Summary: The Council failed to adhere to the Care Act when responding to requests to assess Mr Y’s care needs. It missed opportunities to determine Mr Y’s wellbeing and failed to provide care at the point it was needed.

The complaint

1. Mrs X complains on behalf of her late father, Mr Y. She says the Council:

1. failed to conduct a needs assessment of her father when requested;
2. failed to provide support for her father;
3. failed to deal with her complaint properly.

Back to top

The Ombudsman’s role and powers

2. 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)
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)

Back to top

How I considered this complaint

4. I have:

• considered the complaint and discussed it with Mrs X;
• considered the correspondence between Mrs X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• taken account of relevant legislation;
• offered Mrs X and the Council an opportunity to comment on a draft of this document, and considered the comments made.

Back to top

What I found

Relevant legislation

5. The Care Act 2014 is the legislation that sets out local authorities’ powers and duties in respect of adult social care. The Care Act places a duty on local authorities to promote the wellbeing of people in their area.
6. Sections 9 and 10 of the Care Act 2014 say councils must assess the needs of an adult who appears to need care and support. The council must do this regardless of whether it thinks the person has eligible needs and regardless of the person’s finances.

7. The statutory guidance at part 6 says a council must consider the total extent of a person’s needs before it considers the person’s eligibility for care and support and what types of care and support can help to meet those needs. This must include looking at the impact of the adult’s needs on their wellbeing and whether meeting those needs will help the adult achieve their desired outcomes.
8. After assessing the total extent of a person’s needs, the council should consider which are eligible needs under the Care Act 2014. The guidance says councils must consider whether:
1. The adult’s needs are due to a physical or mental impairment or illness.
2. The adult’s needs mean they cannot achieve one or more specified outcomes.
3. As a consequence of being unable to achieve two or more of the specified outcomes there is, or is likely to be, a significant impact on the adult’s wellbeing.
9. The guidance says: being unable to achieve these outcomes includes being able to achieve them with assistance or achieving them without assistance but where it takes significantly longer than would normally be expected.

