Summary: Miss X complains about the Council’s handling of her care and support needs. She complains the Council failed to assess her needs, did not complete assessments properly, failed to meet her needs, and failed to tell her about advocacy. We find fault with the Council failing to meet Miss X’s eligible needs, and for not properly considering her comments on the care assessment and OT assessment. We have made recommendations.

The complaint

1. Miss X complains about the Council’s handling of her care and support needs. She complains the Council:
• Failed to assess her care and support needs between December 2017 and August 2019.
• Did not complete the assessments properly as the assessments were not accurate or reflective of her needs.
• Failed to meet her assessed eligible needs.
• Failed to accurately report on her family’s circumstances in an Occupational Therapist (OT) assessment.
• Failed to inform her about her right to advocacy.

Miss X says the Council’s actions have caused her distress as she did not receive the support she should have.

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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. 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)
3. 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 spoke with Miss X and considered the information she provided.
6. I made enquiries with the Council and considered the information it provided.
7. I sent two draft decision to Miss X and the Council and considered their comments.

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What I found

Legislation and guidance

8. Sections 9 and 10 of the Care Act 2014 require 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.
9. The Care and Support (Eligibility Criteria) Regulations 2014 sets out the eligibility threshold for adults with care and support needs and their carers. The threshold is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. To have needs which are eligible for support, the following must apply:
• The needs must arise from or be related to a physical or mental impairment or illness.
• Because of the needs, the adult must be unable to achieve two or more of the following:
1. Managing and maintaining nutrition;
2. Maintaining personal hygiene;
3. Managing toilet needs;
4. Being appropriately clothed;
5. Being able to make use of the adult’s home safely;
6. Maintaining a habitable home environment;
7. Developing and maintaining family or other personal relationships;
8. Accessing and engaging in work, training, education or volunteering;
9. Making use of necessary facilities or services in the local community
10. Carrying out any caring responsibilities the adult has for a child.
10. Because of not achieving these outcomes, there is likely to be, a significant impact on the adult’s well-being.
11. Where local authorities have determined that a person has any eligible needs, they must meet these needs. When a local authority has decided a person is or is not eligible for support it must provide the person to whom the determination relates (the adult or carer) with a copy of its decision.
12. Section 67 of the Care Act 2014 outlines when local authorities should arrange for an independent advocate. It states the authority must arrange for a person who is independent of the authority to be available to represent and support an individual for the purpose of facilitating the individual’s involvement, if conditions are met.
13. The condition is the local authority considers that, were an independent advocate not to be available, the individual would experience substantial difficulty in doing one or more of the following:
• understanding relevant information;
• retaining that information;
• using or weighing that information as part of the process of being involved; and
• communicating the individual’s views, wishes or feelings.

What happened

14. Miss X lives with her two children.
15. In December 2017, Miss X said she telephoned the Council to ask for a care assessment. The Council said it did not have any records to suggest Miss X contacted it.
16. Miss X provided us with two documents. One showed Miss X contacted the Council by phone to request a service in December 2017. No further details about what service was requested was noted in the document.
17. The second document showed Miss X contacted the Council by phone in January 2018. The document also noted Miss X said she had requested an assessment in December 2017, to assess her and her children’s’ needs.
18. In October 2018, the Council’s adult services received a referral from its children services department. The referral requested the Council complete a care assessment for Miss X. The records showed the Council tried to contact Miss X to progress the referral, but Miss X did not respond.
19. In May 2019, the Council’s adult services received a further referral from the children services department for a care assessment for Miss X.
20. In August 2019, the Council visited Miss X to complete the care assessment. The care assessment noted Miss X had eligible needs and recommended a care package of one hour a week to meet those needs. It is not clear from the Council’s records what happened following this assessment as no care plan was produced. The Council said the August 2019 assessment was incomplete as it did not result in a care and support plan.
21. In November 2019, an occupational therapist (OT) completed an assessment for Miss X. The assessment noted Miss X had difficulty with completing toilet transfers, transferring over the side of the bath, completing chair transfers, and with closing the door when using the toilet. The OT recommended some equipment to help Miss X with the difficulties identified. The evidence showed the Council ordered the recommended equipment for Miss X.
22. The Council reallocated Miss X’s case to a new social worker at the end of October 2019. In November 2019, the new social worker completed another care assessment. The assessment noted Miss X had eligible needs, but that the Council were already meeting her needs through support provided by children services. The assessment also noted Miss X was working with the OT to install equipment to support her with her mobilising around the home.
23. In December 2019, the Council sent Miss X a draft copy of the assessment. Miss X provided some comments which noted some inaccuracies, and that the assessment did not include information about the medication she took.
24. In January 2020, the Council sent the finalised care assessment and care plan to Miss X. The care plan noted Miss X received support from children services for support with laundry. The care plan also set out the Council would provide Miss X with two hours of support a week to help with domestic chores. This was to support Miss X being able to spend time with her children and to maintain a habitable home.
25. In February 2020, Miss X provided the Council with comments on the assessment. Miss X highlighted the following concerns:
• The medical summary used in the assessment was not full and accurate.
• The OT assessment had not considered several difficulties she had. This included not being able to cook due to pain, not being able to reach items in the cupboards, and not being able to open the kitchen window. Miss X also highlighted her concerns that some items recommended by the OT was not suitable.
• Children services had not provided her with the support as stated in the assessment, so her needs were not being met.
26. The Council said in its complaint response it had offered a home visit to update the assessment, but that Miss X declined this. This was not documented in the Council’s records. The Council accepted it had not followed up on Miss X’s comments until June 2020.
27. In response to our draft decision, Miss X said she declined the home visit because she already had several home visits from the Council and was frustrated. She also said the home visit was offered just before the lockdown due to the Covid-19 pandemic.
28. Miss X said the Council did not tell her about advocacy. The Council said it did not consider Miss X met the conditions set out in legislation. The Council said it had no evidence to suggest Miss X had significant difficulty in understanding, retaining, and weighing up information. The Council also said Miss X was able to communicate her views, wishes and feelings clearly and effectively. For these reasons, the Council did not consider it necessary to arrange an advocate for Miss X.
29. The Council accepted fault for its delays in progressing Miss X’s care assessment and in agreeing the content of the assessments. The Council also acknowledged there was a period of eight months where it should have offered support to Miss X between August 2019 and March 2020.
30. The Council offered Miss X a financial payment of £500 in recognition of the distress and frustration caused by faults identified. The Council also made the following further recommendations:
• Remind officers to adhere to procedures on timescales for responding to referrals, completing assessments and care and support plans within a reasonable timeframe, including the agreement of the content of assessments.
• Discuss with colleagues in other departments, including children services, on combined or integrated assessment and care planning to ensure the Council has a robust system in place when more than one service is assessing or meeting a person’s needs.

Analysis

Failed to assess her care and support needs between December 2017 and August 2019

31. There Council said it had no records of Miss X contacting it in December 2017 to request an assessment. However, Miss X has provided records which suggests she did contact the Council in December 2017. While there is no detail about what was discussed, it is clear she was calling to request a service.
32. Further, there is supporting evidence the Miss X did request an assessment in December 2017 as the record of her call in January 2018 noted she had asked for an assessment in December 2017. Therefore, I am satisfied, on balance, Miss X did ask the Council to complete an assessment in December 2017.
33. At this stage, there is fault as the Council did not assess Miss X’s care and support needs until August 2019. This is service failure. I consider the delay caused some uncertainty. This is because it is not possible to say what the Council would have decided if it had assessed Miss X without delay in December 2017. I also consider the delay would have caused Miss X distress and frustration.
34. The Council received a referral from children services to complete a care assessment for Miss X in October 2018. The Council’s records showed it tried to contact Miss X to discuss the referral but received no response from Miss X. Therefore, while the Council did not assess Miss X in October 2018, I do not consider this to be fault as the evidence shows the Council tried to progress the referral.
35. The Council assessed Miss X’s care and support needs in August and November 2019. This was appropriate as the Council has a duty to carry out an assessment for any adult with an appearance of need for care and support.

Care assessments

36. The role of the Ombudsman is to review how the Council completed its care assessments. It is not for the Ombudsman to assess what eligible needs a person has or what support they should receive.
37. Further, just because someone disagrees with the content and outcome of an assessment does not automatically mean the Council did not complete the assessment properly.
38. The evidence shows the Council appropriately met with and involved Miss X in both assessments. The assessment documents show the assessments were of Miss X’s needs and how they impacted on her wellbeing and the outcomes she wanted to achieve. Both assessments also highlighted Miss X had eligible needs in several outcome areas.
39. However, there is no evidence the Council shared the draft assessment with Miss X for her comments in August 2019. This is not good practice as Council’s should aim to involve service users in the assessment.
40. The Council did share the completed November 2019 assessment with Miss X in December 2019 and January 2020. Miss X responded to the Council with concerns in December 2019 and February 2020. However, it is not clear from the evidence how, and if, the Council followed up on the comments.
41. We recognise the Council has acknowledge it was at fault for not reflecting Miss X’s comments in its care assessment. The Council said in its complaint response it did not consider Miss X’s comments were likely to have a significant impact on eligibility or affect the outcome of the assessment. However, the Council has not evidenced how it reached this decision.
42. Therefore, I am not satisfied the Council has properly considered the comments made by Miss X and whether they had any impact on the assessment. This is fault.
43. I consider the fault identified has caused some uncertainty. This is because it is not possible for me to say whether the Council would have made any changes to the assessment if it had properly considered Miss X’s comments.

Failed to meet eligible needs

44. The Council’s November 2019 assessment noted Miss X had eligible needs, but that these needs were already being met with support provided by children services.
45. However, the care plan issued in January 2020 set out that Miss X needed two hours of support a week to help her with domestic tasks. It is not clear from the evidence if the Council had arranged this support.
46. Further, in its complaint response, the Council accepted it should have offered support between August 2019 and March 2020. This suggests the Council accepts Miss X did not receive the support needed to meet her eligible needs.
47. Therefore, I find fault with the Council as the evidence available suggests the Council did fail to meet Miss X’s assessed eligible needs. I consider the fault identified caused Miss X distress and inconvenience as she did not receive the support she should have for at least eight months.

OT assessment

48. Miss X said the OT’s assessment did not accurately report on her family’s circumstances. There is evidence Miss X told the Council the issues she felt the OT assessment had not considered in February 2020.
49. Again, as with care assessments, just because a service user does not agree with the content of an OT assessment does not necessarily mean the Council did not complete the assessment properly.
50. The OT assessment is detailed and does highlight some of the difficulties Miss X had mobilising around her home. However, Miss X told the Council she felt the OT assessment had not considered some areas. Therefore, the Council should have responded to Miss X’s comments to either explain why it had not considered the highlighted areas, to explain why her comments did not affect the outcome of the assessment, or to include her comments in the assessment. There is no evidence the Council did so. This is fault. I note the Council has already accepted fault for this in its complaint response.
51. I consider the fault identified caused some uncertainty as it is not possible to say what impact Miss X’s comments would have had on the OT assessment if the Council had properly considered them.

Advocacy

52. The law sets out when councils must appoint independent advocates to represent and support individuals.
53. The Council has explained it did not consider Miss X had any significant difficulty in understanding, retaining, and weighing up information. The Council also said Miss X was able to communicate her views, wishes and feelings clearly and effectively. This view is supported by the available evidence.
54. Therefore, I do not find fault with the Council for not appointing Miss X an advocate. This is because it has set out its reasons for why it did not consider it necessary to arrange an advocate. The Council’s decision is also in line with the law.

Agreed action

55. To remedy the injustice caused by the faults identified, the Council has agreed to complete the following:
• Apologise to Miss X for the injustice caused by the faults identified.
• Complete a new care assessment and OT assessment for Miss X and ensure the Council properly considers any comments Miss X makes.
• Pay Miss X £650 in recognition of the distress, inconvenience, frustration, and uncertainty caused by the faults identified.
• Remind officers to adhere to procedures on timescales for responding to referrals, and to complete assessments and care and support plans within a reasonable timeframe.
56. The Council should complete the above within four weeks of the final decision.
• To discuss with colleagues in other departments (including children services) on combined or integrated assessment and care planning to ensure the Council has a robust system in place when more than one service is assessing or meeting a person’s needs.
57. The Council should provide the Ombudsman with the outcome of its discussions within four months of the final decision. If the Council decides to implement a process, the Council should provide the Ombudsman with a copy of its procedure.

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Final decision

58. I find fault with the Council for: failing to assess Miss X between December 2017 and August 2019, failing to meet her assessed eligible needs, and for not properly considering her comments on the November 2019 care assessment and OT assessment. The Council has accepted my recommendations. Therefore, I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman