Summary: Mr X’s needs had increased after a fall and the Council put more care in place. Once his care staff confirmed they could deliver the right care in fewer hours again, and Mr X was expected to improve with rehabilitation, it was not fault on the part of the Council to reduce his hours.

The complaint

1. Mr A (as I shall call the complainant) complains the Council reduced the care hours provided for his father Mr X, although his needs had not changed.

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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. 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

4. I considered all the information provided by Mr A and by the Council. Both Mr A and the Council had an opportunity to comment on an earlier draft of this statement and I considered their comments before I reached a final decision.

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What I found

Relevant law and guidance

5. 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.
6. 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.
7. Everyone whose needs the council meets must receive a personal budget as part of the care and support plan. The personal budget gives the person clear information about the money allocated to meet the needs identified in the assessment and recorded in the plan. The detail of how the person will use their personal budget will be in the care and support plan. The personal budget must always be enough to meet the person’s care and support needs.
8. Where somebody provides or intends to provide care for another adult and it appears the carer may have any needs for support, the council must carry out a carer’s assessment.
9. The Mental Capacity Act 2005 is the framework for acting and deciding for people who lack the mental capacity to make particular decisions for themselves. A person aged 16 or over must be presumed to have capacity to make a decision unless it is established they lack capacity.

What happened

10. Mr X had received care commissioned by the Council for some time. He had three care calls a day (14.5 hours a week) to assist with personal hygiene, meal preparation and domestic tasks. Although Mr X lives in the same property as two of his adult sons, he says his sons do not provide care for him other than helping with a weekly bulk food shopping order. Mr X has capacity to make his own decisions about his care.
11. In May 2021 Mr X had a fall and was lying unattended for some time. A physiotherapist assessed him in hospital; and recommended additional help on discharge. When Mr X returned home on 1 June the Council put in place an additional care call, so he now had a total of 22.5 care hours a week. The Council says this recognised his “reduced mobility and confidence post discharge.”
12. A social worker assessed Mr X on 16 June. She noted that Mr X was on the waiting list for home-based physiotherapy to help him improve his mobility and transfers. She added, “It is anticipated with on-going rehabilitation, care timings can be reduced to reflect new baseline”.
13. Following the assessment, the social worker’s manager did not consider Mr X’s presenting needs justified continuing the number of hours currently in place. The social worker was asked to discuss with the care agency whether it could provide the necessary care within a shorter time period. There was also concern about the amount of time (then two hours) required for cleaning when the house was split into flats, with Mr X’s sons (responsible for their own cleaning) living in the other flats. The care agency said it was prepared to provide care using a reduced amount of time and report back in regard to performance.
14. The social worker submitted a funding request to the Council’s Vulnerable Adults Panel. The report said Mr X had suffered a decline in his mobility and transfer ability since the fall and would benefit from an increase in hours (from the 14.5 previously funded) to provide increased assistance with transfers and with help in putting him to bed. It was recommended that the care agency continue with four calls a day, each of 45 minutes, and that the domestic hours were reduced by30 minutes. The Panel approved a care package of 21 hours a week.
15. Mr A complained to the Council. He said he did not know the hours for his father’s care were going to be reduced until the care agency told him. He then said he had spoken to a social worker who told him the hours were going to be reduced.
16. The Council responded to Mr A’s complaint. It said, “Your father’s domestic care call of 2 hours was reduced to 1.5 hours because your brothers live in the same property as your father. The domestic call is to provide the cleaning support for your father around his section of the house. The approving panel agreed that the timing was enough to meet this need. The morning care call was reduced by 15 minutes because your father’s function improved post discharge and it now takes less time to provide him with personal care. This information was confirmed by the Care provider “. It said the social worker had recorded she had discussed this with Mr A and noted his intention to make a complaint.
