Summary: Ms X complained about the Council’s handling of her care needs assessment. She complained the Council did not take her wishes into account, did not routinely share assessment documents with her, only provided an advocate for a two-week period, and did not consider her in line with safeguarding provisions. Ms X says the Council’s actions caused her to feel bullied. We found no fault by the Council and have concluded our investigation.

The complaint

1. Ms X complains about the Council’s handling of her care needs assessment. She complains the Council:
1. Failed to take her needs and wishes into account during the assessment and care planning process, and subsequently failed to provide a person-centred care plan;
2. Failed to routinely share assessment documents with her. Ms X says documents that were shared contained inaccuracies and did not provide details of her medical conditions;
3. Failed to provide a Care Act advocate, except for a two-week period, and
4. Failed to consider her in line with safeguarding provisions.
2. Ms X says the above issues go back to 2016. She also complains the Council cleared her home of her possessions without her permission.

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What I have investigated

3. I have investigated the complaints referred to in paragraph one, dating back to 2018. I have not investigated the complaint referred to in paragraph two. The final section of this statement contains the reason for not investigating the complaint in paragraph two, and the reason for not investigating Ms X’s complaint back to 2016.

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The Ombudsman’s role and powers

4. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
5. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
6. We cannot investigate complaints about the provision or management of social housing by a council acting as a registered social housing provider. (Local Government Act 1974, paragraph 5A schedule 5, as amended)
7. If we are satisfied with an organisation’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 discussed the complaint with Ms X and considered the information she provided.
9. I made enquiries to the Council and considered the information it provided.
10. I have considered the Care Act 2014 as well as relevant policies and procedures.
11. Ms X and the Council have had the opportunity to comment on a draft of this decision. I have considered their comments before making a final decision.

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What I found

The Care Act 2014 - Assessment

12. 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.

Care Plan

13. 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. 

Safeguarding

14. A council must make enquiries if it has reason to think a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themself. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

The Care and Support Statutory Guidance

15. The Care and Support Statutory Guidance, (the Guidance), says, “The scope of that [local authority] enquiry, who leads it and its nature, and how long it takes, will depend on the particular circumstances…At this stage, the local authority also has a duty to consider whether the adult requires an independent advocate to represent and support the adult in the enquiry”. (Care and Support statutory guidance 14.93).

The Council’s safeguarding policy

16. The Council’s safeguarding policy gives examples of the type of potential abuse and neglect which may lead to a safeguarding enquiry. This includes psychological abuse and self-neglect, including hoarding. The policy says, “Crucial to all decision making is a robust risk assessment, preferably multi-agency that includes the views of the adult and their personal network. The risk assessment might cover:
• Capacity and consent;
• The level of risk to the person’s physical health;
• The level of risk to their overall wellbeing;
• Accommodation.

The London Multi-Agency Adult Safeguarding Policy and Procedures

17. This policy says it aims to better safeguard adults at risk of abuse throughout London. The policy says, “The adult safeguarding procedures do not set definitive timescales for each element of the [safeguarding] process; however, target timescales are indicated…. It is important that timely action is taken, whilst respecting the principle that the views of the adult at risk are paramount”.
18. The policy also says, “An enquiry should establish whether and what action needs to be taken to prevent or stop abuse or neglect”.

What happened

19. This chronology includes key events in this case and does not cover everything that happened.
20. Ms X lives in a Council property. She is disabled and has several health conditions and mobility problems. In December 2017, Ms X contacted the Council to ask for a support worker to help her to go to hospital and GP appointments and to help with shopping. Ms X said she also needed help with de-cluttering her home.
21. The Council carried out a basic assessment in January 2018 which identified Ms X was eligible to receive care and support. The Council agreed to carry out a further comprehensive assessment to identify the type of care and support Ms X required. The basic assessment identified Ms X had a very large quantity of items in her home which the Council said needed to be cleared before further professional assessments could be carried out.
22. In February 2018, Ms X contacted the Council’s safeguarding team regarding the contact she had received from the housing department. At about the same time, Ms X asked the Council to provide details of advocacy organisations. The Council provided Ms X with information about a local advocacy organisation, Organisation A.
23. On 22 February 2018, the Council’s safeguarding team replied to Ms X. It said it had reviewed Ms X’s concerns but considered they were not safeguarding issues. The Council said it had found no evidence to suggest the housing department had breached its policies and procedures and it had found no evidence of abuse or neglect.
24. On 1 March 2018, the Council’s adult social care team recorded a safeguarding concern about Ms X, following receipt of a self-referral. Ms X said she felt very unsafe living in her home due to the build-up of items in her property.
25. A social worker visited Ms X on 6 March 2018. The social worker completed a hoarding assessment which found the rooms in Ms X’s home to be “cluttered” with a very large quantity of items. The quantity of items meant Ms X did not have access to all rooms in her home, including the bathroom. As a result, the Council said it had concerns for Ms X’s health, mobility and general welfare.
26. Ms X contacted the safeguarding team on 8 March 2018 as she said she felt bullied by the housing department. The safeguarding team said the issues raised by Ms X should be dealt with via the Council’s complaints procedure rather than as a safeguarding enquiry.
27. On 20 March 2018, the Council gave Ms X details of another organisation who provided advocacy services, Organisation B. Ms X asked the Council to send the advocacy referral form to her so that she could present it to the advocacy service herself.
28. On 22 March 2018, the Council sent an advocacy referral form to Organisation A on behalf of Ms X. The Council told Organisation A that Ms X had asked for a Care Act advocate to help her with the assessment.
29. The Council visited Ms X’s home on 29 March 2018 as part of its safeguarding enquiries. It considered the hoarding in Ms X’s home placed her at risk of harm and decided it needed to take action to address the concerns raised, specifically to help Ms X clear her home and to provide her with a care and support package.
30. On 6 April 2018, the Council gave Ms X contact details for another advocacy service, Organisation C.
31. Ms X called the Council on 30 April 2018 and asked it to contact several advocacy services to see what type of support they offered. Ms X said she had contacted Organisation B, but they were not suitable for her case. The Council said it would provide Ms X with details of advocacy services and said it would complete the advocacy referral with her once she had chosen which service to use.
32. The Council provided Ms X with details of three local advocacy services on 8 May 2018.
33. On 21 May 2018, Ms X called the Council. She said the Council had recorded false and inaccurate information during its assessment and that she had not participated in the assessment process. Ms X said the Council had breached the Care Act as a result. Ms X called the Council again the following day and said she would like some of the wording in the basic assessment amended.
34. On 5 July 2018, Ms X told the Council she had spoken to Organisation A about the advocacy referral process. She said the person she had spoken to was rude and would not explain part of the process. Ms X said she would not complete the advocacy referral form until Organisation A had explained the process as she did not want her information to be passed onto everyone.
35. On 27 September 2018, the Council completed an independent advocacy referral form with Ms X, and sent it to another advocacy organisation, Organisation D. Organisation D replied on the same day and told the Council the referral needed to go through Organisation A as they were the central point to record the details of advocate requests. It said however, it was aware Ms X did not want her referral to be passed onto Organisation A.

What happened next

36. Ms X contacted the Council on 1 March 2019. She said she wanted to raise safeguarding concerns about problems she was experiencing with her GP and the advocacy services. She said she had made several complaints but had not received any positive outcomes, and she considered this was a form of abuse. Ms X said she tried to raise this with the safeguarding team but was advised to discuss her concerns with her social worker. The Council said it would pass Ms X’s concerns onto her social worker as a result.
37. On 4 April 2019, the Council held a meeting to discuss Ms X’s case. It was concerned Ms X did not have an advocate and it was unable to move forward with its assessment.
38. The Council spoke to Ms X on 5 April 2019 and asked her if she had spoken to advocacy support. Ms X told the Council she had not spoken to them but would do so at some point.
39. The Council wrote to Ms X on 12 April 2019 to tell her about the meeting held on 4 April 2019. It said it was concerned the large quantity of items in Ms X’s home caused a danger to her and was concerned about Ms X’s living conditions. The Council said it considered the risks to Ms X’s health were very high and although Ms X had a social worker, they had not been able to carry out an assessment to arrange help because of Ms X’s ongoing complaint with the advocacy service. The Council suggested a timetable for it to carry out repairs to Ms X’s home and to carry out the assessment.
40. The Council sent a further advocacy referral form to Organisation D on 24 April 2019. Organisation D assigned an advocate to Ms X on 1 May 2019.
41. The Council wrote to Ms X on 1 July 2019. It said Ms X had not allowed its operatives to carry out repairs on the arranged dates and said it was still concerned about the large number of items in Ms X’s home. The Council told Ms X her tenancy agreement said she should allow agents to carry out their legal duty to do repairs, and she should not store or accumulate items in the property.
42. On 2 August 2019, Ms X met with her social worker and advocate to begin the comprehensive assessment. Ms X attended a further meeting on 9 August 2019.
43. In September 2019, a third-party organisation, Organisation E, funded by the Council, visited Ms X to create a plan to clear the items from her home.
44. The Council continued to monitor the progress of the clearing of Ms X’s home. The Council said it could provide carer support to Ms X once the assessment was completed and Ms X’s home was cleared.
45. In January 2020, the Council identified Ms X did not always grant access to her home for Organisation E to carry out the clearance. It said care professionals would not go into the property until it was clear, and access was provided to Ms X’s bathroom.
46. In March 2020, Organisation D’s advocacy with Ms X ended due to contractual reasons. The Council sent a referral to another advocacy service, Organisation F, to secure another advocate for Ms X.
47. In June 2020, the Council called Ms X. Ms X told the Council she was unwell and could not attend to her own personal care as a result. The Council advised Ms X to call the NHS or emergency services. Ms X said she did not want to do this. The Council called again the following day to check on Ms X and decided to call emergency services itself because of its concerns. Emergency services attended Ms X and admitted her to hospital on the same day.
48. The emergency services and NHS submitted safeguarding referrals to the Council. The emergency services reported the issue of hoarding in Ms X’s home as part of its concerns about Ms X’s welfare.
49. The Council obtained an emergency court order to carry out the clearance of Ms X’s home.
50. Ms X moved to temporary accommodation when she was discharged from hospital in June 2020. The Council and Organisation F arranged to carry out the clearance of Ms X’s home during this period.
51. Ms X requested a safeguarding review in July 2020 as she said she felt the Council was psychologically abusing and bullying her.

Ms X’s complaint

52. Ms X complained to the Council in July 2020. She complained she felt bullied and abused by the Council because of her stay in temporary accommodation. Ms X also complained about the Council’s actions regarding the court action taken to clear her property.
53. The Council completed its comprehensive assessment in August 2020. The assessment identified Ms X was eligible for care and support and said the housing department would support her to organise the clearance of her property. The Council said it would not organise services until the clearance was sorted as it did not want to jeopardise the safety of the visiting professionals.
54. The Council provided its complaint response on 7 August 2020. It said Ms X had agreed to stay in temporary accommodation following her discharge from hospital, to allow the clearance of her property to take place. The Council said it reported Ms X’s concerns to its safeguarding team, and her concerns had been addressed as a complaint response.
55. Ms X escalated her complaint to stage two in November 2020. Ms X complained the Council should be helping her because she is disabled, and because she considered she had not received any support since requesting help in 2016. Ms X also complained her social worker did not provide support to her and that the Council’s actions had a negative impact on her mental and physical health. Ms X said she disagreed with the court process, that delays were caused by her not understanding consent, and that the assessment was not completed because her social worker sought her GP information. Ms X complained she had asked for safeguarding but the Council had not given this, and she had been without an advocate for months.
56. The Council provided its stage two response on 9 December 2020. It said Ms X had a social worker since 2016 and since then, it had carried out several assessments. It said it had identified care needs but said Ms X had previously refused support. The Council said Ms X’s social worker tried to engage with her to co-ordinate support, but Ms X had been resistant to assessment visits. The Council said it took court action as a last resort following various alternative interventions. It said these interventions were not successful due to Ms X’s lack of engagement with the process. The Council said it had consistently tried to engage with Ms X to help her and said it would continue to do so.
57. On completion of the clearance, Ms X moved back to her home in December 2020. The Council also provided its Care and Support plan at this time.
58. Ms X says that since 2016, there were periods where she did not have a social worker. Ms X also says she did not refuse support from the Council. As Ms X remained dissatisfied with the Council’s response, she brought her complaint to us.

Analysis

59. I have exercised discretion in investigating Ms X’s complaint back to 2018, when the Council started its assessment. Ms X complained to the Council in July 2020, before the Council completed its assessment, and brought her complaint to us within 12 months of the Council’s final complaint response.
60. The amount of information provided by the Council in response to my enquiries was considerable. In this report I have not referred to every element of that information, but I have not ignored its significance.

Ms X’s complaint about the assessment process

61. Ms X complains the Council failed to take her needs and wishes into account during the assessment and care planning process. I have reviewed the Council’s case notes and assessment documents. Case notes show the Council told Ms X she was able to talk about her strengths, needs and desired outcomes at the assessment meetings. Having reviewed the assessments, I am satisfied the Council discussed these points with Ms X, as they are recorded within the documents. I have reviewed several assessment documents and Ms X’s needs and wishes are recorded in each and are consistent throughout. As a result, I have seen no evidence the Council failed to take Ms X’s needs and wishes into account, and I have found no fault regarding this matter.

Ms X’s complaint about document sharing

62. Ms X complains the Council failed to routinely share assessment documents with her. Ms X says when the Council did share documents with her, they contained inaccuracies and did not provide details of her medical conditions.
63. The Council’s case notes refer to a telephone call on 21 May 2018 in which Ms X said staff had recorded false and inaccurate information during the assessment process. Case notes dated 22 May 2018 indicate the Council shared a copy of the basic assessment with Ms X because she asked for a couple of sentences to be re-worded. This is the only evidence I have seen relating to Ms X disputing the content of the Council’s assessments.
64. I acknowledge the above notes may be about the alleged inaccuracies referred to by Ms X. However, I do not consider the wording of the assessment represents an inaccuracy as it referred to Ms X’s medical condition and the condition of the property. There is no indication the wording is inaccurate as it is supported by other documents which repeat the findings of the assessment. I acknowledge Ms X may have been unhappy with the choice of words used, but this is not evidence of inaccuracy.
65. I have seen no evidence the Council did not share documents with Ms X as appropriate, and in the absence of clarification from Ms X regarding this, I have found no fault by the Council regarding this matter.

Ms X’s complaint the Council failed to provide a Care Act advocate, except for a two-week period

66. Ms X says she asked for an advocate in 2020 but the Council did not sort it out. However, Ms X says she did receive help from an advocate for some period.
67. The Council says it supported Ms X to engage a suitable advocate each time she requested this. It says an independent Care Act advocate was appointed in May 2020 to support Ms X with the assessment process, and says the advocate worked with Ms X to complete a report with recommendations in August 2020. The Council says advocates are appointed to complete specific responsibilities and are not generally appointed for long-term engagement. The Council says the advocate closed their case in September 2020 as they had completed their task.
68. Case notes show Ms X asked for an advocate in 2018 to attend medical appointments with her. However, the Council says this is not the role of an advocate. Potentially, this role may be provided by a personal assistant if this need is identified as part of a care and support plan. However, when Ms X requested an advocate to accompany her to medical appointments, the Council had not yet completed its assessment.
69. The evidence shows the Council suggested several advocacy services to Ms X on several occasions since 2018 and asked her to let it know which one she wanted the Council to refer her to. The Council’s records show Ms X wanted to maintain control of the process and wanted to make an advocacy referral herself, and that she wanted to obtain further information from the services before deciding which one she wanted to help her. The evidence also indicates Ms X was not always willing to engage with the advocacy services or the Council regarding this matter.
70. The evidence shows the Council provided an advocate for Ms X as part of the assessment process. It also shows the Council provided Ms X with details of several advocacy organisations as requested and encouraged her to engage with the advocacy services. As a result, I have found no evidence of fault by the Council regarding this aspect of the complaint.

Ms X’s complaint the Council failed to consider her in line with safeguarding provisions

Ms X’s requests for a safeguarding enquiry

71. Ms X contacted the Council in February 2018 with concerns about contact from the housing department. Ms X’s concerns at that time were that the Council was bullying her. The Council’s safeguarding policy says, “some concerns may not sit under adult safeguarding processes, but remain concerns that may require other action”. The Council considered Ms X’s request but decided her concerns were complaints rather than a safeguarding issue. It wrote to Ms X to tell her its decision and advised Ms X to contact the housing department if she remained dissatisfied. As a result, the Council recommended other action, namely, to go through the complaints process. This is in line with the Council’s safeguarding policy and I do not find the Council to be at fault regarding this matter.
72. Ms X also raised concerns about her GP to the safeguarding team in March 2019. She said she made several complaints about her GP but did not receive any positive outcomes. Ms X said she considered this to be abuse and said the safeguarding team advised her to discuss the matter with her social worker.
73. The Council’s records show it told Ms X it would pass her concerns onto her social worker so Ms X could discuss her concerns with them. The Council’s records show Ms X was satisfied with this arrangement at the time.
74. The Council’s decision was in line with its safeguarding policy. It considered Ms X’s concerns but decided they did not sit under the adult safeguarding process and referred the matter to Ms X’s social worker instead. As a result, I find no fault by the Council regarding this aspect of the complaint.
75. Ms X requested a safeguarding review in July 2020 when the Council sought a court order to clear her property. Ms X said she felt psychologically abused and bullied by the Council. The Council considered Ms X’s concerns but decided they did not sit under the processes of adult safeguarding. It considered them as a complaint instead and provided a response in line with its complaints policy.
76. Ms X’s concerns at that time were because of the actions taken by the Council to clear her property. As a result, the Council considered the concerns raised were due to Ms X’s disagreement with the Council’s actions, which may therefore be considered to be a complaint. I have found no fault in the way the Council made this decision, and therefore cannot question its outcome. As a result, I have found the Council is not at fault regarding this matter.

The Council’s safeguarding enquiry

77. I have reviewed the safeguarding documents provided by the Council relating to the concerns about Ms X’s welfare in her home, raised in March 2018. The documentation records the details of the actions carried out by the Council, which includes:
• Visiting Ms X at home to clarify/establish the risks to her
• Raising further safeguarding concerns of its own in relation to the condition of Ms X’s property
• Liaising with the Council’s housing department and third-party organisations such as the emergency services and various advocacy organisations
• Carrying out regular risk assessment meetings to monitor the progress of the case and the completion of the comprehensive assessment
• Alerting emergency services in June 2020 when the Council considered Ms X required emergency assistance
• Carrying out a mental capacity assessment. This found Ms X had mental capacity regarding the build-up of items in her property and the risk this posed to her health and safety
• Arranging the clearance of Ms X’s home
• Providing Ms X with alternative temporary accommodation while her home was cleared
• The completion of a Care Act assessment which identified the type of support Ms X required
• The implementation of a care and support package
78. The outcome details of the safeguarding enquiry identified that Ms X required support with “clearing the hoarding in her flat”, as well as “support with a care package”. The Council achieved these outcomes; however, I acknowledge Ms X’s Care and Support plan, and the house clearance were not completed until December 2020.
79. The Council’s documents indicate Ms X did not always engage with the process of clearing her home or completing the assessment. The Council then began legal action in June 2020 to enforce clearance of Ms X’s home. Having reviewed the documents provided, I have found no fault by the Council for the time taken to achieve the outcomes identified by the safeguarding review.
80. I acknowledge Ms X’s comments that she considers the Council did not consider her in line with safeguarding provisions, However, I have seen no evidence to indicate the Council failed to consider Ms X’s concerns, or the concerns raised by others, in line with relevant policy and guidance. As a result, I have found no fault by the Council.

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Final decision

81. I have found no fault by the Council and have concluded my investigation.

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Parts of the complaint that I did not investigate

82. I have not investigated Ms X’s complaint back to 2016 because the complaint is late and I have seen no good reason why Ms X could not have brought her complaint to us sooner.
83. I have not investigated Ms X’s complaint that the Council cleared her home of her possessions without her permission. This is because the Council’s actions related to its provision and management of social housing, resulting in court action to remove items from Ms X’s home.

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Investigator's decision on behalf of the Ombudsman