Summary: Mr L complained about the way the Council supported his son, Mr X’s care needs. Mr L said the Council failed to meet Mr X’s care needs and failed to meet his, and his wife’s needs as carers. The Council delayed in assessing the care and support needs and failed to provide supported living when Mr and Mrs L said they could no longer care for Mr X. The Council agreed to arrange appropriate alternative accommodation for Mr X. It agreed to pay Mr X £500, and Mr and Mrs L £3,000 to recognise the distress and additional strain caused to them over a prolonged period as a result of the faults.

The complaint

1. Mr L complained about the way the Council supported his son, Mr X’s, care needs. Mr L complained the Council:
• failed to act in a timely way to ensure Mr X’s care needs were met;
• failed to ensure his and his wife’s needs as Mr X’s carers were met; and
• delayed in responding to his complaints about the matter.
2. Mr L stated this caused Mr X anxiety, and avoidable distress to both Mr and Mrs L and Mr X.

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What I have investigated

3. Mr L complained about events that began in 2019. Mr L was in constant contact with the Council from 2019 until the date of this decision to resolve the problem. During that time Mr L was admitted to hospital. There are good reasons why Mr L did not complain to us sooner, therefore I investigated the Council’s actions from 2019 until March 2022 when it issued its final decision.

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The Ombudsman’s role and powers

4. 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)
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. When considering complaints, if there is a conflict of evidence, we make findings based on the balance of probabilities. This means that we will weigh up the available relevant evidence and base our findings on what we think was more likely to have happened.
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 read the documents provided by Mr L and discussed the complaint with him and on the telephone.
9. I considered the documents the Council sent in response to my enquiries.
10. I considered our Guidance on Remedies, which is available on our website.
11. Mr L 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

Relevant law and guidance

Care and support legislation

12. Councils must 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. (Care Act 2014 Sections 9 and 10)
13. Councils must provide a care and support plan. The plan should consider what support 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.
14. Where somebody provides care for another adult and it appears the carer may have need for support, the council must carry out a carer’s assessment. A carer’s assessment must seek to find out not only the carer’s needs for support, but also the sustainability of the caring role itself. This includes the practical and emotional support the carer provides to the adult.
15. As part of the carer’s assessment, the council must consider the carer’s potential future needs for support. It must also consider whether the carer is, and will continue to be, able and willing to care for the adult needing care. (Care and Support Statutory Guidance 2014)

What happened

16. Mr X is an adult who has physical disabilities and learning difficulties. In 2017 the Council assessed Mr X’s care needs. It found he had eligible care needs all of which were being met by his parents, Mr and Mrs L. It recorded without his parents Mr X would need 24-hour care. At the time of the events in this complaint, Mr X was living at home with Mr and Mrs L, who were both in their seventies.
17. Mr L says that in 2019, Mr X attended day centers four days a week, in line with his care and support plan. The Council did not provided us with a copy of this plan, despite our request. He visited center 1 and 2 for two days each. Mr L says the day centers helped Mr X to achieve his goals around voluntary activities, independence and avoiding social isolation. Mr and Mrs L met Mr X’s basic care needs. Mr L asked the Council to review Mr X’s care and support needs in February 2019. He wanted Mr X to move to supported living as he and Mrs L could not continue to care for him. He also said center 2 was not meeting Mr X’s needs. The Council’s records show it had not updated Mr X’s care and support plan since 2017.
18. The Council assigned Mr X a social worker in November 2019 who spoke to Mr L and recorded his concerns about day center 2.
19. The Council assessed Mr and Mrs L’s needs as Mr X’s carers in January 2020. It recorded Mr and Mrs L supported Mr X in all areas of his life and were finding it more difficult to care for him. Mr and Mrs L wanted Mr X to move to supported living. It said with extra respite care and personal assistant (PA) support at weekends, Mr and Mrs L would be able to continue caring in the short term.
20. The Council discussed the care package offered by the day centers with Mr and Mrs L in March 2020. Mr L suggested three days at center 1 and one day at center 3, plus six hours of PA support.
21. The Council told us Mr and Mrs L had become concerned about the risks COVID-19 posed to them and their son from January 2020. It said they were reluctant for Mr X to visit the centers or to receive support in their home. It did not provided evidence to support this view.
22. At the end of March, the country was subject to the first COVID-19 lockdown. All services Mr X was accessing stopped and he stayed at home with Mr and Mrs L. Mr L said they were no more concerned than anyone else and Mr X only stopped attending the day centers when they closed. He returned as soon as he was allowed to do so by the management of the centers. Mr L stated the Council did not offer any support in the home during this period.
23. In April 2020 Mr L contacted the Council and requested a carers emergency plan. The Council sent Mr L the paperwork. Mr and Mrs L named two of Mr X’s family members who could travel to support Mr X in an emergency.
24. In July 2020 the lockdown was lifted although the country was still subject to some restrictions. Mr X returned to attending center 1 but did not go back to center 2. Mr L contacted the social worker and asked if Mr X could attend center 1 for three days a week until the Council approved day center 3 for the fourth day. The social worker agreed as he said center 2 was not meeting Mr X’s needs.
25. Mr L contacted the Council in September 2020 and said Mr X was only receiving support three days a week; which was affecting the quality of all their lives. He stated he was not expecting a move to supported living at that time due to the impact of the pandemic on services, but Mr X needed the fourth day at a day center he was assessed for, and the PA support.
26. The social worker asked Mr L to provide written confirmation of why Mr X needed a fourth day at a center. Mr L explained Mr X was only reduced to three days at a center temporarily while a fourth day was arranged. He said Mr X’s behaviour had changed and he and Mrs L could no longer manage to care for him full time.
27. The Council began reassessing Mrs L’s needs as a carer in November 2020. It recorded she found it difficult to support Mr X, even with the support of Mr L, and was at risk of burn-out. The Council did not complete the assessment.
28. Mr L told the Council’s social worker if there was no progress in Mr X’s case then he would make a formal complaint. Another Council social worker contacted Mr L and asked him to provide information on why he wanted Mr X to attend center 3 for a fourth day of care. Mr L provided this information again.
29. In January 2021 the country was subject to a further lockdown due to COVID-19.
30. The Council told Mr L in January 2021 it had declined the fourth day of care for Mr X at center 3 that he first requested in March 2020. It agreed six hours PA support and respite care when required, it did not specify what the respite care would be. The Council asked Mr L to let it know when he would like the support to start.
31. The COVID-19 lockdown was lifted in stages from the beginning of April 2021.
32. Mr L had a medical emergency and was admitted to hospital in April 2021. Mrs L spoke to the Council and said she needed emergency support and could not look after Mr X alone. Three days later, the Council identified an emergency placement in a care home. The Council offered to put in place the PA support that had already been agreed while the placement was arranged. Mrs L did not respond to this offer but accepted an additional day at center 1 for Mr X.
33. Two weeks later Mr X moved to the care home for eight weeks. Mrs L asked the Council to find a suitable supported living placement for Mr X after the emergency placement so he would not need to return home.
34. The Council reassessed Mr X’s care and support plan in June 2021, while he was living in the care home. It recorded Mr and Mrs L could not continue supporting Mr X at home. It said Mr X needed support in all areas of his life to meet his needs. Mr X lacked capacity to decide where he wanted to live. The emergency placement at the care home was extended for twelve weeks while the Council arranged supported living. The Council has since told us Mr X could have stayed longer at the care home. It did not provided any evidence to show it agreed this with the care home or discussed it with Mr and Mrs L.
35. A Council social worker contacted Mr L and said that once he had identified suitable supported living, they would discuss it with Mr X to ensure it met his eligible care needs. The social worker completed an accommodation needs assessment for Mr X which stated residential care was not suitable and supported living would be appropriate long-term.
36. Mr and Mrs L told the Council they had concerns for Mr X’s significant weight gain and wellbeing in his emergency placement in June and July 2021. The social worker took action to ensure the emergency placement addressed the concerns and referred Mr X for an independent advocate.
37. Mr and Mrs L stated Mr X gained three stone during the three months he was in the placement. Mr and Mrs L raised the concerns again at the end of July and asked the social worker for advice about removing Mr X from the placement. The records state the social worker confirmed the Council was happy for Mr and Mrs L to withdraw Mr X from the placement, or to meet with the family and placement to discuss the concerns. The Council said it may take it two or three weeks to source a suitable care provider to support Mr X at home if Mr and Mrs L did remove him. Mr and Mrs L confirmed they could manage for two or three weeks and they brought Mr X home at the end of July 2021.
38. The Council told us it still felt the care home was suitable to meet Mr X’s needs, he could have stayed there. The Council told us Mr L removed Mr X without consulting the Council and without its agreement.
39. The Council reviewed Mr X’s care and support plan. The social worker recorded Mr and Mrs L would care for Mr X while the Council found suitable supported living. The social worker said the Council would arrange a fourth day for Mr X at center 1 and six hours of PA support in the interim.
40. The Council assigned Mr X a new social worker in August 2021. Mr L repeated his request for a fourth day at a day center while supported living was arranged. Mr L explained he had funded a PA for Mr X for one afternoon. The social worker reviewed the care and support plan and said they would explore the fourth day and PA support for Mr X while the Council found supported living. The Council did not provide any evidence it contacted any supported living providers.
41. Mr X began attending center 1 for four days and received PA support starting in October. The Council later agreed to repay Mr L the costs he incurred to arrange a PA from August to October 2021.
42. The social worker visited Mr X at the day center at least four times between September and December 2021 and discussed living arrangements with him. The Council told Mr L he needed to tell Mr X about moving to supported living. Mr L confirmed he had spoken with Mr X about moving in December 2021. A month later, the Council asked Mr and Mrs L to meet, along with Mr X, to discuss supported living.
43. Mr L contacted the Council in February 2022 and asked to delay the meeting for a few weeks due to his own medical reasons. Mr L was worried that due to his ill health he would not manage Mr X’s behaviour once they had discussed him moving. Mr L stated that depending on his diagnosis the Council may need a contingency plan for Mr X’s care. The Council told us this is evidence of Mr L blocking all conversation between the social worker and Mr X about supported living. The Council said it was unable to proceed with its effort to identify supported living for Mr X because Mr and Mrs L were not willing to allow the social worker to tell Mr X he would be moving from home.
44. The record shows that Mr and Mrs L asked professionals to call them on the telephone when Mr X was not at home. Mr and Mrs L said Mr X’s behaviour and interruptions made it difficult for them to hold any kind of conversation if he was present. The records show that Mr and Mrs L encouraged social workers to visit Mr X at the center he was attending and provided advice on how best to engage him in conversation.
45. Mr and Mrs L were in regular contact with the social worker. The records show they openly discussed how they were talking to Mr X about moving. Mr and Mrs L asked the social worker for advice on how to discuss the move with Mr X on four occasions between September and December 2021.
46. Mr L told the Council his health was failing in March 2022, and it might need to move Mr X soon.
47. Records show social workers took all Mr X’s proposed care packages to the Council’s practice forum for approval.

Events that occurred after the period covered by this investigation

48. Mr L sought extra support to meet Mr X’s needs while he remained at home in April 2022. He asked for a temporary placement for Mr X in July 2022 as he was being admitted to hospital and would not be able to care for Mr X. Mr L also said he still wanted the Council to arrange supported living.
49. At the date of this decision Mr X had temporarily returned to the care home he was placed in as an emergency in April 2021 as Mr X was admitted to hospital.

Complaint

50. Mr L stated he complained to the Council in June and July 2021 about the lack of progress in Mr X’s case. The Council says it did not receive those letters.
51. In August 2021 Mr L wrote to the Council and complained it had not made any progress in Mr X’s case in two years. He said they did not understand the cover provided by the emergency carers plan. He said he was paying a PA to meet Mr X’s needs. The Council says it did not receive this letter.
52. In September 2021 Mr L complained to us. We asked the Council to consider Mr L’s complaint.
53. In November 2021 the Council responded to Mr L. It said:
• it would pay back Mr L for the PA between August and October 2021, which it did; and
• Mrs L should have called her family member when Mr L was admitted to hospital according to the carer’s emergency plan.
54. Mr X was dissatisfied with the Council’s response and complained to the Council again in December 2021.
55. The Council responded to Mr L’s complaint three months later. It said it needed to improve:
• staff confidence to progress cases in a timely manner; and
• address staff’s misunderstanding that its practice forums made decisions on the social worker’s behalf. The Council has provided us with a draft copy of its terms of reference for the practice forum. This showed it addressed the confusion social workers had about the role of the forum in decision-making.
56. The Council offered to update the emergency carer’s plan and complete a further carer’s assessment. It apologised for not providing suitable support in a timely way and offered Mr and Mrs L £250 to recognise the inconvenience caused.

My findings

Mr X’s care needs

57. Mr X had eligible care needs. The Council did not provide a copy of the care and support plan for Mr X that was in place before February 2019 and so I cannot know the date it was completed. Council records state it was last reviewed in 2017. The law says councils should keep care and support plans under review. Statutory Guidance says councils should review plans at least every 12 months. It should carry out reviews as quickly as is reasonably practicable (Care Act 2014 Section 27). As the Council did not review the plan until June 2021 the annual review was not completed within the 12 months specified by the guidance. That was fault.
58. Council’s must conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one (Care Act 2014 Section 27). Mr L told the Council Mr X’s needs had changed in February 2019. The Council should have reassessed Mr X’s needs as quickly as possible, given its records show it had failed to carry out a review since 2017. It did not complete its reassessment of Mr X’s needs until June 2021, after he was placed in an emergency placement. This assessment concluded Mr and Mrs L could no longer care for Mr X at home. The delays in reassessing Mr X’s needs were not in line with the statutory guidance and was fault.
59. The faults identified in the two paragraphs above leaves uncertainty whether the Council would have reached its conclusion sooner, that Mr and Mrs L could no longer care for Mr X alone, had it acted without fault. If so, the Council would have been in a position to seek alternative accommodation for Mr X sooner. Therefore, on balance, had the Council acted without fault, I find it would have found Mr X suitable accommodation before the emergency arose in April 2021. Instead, the Council moved Mr X to an emergency placement in April following Mr L’s medical emergency. The sudden move caused Mr X significant avoidable distress and meant Mr X, and Mr and Mrs L, had not had time to prepare for this significant life change.
60. Mr L says Mr X’s care and support plan in force before February 2019 stated he should have four days at a day center per week. On balance, I am satisfied that was the case because even though the Council has failed to provide us with a copy of the plan, this was the support the Council arranged at the time – two days at center 1 and two days at center 2. Following the easing of the March 2020 lockdown, Mr X stopped attending center 2 for two days and instead went to center 1 for three days a week. This was with the agreement of the social worker while they found a fourth day at another center. The Council did not complete a reassessment of Mr X’s needs to satisfy itself his needs were still being met without the fourth day until June 2021 and therefore it should have continued to provide it. When it completed the reassessment, Mr X was in a residential placement and so it did not consider the day center placements. The Council did not arrange for Mr X to receive a fourth day at a day center each week. That was fault and meant that Mr X was without the assessed support to meet his needs between June 2020 and April 2021.
61. The Council said it could not arrange Mr X’s care sooner due to the impact of COVID-19 from January 2020 due to the limited placements available and needing to provide support to those with higher priority. Also, because Mr and Mrs L would not allow social workers to discuss the move with Mr X. However, I find:
• the impact of COVID-19 on Council services did not occur until March 2020.
• it has provided us with no evidence of it approaching any providers to provide full-time care and support or supported living for Mr X in the period covered by this investigation, February 2019 to March 2022, apart from the emergency provision in April 2021.
• there is no evidence the first two social workers attempted to meet Mr X and were prevented from doing so by Mr and Mrs L. There is no evidence a social worker attempted to meet Mr X until September 2021. One social worker told Mr L he would identify supported living first and then discuss it with Mr X. Another social worker said Mr and Mrs L must tell Mr X first then identify supported living.
• Mr L told Mr X about moving when the social worker said it was necessary. He asked their advice about the best way of doing this. Mr L also shared with the social worker the best way to engage Mr X in conversation and encouraged her to meet him alone.
• The further meeting with Mr and Mrs L and Mr X in January 2022 was delayed by Mr L’s ill health.
62. There is no evidence the Council spoke with Mr X’s advocate or took action if it felt its access to discuss matters with Mr X was being obstructed. Mr and Mrs L did not contribute to the Council’s lack of action. As a result, I am not persuaded by the Council’s arguments that the delays were out of its control.
63. The Council told us it could not provide support sooner to Mr X at day centres or care in the home because Mr and Mrs L wanted to limit their contact between other people due to the risk of COVID-19. However, the evidence shows:
• that Mr X attended day centers up until they were closed in March 2020 and returned as soon as he was able to do so in July and August 2020.
• Mr L arranged a PA himself in August 2021 when the Council failed to do so.
64. Even taking in to account the impact of COVID-19 on Council services, Mr and Mrs L requested long term support in February 2019 and their position currently remains unchanged in October 2022, three and a half years later. The delay was fault and exacerbated the injustice identified.
65. Mr X had three social workers between November 2019 and April 2022. Each worker suggested the same package of support while they sought supported living. They took each proposed package to the Council’s practice forum for a decision, all of which added to the delay and was fault. The Council has suggested appropriate steps to prevent that fault occurring again by changing the terms of reference for the forum to clarify its role. I made a recommendation to ensure it completes that action.
66. The Council told us Mr X could have remained at the care home he moved to as an emergency in April 2021. It says it was Mr L’s decision to move Mr X back to their home without the Council’s agreement. The Council was satisfied the care home could meet Mr X’s needs and it had taken action about Mr and Mrs L’s concerns. There are no contemporaneous records that show a permanent placement was an option or ever discussed with the care home or anyone in the family. The records show Mr and Mrs L raised their concerns about the placement three times and the social worker took steps to address their concerns. Mr L asked the social worker for advice and waited until the Council agreed before removing Mr X. Mr and Mrs L declined to meet with the care home to discuss the concerns. However, at the time they understood the placement would be ending six weeks later anyway. As a result, I do not accept the Council’s arguments that Mr and Mrs L contributed in any significant way to the delay in the Council finding Mr X suitable care and support.

Mr and Mrs L’s needs

67. Mr and Mrs L sought a carers’ assessment in February 2019. The Council did not assess their needs until January 2020. The delay in completing the assessment was fault and leaves uncertainty whether additional respite care and support would have been arranged sooner.
68. In each assessment or review since February 2019 Mr and Mrs L, who were in their 70s, said they could not continue to care for Mr X. Mr and Mrs L consistently requested supported living for Mr X. The Council concluded in the January 2020 carers’ assessment that with extra respite care and personal assistant support Mr and Mrs L would be able to continue caring in the short term. The Council did not provide this respite or PA support until October 2021. That was fault. The Council has already reimbursed Mr L for the PA care he sourced and paid for from August 2021. There is still outstanding injustice caused to Mr and Mrs L for the period January 2020 to August 2021, minus the periods of national lockdown when that support could not be provided,
69. Although the Council provided some respite care in October 2021 and paid backdated support to August 2021, there is no evidence it took any steps to identify or arrange longer term support or provide the agreed PA support sooner. The PA support and respite was only meant to be for the short term. During this time Mr L suffered a medical emergency and other medical conditions necessitating hospital stays. In June 2021 the Council’s assessment recorded Mr and Mrs L could not continue supporting Mr X at home. At the date of this decision Mr X, although temporarily in a placement, remained living at home. The Council’s failure to act or consult possible placements was fault and contributed to the significant delays in this case.
70. There was no fault in the Council’s actions when Mr L had a medical emergency. It initially referred Mrs L to the emergency carer plan she and Mr L had written and agreed. It then took action to identify an emergency placement for Mr X. The placement was delayed by two weeks due to COVID-19 protocols which were outside of the Council’s control. In the interim it offered additional respite and PA support to Mr X and Mrs L.

Injustice arising from the faults

71. The faults identified in assessing, arranging and providing the care and support for Mr X and Mr and Mrs L meant that there were periods where the Council did not provide support:
• Between January and March 2020 (11 weeks) Mr X did not receive the respite or the weekend PA support.
• Between March 2020 and July 2020 the country was subject to COVID-19 restrictions and it was not appropriate for the Council to arrange the additional support.
• Between July 2020 and January 2021 (26 weeks) Mr X did not receive the fourth day at a day center, the respite or weekend PA support.
• Between January 2021 and April 2021 the country was subject to COVID-19 restrictions and it was not appropriate for the Council to arrange the support.
• Between May 2021 and July 2021 Mr X was receiving 24-hour residential care.
• Between August 2021 and October 2021 (9 weeks) Mr X did not receive the fourth day at a day center or respite care, taking in to account the Council stated it would take two to three weeks to arrange the support once Mr X left the emergency placement in July 2021.
• Between August 2021 and October 2021 Mr L arranged and funded the PA support for Mr X.
72. The lack of care and support identified above impacted on Mr X’s wellbeing and social skills and caused him distress. The faults also caused extra strain to Mr and Mrs L who had to meet Mr X’s needs at home at a time when Mr L was suffering with his own ill health and Mrs L was also caring for her husband.
73. The faults outline in paragraphs 57, 58, 60, 65 and 67 to 69 caused Mr and Mrs L ongoing distress and placed them under significant strain. They continued to meet Mr X’s needs at home since February 2019 despite stating they could no longer manage. The Council has suggested a payment of £250 to remedy the distress caused to Mr and Mrs L and reimbursed Mr L for the PA support he arranged from August 2021. However, this is not an appropriate remedy. The injustice is compounded due to Mr and Mrs L’s age, Mr L’s ill health, and Mr X’s significant needs, and the prolonged delay from February 2019 to the date of this decision.

Complaint handling

74. Mr L said he sent the Council four complaint letters before it responded. The Council said it did not receive Mr L’s first three complaint letters. I cannot say whether the Council received the letters or not. Further investigation on this point will not provide a different outcome.
75. The Council acknowledged Mr L’s complaint in September 2021 and replied to it in November. It then responded to Mr L’s further complaint within three months. Although the Council did not maintain contact with Mr L during its consideration of the complaint it dealt with it within an appropriate time once it acknowledged it, it was not at fault.

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Agreed action

76. Within one month the Council will:
• pay Mr X £500 to recognise the distress and impact on his wellbeing caused by the Council’s failure to reassess his needs, provide timely care and support and provide the agreed support over 46 weeks. The Council will not include this amount in any financial assessment it completes for Mr X’s care contributions;
• apologise to Mr and Mrs L to recognise the significant strain caused to them by the Council’s failure to meet their needs as carers from February 2019 to April 2021 and August 2021 to March 2022; and
• pay Mr and Mrs L a symbolic payment of £1500 each for the unnecessary distress and strain caused by the Council’s delays, failure to provide agreed support, and failure to act quickly on the need for longer term care for Mr X.
77. Within three months the Council will:
• ensure an appropriate permanent alternative living arrangement is identified and arranged for Mr X based on his assessed needs. If it is able to demonstrate there are good reasons for any delay that is beyond the Council’s control, it needs to put in place additional support for Mr and Mrs L and Mr X to make up for the lack of a suitable placement;
• remind staff of the timescales for reviews of care and support plans, at least every 12 months, and that when someone’s needs have changed, they must carry out a new needs assessment without delay; and
• complete a final version of the amended forum guidance document and share it with relevant staff members.
78. The Council will provide us with evidence it has completed the above recommendations.

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Final decision

79. I have completed my investigation. I found fault leading to injustice and the Council agreed to my recommendations to remedy that injustice.

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Investigator's decision on behalf of the Ombudsman