the Council used its discretion in October 2019 to disregard the property, based on information Mrs X provided. It backdated the decision to December 2017 and cancelled all outstanding charges on her account.
58. Mrs X told the Council that her relative living in the second property refused to pay any rent or move out of the property so she could sell it. The Council acted appropriately by giving Mrs X advice and directing her to independent agencies that could help her further. Mrs X chose not to pursue legal action to evict her relative. This was Mrs X’s choice and not Council fault.

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Final decision

59. I have completed my investigation. The Council was not at fault.

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Investigator's decision on behalf of the Ombudsman