Summary: We did not uphold complaints about inaccurate records or a lack of carer support because the Council carried out assessments of Mr Y’s needs and a carer’s assessment for Ms X in line with the Care Act 2014. We were satisfied the records were accurate.

The complaint

1. Ms X complained Cheshire West and Chester Council (the Council):
1. Incorrectly recorded details of an incident in March 2021
2. Did not provide her with carer support during the pandemic and offered inappropriate care services
3. Made errors in responding to her complaints.
4. Did not accept her husband Mr Y has vascular dementia
5. Did not give costs for telecare
6. Contacted her from an unrecognised mobile number to ask about her husband’s finances
7. Gave her an incorrect emergency number for social services, and did not provide a reliable contact number after repeated requests

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What I have investigated

2. I have investigated complaints (a) to (e). My reasons for not investigating complaints (f) and (g) are at the end of this statement.

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The Ombudsman’s role and powers

3. We provide a free service, but we must use public money carefully. We do not start or may decide not to continue with an investigation if we decide any injustice is not significant enough to justify our involvement. (Local Government Act 1974, section 24A(6))
4. We investigate complaints about ‘maladministration’ and ‘service failure’. In this statement, I have used the word fault to refer to these. 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 considered Ms X’s complaint to us, the Council’s response to the complaint and documents in this draft statement. A colleague discussed the complaint with Ms X on the phone. I considered comments from the Council and Ms X on two drafts of this statement.
6. Ms X and the Council had an opportunity to comment on two draft decisions. I considered any comments received before making a final decision.

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What I found

Relevant law and guidance

7. A council 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 outcomes they want to achieve. It must also involve the individual and where appropriate their carer or any other person they might want involved. (Care Act 2014, section 9)
8. An adult’s needs meet the eligibility criteria if they arise from or are related to a physical or mental impairment or illness and as a result the adult cannot achieve two or more of the following outcomes and as a result there is or is likely to be a significant impact on well-being:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Making use of the home safely
• Maintaining a habitable home environment
• Accessing work, training, education
• Making use of facilities or services in the community
• Carrying out caring responsibilities.

(Care and Support (Eligibility Criteria) Regulations 2014, Regulation 2)

9. A council must carry out a carer’s assessment where it appears a carer may have needs for support. The assessment must include an assessment of the carer’s ability and willingness to continue in the caring role, the outcomes the carer wishes to achieve in daily life and whether support could contribute to achieving those outcomes (Care Act 2014, section 10)
10. Council social care is financially assessed and people who have savings of £23,250 or more have to pay the full cost of their care.
11. Social prescribing schemes involve various free activities typically provided by community and voluntary organisations like volunteering, arts activities, group learning, gardening, befriending, cookery and sports. Most schemes involve a link worker (not usually a council officer) who helps people connect to community groups and agencies for practical and emotional support.
12. Information on the NHS website (How to get a dementia diagnosis - NHS (www.nhs.uk) says dementia can be difficult to diagnose and the GP will refer a patient to a specialist doctor (like an old-age psychiatrist or a doctor specialising in care of the elderly). The specialist may do a brain scan or more detailed memory tests.

What happened

13. The Council’s case records of March 2021 said:

‘Ambulance report – carer breakdown/domestic abuse – police on the scene

Police called as this dementia patient assaulted partner (domestic assault) Ms X had been hit over the head……Mr Y was reported to be calm, lucid, compliant and is diagnosed with vascular dementia……this referral is being submitted as the clinician feels that given how volatile and emotional this situation is now and due to Mr Y’s presentation due to his dementia, both Ms X and Mr Y would benefit from an assessment of their situation to look at what the needs are and what support is available’

14. The case records noted a social worker and Ms X spoke on the phone the same day as the ambulance report described in the last paragraph and Ms X gave information about Mr Y’s health, family and other personal details including some general information about the couple’s finances. The social worker noted Mr Y had savings over £23,250. The social worker noted Ms X also told her:
• She prompted Mr Y to shower. He could shower independently
• He could dress and undress independently although he did not always wear appropriate clothes and this caused arguments
• He could make himself a hot drink. She prepared all his meals
• She did the cleaning.
15. The social worker noted Mr Y did not require support from (paid) carers as he was physically independent. The social worker also noted:
• Ms X was worried about what would happen if she became unwell.
• Ms X had a carers’ emergency card and the social worker said she should contact the service again to update the card and the contingency plan.
• She had discussed a referral for mental health support (‘IRIS’) through Mr Y’s GP. Ms X said she did not think this would help
• Ms X said she felt stressed about what had happened and about the lack of support for Mr Y.
16. Another social worker carried out a social care assessment for Mr Y and a carer’s assessment for Ms X in June 2021. Mr Y’s social care assessment said:
• Mr Y had vascular dementia
• Ms X was his carer, she found the role stressful at times
• Mr Y was independent with personal care, Ms X helped him choose clothes, she prepared meals, he needed encouragement to drink regularly. She dealt with his medication
• Mr Y was eligible for care and support in the following domains:
1. Managing and maintaining nutrition (Ms X encouraged him to help with meal preparation and encouraged him to drink
2. Being appropriately clothes (Ms X assisted with this)
3. Making use of necessary facilities or services in the community (referral made to the social prescriber so Mr Y could mix with others)
• The social worker would refer Mr Y for telecare services and to the social prescriber.
17. The carer’s assessment for Ms X said:
• She was the carer for Mr Y and found this stressful during lockdown. Following a crisis a few weeks ago, her mental health had improved. She felt she had no support as they were both shielding
• She wanted some extra support for Mr Y so she could spend more time attending to her own needs. She had no support from family or friends.
• Her physical or mental health was at risk of deteriorating. A referral to the Carer’s Trust was to be made (to enable her to enjoy some activities away from the caring role) and to the social prescriber.
18. A case note in September said Ms Y had in the past been stressed with her caring role especially during lockdown, but this now appeared to be settled, referrals had been sent to the Carer’s Trust, to a befriending service and to the wellbeing service. She had declined the latter two.
19. The Council’s complaint response summarised the record of the incident in March (see paragraph 13) and said:
• Ms Y could look at the section of the Council’s website called ‘live well’ for advice and for a directory of services
• There had been a joint assessment of her needs as a carer and of her husband’s needs
• The records indicated there was no current formal diagnosis of vascular dementia
• Mr Y was not entitled to adult social care support funded by the Council
• Mr Y was offered a telecare alarm – the website said this cost started at £15.96 a month
• The Council was sorry that the offer of a three-hour service to allow her a break from caring, was not suitable.
20. The Council told me a formal diagnosis of dementia needed to come from a specialist doctor. It went on to say information about Mr Y that it had on record was from other public services and information from Ms X that a heart specialist said Mr Y had vascular dementia. The Council said it had no information from a dementia specialist to confirm Mr Y had vascular dementia.

Was there fault?

(a)The Council incorrectly recorded the details of an incident in March 2021

21. The Council’s records contained a summary of the report from the emergency services and described Mr Y assaulting Ms X. There is no incorrect recording as the Council’s records reflected information it received from the emergency services.

(b)The Council did not provide Ms X with carer support during the pandemic and offered inappropriate care services

22. There is no record of Ms X asking the Council for support from adult social care before March 2021. My investigation deals with contact between March and December 2021.
23. There is no fault by the Council in the way it responded to Ms X. It completed a carer’s assessment, the outcome was the offer of services by the Carer’s Trust and a referral to the social care prescriber. This is in line with the duty to assess a carer’s needs in Section 10 of the Care Act 2014.
24. In terms of Mr Y, the Council acted in line with section 9 of the Care Act 2014 by completing an assessment of his needs and so there was no fault. Mr Y met the eligibility criteria described in paragraph eight in three of the domains. However, as Ms X was meeting Mr Y’s needs in those domains, there was no requirement for the Council to arrange care and support for Mr Y. And in any event, Ms X said Mr Y had savings of £23,250 and so he was not entitled to council funding.

(c)The Council made errors in responding to her complaints and did not accept Mr Y has a formal diagnosis of vascular dementia

25. There is no fault in the Council’s complaint response which said there was ‘no evidence of a formal diagnosis of dementia’. The Council’s records do not have any information from a doctor specialising in dementia (like a psychiatrist or a doctor specialising in care of the elderly) suggesting Mr Y has a formal diagnosis of vascular dementia. The NHS website suggests a specialist doctor needs to diagnose vascular dementia with a scan or detailed tests and the Council has no written evidence to confirm this. I have no grounds to criticise the Council because it has not got any written information from an appropriate specialist to confirm Mr Y’s diagnosis.

The Council did not give costs for telecare

26. The complaint response gave the cost. There is no fault.

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Final decision

27. I did not uphold complaints about inaccurate records or a lack of carer support because the Council carried out assessments of Mr Y’s needs and a carer’s assessment for Ms X in line with the Care Act 2014. I am satisfied the records are accurate.
28. I have completed the investigation.

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Parts of the complaint that I did not investigate

29. I stopped investigating complaint (g) because I do not consider there is significant injustice to Ms X.

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Investigator's decision on behalf of the Ombudsman