Summary: The complaints’ father (Mr Z) said the Council failed by not allowing his daughters Miss X and Miss Y to attend a local community support service (the Day Centre) five times a week. Mr Z also complained about the way the Council handled his complaint. We found fault with the Council’s complaint handling. This fault did not cause Mr Z injustice. We did not find fault with the actions the Council took to meet Miss X’s and Miss Y’s care needs.

The complaint

1. Mr Z, acting on behalf of his daughters Miss X and Miss Y, says after the COVID-19 pandemic the Council reduced the allocation of the Day Centre for each of them from five to three days a week. This happened despite, Mr Z says, of the Council’s assurances directly after the re-opening of this centre the provision would be increased to the pre-pandemic levels.
2. Mr Z also says the Council failed to communicate with him during the complaint process and in its further review response copied the stage one response.
3. Mr Z says the reduced provision caused Ms X’s and Ms Y’s physical decline, which was confirmed during the re-assessment of their care needs. Mr Z says this resulted in the increased staffing for their supported living.

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The Ombudsman’s role and powers

4. 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)
5. We consider whether there was fault in the way an organisation made its decision. If there was no fault in the decision making, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
6. 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

7. I spoke with Mr Z and considered the information he provided.
8. I made enquiries to the Council and considered the information it provided.
9. I reviewed the Council’s website information on making complaints and the document ‘Statutory complaints procedure’.
10. Mr X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.

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What I found

Legal and administrative background

11. Councils must meet the adult’s eligible care needs after determining them through a care needs assessment if:
• The adult is ordinarily resident in the council’s area;
• The adult’s accrued costs do not exceed the cap on care costs; and
• There is no charge for meeting needs or one of the specified conditions apply.

(The Care Act 2014 Section 18 (1))

12. The concept of ‘meeting needs’ is intended to be broader than a duty to provide or arrange a particular service. Because a person’s needs are specific to them, there are many ways in which their needs can be met. The intention behind the legislation is to encourage this diversity, rather than point to a service or solution that may be neither what is best nor what the person wants. The purpose of the care and support planning process is to agree how a person’s needs should be met, and therefore how the local authority will discharge its duty, or its power, to do so. (Care and Support Statutory Guidance paragraph 10.10)
13. Needs may be met through types of care and support which are available universally, including those which are not directly provided by the local authority. For example, in some cases needs could be met by a service which is also made available as part of a local authority’s plans for preventing or reducing needs for care and support (under Section 2 of the Act). Needs could also be met, for example, by putting a person in contact with a local community group or voluntary sector organisation. (Care and Support Statutory Guidance paragraph 10.13)
14. When meeting needs the local authority should ensure the process is person-centred and involving and taking all reasonable steps to agree the plan with the person. The local authority must take into consideration the individual’s preference. (Care and Support Statutory Guidance paragraph 10.19 and 10.20)

What happened

Background

15. Miss X and Miss Y are sisters and both live in purpose-built accommodation in their parents’ garden, with support provided by the Care Provider.
16. In Miss Y’s care needs assessment of June 2020 a significant decline in mobility which could not be medically explained was noted.

Care needs reassessment

17. During the COVID-19 pandemic Miss Y’s mobility deteriorated. Miss Y’s parents got involved and supported the Care Provider. After some months Miss Y’s mobility improved and she could walk further with a walking frame.
18. Due to their daughters’ specific needs as well as frequent changes of staff who needed training, Miss X and Miss Y’s parents found themselves increasingly involved in supporting them, which was not sustainable in view of the parents’ age and other commitments. They asked for the Council to reassess their daughters’ care needs.
19. The Council reassessed Miss X’s and Miss Y’s care needs in July and August 2022. Occupational Therapists from two different teams took part in this process.
20. The reassessment of Miss X’s care needs found:
• Significant deterioration of Miss X’s communication and cognition since 2014;
• Need for 2:1 support for safe transfers, routines and continence care;
• Requirement for 1:1 support with all areas of daily living;
• Current support was not effective.
21. The reassessment of Miss Y’s care needs found:
• A gradual deterioration in Miss Y’s physical abilities with walking and transfers;
• More support needed for daily living routines and activities;
• Clear guidelines for staff were needed to ensure consistency of support;
• Need for 2:1 staff support with transfers, walking, aspects of showering and continence routines;
• The continuous need for a four-wheel walker and a wheelchair;
• Impact of Miss Y’s moods on her daily life and need for support.

Care and support plans

22. At the end of September the Council started reviewing Miss X’s and Miss Y’s care and support plans. The plans confirmed the increase of support needed for Miss X and Miss Y during the day to 2:1 excluding the times spent at the Day Centre. The Council funded the higher level of staffing from mid-October 2022.
23. The care plans noted the Care Provider’s efforts to arrange activities for Miss X and Miss Y in the community were negatively impacted by not having a mobility care with wheelchair access and still waiting for power packs for the wheelchairs. Despite these difficulties the Care Provider supported Miss X and Miss Y to attend a church social group and a shopping centre. The parents facilitated the travel in their car.
24. The OTs were involved in reviewing Miss X’s care plan. They provided their advice on the equipment already in use and considered any possible changes. The OTs also recorded their concern that Miss X’s decline with mobility might be neurological.
25. Miss Y’s care plan reflected the OTs continuing involvement in providing consistency of support around transfers, daily living, routines and communication needs. Although there were no immediate concerns, the gradual decline over the years in Miss Y’s physical abilities was recorded.
26. The Council prepared support plans for Miss X and Miss Y in which it noted the importance of keeping active and accessing the community. The plans specified Miss X and Miss Y would attend a local church group once a week, a disability hub and sport facility once a week and the Day Centre three times a week.

Day centre

27. Until the outbreak of COVID-19 pandemic Miss X and Miss Y attended the Day Centre five times a week. During the pandemic the Day Centre was only open for people deemed as high priority. These were the service users who lived at home with their families, rather than in supported living accommodation.
28. When the Day Centre reopened after the COVID-19 pandemic Miss X and Miss Y started attending twice a week, which after some time increased to three times a week. The Council told Mr Z this provision would be increased further once the staffing shortages were addressed.
29. In the autumn 2022 the Council told Mr Z his daughters would continue attending the Day Centre three times a week. For the parents’ trip abroad, however, they attended five days a week.
30. In the response to my enquiries the Council explained there were no terms of allocation for people accessing the Day Centre. The allocation is based on the assessed needs and desired outcomes. Since the COVID-19 pandemic the Council has faced a greater demand for the Day Centre and is currently in the process of creating a prioritisation tool for all service users referred to this service. The Day Centre is fully staffed. It is at full capacity and cannot currently accept any new service users. The Council holds a waiting list for those who cannot get a place.
31. Out of 93 people accessing the Day Centre, 34 live in a Supported Living accommodation. Only four people who live in a Supported Living accommodation access the Day Centre five days a week.

Complaint

32. In the second week of December 2022 Mr Z complained about the reduction of the Day Centre services for his daughters from five days a week to three. This, Mr Z said, caused deterioration in their presentation.
33. In the response sent to Mr Z nine days later the Interim Area Service Manager explained normally people living in the Supported Living accommodation would get two days in the Day Centre as the Council prioritises people supported by family carers. As an exception Miss X and Miss Y attend three days a week. The complaint was not upheld.
34. Responding to Mr Z’s request for a further review, at the end of January 2023 the Interim Area Service Manager sent a copy of his previous letter, advising Mr Z of his right to contact us.

Analysis

Meeting Miss X’s and Miss Y’s care needs

35. In his complaint Mr Z implied that by not allowing his daughters to attend the Day Centre five days a week, the Council failed to meet their care needs. He was particularly concerned about their access to community activities and their physical needs.
36. Although the Care Act 2014 specifies councils’ duty to meet eligible care needs of their residents, it is for the councils to decide how they will carry out this function. This is explained in the Statutory Guidance quoted in paragraphs 12 and 13.
37. Having reviewed all the evidence I found the Council acted correctly, when told of the difficulties in meeting Miss X’s and Miss Y’s needs, by:
• Reassessing their care needs;
• Reviewing their care and support plans;
• Continuous involvement of OTs in providing advice on the equipment, handling techniques, mobility issues, transport solutions and other relevant aspects of Miss X’s and Miss Y’s care.
38. I asked the Council to provide me with the details of how it allocates places in the Day Centre. This was to check whether the process is fair. Although the Council does not have any specific criteria for allocation it explained the allocation of places are based on the individual circumstances with the priority given to the people living in their homes rather than in the supported living accommodation. It is also clear that since the COVID-19 pandemic the demand for this service has increased which means the Council has to seek alternative ways of supporting its residents. This explanation correlates with the evidence I have seen.
39. Mr Z told me there were transport difficulties in getting Miss X and Miss Y to other activities which might be an alternative to the Day Centre. These difficulties, however, can be resolved through the Council, the Care Provider, the parents and other professionals supporting Miss X and Miss Y working together and accessing appropriate services. It is not our role to get involved in this process.
40. During my telephone conversation with Mr Z he was very appreciative of the Adult Social Care (ASC) team responsiveness to his communications. This is commendable and bodes well for the future.

Complaint handling

41. The Council’s process for considering Adult Social Care complaints consists of:
• A local resolution stage – during this stage the Council aims to understand the complaint issues and plans a resolution. Following the investigation either an official letter from the service manager, a phone call or a meeting will happen.
• If the complainant is not happy with the resolution plan or raises further issues, another resolution plan and timeframe may need to be drawn and acted upon. If, however, it is decided that an appropriate and proportionate response has already been given the Council may not look into the complaint any further. This decision will need to be signed off by the Director of Social and Community Services.
• Once the Council decides not to review the complaint further, there is an option of bringing it to the Local Government and Social Care Ombudsman.
42. The Council’s complaint process allows the Council to investigate a complaint at a single stage. This is what the Council did for Mr Z’s complaint. The Council should have better explained its reasons for not looking at the complaint any further rather than resending the letter it sent before. However, this was poor practice rather than maladministration.
43. The Council accepted the Director for Social and Community Services did not sign off the Council’s refusal to look at Mr Z’s complaint further. This was fault but it did not cause injustice to Mr Z as, on balance, the Council’s position is likely to have remained the same.

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Final decision

44. I uphold part of this complaint. I found fault with the way the Council handled Mr Z’s complaint. This fault did not cause him injustice. I did not find fault with the Council’s actions undertaken to meet Miss X’s and Miss Y’s care needs.

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Investigator's decision on behalf of the Ombudsman