Summary: Mr X complained the Council failed to properly assess his care needs and that his contributions to his care were too high. We find the Council was at fault for failing to record its decision not to increase Mr X’s support hours. However, that did not cause Mr X an injustice. The Council has agreed to remind relevant staff to ensure any decision making is recorded within case records to stop the same problem affecting other people.

The complaint

1. Mr X complained the Council failed to properly assess his care needs. He said that means he does not receive the level of support he needs especially around attending medical appointments. He feels this has caused his health to deteriorate over the past twelve months.
2. Mr X also complained that his financial contributions towards his care were too high causing him financial hardship.

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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 discussed the complaint with Mr X.
6. I asked the Council questions about Mr X’s complaint and considered the evidence it provided including Mr X’s care needs assessment and case records.
7. I referred to the Care and Support Statutory Guidance 2014.
8. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

9. Councils must assess anybody in their area who appears in need of care services. Following an assessment, the council must decide which needs are eligible for their support.
10. If the council provides support, it must produce a written care plan. This plan may include a personal budget which is the money the council has worked out it will cost to arrange the necessary care and support for that person. The council can charge an adult for the care and support specified in the care plan. The Care Act 2014 states that any charges must not reduce people’s income below a certain amount. This is known as the Minimum Income Guarantee. This is set at £91.40 per week for a person aged over 25 but below state pension age.
11. Councils can decide someone’s care and support needs may be met through services anyone can use such as a local community group or voluntary sector organisation.

Direct payments

12. Direct payments are monetary payments made to individuals who ask for one to meet some or all of their eligible care and support needs. They enable people to pay for their own care and support to meet their eligible needs.

What happened

13. Mr X has trouble understanding difficult information and a medical condition that requires a specialist diet. He also experiences severe anxiety. Mr X had lived with his parents who provided him with support up until they died. Following that, Mr X struggled to manage his own care.
14. The Council received an adult social care referral for Mr X in April 2020. The Council completed an initial assessment and arranged for its enablement service to visit him twice a day for six weeks to assess the level of support he needed.
15. Following feedback from the enablement service the Council assessed Mr X as needing ongoing care and support. It completed a care needs assessment. That said Mr X had eligible needs with managing his nutrition, personal care, and doing activities in the local community. It assessed Mr X as needing 10 hours of weekly support; twice daily to assist with personal care and nutrition and three hours for social activities. The support plan included information about community groups Mr X could go to.
16. Mr X agreed with the plan. He asked for a direct payment so his care could be provided by a company he already used (the Care Provider). That package of support started on 8 June 2020.
17. The Council completed Mr X’s financial assessment with help from his brother, Mr Y. It decided Mr X needed to contribute £53 a week to his support. It sent Mr Y information about the appeals procedure and explained Mr X could appeal if his weekly spending was greater than the allocated general living allowance of £136.63 a week. Mr Y agreed to oversee Mr X’s direct payment account.
18. The Council reviewed Mr X’s support plan in July 2020 after Mr X asked for more support. The Care Provider also contacted the Council and said Mr X needed more support for community activities as he did not want to attend the groups suggested by the Council. It said he needed additional support with managing his money, housing and attending medical appointments. It said it was providing Mr X’s support over four days at his request. It provided a letter from Mr X’s hospital consultant stating he would benefit from an increase in his social support hours.
19. The case records show the Council considered the information provided but decided not to increase Mr X’s support hours. It emailed the Care Provider and set out different community support groups available to Mr X to meet his needs. It said the Care Provider needed to encourage Mr X to look after himself as much as possible.
20. Mr X contacted the Council in September 2020 stating he could not afford his client contribution towards his care. He also said Mr Y could no longer manage his direct payment account. The Council reopened Mr X’s case. It referred him to its Welfare Rights Service to provide support to him around appealing his client contribution. It provided advice about the different ways he could get help managing the direct payments it paid him.
21. Mr X’s advocate contacted the Council in October 2020 and said Mr X remained unhappy with the amount of support hours the Council had allocated. The Council asked the Care Provider for details of support it provided Mr X. It also spoke to Mr X about how he was using his support hours. He reported he used them for dog walking; shopping; helping to keep his home clean and doing other social activities. He said he wanted support daily with his medication and personal care. The Council sent Mr X further details of community projects that provided support around wellbeing. It offered to refer him to a service that could help him make friends.
22. The Council considered Mr X’s appeal for his client contribution in December 2020. It wrote to him and sent the letter care of his brother. It assessed his contribution as affordable if he was more careful with what he spent his money on.
23. Mr X’s social worker met with him in January 2021 to go through the outcome from the Panel. The case records of that meeting state “I shared the case panel’s decision re the appeal for increase of hours being refused at this stage as panel identified [Mr X’s] outgoings were more than his income and unnecessary expenditures were identified such as TV insurance and pet insurance”. The case records also said that after discussions with management, the increase in Mr X’s care hours had been refused.
24. Mr X complained to the Council about its decision not to increase his support hours because his spending was too high. He also complained the Council did not tell him how to make his client contributions. In response the Council said Mr X’s support hours were based on his care needs assessment and should not be based upon how much he was spending. It partially upheld that part of Mr X’s complaint. The Council said it had not agreed to increase his support hours as Mr X could access other freely available community help and that it assessed ten hours as sufficient. It said that it had given Mr X information about his client contribution.

My findings

25. The Ombudsman is not an appeals body. We cannot decide the number of care and support hours Mr X needs. We can only consider whether the Council followed the right steps before making its decision about the amount of support Mr X needed.
26. The Council assessed Mr X as needing ten hours of weekly support with three hours a week to support him with social activities. It reviewed that decision in July 2020 based on feedback from its enablement service, information provided by Mr X and comments from the Care Provider. It signposted Mr X to community projects and relevant services for additional support. The Council was not at fault.
27. The Council reviewed Mr X’s support plan further in January 2021 based on what Mr X and the Care Provider told it. The case records do not show how the Council decided not to increase Mr X’s hours. That is fault. However, there is nothing in the information provided by Mr X and the Care Provider to indicate his care needs changed between July 2020 and January 2021. Therefore, the problem with recording the decision did not mean Mr X went without the support he needed. The Council followed the right steps to decide what help he needed. It decided he could get this support using the amount of money it paid as well as using other free local services.
28. The case records indicate the Council incorrectly told Mr X that the support hours were not increased because of his weekly expenditure. That was fault. That caused him avoidable confusion. The Council provided the correct information in its complaint response.
29. The Council completed Mr X’s financial assessment in line with statutory guidance. The Council was not at fault. However, it did not set out why it considered his client contributions as affordable in its letter to him following appeal. That was fault. Although a social worker visited Mr X and explained why the Council did not uphold the appeal, Mr X said that meeting was confusing and caused him to worry about finances and the impact on his care. However, the Council had regular contact with Mr X about his finances, so I do not consider this caused him a significant injustice.

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Agreed actions

30. Within one month of my final decision the Council has agreed to remind relevant staff to:
• Ensure client contribution appeal decision letters demonstrate the reasoning behind the Council’s decision.
• Ensure management discussions/oversight of decision making are recorded in case records.

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Final decision

31. The Council failed to record its decision for not increasing Mr X’s care and support hours. However, that did not cause Mr X an injustice. The Council has agreed to my recommendations therefore I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman