Summary: Mr X complains on behalf of Ms Y. He complains about a delay in providing care and support to Ms Y, providing reablement rather than direct payments without agreement from Ms Y and providing a care plan and direct payments which do not meet Ms Y’s needs. The Council is at fault as it delayed in progressing Ms Y’s assessment and did not consult Ms Y when providing reablement and ensure it met her needs. This caused avoidable distress to Ms Y which the Council has agreed to remedy by apologising and making a payment of £300 to Ms Y. The Council will also remind officers of the need to make person centred decisions when offering reablement.

The complaint

1. Mr X complains on behalf of Ms Y. He complains that the Council:
1. Delayed for four months in providing care and support to Ms Y following its Care Act assessment of 21 January 2021 which identified she had eligible needs as the authorisation panel did not have capacity to consider Ms Y’s case.
2. Provided reablement rather than direct payments without discussion with, or agreement from Ms Y. The reablement package was inappropriate as it did not meet Ms Y’s needs identified in the Care Act assessment.
3. Delayed in carrying out support planning for Ms Y. The Council then provided an inadequate support plan which did not meet her needs identified in the Care Act assessment of January 2021. The authorisation panel also arbitrarily reduced Ms Y’s direct payments from 12.25 hours per week to 7 hours per week.
4. Failed to respond to Mr X’s complaint.
2. Mr X says that as a result, and in view of the previous upheld complaints, Ms Y has not received support for over three years which has caused significant distress to her.

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The Ombudsman’s role and powers

3. 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)
4. 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

5. I have:

• Considered the complaint and the information provided by Mr X;
• Made enquiries of the Council and considered the information provided;
• Invited Mr X and the Council to comment on the draft decision. I considered any comments received before making a final decision.

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What I found

Law and guidance

6. 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.
7. 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.
8. Paragraph 11.4 of the Care and Support Statutory Guidance states that the process used to establish the personal budget should be transparent so people are clear about how their personal budget was calculated.
9. Councils may propose a period of reablement to help a person regain their skills and capabilities to reduce their needs. Reablement is free of charge for a period of up to six weeks.

What happened

Background

10. Ms Y has a visual impairment, autism spectrum disorder (ASD) and physical and mental health conditions. In 2020 Mr X made a complaint to the Ombudsman on behalf of Ms Y. He complained about the adequacy of a Care Act assessment carried out for Ms Y by the Council. We found fault in how the Council carried out the Care Act assessment and concluded it was inadequate. It did not explore whether Ms Y had needs arising from her physical and mental health conditions, the impact of those conditions on her well being and ability to meet her outcomes. This meant Ms Y could not be satisfied the Council had a complete picture of her needs and this could have compromised a review of her needs carried out by the Council in May 2020.
11. In order to remedy Ms Y’s injustice the Council agreed to carry out a new Care Act assessment. This was to fully consider if Ms Y had needs arising from her physical and mental health conditions which impact on her wellbeing and ability to meet the outcomes.

Events since February 2021

12. The Council carried out a new Care Act assessment for Ms Y in January and February 2021. It found Ms Y had eligible needs and recommended a care package via direct payments. The assessment noted Ms Y would benefit from this option of care as it takes her time to build a trusting and supportive relationship.
13. The Council says it sent Ms Y a copy of her assessment for her comments in March 2021. The Council also did not progress to support planning as the allocated social worker was absent.
14. In April 2021 the Council allocated Ms Y’s case to a new social worker, officer A. She chased Ms Y’s comments on the assessment. Ms Y submitted her comments pointing out factual inaccuracies in the assessment. Officer A advised Ms Y that her manager, officer B, would consider the assessment and once authorised she would be able to start support planning and take it to the care authorisation panel. Officer A said no panel dates were currently available. In correspondence with Mr X, officer B said the assessment could not be changed and suggested a further assessment but this was not pursued.
15. The Council’s records show Officer A consulted other professionals on whether it would be appropriate to refer Ms Y for reablement. The record notes the Council considered Ms Y would benefit from support on building her confidence with meal preparation and prompting and supervision of her personal care. In response to my enquiries the Council has said the reablement support was an interim package to ensure Ms Y received care until her support plan and direct payment was processed. It was also intended to help Ms Y regain some independence and establish her strengths.
16. In June 2021 officer A notified Ms Y that she would be offered reablement and this would be included in her support plan. She advised this was to help Ms Y regain her independence and develop a better understanding of her needs.
17. I understand reablement started in June 2021 and was for 12.25 hours per week. The Council’s records show Ms Y’s advocate contacted officer A and said it would be good to establish a routine and have a timetable so Ms Y knew when support and who was coming. I understand the care provider had tried to contact Ms Y to carry out an assessment. However, she could not cope with a long assessment and her advocate asked officer A if it could be broken down. I understand officer A suggested this to the care provider
18. The records also show an officer contacted Ms Y to see how the care was going and she said she was happy to have some of the carers attending regularly. Shortly afterwards Ms Y’s advocate raised concerns about her mental health.
19. Mr X complained to the Council the reablement package was inappropriate as it was not designed to meet Ms Y’s specific needs, in particular her mental health and autism. Officer B responded and advised reablement was intended to provide a better understanding of Ms Y’s needs.
20. Officer A contacted Ms Y’s advocate to discuss support planning. The advocate said Ms Y was unhappy with reablement as some support workers did not help her and she was tired of different people coming into her flat who she did not know. The advocate said some of the support workers had been good and understood Ms Y’s condition.
21. In July 2021 officer A arranged a meeting to carry out support planning for Ms Y. The meeting included Ms Y’s mental health care co-ordinator and the care provider. The record of the care planning meeting shows officer a discussed with Ms Y, her advocate and the care provider the problems experienced with reablement and how Ms Y would like to be supported. Ms Y said she would prefer direct payments so she could appoint her own personal assistant. Officer A concluded Ms Y would benefit from more support with her mental health which impacts on her day to day outcomes. She would also benefit from regular carers who understand her diagnoses and who she could build a relationship with. The record notes officer A would finalise the support plan and make a recommendation of a care package to be provided by direct payments.
22. Officer A drew up the support plan for Ms Y. This shows an indicative budget of £94.43 for seven hours of care per week. The support plan was then agreed by a senior officer. In response to my enquiries the Council has said officer A recommended a care package of seven hours per week in addition to other professional support. The Council would review Ms Y’s care once in place after six weeks to ensure it met her needs.
23. The Council awarded the direct payment in July 2021. It has said Ms Y has not used the payment as she has not yet appointed a personal assistant.
24. In autumn 2021 officer B notified Mr X that Ms Y would receive direct payments for 12.25 hours of care. Officer B later acknowledged this was an error on her part and she should have notified Mr X that Ms Y would receive direct payments for 7 hours of care per week. She stated this was agreed by the care authorisation panel. The Council, in response to my enquiries, has said this was agreed outside of the panel process. This is because care packages of seven hours or less do not require panel authorisation.

Complaint

25. Mr X made a complaint to the Council in May 2021 about the delay in finalising Ms Y’s assessment and in providing a care package for Ms Y. He later complained about the Council providing reablement rather than the care package to Ms Y. Officer B explained why the Council had offered reablement and referred Mr X to the Council’s complaints procedure for adult social care complaints. The Council has acknowledged it did not respond to Mr X’s complaint.
26. The Council responded to Mr X’s email to legal services in June 2021. Mr X made a complaint in November 2021 as he considered Ms Y’s support plan to be inadequate as it did not make reference to the difficulties experienced by Ms Y during reablement and that she required prompting to do some daily tasks. He also complained about a lack of transparency in the setting of Ms Y’s personal budget. The Council did not uphold Mr X’s complaint.

Analysis

Delays in finalising the Care Act assessment

27. The Council, in response to my enquiries, has acknowledged Ms Y’s assessment could have been finalised in a more timely manner. I am mindful Ms Y’s assessment had to be reallocated to another officer and that Ms Y did not provide her comments on the assessment when sent to her in March 2021.But this meant Ms Y’s assessment was not progressed between early February and April 2021 which is fault. I am also not clear why the Council was suggesting a further assessment when Ms Y’s disagreement was only over minor factual matters rather than her needs.

Reablement

28. The Council is not at fault for considering reablement for Ms Y. It is an option for councils to establish what support is needed and to assist them in regaining independence.
29. But the statutory guidance provides that care and support planning should be person centred. There is no evidence to show the Council consulted Ms Y on the decision; the Council simply told her that reablement would be included in her support plan. There is no evidence to show the Council considered how reablement could be adapted to meet Ms Y’s needs arising from her ASD. The Care Act assessment noted Ms Y needed time to build a trusting relationship but there is no evidence to show this was considered when arranging reablement. Ms Y declined the reablement provider’s assessment but this was because she could not cope with a lengthy assessment. Officer A later suggested regular carers and the assessment to be carried out over several sessions. But such adjustments should have been made in consultation with Ms Y before reablement commenced. On balance, I consider the Council’s decision to provide reablement was not person centred and did not take account of her needs arising from ASD. This is fault.

Direct payments

30. The Council carried out support planning with Ms Y towards the end of the reablement period. It also agreed to provide direct payments which was Ms Y’s preference. So, I am satisfied it carried out person centred support planning when determining Ms Y’s ongoing care package.
31. In response to my enquiries the Council has explained it considers Ms Y’s needs could be met with a care package of seven hours per week in addition to other professional support. It would have been better for the Council to have fully explained to Mr X and Ms Y why it considered the care package to be sufficient in order to ensure transparency. But I will not pursue this matter further as I do not consider there is sufficient injustice to Ms Y as there is no evidence the care package cannot meet her needs. This is because Ms Y has not yet used her direct payments as she has not been able to find a personal assistant. When she does appoint a personal assistant the Council will review Ms Y’s care package after six weeks and can determine if the care package of seven hours per week is sufficient to meet her needs.

Injustice to Ms Y

32. The Council’s delay in progressing Ms Y’s Care Act assessment caused some frustration to her. Ms Y received care but the Council’s failure to consult Ms Y on the decision to provide reablement and consider her needs arising from ASD caused avoidable distress to her. The Council should remedy this injustice.

Complaint

33. The Council’s complaint handling was poor. It has acknowledged that it failed to provide a response to Mr X’s complaint in May 2021. The Council also should have dealt with Mr X’s correspondence of May 2021 to officer B as a complaint rather than expecting him to make a separate complaint. But as Mr X was acting for Ms Y, I do not consider the failure to deal with Mr X’s complaint to have caused significant injustice to Ms Y. The Council responded to Mr X’s complaint to legal services in June 2021 and his complaint of November 2021.

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Agreed action

34. That the Council:
1. Sends a written apology and makes a payment of £300 to Ms Y to acknowledge the frustration and distress caused to her. The Council should take this action within one month of my final decision.
2. By training or other means, ensure officers make a person centred decision when offering reablement by consulting service users on a decision to provide reablement and ensuring specific needs are met by the reablement service. The Council should take this action within two months of my final decision.

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Final decision

35. I find fault by the Council causing injustice to Ms Y. The Council has agreed to remedy the injustice in an appropriate and proportionate way so I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman