Summary: Ms X complained the Council failed to provide her with suitable care. The Council was at fault for failing to reassess Ms X’s needs or review her care and support plan and for failing to take suitable action to identify a care provider. This meant Ms X has been without a suitable care package since August 2021, which caused her distress. The Council has agreed to carry out a new needs assessment, pay her £300 and remind its staff of the proper processes.

The complaint

1. Ms X complained her previous care package was inadequate and the Council failed to provide her with care since May 2021. She said this was harmful to her health and welfare and negatively affected her two children.

Back to top

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. 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)

Back to top

How I considered this complaint

5. I have considered:
• all the information Ms X provided and discussed the complaint with her;
• the Council’s comments about the complaint and the supporting documents it provided; and
• the relevant law and guidance and the Ombudsman’s guidance on remedies.
6. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

Back to top

What I found

Needs assessments and care plans

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. 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 have a duty to provide a care and support plan to a person with eligible needs. The care and support plan should consider what needs 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. It should also include a personal budget, setting out how much the care will cost and how much the council will pay, if any, towards the care. The council is responsible for ensuring the support set out in the care and support plan is delivered.
9. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. The Care and Support Statutory Guidance says councils should review plans at least every 12 months. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one. If there is information which suggests the person’s plan is no longer appropriate, the council should immediately review the plan to see if it needs revision. The person should be fully involved in the review. If the person’s needs substantially change, the council should carry out a reassessment and produce a new care and support plan.

Direct payments

10. Direct payments are a means of paying some, or all, of the personal budget to the person to arrange and pay for their own care. They are intended to provide independence, choice and control over the way a person’s needs are met and outcomes achieved. The person can use the direct payments to buy services from an agency such a care agency, or hire a carer or personal assistant. This can include a relative, if they live outside of the person’s home.

Reablement care

11. Reablement services are those usually provided to people after a period of significant and sudden illness. They are provided for a limited period of time, often around six weeks, to help a person to maintain or regain the ability to live independently. They involve assessment of the person to determine what support they may now need.

What happened

12. Ms X has a number of conditions which affect her mobility and ability to care for herself and her vulnerable child. Her adult daughter sometimes visited to help her at home.
13. In January 2021, the Council carried out a needs assessment. It spoke to Ms X, who explained that when she was unwell she struggled to prepare food, clean her home or walk to access a toilet. The Council assessed Ms X’s needs and decided she had eligible needs for care and support. It decided a carer coming into Ms X’s home could help her do activities like getting washing, emptying her urinal, preparing microwave meals and cleaning. The Council also referred Ms X to a Council service which would help her with shopping. Given Ms X’s needs fluctuated, the Council offered Ms X direct payments for 2.5 hours per week, which it set out in her care and support plan. Ms X agreed and found a personal assistant (PA) to support her.
14. In late May, Ms X told the Council her PA left and she would try and find a new one.
15. In mid-June, Ms X’s daughter told the Council Ms X’s needs had significantly increased due to a flare up of her conditions. The Council offered Ms X an emergency placement in a care home but she refused because she felt unable to leave her younger child. The Council said it would refer Ms X’s child to its Children’s Services to explore support for them and would reassess Ms X’s needs. It also offered support to allow Ms X’s adult daughter to stay at her home and care for her child while Ms X’s sought medical help. Ms X refused.
16. The Council carried out a needs assessment two days later and decided she needed reablement for 10.5 hours per week. It produced a new care and support plan to reflect that. The Council's assessment noted that Ms X was experiencing significant pain, was solely reliant on others to do daily living tasks and was not mobile. It said that during the reablement the Council would reassess Ms X’s needs and decide what support she needed long-term and what contingency plan it could put in place for future flare-ups. The Council sent details of Ms X’s care package to its list of care providers.
17. In late June, the Council offered Ms X respite in a care home as it had not been able to find a care provider. Ms X refused as she felt unable to leave her young child. The Council therefore said it would try to find a provider who could provide at least part of Ms X’s care package. It sent the request to its brokerage team the same day.
18. Ms X was unhappy and complained in early July. The Council responded in mid-July. It said:
• it was affected by a lack of availability of providers in the Council's area, and particularly where Ms X lived;
• care providers were also struggling due to staff having to isolate during the COVID-19 pandemic;
• Ms X’s adult daughter was able to provide some support but noted that was not ideal; and
• it had looked at getting someone to provide part of the care package but that was not possible either.
19. The following day, the Council chased its brokerage team as it had not received a response to its request to see if a care provider could offer part of Ms X’s care package.
20. Ms X remained unhappy with the Council's complaint response and requested a stage two response. The Council replied in late July. It said:
• it was continuing to try and find a care provider for her;
• it could offer Ms X direct payments instead of the reablement package. She could use the direct payment to pay her daughter to care for her. But, she could only pay her daughter for 2.5 hours per week, based on her January needs assessment.
21. Ms X complained to the Ombudsman. Ms X told me she decided not to use direct payments to pay her daughter because 2.5 hours per week would not be enough money for her daughter to live on. Ms X said she had been paying for her daughter to get taxis to and from her home to care for her. After some time her daughter became unable to care for her. Since then she has been paying someone between three and seven hours per week to clean, cooking and do other household chores.
22. In late July, the Council again chased its brokerage team to see if a provider could provide part of the care package. Records from that day show brokerage called four providers, none of whom were able to care for Ms X.
23. The Council spoke to Ms X in late September to ask if she still felt she needed reablement. Ms X said she was not sure, her conditions fluctuated but she still felt she needed support. The Council said it was still trying to find a care provider. It asked its brokerage team for an update.
24. In early November, the brokerage team spoke to six care providers. None had capacity to carry out Ms X’s care package.