17. Mr A complained to the Ombudsman. He said the care provider had told him the social worker said she did not care where the reduction was, she wanted a reduction of 45 minutes. He said he had never given permission to assess his father’s needs by telephone. He also says he has never had a carer’s assessment.
18. The Council says it cannot find any evidence from the assessing officer, the team which arranges care or the care provider that the social worker asked for any reduction of 45 minutes and it points out the reduction was actually 1 hour 30 minutes.
19. Mr A has supplied a copy of the email to which he refers but it does not contain the words he says. The care agency says, “the AM call takes one hour….(Mr X) now eats his main meal at lunchtime and the tea visit can changed (sic) to 30 min. Can you change the AM call to one hour and the tea visit 30 mins.””. The social worker replies: “it’s fine as long as it evens out and the weekly hours remain the same.”
20. Mr A says the Council did not speak to him about the reduction in hours: the Council says, “The assessing social worker, when questioned, said that she had spoken with (Mr X) about this and that he had asked her to speak with his son (Mr A) about it. Unfortunately, we cannot evidence that conversation as it is not case noted”. The social worker’s report to the Vulnerable Adults Panel said, “I discussed possible reduction in POC with (son) and he reported that family are not able to support him as they’re hardly there and do not visit regularly…..(Mr A) has stated that should domestic care calls/reduce to support hours be reduced, he would be writing a letter of discontentment and would also like written plan on how the reduction in care hours will be covered by ASC and carers”. Mr A says it is the Council’s duty under the Care Act to maintain correct records and it has not done so in his case.
21. The Council says, “With the exception of weekly bulk food shopping, it has been repeatedly reported that (Mr X) does not receive informal care from his family, despite that being his wish. The care and support (Mr X) receives is formal.” The Council says that it has not therefore completed a carer’s assessment for Mr A.
22. Mr A says this is not true: he says he takes his father for appointments, assists with his finances and benefits, and provides emotional support. However, Mr X says his sons do not provide assistance towards his long-term care. The social worker noted in her assessment of his needs, “(Mr X) says he sees his kids less than often due to their own commitments. This was further clarified by his son….who reports that his siblings have their work and family commitments”. The assessment goes on, “(Mr X) continues to require support with domestic tasks as family do not assist in this area”.
23. In respect of the reduction in Mr X’s funded hours of care, the Council says. “The increased amount was in place from 29 June 2012 until 11 July 2021 when the package of care was reduced by 1.5 hours to 21 hours weekly. (Mr X’s) assessment of need recognised that he would receive home-based rehabilitation, specifically Physiotherapy input, in the hope of returning him to his previous baseline before being admitted to hospital. At the point of assessment (Mr X) was on the waiting list for that input and it was anticipated with on-going rehabilitation, that care timings could be reduced in the future.”

Analysis

24. In total Mr X’s care package was increased by the Council to 21 hours from 14.5. This recognised his increased needs. For a short period post-discharge, he benefited from an additional 1 hour 30 minutes, but after assessment and discussion with the care agency, this was no longer deemed necessary to meet his needs. There is no evidence of fault on the part of the Council in the way it reached that decision.
25. Mr X’s adult sons live separately from him, two of them in the same property and do not provide informal care. In those circumstances there is no requirement for the Council to conduct a carer’s assessment, but in the light of what Mr A now says about the amount of support he provides for Mr X, the Council should review the need for a carer’s assessment.
26. Although Mr A says the social worker did not discuss a reduction in hours with him, and the officer in question did not note this in her case recording, the way in which she noted her conversation in the report to the funding panel seems on the balance of probabilities to agree with her version of events. The Council acknowledges the social worker should have made a note of her conversation and that was fault on its part, but I cannot see that on this occasion that caused any injustice to Mr X. In any event Mr X has capacity to consent to the assessment and did not require the agreement of his sons.

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Final decision

27. I have completed this investigation as there is no evidence that fault on the part of the Council has caused injustice to Mr X.

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Investigator's decision on behalf of the Ombudsman