Summary: Miss A complained the Council failed to carry out a proper adult social care assessment of her needs and that it did not consider all the information she, and other agencies gave it. As a result, the Council reduced her care package. The Council was at fault for delaying Miss A’s care plan review and it caused Miss A avoidable uncertainty. The Council agreed to pay her £100 to remedy this injustice.

The complaint

1. Miss A complained the Council:
• reduced her domestic support hours from 8¼ to 2½ hours without proper consideration of her eligible needs;
• did not properly consider the information Miss A gave it about her needs; and
• carried out the care reduction in an unprofessional, uncaring way and showed a lack of understanding of her physical condition.
2. Miss A said that as a result, her care plan is not meeting her needs.

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The Ombudsman’s role and powers

3. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word ‘fault’ to refer to these. We cannot question whether a council’s decision is right or wrong simply because the complainant disagrees with it. We must consider whether there was fault in the way the decision was reached. (Local Government Act 1974, section 34(3), as amended)
4. 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

5. I considered the information provided my Miss A.
6. I considered the information the Council provided. This included Miss A’s care assessments from August 2019 and July 2021. I also considered her support plans and the Council documents about its decision to reduce Miss A’s care package.
7. Miss A and the Council had an opportunity to comment on my draft decision. I considered their comments before making a final decision.

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What I found

Law and council policy

8. The relevant legislation is the Care Act 2014 and the Care and Support Statutory Guidance 2014.
9. The Care Act 2014 says councils must assess someone’s care and support needs where they appear to need support. Councils then write a care and support plan. The care and support plan should consider what the person has, what they want to achieve, what they can do with or without support and what support is available. It should set out the person’s eligible needs and outcomes.
10. 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. 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. 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

Background to the events I have investigated

11. Miss A has some eligible needs which means she requires a care support package. She lives with her adult son who is away during the week and only provides limited support with Miss A’s eligible needs.
12. Miss A is in a wheelchair but can independently move around her house. This includes transfers in and out of the wheelchair. She does require support with keeping her home tidy, getting dressed and fuelling her car.
13. The Council carried out a care needs assessment in 2016 and 2018.
14. Miss A’s care plan provided 4½ hours of personal care. This time was dedicated to help Miss A with strip washing, application of creams and getting dressed. The plan accounted for an additional 8¾ hours of domestic support for tasks such as laundry, bedding changes, maintaining a habitable environment and disposal of rubbish.

Care assessment 2019

15. In 2019 Miss A contacted the Council and indicated that she wanted to change her care provider.
16. The Council appointed a social worker, Officer X, who carried out the care assessment in August 2019.
17. Officer X visited Miss A three times as part of the assessment process. The case notes show they spoke to her about her needs, got information from the care provider and considered previous OT assessments.
18. The Council offered Miss A the services of its reablement team to support Miss A in carrying out the daily domestic tasks and to boost her confidence. The Council said Miss A turned down the Council’s offer of a reablement programme and said the offered times for a visit did not suit her. In response to my enquiries the Council said the reablement team member visited Miss A once, in October, but it said that Miss A declined its support and said she had established carers that cared for her. As supporting evidence, the Council provided me with an email from the reablement team manager dated July 2021 but supplied no other contemporaneous notes. Miss A said during the visit the reablement team member said her care plan did not need amending.
19. The Council consulted its Occupational Therapy (OT) department for an assessment of Miss A’s ability to carry out domestic tasks, but it said that it did not carry out assessments for domestic tasks. OT also said that it was unlikely that Miss A’s circumstances would have changed from its last assessment completed in 2016.
20. The care assessment stated that Miss A had eligible needs in five of the ten domains. It recorded that Miss A’s adult son provided some support for her but noted that because of his job he was away a lot.
21. The assessment said Miss A did not have eligible needs in areas of ‘Being appropriately clothed’ and ‘Making use of necessary facilities in the local community including public transport, recreational facilities and services’. It also said that Miss A needed support with doing her bra up and putting footwear on. Additionally, the assessor noted that for Miss A to engage in her interests she needed help with fuelling her car.
22. After the last visit Officer X decided the Council could meet Miss A’s eligible needs with 4½ hours of personal care, and 2½ hours for domestic support. Officer X suggested that Miss A could fund additional support herself. As for the car fuelling, Officer X confirmed Miss A’s local garage had agreed to provide support when she needed to put petrol in her car. Miss A disagreed and said that she could not afford to pay for additional support services, as she did not pay for the support the Council was providing her.
23. On this occasion the Council considered and suggested other options available to Miss A to make sure she can still use her car. I understand that Miss A would rather continue with services she received up till now, but the Council reconsidered how it can meet her eligible needs. The Council is entitled to consider all options available before agreeing to fund a particular need/service.
24. The Council also questioned whether daily vacuuming formed part of Miss A’s eligible needs or whether it was her preference. The Council confirmed that domestic tasks that are related to Miss A’s medical condition are included in her care package. After the needs assessment the Council decided that daily vacuuming was not an eligible need and went beyond the requirement of maintaining a habitable home. Because of this, Officer X suggested that Miss A could fund daily cleaning service privately if she wished to do so.
25. Miss A complained about the reduction in hours and conduct of Officer X to the Council. She said that it did not properly consider the information Miss A and the care provider gave it.
26. The Council responded to her complaint and in the same letter it addressed Miss A’s appeal against the reduction of domestic care hours. The Council said that it only provided support for the domestic tasks that were connected to Miss A’s medical condition. It said that it was reasonable for Miss A’s adult son to undertake some of the domestic tasks within his home.
27. During our investigation the Council said that it will assign a new social worker to Miss A, who will visit her to review her care needs. The Council said that it will do this in early December 2020, but it said the review may have to be done over the phone because of the COVID-19 pandemic.
28. In June 2021, the Council visited Miss A once, and carried out a review of the care plan. It spoke to the care provider who confirmed that following the change to Miss A’s plan following the August 2019 review it had not received any complaints from the carers or Miss A. The care provider said Miss A only allowed specific carers to visit her, and if they were unavailable Miss A would cancel the visit.
29. The social worker noted Miss A’s continued dissatisfaction with the reduction of her domestic support hours. She said that the carers were always rushing, and she missed appointments because of the lack of support. The social worker asked Miss A about what happened on the days she cancelled the support and she said that she found it too stressful to explain her support needs to new carers, and she preferred to go without the support on those days.
30. Following the visit, the Council decided that the plan that was implemented in March 2020 was still suitable and was meeting Miss A’s eligible needs. It said that it would look to involve the Community Support Team to help Miss A with fuelling her car, accessing a cash point and attending appointments.

My findings

Reduction of care package

31. The Ombudsman is not an appeal body. Our role is to investigate how a decision is made. If a decision is made without fault, we cannot criticise it. A council can reduce the amount of care provided but it must demonstrate it has considered the service user’s eligible needs and the personal and family circumstances of the service user and their carers.
32. Officer X visited Miss A three times, spoke to her about her needs, got information from the care provider and considered previous OT assessments. The reablement team did not provide Officer X with any official report, or assessment of Miss A therefore I consider the Council looked at all available information in completing its assessment of Miss A.
33. I recognise there is conflicting information about what happened during the visit from the reablement team to Miss A. The Council said that it did not provide Miss A with the service because Miss A turned the offer down, however Miss A said that the person that visited her told her there was no need for the service because her care plan was working well. The Council provided me with evidence that the reablement team visited Miss A, however it did not complete a contemporaneous record of that meeting. This is fault. The Council cannot demonstrate the information it received at the time of the visit. It retrospectively provided more information in response to my enquiries.
34. The care needs assessment did not recognise ‘Being appropriately clothed’ and ‘Making use of necessary facilities in the local community including public transport, recreational facilities and services’ as eligible needs. Miss A does require assistance in those areas. This is fault; however, this has caused no injustice to Miss A as the Council considered how it would meet these needs.
35. In June 2021 the Council visited Miss A and reviewed her eligible care needs and support plan. This was 15 months after the Council changed Miss A’s care plan, and six months later than it said it would. The Council said this was because it could not visit Miss A, but in November the Council emailed us and said it “will contact her and arrange for a keeping in touch conversation to be completed at the beginning of Dec. This may be via Microsoft teams or video call, due to current pandemic”. The Council knew it could review the plan without a face-to-face visit, but it did not.
36. Considering all the above information the Council’s delay has contributed to Miss A’s uncertainty about the changes made to her care plan. I do not consider there is any further injustice arising from the delay. The review the Council carried out, albeit late, confirmed that the Council was meeting Miss A’s eligible needs with the amended care plan. This was also confirmed by the care agency. I have recommended the Council makes service improvements to address its service failures. I also recommended a symbolic payment for Miss A’s uncertainty that resulted from the Council’s delay in reviewing her care plan.

Conduct of the social worker

37. Miss A complained about the conduct of the social worker that conducted the assessment. As I was not there, I cannot comment on what was said or what happened. Therefore, I did not investigate this further.

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Agreed action

38. Within a month of the final decision the Council agreed to:
• Apologise to Miss A for the delay in reviewing her care plan and the lack of light touch review following the changes to her care plan.
• Pay £100 to Miss A to remedy the uncertainty the delay in reviewing her plan caused her.
• Confirm what action it will take to make sure it carries out timely care plan reviews as required by Section 27 of the Care Act 2014.

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Final decision

39. I completed my investigation and uphold Miss A’s complaint. The Council was at fault for delaying Miss A’s care plan review and it caused Miss A avoidable uncertainty. The Council agreed to pay her £100 to remedy this injustice.

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Investigator's decision on behalf of the Ombudsman