What happened

10. This is not meant to be an account of everything that happened. I have focused on the material issues in the complaint.
11. At the time of the events, Mr Y was 95 years and old lived alone. He had diabetes and various other health conditions. He had a below knee amputation many years ago and used a prosthetic leg. Latterly his knee joint had withered so his prosthetic leg was ill fitting and caused mobility difficulties.
12. Mrs X contacted social services on 23 March 2020. She was concerned about how Mr Y would manage during the pandemic. He usually did his own shopping, but Mrs X was unsure if he was leaving the house. She, and her sister, lived over two hours away.
13. Mrs X contacted the Council to request for support for Mr Y, which she says it refused. I have seen the records of the conversation between Mrs X and the council officer. It does not show any advice given by the officer, it only records the action Mrs X agreed to take, that she was going to search online for community groups that may deliver food to Mr Y, and that she was going to contact the police.
14. The police visited Mr Y and provided a food parcel. The police contacted the Council to provide an update and asked it to check on Mr Y in 2/3 weeks, that he had enough food until then, but he would be unable to obtain further supplies after then. It also advised Mr Y was very hard of hearing.
15. Mrs X says Mr Y’s condition began to deteriorate from November 2020 onwards.
16. In December 2020, Mr Y was found in a post-office in a confused state. He was referred to Officer J at the Council’s community wellness centre. Mr Y told the officer he did not need any help at that time. Mr Y agreed that Officer J and another worker could visit him at home every now and again.
17. Officer J contacted social services to ask if Mr Y was a service user, which he was not, but he was known to the service because of Mrs X’s previous referrals. Officer J was given Mrs X’s contact details.
18. Officer J contacted Mrs X to inform her of her involvement with Mr Y, and her professional role. Mrs X explained that she had tried to obtain support for Mr Y before, but he had refused, so she was happy with the proposed visits.
19. Mrs X telephoned Mr Y on 4 January 2021, he was distressed and did not appear to understand who was calling. Mrs X contacted Officer J to say Mr Y was no longer able to drive, and she was concerned he would not be able to do his food shopping. She said the family were assisting with shopping in the short term but could not continue in the longer-term. Officer J agreed to visit Mr Y to discuss all available options with him, such as a local church group who would be able to do his shopping in the short term, until a permanent support could be implemented.
20. Officer J contacted social services. I have seen the notes written by the officer taking the call, part of which records “When [Mrs X] called her father this morning he did not know it was her he thought she was someone calling to help him he started crying on the phone saying he needed help. [Mrs X] has written to her father as he could not hear her on the phone letting him know she is requesting some help for him from ASC”. The officer recorded Mr Y to be very hard of hearing and confused”.
21. An officer from social services contacted Officer J to enquire if Mr Y needed services. Officer J said she believed Mr Y needed help with shopping and cleaning, and that she was visiting him the following day to ask if he would accept support. She asked if a referral should be made to social services if Mr Y agreed to accept support. The officer from social services said if Mr Y only needed help with shopping and cleaning, it could be arranged privately. Officer J said she would make a formal referral if more support was needed, if not she would make a referral to a charity.
22. Officer J visited Mr Y the following day but got no response. She contacted Mrs X who reported her sister had visited the previous day and Mr Y appeared confused and disorientated to time, his home looked unkempt, and the house was dirty. He had insufficient food and had been eating mouldy bread. Mrs X’s sister bought fresh food and attempted to clean the house, but Mr Y had become aggressive. Officer J reported this to social services on 5 January 2021 and made a safeguarding referral.
23. The records show the Council reviewed the safeguarding referral and concluded no further safeguarding enquiries were needed. Officer J was informed. The Council also informed Mrs X’s sister.
24. Mrs X and her sister continued to contact social services expressing concern about Mr Y and asking for a needs assessment. Social services agreed to visit Mr Y.
25. Mrs X spoke with social services on 7 January 2021 about the impending visit. She said she would not be present, but her sister would. She confirmed she had been informed about Officer J’s offer to refer Mr Y to a charity for help with shopping and cleaning, and said she believed Mr Y needed more support.
26. A social worker visited Mr Y at home on 11 January 2021. Mrs X’s sister was present, along with Officer J and a police community support officer (PCSO). Due to his impaired hearing Mr Y had difficulty following and engaging in discussion so the social worker wrote some questions for Mr Y.