Findings

January needs assessment

25. The Ombudsman cannot question a Council's decision if it is made without fault. The Council spoke to Ms X and noted the information she gave on the impact of her conditions. The Council considered how it could best meet Ms X’s eligible needs and decided that 2.5 hours of care per week and a referral to a service to help with shopping would be sufficient. The Council also noted Ms X's conditions fluctuated and therefore offered her direct payments. The Council considered the relevant information in deciding what package of care to offer Ms X so was not at fault.

Early attempts to find a care provider

26. In mid-June, Ms X’s needs increased due to a flare up of her conditions. The Council acted suitably by carrying out a new needs assessment within two days and exploring what other support it could offer Ms X, including respite in a care home.
27. The Council decided Ms X needed a reablement package of 10.5 hours per week. It sent details of the care package to its approved care providers but none responded to say they could fulfil the care package. In late June, the Council asked its brokerage team to see if any of the care providers could do part of the package and again offered Ms X respite. This was a suitable response to try and ensure Ms X could receive some care.
28. However, the brokerage team did not respond to the request until late July. There is no evidence it contacted the care providers about part-fulfilling the package until that date. The Council did not contact any care providers again until early November, despite telling Ms X it would do so in late September. The Council allowed Ms X’s case to drift, which was fault.

Later efforts to support Ms X

29. The Care and Support Statutory Guidance states that where a council becomes aware a person’s care and support plan is not appropriate, it should immediately review the plan. Ms X’s June 2021 care and support plan stated the Council would provide her with 10.5 hours of reablement per week. In late July, the Council offered Ms X direct payments as an alternative because it had been unable to find a provider. At that point, the care and support plan was not appropriate to meet Ms X’s needs. The Council should have immediately reviewed the plan and considered what direct payments to offer Ms X to meet her assessed needs according to the June 2021 assessment. Instead, it told Ms X she could only have 2.5 hours of care per week based on its January 2021 needs assessment. This was fault. Reablement allows carers to assess someone’s need for support. They may find the person does not need the entire care package. Therefore, 10.5 hours per week of reablement does not necessarily equate to 10.5 of hours personal care. As such, I cannot say the Council should have offered Ms X 10.5 hours per week of direct payments. I am nonetheless satisfied the 2.5 hours it did offer was probably insufficient to meet her assessed needs at the time.
30. When the Council spoke to Ms X again in September 2021, she said she was unsure if she still needed reablement but felt she still needed support. That suggests Ms X’s need for care and support was different than it had been in June during her period of acute illness. The conversation should have triggered a new needs assessment. Instead, the Council continued to try and find a care provider to offer the reablement package. This was also fault.
31. The fault identified in paragraphs 28, 29 and 30 meant Ms X went without a suitable care package from August 2021 onwards. This caused her significant distress. Ms X had to rely on her daughter providing informal care and support and later, paid someone to help her in the home.

Back to top

Agreed action

32. Within one month of the date of my final decision the Council will:
• apologise to Ms X for the distress caused by the fault identified in this decision.
• pay her £300 in recognition of the distress the fault caused her; and
• carry out a reassessment of Ms X’s needs.
33. Ms X says she paid for taxis for her daughter to come to her home and care for her and has been paying someone to come in and provide her with support. If Ms X can provide the Council with suitable evidence of what she paid for taxis and that support, the Council will reimburse her for those costs. It will do so from August 2021 to the date it carries out the new needs assessment. Ms X will send the evidence within one month of the needs assessment. The Council will therefore make the payment within two months of the date of the new assessment.
34. Within three months of the date of my final decision, the Council will remind its staff:
• that when the Council offers someone a package of care different to that set out in their care and support plan, they should review the plan;
• they should carry out a new needs assessment where it is clear the person’s needs have changed; and
• they must ensure they check whether care providers have capacity to fulfil a care package regularly.

Back to top

Final decision

35. I have completed my investigation. I have found fault leading to personal injustice. I have recommended action to remedy that injustice and prevent reoccurrence of this fault.

Back to top

Investigator's decision on behalf of the Ombudsman