Summary: Miss X complained the Council provided inadequate reablement care following a hospital stay in November 2022 and has failed to meet her care needs since this ended. We have ended our investigation as it is unlikely we could achieve a worthwhile outcome. Miss X has since been admitted to hospital and her needs will be assessed on discharge.

The complaint

1. Miss X complained the Council provided inadequate reablement care following a hospital stay in November 2022 and has failed to meet her care needs since this ended. In addition, it has refused to provide her with an advocate. As a result Miss X says her care needs have not been met and she has been left without food and support. Miss X wants advocacy support and care and support to meet her needs.

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The Ombudsman’s role and powers

2. We investigate complaints about ‘maladministration’ and ‘service failure’, which we call ‘fault’. We must also consider whether any fault has had an adverse impact on the person making the complaint, which we call ‘injustice’. We provide a free service, but must use public money carefully. We do not start or continue an investigation if we decide:

• there is not enough evidence of fault to justify investigating, or
• any fault has not caused injustice to the person who complained, or
• further investigation would not lead to a different outcome, or
• we cannot achieve the outcome someone wants, or
• there is no worthwhile outcome achievable by our investigation.

(Local Government Act 1974, section 24A(6), as amended, section 34(B))

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How I considered this complaint

3. I have considered information provided by Miss X and discussed the complaint with her. I have considered information provided by the Council in response to my enquiries.
4. I gave Miss X and the Council the opportunity to comment on a draft of this decision. I considered any comments I received in reaching a final decision.

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What I found

5. 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.
6. An adult with possible care and support needs may choose to refuse an assessment. In these circumstances councils do not have to carry out an assessment. But where a council identifies that an adult lacks mental capacity and that carrying out a needs assessment would be in the adult’s best interests, it must do so.
7. Reablement support services are for people usually after they have left hospital or when they are at risk of having to go to hospital. They are time limited and aim to help a person to keep or regain the ability to live independently at home. This is provided free of charge for up to six weeks.

What happened

8. Miss X has mental health difficulties and back problems which affect her mobility. Following a hospital stay Miss X received reablement care services starting in late October 2022. This comprised a 45 minute visit in the morning to help with personal care, getting dressed and breakfast, 30 minutes in the afternoon to get lunch and assist with toileting and 45 minutes in the evening to prepare dinner and to get her ready for bed.
9. In early November 2022 Miss X contacted the Council to says the care workers would not support her with food shopping. An officer called Miss X back and she was verbally abusive. They noted Miss X wanted significantly more hours of care. The call ended due to Miss X’s behaviour. Another officer contacted Miss X and explained her case would be allocated to a social worker to fully assess her needs.
10. The Council allocated Miss X a social worker in mid November 2022 to complete a needs assessment. Miss X did not want to engage with the social worker and would not agree to a visit. She complained to the Council that care workers were not visiting however the care provider confirmed it was still attending three times a day. She reported she had no food but declined the offer of a food parcel.
11. The Council referred Miss X for advocacy support in December 2022 but Miss X did not want to use the particular advocacy service.
12. In early December 2022 the care provider reported to the Council that Miss X was verbally abusive to staff, tried to lock a member of staff in and repeatedly phoned the head office, the Council’s contract compliance team and the Care Quality Commission to complain about staff. She wanted staff to do shopping for her for both food and electrical items which was not in her care plan. It told the Council it wanted to end the care package. Miss X also told the Council she wanted the care package to end. She denied being verbally abusive and said care workers were rude to her. The reablement care package ended in early December 2022.
13. Miss X repeatedly rang the Council complaining she needed support or was running out of food. Several officers spoke to her to try and persuade her to engage with an assessment. In some of the calls Miss X was verbally abusive and she did not agree to an assessment.
14. Miss X complained to the Council that reablement had ended and the Council had not arranged anymore care. The Council responded to Miss X’s complaint in late January 2023 and did not uphold her complaints. It provided Miss X with a single point of contact to support her due to the number of calls she made to the Council and other agencies. It said the officer would refer her for advocacy with her consent so they could conduct a needs assessment. It also said it would refer her to the local Mental Health Integrated Network Team (MINT) for a review of her mental health.
15. Miss X’s nominated officer spoke with her weekly and liaised with housing regarding housing repairs. Miss X did not want a home visit by the officer and did not agree to a needs assessment. The Council says she later agreed to a joint visit from the officer with her GP which took place in late February 2023.
16. In February 2023, the officer arranged for an advocacy service to support Miss X and at a professionals meeting in April 2023 the Mental Health Integrated Network Team (MINT) accepted a referral for Miss X. Throughout this time Miss X regularly rang 111, the police and the Council’s single point of access with a range of concerns. The police made referrals to the Council. In these they noted they had no immediate concern for Miss X’s safety or well being and Miss X appeared clean and healthy and was getting food delivered.
17. In early May 2023 Miss X agreed the nominated officer could visit to introduce the newly assigned advocate. Miss X reported she wanted support with cooking hot meals, cleaning, washing, driving to the cash point and rubbish removed. She declined the suggestion of ordering hot meals or moving house to allow for increased support. The advocate later reported they were having difficulties communicating with Miss X and she was verbally abusive.
18. The officer visited Miss X again later that month and tried to encourage her to seek medical help for the physical concerns she reported. The officer suggested Miss X agree to a carer visit once a week to assist with removing rubbish and tidying the flat. The officer noted Miss X planned to approach someone she knew who may be willing to be a paid carer and would let the officer have the details.
19. In late June the officer visited with a Community Psychiatric Nurse from the MINT team. They noted Miss X continued to report she had run out of food and no-one to support with shopping. They noted the flat was relatively tidy and they completed food shopping for Miss X.
20. In mid August 2023 Miss X was admitted to hospital.

Analysis

21. Miss X considered the reablement package she was given was inadequate. I do not intend to investigate this further as it would not be a proportionate use of resources and it is unlikely I could achieve a meaningful outcome.
22. Miss X is currently in hospital. The Council has confirmed Miss X’s needs will be fully assessed before she is discharged. This should ensure Miss X’s eligible needs are identified and appropriate support is arranged before she returns home. If I were to investigate and find fault causing injustice I would look to achieve a similar remedy.
23. The records show Miss X wanted support over and above that set out in her reablement care package and the care provider ended the care package due to its concerns about Miss X’s behaviour and her interactions with its care workers.
24. The Council was willing to carry out a needs assessment and allocated a social worker within two weeks of Miss X’s hospital discharge but Miss X was unwilling to engage with them. The Council has been unable to fully assess Miss X’s eligible needs so that it can determine what support to provide. The Council also arranged an advocate for Miss X, but Miss X initially refused advocacy involvement then the advocate had difficulties communicating due to Miss X’s behaviour. Even if I were to investigate these matters further it is unlikely I could say this was fault or add to the Council’s offer of a needs assessment that Miss X rejected.
25. For the reasons set out in paras 21-24 it is therefore unlikely I could achieve anything more by further investigating this complaint.

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Final decision

26. I have ended the investigation as I do not consider I could achieve a worthwhile outcome by further investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman