Summary: Miss E complains about the Council’s delay in finding her a provider to deliver care and support. Also a delay in putting any interim provision in place, unsuitable interim provision when it was provided, and poor communications. The Ombudsman upholds the complaint because of delay and poor communication. This caused Miss E some distress and uncertainty. The Council has agreed to our recommendation of an apology and symbolic payment as a remedy.

The complaint

1. The complainant, whom I shall refer to as Miss E, complains the Council:
• delayed putting in place a new package of care after her old one ended;
• could have considered funding a care provider she found. Although this was expensive, the Council had not been able to find a provider. So it should have considered using such a service;
• could have earlier offered her a bathing service;
• did belatedly commission a bathing service, but this did not meet her needs;
• has been poor in its communications with her. It has acknowledged it should have assigned a new social worker. But that does not make up for what she experienced.
2. Miss E says the injustice to her was that she was isolated due to her concerns about her physical condition and appearance. This affected her mental health.

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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)
5. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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How I considered this complaint

6. As part of the investigation, I have:
• considered the complaint and the documents provided by Miss E;
• made enquiries of the Council and considered its responses;
• spoken to Miss E;
• sent my draft decision to Miss E and the Council and considered their responses.

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What I found

Legal and administrative background

The Care Act and care and support provision

7. The Care Act 2014 and the Care and Support Statutory Guidance (“the Guidance") set out how councils must assess and meet identified needs for care and support.
8. After an assessment, if a council decides a person has unmet eligible needs, it must set out how it will meet those needs in a care and support plan.
9. The Guidance says:

• the concept of ‘meeting needs’ is intended to encourage diversity into how councils meet support;
• the type of support can take many forms;
• councils should keep arrangements under review.

10. The council must set a personal budget as part of the care and support plan. The personal budget is the money the council has worked out it will cost to arrange the necessary care and support for that person.
11. The Guidance says:
• in determining how to meet needs, a council may take into reasonable consideration its own finances and budgetary position;
• it is important that councils have a consistent method for calculating personal budgets.

Direct payments

12. Direct payments are cash payments made by a council to individuals who wish to have them. They allow people to arrange and pay for the provision themselves.

Adult social care complaints

13. Councils should have clear procedures to deal with social care complaints. Regulations and guidance say they should investigate and resolve complaints quickly and efficiently, although they do not say how long an investigation should take.

The Ombudsman’s Principles of Good Administrative Practice

14. The Ombudsman publishes guidance on good administrative practice, which we use as a benchmark for the standards we expect when we investigate the actions of local authorities. The guidance has examples of what good administrative practice looks like. Examples relevant to this complaint include:
• explaining and responding to any delays proactively; and
• retaining continuity for service users when services are changed.

What happened

15. Miss E lives with her parents and has a range of disabilities. For several years she had been receiving four hours a week home care, arranged by the Council. This was for personal hygiene, being appropriately clothed and maintaining a habitable home environment.
16. In April 2022 Miss E’s previous care provider served notice after a breakdown in its relationship with Miss E. The Council says its duty social worker began to try to source a new care provider, with the aim of a start date at the beginning of May.
17. The Council assigned Miss E’s case to a social work assistant (whom I shall refer to as Officer 1). The Council had not found a new care provider before Officer 1 went on unplanned leave between the middle of May and the beginning of August. Miss E and her mother’s main contact with the Council during this period was with its duty social workers.
18. Miss E wanted to explore a direct payment, so she could employ a personal assistant. The Council sent Miss E a list of personal assistants. But she and the Council could not source one.
19. Officer 1 returned to work at the beginning of August. The Council’s brokerage team was still trying to identify a care provider. Officer 1 started her reassessment. The new care plan noted there were no changes from the previous assessment, but Miss E was not having her needs met by a professional agency.
20. In August and September Officer 1 suggested to Miss E that she could look for any care provision – even if this was less than her care and support plan allowed for. Miss E agreed. Despite this, Officer 1 could still not source a care provider.
21. In October Officer 1 suggested to Miss E that she could enquire about her attending a day centre for a weekly bath. Miss E agreed and started attending the day centre from the beginning of November. She attended this facility for four weeks, with a further planned visit in December cancelled, due to snow on the ground.
22. At the end of November, Miss E’s mother mentioned to the Council that they had tried to commission a private care agency to provide care, but it had not been able to deliver, for insurance reasons. The Council says this was the first it was aware of a privately funded package of care. Officer 1 contacted that care provider which explained why it had not felt able to provide care.
23. At the end of December 2022 Miss E cancelled the bathing visit, as she did not feel the day centre was providing the right support for her.
24. On 12 January 2023 Officer 1 emailed Miss E asking when she could visit to complete a reassessment. Miss E responded to advise she was out of the county. So further discussions would have to wait until her return.
25. Miss E says on the same date Officer 1 offered her direct payments for spa treatments. Miss E says it would have been better if the Council had used that money to commission care from a provider not on its brokerage list. Miss E says that in January 2023 she commissioned care from an alternative care provider. But the Council refused to fund the costs of that care.
26. After Miss E’s return, Officer 1 carried out her reassessment at the end of February. The Council found a new provider, which began providing support from the end of March.

Miss E’s complaint and the Ombudsman’s investigation

27. In early August 2022 Miss E complained about how the Council had not supported her while Officer 1 was absent from work. The Council’s complaints team did not acknowledge the complaint until the third week in September – it seems there was a delay in the Council passing it through. Miss E then provided further information about her complaint. She followed this up with further information in September. The Council provided its response towards the end of October. It said:
• when Officer 1 was off work, it should have reallocated Miss E’s case;
• it was now instigating a buddying system. So if an officer was off work, another worker would pick up a case and make contact;
• it had still been unable to find a provider or personal assistant.
28. In December 2022, when she cancelled the provision, Miss E also complained about the bathing service. She said it was sub-standard and did not meet her needs. She said she should not have to pay her assessed contribution towards that provision.
29. The Council responded in March 2023, apologising for the delay, which was caused by officer illness. It said it had provided the bathing service as a temporary measure. Miss E had not told staff at the day centre she was unhappy with the care and support they provided. So it had done everything it could to provide Miss E with interim support to meet some of her needs.
30. Miss E first complained to the Ombudsman in a letter we received in early 2023. We asked Miss E for further information, which she provided in February. We then accepted a complaint from her. We later added the complaint about the bathing service to this investigation.
31. In response to my enquiries the Council advised (regarding whether Miss E’s complaint about finding a new care provider raised wider concerns) that the town where Miss E lives has only a limited number of available providers. However, the Council provided information showing:
• that it had found care providers for most support packages it commissioned in the town. It said this showed the problems it experienced in finding a care provider for Miss E were not due to systemic issues in the local care market. It provided information about this;
• the amount provided in Miss E’s personal budget was sufficient to meet the costs of care provision. It provided information showing the same formula for calculating personal budgets as it used for Miss E, was funding other support packages in the town;
• Miss E’s particular care package might have been less attractive to providers, as care was not provided every day. And two of the limited number of providers had previously experienced relationship breakdown with Miss E.
32. The Council also advised it:
• recognised that when Officer 1 was absent, its communications were not as effective as they should have been;
• had offered Miss E a bathing service after she provided extra information to support her complaint;
• did not have a record of Miss E contacting it in January 2023 about the alternative provision she said she commissioned (see paragraph 25).

Was there fault by the Council?

The period of officer absence

33. The Council has not been able to meet Miss E’s eligible care and support needs for a significant period. Part of the problem was that it did not re-assign Miss E’s case after its officer was unexpectedly off work. My decision is this did not retain continuity for Miss E and so was fault.

Communications

34. Not providing a new officer meant the Council’s communications with Miss E were not as she should have expected. My decision is that was fault.
35. The Council did not acknowledge Miss E’s August 2022 complaint until well after a month following her contact. My decision is that delay was avoidable and so was fault.

Finding care provision after the Officer’s return

36. The Council had not found a care provider to take on the care and support by the time Officer 1 returned to work.
37. I asked the Council for some information about the local care market, as the Council had noted limited care providers in the area. It provided me information that leads me to conclude this was not a systemic issue, as it was able to meet provision for most support in the area. And that the amount it allocated as a personal budget was not a significant contributor to the problems in finding a provider for Miss E.
38. There were additional issues with Miss E’s package of care that led to problems with the Council finding a provider. But my decision is I cannot say the delay in finding a provider was due to fault by the Council.

Alternative and interim provision

39. That is not to say the Council could not have done more. It had been aware since April 2022 that Miss E had no care provision. I have already noted my finding of fault in not reallocating Miss E’s case. But the problems with finding a provider continued after Officer 1 returned to work.
40. I would have expected to see evidence the Council investigated and discussed with Miss E whether there was any interim provision it could explore, or whether they needed to revisit the care and support plan to consider alternatives, given what the Act and Guidance say (see paragraph 9).
41. The Council went some way to doing this in August and September 2022, which was unsuccessful (see paragraph 20). But it was only in October 2022 that it considered any interim provision. And that was only after Miss E complained. She should not have had to complain before the Council considered interim provision. My decision is that delay was fault.

Suitability of the bathing service

42. Miss E complains the bathing service the Council provided was not suitable, which was why she stopped using it after a few weeks.
43. The Council’s says Miss E did not express dissatisfaction in the time before she cancelled the bathing service. That fact, combined with the fact the provision was only intended as an interim service to meet part of Miss E’s support needs, means I do not have the evidence to uphold this part of Miss E’s complaint.

The alternative provision Miss E found

44. Miss E says, in January 2023, she and her family found an alternative care provider that provided around two weeks’ care. And the Council refused to use that service or to refund Miss E’s costs.
45. The Council has records of Miss E’s mother contacting it in November 2022 about a care provider they had found. The Council says the care provider said it could not meet Miss E’s needs.
46. The Council does not have any record of contact from Miss E about the January 2023 care provision. Its record of contact in that month noted Miss E asked to postpone an assessment, as she was away. So, in the absence of further evidence, I cannot uphold this part of Miss E’s complaint.

Did the fault cause an injustice?

47. The faults I have found are with:
• not reallocating Miss E’s case;
• poor communications related to the officer absence;
• a delay in considering interim support options, including the bathing support;
• a delayed response to Miss E’s complaint.
48. I accept Miss E’s assertion these faults led to some distress for her. The lack of communication would have caused her uncertainty. And the other faults likely cause some uncertainty about whether, but for the faults, the Council could have earlier found some care and support for her, including interim provision.

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Agreed action

49. I recommended that, within one month of my final decision the Council:
• apologise to Miss E for the faults I have identified;
• make Miss E a symbolic payment of £300. This is for the distress and uncertainty caused by the faults I have identified;

• send a reminder to its social workers and other officers working on assessments that, when there are delays in meeting care and support needs, we would usually expect to see evidence of the assessor revisiting the plan with the service user and, for example, considering interim measures.

50. The Council has agreed to my recommendations. It should provide us with evidence it has complied with the above actions.

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Final decision

51. I uphold this complaint. The Council has agreed to my recommendations, so I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman