Summary: The Council was not at fault for failing to provide care to Mr X nor for its decision to cancel his care package.

The complaint

1. Mr X complains the Council:
1. Cancelled his care package in November 2020 and did not properly consider his needs when doing so.
2. Did not put in place a care package after reinstating his care in March 2021.
3. Cancelled his care package in October 2021.
2. Mr X says he has not received the care he needs, and his parents had to come and live with him to provide care and support.

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The Ombudsman’s role and powers

3. 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)
4. 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)
5. 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

6. As part of this investigation I considered the information provided by Mr X. I discussed the complaint over the telephone with Mr X. I made enquiries with the Council and considered the information received in response. I sent a draft of this decision to Mr X and the Council for comments.

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What I found

7. Sections 9 and 10 of the Care Act 2014 require councils to carry out an assessment for any adult with an appearance of need for care and support. They must provide an assessment to everyone regardless of their finances or whether the council thinks the person 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.
8. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
9. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). The care and support plan should consider what the person has, what they want to achieve, what they can do by themselves or with existing support and what care and support may be available in the local area. When preparing a care and support plan the council must involve any carer the adult has. The support plan must 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.
10. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

What happened

11. There has been extensive correspondence between Mr X and the Council since September 2020. In this section of the statement I summarise key events, but I do not refer to every single contact and communication.
12. Mr X suffers with degenerative disc disease. He received a care package from the Council for five hours per week of reablement care. He also received three 30 minute daily calls from carers to assist him with medication, dressing and washing.
13. In March 2020 Mr X’s reablement care was cancelled due to the Covid 19 lockdown restrictions. In September 2020 the care provider who was providing care for Mr X told the Council it intended to give notice to end its services with Mr X. The care provider said nine carers had refused to visit Mr X due to his behaviour. The care provider said Mr X only wanted female carers, got angry if carers were early or late, refused to accept a later morning call and pretended to be unconscious in the bath during a night call.
14. At this stage the Council started to look for an alternative care provider for Mr X. Mr X’s parents also travelled from abroad to live with him and provide support.
15. The care provider ended its service with Mr X on 11 October 2020. Prior to this the Council assigned Mr X a social worker to assess his needs as the Council had received information from the care provider that Mr X did not require carers.
16. The social worker contacted Mr X’s GP, previous care manager and the care provider who had just stopped providing care. The feedback the social worker received was carers had observed Mr X carrying out shopping, and walking to his car with shopping. Carers also witnessed Mr X in the bath despite him needing assistance with bathing and walking his dog. The social worker referred Mr X for an occupational therapy assessment to establish his needs.
17. The Occupational Therapist (OT) assessed Mr X on 5 November 2020 via telephone. The OT established nothing had changed with Mr X since his original package of care was implemented and Mr X’s care plan should be reinstated with support for washing dressing and medication prompts.
18. The social worker took steps to reinstate a long term care provision for Mr X, but this was based on the the outcome of a five day assessment from the Council’s inhouse short term support service (STSS) which picked up Mr X’s care package in the interim. The Council considered there remained questions about Mr X’s ability to meet his own care needs which the OT assessment had not resolved. This included Mr X’s ability to manage his medication, bathing and whether there were any alternatives which could help Mr X.
19. On 20 November 2020 the STSS took over Mr X’s care package. This consisted of three visits per day to Mr X’s home. The Council also found a new care provider to take over Mr X’s long term care should he need this.
20. Following the STSS’s assessment, the STSS team updated Mr X’s social worker to say they were going to end their support for Mr X, for the following reasons:
• Mr X knew every single medication and even corrected care workers.
• Each time carers visited, Mr X was not sleepy so they did not believe medication support was required.
• Mr X manages his own medications and can use his own Dossett box.
• Tea and evening calls were not needed.
• Carers used minimal assistance helping Mr X into the bath. However Mr X should be assessed for bathing equipment.
• There was a perching stool in the kitchen Mr X could use for food preparations and carers saw no reason why he could not use this.
• Mr X has his own privately purchased bathing seat but was asking carers to lift his legs into the bath, but carers were only providing minimal assistance.
21. Following the feedback from the STSS team Mr X’s social worker and supervising manager agreed Mr X did not have long term care needs which cannot be managed without equipment. The Council told Mr X it had concluded his physical care needs could be met with the use of equipment and he did not require assistance with medication.
22. On 22 December 2020 Mr X made a formal complaint to the Council about its decision to end his care provision. Mr X said the assessment carried out had errors and did not reflect his circumstances. Mr X said he could not lift pots and pans in his kitchen so needs assistance with food preparation and could not shower without assistance or put on his socks.
23. On 11 February 2021 the Council responded to Mr X’s complaint. The Council said it would offer Mr X a reassessment of his care needs with a different social worker.
24. On 10 March 2021 Mr X’s new social worker visited him at his home. Mr X provided two letters from his consultants saying he has care needs. Mr X also explained to the social worker he needed help with washing, dressing and administering his medication as he forgets to take this.
25. Following on from the visit the social worker decided to reinstate Mr X’s care plan. This involved three 30 minute calls per day to Mr X’s home to assist with dressing, washing and administering medication. The social worker also reinstated Mr X’s enabling care of five hours per week from April 2021.
26. At the end of March 2021 Mr X asked the Council to end his care plan as he was not happy with the care provider. At this time Mr X did not wish to have discussions with the care provider and said his parents were available to support him. The social worker ended Mr X’s care plan and started looking for a new care provider.
27. From the end of March 2021 to the end of April 2021, the Council tried to find a care provider for Mr X. The case notes show the Council’s brokerage team contacted many care providers at various times. At the beginning of May 2021, Mr X’s parents returned home. Mr X’s social worker got the STSS team to provide care for Mr X for a few days after his parents left.
28. On 5 May 2021 two carers from the STSS team visited Mr X. The notes from the visit showed Mr X asked them to leave after a carer said they would assess Mr X getting dressed. On the same day Mr X telephoned the Council and told it to cancel his care package.
29. The Council cancelled Mr X’s care from the STSS team but continued to look for alternative providers for Mr X. The Council decided it would review Mr X and carry out an OT assessment and obtain further advice regarding the pain Mr X suffers with. The Council did receive an offer from a care provider to provide care to Mr X, however the care provider asked for an additional £5 for each visit as they did not have carers in the area. The Council initially declined this but then the care provider said it could no longer offer its service to Mr X.
30. In May 2021 Mr X’s social worker telephoned his doctor who told the social worker Mr X was tolerant of his pain medication and had overdosed once in the past. The doctor said Mr X should be promoting independence.
31. In late June 2021 the OT visited Mr X to carry out an assessment. The notes from this showed Mr X told the OT he needed help with cooking, dressing and washing himself. Mr X declined to participate in a functional assessment and would not demonstrate the difficulties he has showering. The notes said the OT ended the assessment as Mr X became angry. The OT also said they observed Mr X independently and without walking aids. He was able to cross his legs and reach out from a seated position.
32. On 14 July 2021 the Council found a care provider who could provide care to Mr X from Monday to Friday only. Mr X accepted this but declined the afternoon call as it was at the wrong time for him.
33. At the end of August 2021 Mr X’s social worker held a review meeting with Mr X at his home. Mr X said he was happy with the carers but explained he found weekends difficult as he has no care.
34. Mr X’s social worker also spoke with the enablers who were assisting Mr X in the community. Their feedback was Mr X had pain but not to the point where he could not shower. They also said Mr X was able to bend over, walk and take a load on his back. They said Mr X walked his dogs and was able to put his mobility scooter in his car. Mr X’s social worker also talked to his pain consultant who confirmed there was no reason Mr X could not manage his own medication.
35. In early September 2021 Mr X’s social worker obtained feedback from the care provider who was providing Mr X’s care. Carers said they were only really helping Mr X with putting his socks on and most of the time he asked them to carry out chores. Carers were of the view Mr X could manage without support or could have a shorter call to help him put on or remove socks.
36. After discussing Mr X’s case with the OT, the STSS team, his consultant, the enablers and the care provider currently providing care, the social worker decided Mr X did not have eligible care needs. The Council told Mr X it would end his care package on 15 October 2021.

Mr X’s complaint

37. Following on from the Council’s complaint response in February 2021, Mr X contacted the Ombudsman to complain the Council had not provided the care services in his care package.
38. When the Ombudsman contacted the Council about this it agreed to consider these matters through its complaints procedure as the initial complaint Mr X made in December 2020 only concerned the Council’s decision to stop his care in 2020.
39. The Council provided its complaint response to Mr X on 12 October 2021. The Council said:
• The social worker made a professional judgement to stop Mr X’s care in November 2020. This was based on feedback from OT, the STSS team, Mr X’s GP, and previous care provider. The social worker decided based on the information they received, Mr X could meet his own care and support needs and no longer had eligible needs.
• Following Mr X’s complaint about the Council’s decision to stop his care, the Council agreed to relook at this and assign Mr X a new social worker who reinstated his care. However Mr X refused care in March 2021 and cancelled the care provider. Mr X refused care again in May 2021 from the STSS team.
• It had no records of missed calls or emails from the Team Manager or social worker.
• It sent Mr X a copy of his care plan in November 2020. He requested a further copy on 27 April 2021, 5 and 6 May 2021 and the Council provided him with this on 12 May 2021. The Council apologised for taking two weeks to send Mr X’s care plan to him and for any frustration caused.
• The Council’s brokerage service contacted 28 different domiciliary care providers on the system and sent out daily requests to all providers. The Council did consider a care provider’s request for additional funding but then the provider said it could not accommodate Mr X.
• In 2021 the new social worker discussed Mr X’s case with consultants, the OT, enablers, the STSS team and current carers to reassess Mr X’s care plan. The social worker’s professional judgement was Mr X did not need care and did not have eligible needs. The Council said it would end Mr X’s care on 15 October 2021.

Analysis

40. It is not the Ombudsman's role to decide what, if any, care and support a person needs. That is the Council's role. The Ombudsman's role is to consider if the Council has followed the correct process for establishing a person's needs and if it acted correctly when this process was complete.

Complaint a) The Council cancelled Mr X’s care package in November 2020 and did not properly consider his needs when doing so.

41. The Council was not at fault for cancelling Mr X’s care in November 2020. In coming to this decision, the social worker who considered Mr X’s case sought advice from OT, Mr X’s previous care managers, his GP, and the STSS team who had provided Mr X with care.
42. While the OT assessment did say nothing had changed since Mr X’s care plan had started, the Council considered there were still issues the OT assessment had not addressed. It obtained feedback from the STSS team who were of the view Mr X did not require care after carers visited him. After considering the feedback received, the social worker took the decision Mr X did not have eligible care needs.
43. While I recognise Mr X disagreed with this decision, I cannot find the Council at fault for the way it made this decision to cancel Mr X’s care.

Complaint b) The Council did not put in place a care package after reinstating Mr X’s care in March 2021.

44. When Mr X’s care was reinstated after a new social worker took over his case, it was again stopped at the end of March 2021 after Mr X requested this. Mr X was unhappy with the care provider the council commissioned to provide his care.
45. Following this, the Council sought to find Mr X an alternative care provider. The Council contacted nearly 30 different care providers in the coming months to try to source care for Mr X but none of the providers could assist. There was one provider who initially said it could provide Mr X with care but asked for increased funding for travel, however it later told the Council it would be unable to provide care for Mr X even with the increase in funding.
46. In May 2021, after not being able to source a care provider for Mr X, the Council managed to put in place care from its STSS team, however this only lasted two days as Mr X cancelled the service. The Council managed to source a care provider for Mr X in July 2021, however they could only provide care during the week.
47. Overall I consider the Council used its reasonable endeavours to try to find Mr X a care provider, therefore do not consider it was at fault.

Complaint c) The Council cancelled Mr X’s care package in October 2021.

48. I have not found the Council at fault for cancelling Mr X’s care package. In coming to this decision, the social worker commissioned an OT report for Mr X, discussed his needs with enablers, current carers and Mr X’s consultant. The Council also received feedback from carers in the STSS team who had provided care to Mr X.
49. After considering the feedback received about Mr X’s needs, the Council decided he did not have eligible care needs. This was a decision the Council was entitled to make after considering the evidence presented to it.
50. Without evidence of administrative fault, the Ombudsman cannot question the professional judgement of the Council’s officers, or intervene to substitute an alternative view.

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Final decision

51. I have completed my investigation and found the Council was not at fault for not providing Mr X with care during 2021 and for how it decided to cancel Mr X’s care package.

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Investigator's decision on behalf of the Ombudsman