Summary: Ms C complained about the way the Council responded when she asked the Council to carry out a needs assessment for her father. She said this caused her distress. We found there was fault with the way the Council eventually carried out the needs assessment. The Council has agreed to apologise for this to Ms C and review the way it plans and carries out (refresher) training for its staff on carrying out such assessments.

The complaint

1. The complainant, whom I shall call Ms C, complained to us on behalf of her (late) father, whom I shall call Mr F. Ms C complained there was an unreasonable delay by the Council in carrying out her father’s needs assessment. Ms C said that, in the interim:
• The Council failed to liaise with health professionals (her father’s GP) when the family raised concerns and risks in relation to his health and medication management.
• The Council lied to the family about contacting the GP and forwarding the family’s concerns to the GP about confusion and medication.
2. Ms C also complained that the allocated worker was not a social worker and the needs assessment he carried out was of poor quality.
3. Furthermore, Ms C says the Council failed to liaise with health professionals immediately after the needs assessment was carried out, even though it should have been clear from / at the assessment that he was at risk because he was unable to manage his medication.
4. Ms C says that, if the above faults had not occurred, it is more likely than not that her father would not have died of a toxic level of methadone.

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The Ombudsman’s role and powers

5. 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)
6. 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)
7. 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

8. I considered the information I received from Ms C and the Council. I also interviewed a manager who had been involved in the case. I shared a copy of my draft decision statement with Ms C and the Council and considered any comments I received before I made my final decision.

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What I found

The complaint about the delay in the needs assessment and contact with the GP

9. Ms C complained there was an unreasonable delay by the Council in carrying out her father’s needs assessment.
10. Following an incident of theft, which resulted in a safeguarding referral, the Council carried out a safeguarding check on Mr F in April 2020. During the conversation, Ms C said her father lives in a sheltered scheme. She said he is in reasonably good health, can be a bit forgetful at times, and can still manage most everyday tasks himself. Ms C said she provides some support to him (shopping) and she would contact the Council ‘when things get back to normal and coronavirus is under control’.
11. Ms C contacted the Council in early May 2020 to ask for an assessment for her father. The record states that Ms C:
• Said her father had become very disorientated and confused, which had become worse since lockdown.
• Was unsure if her father had been managing his daily living.
• Advised her father's methadone dose had never been changed. She was worried that, if he has got any form of dementia, any other medication may react with that.
12. The Council has said this was at the height of the first Covid-19 outbreak and lockdown, which it said had a major impact on its services. During this time, it kept case allocation and progression under constant review on the basis of risks and priority.
13. The Council allocated Mr F’s case to a care manager in a timely manager, who contacted the family on 21 May 2020. According to the records:
• Mr F had been staying with his ex-wife for four days but had since moved back to his own flat. She told the care manager that Mr F would visit her tomorrow and possibly stay for another few days. She also told the care manager the name of Mr F’s support worker at the local Drugs and Alcohol Support Service.
• Ms C said she would chase her father’s GP to see if the GP could make a referral to the Memory Services. The allocated worker said it was important to understand from the GP and the Drug Support Service what the medication situation was in light of his methadone. A care worker could support him with his medication. Ms C said she would talk to her father about accepting support as he had been independent with his own routines so may not accept support.
14. Two weeks later, upon the care manager’s return from leave, Ms C said her father had stayed with his ex-wife a couple of times but was now at his flat again. The record states that Ms C said:
• Her mother had spoken to Mr F’s GP, but there did not seem to be a plan or input, and the GP was not aware of his methadone script.
• The Pharmacy staff had been concerned about Mr F when he collected medication and contacted the Drugs Support Service. Her father would now have to collect his medication more frequently.
• She was unclear if the GP had referred him to the memory clinic or arranged a blood test.
• She was worried about the state of his flat and would try to visit him.
15. On 24 June 2020, Ms C spoke again to the care manager. The record states that:
• Ms C said she had no update but thought the care manager would contact her father's GP. She said her father’s appointment at the Drugs Support Centre in June 2020 had been cancelled and his worker had not returned calls.
• The care manager asked if Ms C had visited her father, as she had said she would, but Ms C said she had not. She said she was frustrated she was not getting anywhere with the GP, and that no one had been to see him or spoken to him.
• Ms C said she would like something to happen before any kind of emergency occurs. As such, she wanted the Council to assess her father’s care support needs. In response, the care manager said he would contact Mr F.
16. Ms C told me that family members were unable to make contact with the GP. The family tried many times but, due to data protection, the GP said they would only see her father if he would make the appointment. She said she made the care manager aware of this on a number of occasions and asked him to contact the GP several times.
17. Following the above conversation, the care manager called Mr F’s GP and left a message to be called back. He also sent a request to the Council’s Prevention Team for a Safe & Well check. The team acknowledged the referral and said it would progress it. The team spoke to Ms C the next day, who confirmed her father was safe. The records also state that Ms C said she was concerned about a recent deterioration in her father’s health in terms of his forgetfulness and confusion. The team told Ms C it would carry out a safe and welfare check visit. However, it subsequently decided the case did not meet its criteria for a visit, because Ms C confirmed her father was safe, and he had people regularly in contact with him. However, the record states that, what Mr F would need was a visit to determine his level of support needs, if any.
18. The care manager called Mr F the same day (26 June). Mr F said he was at the house of his ex-wife and the care manager said he would call again on 29 June to confirm a visit for next week.
19. Mr F said on 29 June that he was feeling unwell. The record states that he described his symptoms, which sounded like possible Covid. As such, the care manager agreed with his supervisor to postpone the visit. The care manager also:
• Called Mr F’s sister, who said she would call the GP, see him later in the week and talk to him about support needs, carers, domestics etc. She felt his confusion was increasing and his flat could be tidier. She would try and encourage her brother to have matters looked at, although he has never been keen to see doctors.
• Called the GP, who said the family had been told that Mr F needs to be 'on board' and attend an appointment for some tests, before the GP could make a referral to the memory service.
20. Mr F’s sister spoke to the care manager again on 1 July 2020 and said that Mr F was not keen to go to the GP. He said he was still not feeling well. The care manager visited Mr F on 31 July 2020.
21. The Council says the case happened during a very challenging time when the country went into lockdown and the Council had to rearrange its working practices to deal with this and the additional work needed to support and protect those in need of adult social care. It says:
• The timeline shows ongoing contact with the family and the Council was aware that he was supported by his family.
• While the family did raise some concerns, non were deemed to be an emergency that needed to be immediately addressed.
• It is acknowledged that the timescales did not meet the standards of service it usually expects to deliver. However, the events occurred during a very challenging time that had unavoidable impacts on the Council’s service delivery.

Analysis

22. I did not find fault with the way in which the Council progressed the case. It allocated the case within a reasonable timeframe and the Council says the information provided to the allocated worker did not indicate the case required an immediate / urgent response. The Council acknowledged it took longer than usual to carry out the assessment. However, this was in light of the unprecedented circumstances at the time. Furthermore, the assessment would have taken place early July 2020, if Mr F had not become unwell. The care manager was in contact with the family throughout.
23. Ms C told the care manager on 24 June 2020 and said she thought she had agreed with him that he would call the GP. I have not seen any reference in the Council’s records that the care manager had said he would do this. However, when she told the care manager that day that she was frustrated she was not getting anywhere with her father’s GP, the social worker contacted the GP and updated Mr F’s family about the outcome.
24. However, my view is the care manager should have contacted Mr F’s support worker at the Drugs Support Service as part of, and in preparation for, the needs assessment.

The complaint about the qualifications of the allocated worker

25. Ms C told me the allocated worker was not a qualified social worker.
26. In response, the Council said that:
• It is standard practice for councils to employ a mix of social work qualified and vocationally qualified staff in undertaking its duties under the Care Act.
• The allocated worker has confirmed he completed his Care Act Training in 2013/14. Due to a change in systems this is not recorded centrally.
• The Council’s system does not show when the allocated worker completed his training on how to complete a Care Act Assessment. This could be due to the system change and this information not being transferred over.
• The Manager of the allocated worker said: ‘I can confirm he is an experienced Care Manager and has held this role from April 2015. The 2 years prior to this (2013-2015) he was a referral officer’.
• All assessments are signed off by a Team Manager when completed.
• The Council has sent a request for refresher training to all staff in October 2021.
27. The Council told me during the interview that it has been focussing on staff (refresher) training, identifying needs and drawing up training plans, progress of which is being monitored through its Quality and Standards Practice Board.

Analysis

28. The Care Act Guidance does not state that needs assessments can only be caried out by qualified social workers. However, it does say that:
• 6.3 A face-to-face assessment must always be done by an assessor who is appropriately trained and has the right skills and knowledge.
• 6.85 Councils must ensure that their staff have the required skills, knowledge and competence to undertake assessments and that this is maintained.
• 6.86 Councils must ensure assessors undergo regular, up-to-date training on an ongoing basis. The training must be appropriate to the assessment, both the format of assessment and the condition(s) and circumstances of the person being assessed.
29. I found there was fault by the Council, because it has been unable to evidence that the assessor received (regular) training on how to carry out a needs assessment.
30. The Council said the care worker had significant experience in carrying out needs assessments and a line manager would always check and sign off any assessments carried out.

The complaint about the quality of the needs assessment and the actions taken following the assessment

31. Ms C complained that the needs assessment that was eventually carried out was of poor quality. She says the allocated worker sent a copy by email which:
• Was not completed on a Care Act compliant assessment form that showed and explained how / why the Council concluded, for each outcome area, if her father had an eligible need.
• It failed to include important information the family had provided to the allocated worker during conversations.
• It said her father had capacity but failed to explain how this was determined.
• It failed to record that her father was unable to recall his medications without his sister pointing out to him, at the assessment visit, what he took.
• Despite the concerns raised by the family about his confusion, and him sometimes being unable to determine what time it is, the assessment failed to conclude her father would need support with medication management.
• It should have concluded he had eligible needs for:
1. Maintaining a Habitable Home Environment and Being able to make use of the adult's home safely, as he had an ongoing need for support / prompting.
2. Nutrition. It was clear that her father’s nutrition was not good. It is not clear from the assessment if her father understood that his diet was not healthy and/or what impact it could have on him.
• Outcome / aims section: it was not clear who would do what and when.
• It failed to mention risks to his safety that had been pointed out by the family and should have been clear at/from the assessment, and/or how these should be managed, including: confusion, the unsafe environment in which her father was living (mould, dangerous electrical witch, leaking sink).
• The allocated worker failed to pass the environmental concerns onto the Housing Association.
32. I reviewed the records related to this and found there were two documents. One email that the care manager sent to Mr F’s sister on 31 July 2020, and one form the care manager completed after his visit. Ms C’s comments were with regards to the email; she did not see a copy of the form. I have reviewed the form to determine if it contained sufficient information. The Council told me the form used is the form the Council uses to record needs assessments to determine eligibility. The form:
• Mentions Mr F’s increased confusion, as reported by his family.
• Said the lounge and kitchen were very cluttered, and Mr F said he was unable to stay on top of it.
• Stated there was a leak under the kitchen sink, and a heater and light were not working.
• Said that Mr F told he mainly relied on eating one meal (take away) a day.
• Medication: “appears to have knowledge of what to take and when as he talked through competently initially but then was sketchy when asked to clarify”.
• Memory: He does have capacity to make decisions but is 'sketchy' when trying to recall facts around events such as details of GP appointment, recent electrician visit.
• The form said Mr F had eligible needs in the following areas:
1. Being able to make use of the home safely
2. Managing and Maintaining Nutrition
3. Making use of necessary facilities or services in the local community including public transport and recreational facilities or services
4. Maintaining a Habitable Home Environment
• Support Plan:
1. He does not require formal intervention from care workers for activities of daily living and personal care at this time.
2. He is able to make decisions around his diet albeit he frequently chooses take away options. Mr F may be able to cook microwave meals once his kitchen is cleaned.
3. Support with decluttering and maintenance issues
4. Needs encouragement to clean so he may need a private cleaning service
33. The Council told me that:
• Ms C does not have a copy of the assessment form, which is why she believes the assessment was not documented on the correct form, and that the assessment was poor.
• The allocated worker started on Friday 31 July 2020. He subsequently learnt on 4 August of Mr F’s death and the assessment form was concluded without being completed.
• The outcome of the assessment did state eligible for support. The support plan was to refer Mr F to Prevention officers for support, before exploring a formal care package. If needed, a referral would also have been done to the Housing Association. This did not take place due to the short timescales between the meeting taking place on Friday 31 July 2020 and Mr F passing away.
• This timescale was also the reason as to why a line manager had not yet reviewed the assessment form. The Council told me the line manager would probably have asked the care manager to verify and clarify things further around capacity and medication management.
34. Ms C also complained the care manager failed to immediately liaise with health professionals after the needs assessment, even though it should have been clear from / at the assessment that he was at risk because he was unable to manage his medication.
35. Ms C said the coroner’s office advised that the autopsy report said her father had a toxic level of methadone in his system.

Analysis

36. I found that the assessment failed to explain if / how the assessor determined that Mr F had capacity to make decisions about his diet.
37. The assessment indicates that Mr F was not totally clear about issues in relation to his medication. Medication management is an important area with potential risks attached. However, the assessor failed to describe what these areas of uncertainty were and why / if these would not need support from a care worker.
38. Based on the information presented, it was the view of the allocated worker that Mr F was not at significant or immediate risk with regards to his medication management. It is likely that this issue would have been further explored as part of the assessment process, with the family and his line manager if Mr F had not passed away shortly afterwards.
39. However, the care manager did suggest that medication compliance should be monitored and that a Nomad could help. A Nomad is a pre-packed medication packaging system that divides a patient’s medication into time-specific dosages. They are available for elderly patients on complicated drug regimens or people with memory problems. However, as Ms C had mentioned that her father sometimes was confused about the time of day, this may not have been able to completely manage all risk.
40. The support plan identified the need for decluttering and repair works, but it did not identify who should do this. However, it has become clear that the care manager handed over the case to the Prevention Team to visit Mr F to facilitate this process.

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Agreed action

41. The Council has already provided an apology to Ms C with regards to the faults it previously identified as part of its complaint response. I recommended it should also apologise, within four weeks of my decision, for any additional faults identified above.
42. Furthermore, I also recommended that, within 8 weeks of my decision, the Council should review the way it plans, records and monitors (refresher) training of those responsible for carrying out needs assessments (care managers, social workers etc) to ensure it complies with the (refresher) training and skills requirements of the Care Act.
43. The Council has told me it has accepted my recommendations.

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Final decision

44. For reasons explained above, I found there was some fault and I should therefore uphold Ms C’s complaint.
45. I am satisfied with the actions the Council will carry out to remedy this and have therefore decided to complete my investigation and close the case.

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Investigator's decision on behalf of the Ombudsman