Summary: There is evidence of fault in this complaint. There are inconsistencies in two needs assessments completed eight weeks apart. The Council failed to record an increase in care hours as temporary and failed to inform Mrs X of the same. The latter assessment failed to properly consider if/how Mrs X’s health impacted on her care needs.

The complaint

1. Mrs X complains the Council failed to properly reassess her care needs and unfairly reduced her care and support hours.

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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 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

4. I have:

• considered the complaint and discussed it with Mrs X;
• considered the correspondence between Mrs X and the Council, including the Council’s response to the complaint;
• made enquiries of the Council and considered the responses;
• considered relevant legislation;
• offered both parties an opportunity to comment on a draft of this document, and considered the comments made.

Relevant legislation

5. Sections 9 and 10 of the Care Act 2014 require local authorities 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.
6. The statutory guidance at part 6 says a council must consider “the total extent of a person’s needs” before it “considers the person’s eligibility for care and support and what types of care and support can help to meet those needs”. This must include looking at the impact of the adult’s needs on their wellbeing and whether meeting those needs will help the adult achieve their desired outcomes.

What happened

7. Mrs X is in her sixties. She has numerous medical conditions which have a significant impact on her life and her ability to undertake daily living tasks. She has been housebound for six years. Mrs X says her poor physical health affects her mental health.
8. The Council reviewed Mrs X’s needs in February 2021. At this point she was allocated 20 care hours per week. Previously, she received 30 hours, the Council reduced this to 20. Mrs X challenged this via Judicial Review. Following mediation, the matter was resolved. I do not intend to comment further.
9. From February 2020 onwards Mrs X says her health deteriorated and she had four admissions to hospital in as many weeks, so she requested a review of her care needs. The Council completed the review in May 2021. I have had sight of the review document dated 25 May 2021. Both Mrs X and her personal assistant were present. Mrs X told the assessor her health had deteriorated rapidly in the last month, that she had lost a significant amount of weight and she was booked for a review with her GP and the falls clinic. She said she was virtually bed bound and suffering with constant pain and fatigue, and this was having a detrimental effect on her mental health.
10. Mrs X’s personal assistant said Mrs X’s health had deteriorated significantly since she began working with her in November 2020, and she often worked above the allocated 20 hours in order to meet Mrs X’s needs.
11. The assessor noted Mrs X to have an “…extensive medical condition which has since deteriorated… However, due to rapid deterioration in her health and mobility as she is now bed bound and unable to carry out some of the activities, she could do prior to the rapid change in her health. A request to reinstate the additional 10 hours has been requested by [Mrs X]. During a home visit, it was evident she is relying on her PA to support with her daily living activities”. And, that Mrs X was seeking additional hours for support in the evening with meals and personal care.
12. The assessor noted Mrs X’s personal assistant provided 3 hours daily support in the morning, and that she “…was asked to split the 3 hours in the morning in order to manage her evening calls. However, due to incontinent issue, laundry is carried out every day”.
13. The assessor concluded Mrs X needed an increase in care hours, (20 to 25 per week) to meet her evening needs. The increase took effect on 25 May 2021. Mrs X says she was not told the increase was temporary. The assessor noted a Continuing Healthcare (CHC) checklist had been completed on 18 February 2021, following which Mrs X was referred to the NHS for a full CHC assessment.
14. The Council says the review was completed by its joint emergency team (JET). The increase in care hours was agreed pending further assessment by its crisis and intensive treatment (CAIT) team.
15. Mrs X sent the Council an email in June 2021 to say she believed her care hours needed increasing. She says an Occupational Therapist (OT) and a physiotherapist told her they had advised the Council that she required an increase in care hours. I have seen no evidence which confirms this. Mrs X decided to employ a second personal assistant to support her on four evenings a week, and that she hoped her existing personal assistant would work the remaining evenings.
16. The Council reviewed Mrs X needs again in July 2021. I have had sight of a copy of the review document dated 7 July 2021. The assessor recorded the previous increase in support hours was subject to further assessment and that the evening support was already accounted for in the allocated hours prior to JETS involvement. I have seen no evidence to show any further assessment had taken place.
17. The assessment shows very little change in Mrs X’s needs from that of the previous assessment apart from ‘managing toilet needs’. The previous assessment completed in May 2021 records Mrs X was no longer able to use the toilet and required support with using the commode. The June assessment recorded Mrs X struggled to use the toilet; that she had a commode by her bed which she could use independently.
18. The assessor recorded Mrs X chose to use her allocated hours in block each morning instead of spreading her care hours out through the day. The previous assessor recorded this was due to incontinence and resulting laundry.
19. The assessor noted Mrs X had available 15 support hours to enable her to organise her home and belongings. The hours were unused but were still available. Mrs X disputes this. She says she informed the direct payment team that these hours had been used by her personal assistant during the period 3 May 2021 - 30 May 2021, and this was recorded on the personal assistant’s time sheet in order payroll were informed.
20. The assessor also noted there were 128 hours accrued and that Mrs X could use as she wished. Mrs X again disputes this and says this is evidence that officers fail to heed her emails and fail to update records. She says she has used all her allocated hours and on 3 December 2021 she had only £18 in her direct payment account which resulted in a delay in paying her personal assistant. The evidence I have seen supports what Mrs X says. Statements of her direct payment account show she had low funds in late November/early December 2021 and do not show accrued monies.
21. The assessor concluded Mrs X needed 22 hours per week, and provided a breakdown of tasks required at each visit:

• 1hr am x7 days to support with personal care, breakfast, empty commode and tidy around
• 1hr midday x7 days to support with meal preparation and clean up afterwards.
• 30mins at teatime x7 to support with preparing snack and drink.
• 30mins at bedtime x7 to assist with personal hygiene and assist to bed
• 1hr weekly to support with housework and laundry.

22. Shopping is delivered weekly to Mrs X’s home. The assessor recommended carers assist with putting it away.
23. The assessor recommended that the direct payment team and workers involved with Mrs X advise her to spread her care hours over the day. She made referrals to Mrs X’s GP, a befriending service, and made a note to contact the NHS Continuing Health Care Team (CHC) for an update on the CHC referral.
24. Mrs X says the Council has not consulted her GP or any other clinician involved in her care to enquire about her medical conditions.
25. The records show a social worker sent an email to the NHS on 3 August 2021 requesting information from two consultants involved in Mrs X’s care. She also said Mrs X was known to other NHS specialities and wondered whether there was ‘more going on’ with her.
26. Mrs X sent two emails to the Council in August 2021 expressing concern about the way the review was conducted and complaining about the reduction in care hours. She confirmed receipt of an email attaching her care plan, but said it was too long a document to read online. She said she had not received a hard copy of her care plan as she requested.
27. I have had sight of the Council’s complaint response dated 17 September 2021. The author of the letter refers briefly to Mrs X dissatisfaction and says, “I have reviewed this and am satisfied the new care plan meets your current needs”. He then went on to comment on previous complaints Mrs X made about reductions in her care hours and the outcome.
28. Mrs X responded directly to the author of the letter the same day setting out her dissatisfaction and disagreement with the officer’s response.

Analysis

29. It is not the Ombudsman’s role to decide if a person has social care needs, or if they are entitled to receive services from the Council. The Ombudsman’s role is to establish if the Council assessed a person’s needs properly and acted in accordance with the law.
30. In this case I am not persuaded the Council has acted properly.
31. I have seen no evidence that confirms the increase in care hours following the May 2021 assessment was temporary and subject to further assessment. Neither have I seen evidence that Mrs X was informed of such.
32. The assessor noted a deterioration in Mrs X’s condition, that she was experiencing incontinence and there was increased laundry, and this was the reason she was not splitting her care hours throughout the day. I note Mrs X’s health warranted a referral to the NHS CHC for assessment. This suggests Mrs X’s needs were complex.
33. There is no evidence of further assessment of the situation until Mrs X contacted the Council again to ask for a further increase in care hours.
34. The assessment completed in July 2021 shows no change in Mrs X’s needs apart from continence. The assessor confirmed Mrs X struggled to use the toilet but said she could use a commode unaided. There is no mention of the incontinence referred to in the previous assessment, or the resulting laundry. If this had improved or resolved, then I would have expected the assessor to refer to it. As it stands the two assessments, completed only eight weeks apart, have opposing views about Mrs X’s abilities and needs on toileting/continence. As such I am not persuaded this matter has been properly considered. This is a significant issue, if incontinence is an issue then 1hr per week for laundry would be insufficient. I also note the assessment fails to record any consideration the frequent hospital admissions and the reasons for this.
35. There appears to have been no assessment undertaken by an occupational therapist or physiotherapist. Given Mrs X’s complex needs, I would have expected such assessments to have been completed.
36. Mrs X believes the Council failed to consult her GP and other clinicians involved in her care. The information I have seen shows a social worker did contact her GP and that the GP responded. However, the information the GP provided is a clinical overview, and I cannot see it would inform any assessment of need. The social worker also attempted to contact specialist clinicians involved with Mrs X, but it appears there was no response. I note the Council refers to the number of clinical specialities Mrs X was known to and considered if she had ‘more going on’. Clearly there was some concern that Mrs X’s needs maybe more complex than was known. I have not seen any evidence to show this was clarified. There appears to have been insufficient consideration of Mrs X’s overall health and any dependency this may create.
37. The Council sent Mrs X’s care plan via email. It should have followed this with a hard copy as requested.
38. In respect of the Council’s complaint response. I can understand Mrs X’s dissatisfaction here. The response failed to adequality respond to the issues Mrs X raised and then referred to matters not relevant and which had been previously dealt with, which the author appeared to use to support the Council’s position.
39. Overall, there is evidence of fault by the Council. There are inconsistencies in two assessments completed eight weeks apart. The Council failed to record an increase in care hours as temporary and that it was subject to further assessment. It also failed to inform Mrs X of the same. The latter assessment also failed to properly consider if/how Mrs X’s health impacted on her care needs.

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Agreed action

40. The Council will within four weeks of the final decision:

• provide Mrs X with a written apology for shortcomings highlighted above;
• arrange a full re-assessment of Mrs X’s care needs, undertaken by someone not previously involved with her. And provide Mrs X with a hard copy of a care & support plan;
• confirm the outcome of the CHC referral;
• provide evidence of the all the above to this office.

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Final decision

41. There is evidence of fault in this complaint. There are inconsistencies in two assessments completed eight weeks apart. The Council failed to record an increase in care hours as temporary and that it was subject to further assessment. It also failed to inform Mrs X of the same. The latter assessment also failed to properly consider if/how Mrs X’s health impacted on her care needs.
42. The above recommendations are a suitable way to address the injustice caused.
43. It is on this basis; the complaint will be closed.

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Investigator's decision on behalf of the Ombudsman