27. The records of the meeting show the social worker discussed all aspects of Mr Y’s daily living tasks. The Council said Mr Y did not consent to a formal assessment. After further enquiries about this, the Council said it had not been able to identify if there had been a discussion with [Mr Y] in regards to a needs assessment. Mr Y acknowledged he needed support with shopping, and that his daughter was unable to continue to do this. Mrs X’s sister expressed concern that Mr Y was unable to hear when someone was at his door. Mr Y initially declined the offer of a key safe but accepted after the benefits were explained by a PCSO.
28. A discussion was had about Mr Y’s medication, Mr Y understood his medical conditions and explained his medication routine. Mrs X’s sister said she would prefer someone to visit to check Mr Y was taking his medication because she was concerned his was forgetting to take it on time. The social worker said she should discuss this with Mr Y, and if he agreed, she, (Mrs X’s sister) could arrange this privately.
29. Mrs X’s sister expressed concern about the cleanliness of Mr Y’s property. The social worker, PCSO and Officer J all agreed that the property was in a satisfactory state, and there was no hazard to Mr Y. Mr Y refused a cleaner.
30. The social worker gave Mrs X’ sister a list of care agencies that could support Mr Y with medication prompts and shopping. A referral was made for Mr Y to have a benefits check.
31. Mrs X contacted the social worker the following day for an update on the meeting and asked for a copy of Mr Y’s needs assessment. The social worker said a needs assessment had not been completed, because Mr Y had not consented to an assessment, and he had capacity to make decisions about his care needs.
32. Mrs X expressed her concern and said she understood the Council had a duty to formally assess Mr Y’s needs. In response to the Ombudsman’s enquiries the Council said, following this complaint “…if a person would prefer a written assessment that worker complete the request because it will enable the person or their representative to have access to documentation, including the rational for decisions relating to their needs and eligibility, including how any ongoing needs can be met”.
33. As part of this investigation, I asked the Council to obtain comments from the PCSO. The PCSO confirmed he and another PCSO visited Mr Y on approximately 20 occasions, and during that time Mr Y’s understanding deteriorated. He said he and Officer J from the Council pushed the Council to assess Mr Y “…however, considering the content of the discussions that took place at the meeting the proposed outcomes felt appropriate at that time”.
34. Mrs X says Mr Y’s condition continued to deteriorate. She contacted social services again on 22 January 2021. She was told her father’s case was closed and a new referral would have to be made. Mrs X submitted a formal complaint using the Council’s on-line complaint form. As part of the complaint, she requested an urgent needs assessment for Mr Y. She received an automated reply confirming her complaint but did not make a note of the reference number.
35. On 31 January 2021, Mrs X was unable to contact Mr Y, so she contacted his friend, who, after visiting Mr Y, called an ambulance. The paramedic contacted the Council to report that he had found Mr Y in bed, without the heating on, and that he had stopped eating. Mr Y was said to have full capacity to make decisions, and that he said he wanted to remain at home to die.
36. Mrs X’s sister travelled from her home to be with Mr Y. She contacted the Council the following day to say she could not stay, that a GP would be visiting that day and that she wanted reassurance that care would be put in place for Mr Y.
37. The records show the Council contacted its triage care services to arrange home care for Mr Y. The service said it had no capacity to start the care immediately. I have seen no records to show the Council contacted alternative care providers.
38. On 3 February 2021 Mrs X and her sister had been unable to contact Mr Y for over 24 hours, so Mrs X’s sister travelled to his home, where she found him on the floor unable to summon help. The food she had provided on her previous visit had not been touched, suggesting he had not eaten for several days. Mr Y taken to hospital by ambulance.
39. Mrs X submitted a second complaint to the Council on 5 February 2021 saying she had not received a response to her complaint. She reiterated her request for an urgent needs assessment for Mr Y.
40. The Council says an officer attempted to call Mrs X on 8 February 2021, without success, so the officer sent an email. Mrs X confirms she received the email on 8 February 2021 in which the officer said the Council could not locate the original email and Mrs X should complain again under stage 1 of the Council’s complaints procedure. The officer did not address Mrs X’s request for an urgent needs assessment of Mr Y.
41. Mr Y sadly passed away on 14 February 2021.
42. Shortly after Mr Y’s death Mrs Y received a call from the Council. The officer said Mrs X’s complaint had not been upheld, and that the Council had not completed a needs assessment because Mr Y had capacity to make his own decisions.
43. Mrs X received a written response to her complaint on 19 February 2021. I have seen a copy of this letter. The author explained there was “...clear evidence that [Mr Y] had the capacity to make his own decisions, and the social worker responded appropriately… I have fully considered the impact that not producing a written document had had on you and your family, and will make changes to our practice to ensure that people are given an opportunity to receive written documentation, with the consent of the service user”.

Analysis

44. It is not the Ombudsman’s role to decide what services a person is entitled to receive. The Ombudsman’s role is to establish if the Council assessed a person’s needs properly.
45. In this case I find the Council at fault.
46. I have seen no evidence the Council contacted Mr Y following Mrs X’s initial request for help in March 2020, given Mr Y’s age, that he had diabetes, and the pandemic, which meant vulnerable people were advised not to leave the house, it would have been good practice to have made direct contact to ensure his wellbeing. However, the evidence suggests it is unlikely Mr Y would have accepted support at this point.
47. From December 2020, Mrs X asked the Council numerous times to assess Mr Y’s needs. The Council believed him not to be eligible for services, and that he may not accept services as he had previously refused. The Council should have taken note of Mrs X’s concerns and arranged for a social worker to visit Mr Y to establish if a needs assessment was required. Whilst input from Officer J and the PSCO’s were beneficial it should not have been a substitute for an offer of a formal assessment.
48. Officer J visited Mr Y on 4 January 2021 but received no response. Such was her concern she made a safeguarding referral to the Council. Whilst the Council may not have considered the issues to be safeguarding matters it should have arranged for a social worker to visit Mr Y as a matter of priority.
49. It was only due to Mrs X and her sister’s persistence, that the Council arranged for a social worker to visit Mr Y on 11 January 2021. The records a show a discussion about Mr Y’s needs and how these were being met. This amounted to an informal assessment. The Council says Mr Y declined a formal assessment. I am not persuaded by this claim. There is no evidence which shows Mr Y was offered or declined an assessment, and given he freely engaged in a discussion about his needs and how they were being met I find it more probable than not, that he would have accepted an assessment had it being offered.
50. Following the discussion, the social worker concluded Mr Y did not meet the criteria for social care. The evidence shows he needed support with shopping and medication. Shopping falls under managing and maintaining nutrition, which includes circumstances where a person may have difficulty in getting to the shops to buy food, medication was particularly important because Mr Y was diabetic. In any event, the Council has a duty under the Care Act to promote wellbeing. Wellbeing applies to several areas of life, not just one or two.
51. The social worker told Mrs X’s sister she could, with Mr Y’s consent, obtain care privately. It was the Council’s duty to commission care for Mr Y, not his family. This error flows from the failure to complete a formal needs assessment. Had a formal assessment been completed it would have highlighted any eligible care needs. The care options could then have been discussed with Mr Y. If Mr Y had declined then this should have been formally recorded on the assessment.
52. The Council refers to a strength-based approach. The actions of the Council from January 2021 onwards did little to promote this ideal. People’s strengths are promoted when they have the services they need in place at the time they need them. This is not what happened here.
53. Mrs X contacted the Council again in January 2021 to raise concerns about Mr Y and to reiterate her request for a needs assessment. She was told the case had been closed. This was wholly inadequate. Social services were aware of Mr Y’s circumstances and should have responded promptly. This was a missed opportunity to determine Mr Y’s wellbeing. Mrs X was frustrated and dissatisfied so she submitted an online complaint to the Council and reiterated her request for a needs assessment. She received an acknowledgement from the Council but heard no more.
54. The Council was alerted to Mr Y’s deteriorating condition by a paramedic on 31 January 2021, by this time it was clear Mr Y needed care and support. Initially the Council responded and attempted to secure services from its triage service, which was unsuccessful. The Council should have immediately commissioned services from another care provider. It’s failure to do so denied Mr Y, a vulnerable adult, the opportunity to receive the care he needed.
55. Mr Y was found on the floor on 3 February 2021, having been there for a considerable time. Whilst care and support may not have prevented a fall, he would have been found sooner.
56. The way the Council dealt with Mrs Y’s complaint was poor. It failed to follow up her initial online complaint. It later said it could not locate the complaint. Following Mr Y’s death, Mrs X received a call from a Council officer informing her complaint had not been upheld. Mrs X later received a written response acknowledging the impact on Mrs X of not producing a written document about Mr Y’s needs, and that changes to practice that would subsequently be made. I am unclear what the Council deems to be a written document. This caused further confusion and upset for Mrs X.
57. Overall, there is evidence of a failure to adhere to the Care Act, missed opportunities to determine Mr Y’s wellbeing, and a failure to provide care at the point it was needed. It is more probable than not, that this caused an injustice to Mr Y. As he has passed away, it is not possible to provide a remedy.
58. The Council’s failures also caused significant injustice to Mrs X and her sister, who had the distress at seeing their father without the care he needed at the end of his life. In recommending a remedy, I am also mindful of the efforts that Mrs X and her sister went to in an attempt to obtain care services for Mr Y.

Back to top

Agreed Action

59. The Council will within four weeks of the final decision:

• provide Mrs X with a written apology for the faults identified above;
• pay Mrs X and her sister £500 each to acknowledge their distress;
• make an additional payment to Mrs X of £250 to acknowledge her time and trouble pursuing this complaint with the Council and this office.

60. Within three months:

• consider the lessons learned from this complaint;
• consider any training needs of officers completing or overseeing need assessments under the Care Act;
• provide this office with evidence of the above.

Back to top

Final decision

61. There is evidence of a failure to adhere to the Care Act, missed opportunities and a failure to provide care at the point it was needed. It is more probable than not, that this caused an injustice to Mr Y.
62. The above recommendations are a suitable way to remedy the injustice caused to Mrs X and her sister.
63. It on this basis; the complaint will be closed.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman