Summary: Mr X complained about delays and the way the Council managed the care needs assessment process for his mother. We found fault with the Council for not properly explaining its decision about how it considered her care needs could be met, and for poor communication with Mr X. The Council has agreed to our recommendations to remedy this injustice.

The complaint

1. Mr X, on behalf of his mother, complains about an outcome decision that said two care calls per day for her were appropriate. Even though originally when she was assessed by the Council, it recommended four calls per day. He says it had not explained its rationale to justify that this was sufficient for her needs.
2. He also complains the Council has taken into account irrelevant considerations, such as financial constraints, during the care assessment process. He raises concerns about the time taken for the assessment process, inadequate record keeping, and poor communication. He says this has had an impact on the family financially and the whole process has also caused uncertainty, frustration, and distress.

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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. We may investigate complaints made on behalf of someone else if they have given their consent. (Local Government Act 1974, section 26A(1), as amended)
5. 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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What I have and have not investigated

6. Since Mr X complained to us, I recognise events have moved on since and he has raised additional ongoing concerns with the Council. After consideration, it is my view these are different matters based around a further assessment which took place after this complaint came to us. Therefore, I will not take a view on further substantive matters after Mr X received his final response to this complaint in February 2023.
7. Whilst linked, any further related matters are not within the scope of this investigation and should be directed to the Council first as a new formal complaint. This is because we expect councils to have an opportunity to respond to new complaints before we consider them. We are also entitled to determine an appropriate cut off point for our investigations.

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How I considered this complaint

8. I discussed the complaint with Mr X, Mrs Y’s son, who is dealing with the complaint on her behalf. I considered his views and the information he sent me.
9. I made enquiries of the Council and considered its written responses and information it provided.
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

Law and administrative background

Assessment

11. 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.
12. Councils must carry out assessments over a suitable and reasonable timescale considering the urgency of needs and any variation in those needs. Councils should tell people when their assessment will take place and keep them informed throughout the assessment.
13. Paragraph 6.15 of the Care and Support Statutory Guidance notes that during an assessment, councils must consider all the adult’s care and support needs, regardless of any support being provided by a carer. Where an adult has a carer, information on the care they provide can be captured during the assessment, but it must not influence the eligibility determination. After the eligibility determination has been reached, if the needs are eligible or the local authority otherwise intends to meet them, the care which a carer is providing can be taken into account during the care and support planning stage. The local authority is not required to meet any needs which are being met by a carer who is willing and able to do so, but it should record where that is the case. This ensures that the entirety of the adult’s needs are identified and the local authority can respond appropriately if the carer feels unable or unwilling to carry out some or all of the caring they were previously providing.

Care Plan

14. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan. When preparing a care and support plan, the local authority must involve any carer the adult has. The care and support plan should consider what needs 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. 

Background

15. Before and during this complaint, Mr X’s mother (“Mrs Y”) had a self-funded, privately arranged package of care consisting of four care calls a day at home.

What happened

16. I have summarised below an overview of the key relevant events. This is not intended to be a detailed account of each communication between the parties or an exhaustive chronology of everything that happened.
17. In late March 2022, Mr X contacted the Council for assistance towards the costs of the care Mrs Y was receiving as her savings were being used up. A referral was made for an assessment of her care needs.
18. At the start of June, Social Worker 1 (from an external agency) visited Mrs Y at her home, Mr X’s sister was present. A case note entry dated 21 June by Social Worker 1 recorded their assessment and noted Mrs Y was reliant on others to meet most of her daily care needs. They recommended four visits a day in a care and support plan. The request was to be taken to an internal decision making Forum.
19. In July, Mr X chased the Council for updates about the outcome of the care assessment. His sister had not received a response to a follow up email to Social Worker 1.
20. In mid-July, Social Worker 2 (also external agency) took over the case as Social Worker 1 had unexpected leave due to bereavement. They advised Mr X the care and support plan had not yet been presented to the Forum. Social Worker 2 noted Mr X said there was an additional requirement for Mrs Y since the June visit, relating to managing her stoma care.
21. The Council suggested another visit could be arranged to assess this need. It also gave Mr X the option the June assessment could be presented at Forum sooner. It further explained after the support was agreed, a review of the care and support plan would be arranged after six weeks to see if any amendments were needed, or if a reassessment was required.
22. Mr X raised a number of points, including that he had received the same inaccurate response from different staff members about the date of the visit to Mrs Y. He raised concerns about the Council’s record keeping and how it monitored performance targets if dates were not recorded correctly on the system. He asked for the case to be presented at the Forum, with a review arranged later, and for additional time to one of the visits to be considered. The Council said the date given was when Social Worker 1 entered the notes onto the system. It acknowledged the date of the visit should normally be recorded in the assesment itself and would ensure it was now recorded. The Council said it would respond to his further additional points at a later date.
23. At the end of July, the Forum said it needed further information about how Mrs Y’s needs could be supported. It deferred making a decision. It recommended an internal team should assess Mrs Y’s package to determine the correct level of support.
24. The Council informed Mr X of the outcome and to arrange for its inhouse team to support Mrs Y for a period. The Council said Mr X declined, saying it would be distressing to Mrs Y as she was comfortable with the current care package she had privately. Mr X disputed this and said the inhouse team itself had ended its involvement after it clarified the situation with his sister.
25. Two days later, the case was presented at the Forum again. The notes said there was no evidence to support the recommendations. It decided the case would be reallocated to a senior social worker and prioritised for reassessment. A handover case note by Social Worker 2 recorded Mr X had raised inaccuracies with the content of Mrs Y’s plan and so there was a need for reassessment.
26. In mid-August, Social Worker 3 visited Mrs Y to reassess her, with Mr X’s two sisters present.
27. In September, the case was presented to the Forum. It agreed a care package that two visits a day was sufficient for Mrs Y. The Council made a referral to set up direct payments to Mrs Y to fund towards the two agreed visits per day.
28. In late November, Mr X emailed the Council asking for the rest of the response to his concerns promised in July. He raised concerns with the agreed daily care visits being reduced to two by the Forum in September, after Social Worker 1 had originally recommended four visits in June. Mr X said his sister had been verbally told at the second assessment in August that for financial reasons, the Council was reducing the number of care visits and hours it was providing to individuals. He said it was unlawful that the Council was taking its own financial circumstances into account with care assessments.
29. In December and January 2023, the Council responded to further emails from Mr X. These answered some of his points. The Council said the care and support planning process determined which needs could be met by the Council. It said a plan is proposed to meet the needs and took into account informal support from family and health care services. It outlined Mrs Y’s plan provided the social care support for her eligible assessed needs.
30. In late January 2023, Mr X made a formal complaint to the Council. He raised several points under three main issues:
1. He said the Council had not explained how two visits could meet Mrs Y’s needs, considering she needed to be prompted to eat meals and also medication, three times a day.
2. The Council should not have taken its own financial position and input of relatives into consideration for the assessment. He had raised concerns about this, but the Council’s response did not address these.
3. He was dissatisfied with the delays, poor record keeping and poor communication throughout.
31. In February 2023, the Council responded. It did not uphold part a) or b). Its position was two visits covered assistance with showering and getting Mrs Y ready for bed. It upheld and partially upheld some complaints in part c) and apologised for the distress caused by these parts.
32. Mr X then complained to us. Shortly after his complaint to us, Mr X said to me he informed the Council of an update about Mrs Y’s vision. The Council reassessed her in April 2023 with a recommendation of four care calls a day. This was approved by the Forum.

The Council’s response to my enquiries

33. The Council said there was a delay due to a high volume of referrals with a large backlog. As a result, the assessment was referred to an external agency which visited Mrs Y in June 2022.
34. The Council sent me notes of the Forum meetings. These were very brief with no detail of what was discussed in each meeting or what it had considered to make their decisions.

Analysis

Care assessment process

35. I recognise Mr X’s concerns about potential wider implications of the date of visit not being recorded on the first assessment. In my view, this appeared to be a mistake by Social Worker 1. The Council acknowledged it is good practice to record the date which I agree with. However, the assessment is a process which the date of visit is a part of but there is no legal set timeframe for completing them. The Council mentioned an internal guideline of 28 days but the Care and Support Statutory Guidance says it should be reasonable and proportionate, dependent on the complexity of the case. I do not consider this caused Mrs Y significant injustice as this did not specifically contribute to the delay with her case. However, I recognise there was confusion and frustration caused with the Council’s communication about it with Mr X (covered later). The Council has acknowledged the issue with the date of visit and sufficiently addressed it; this is appropriate.
36. The first part of the assessment noted what Mrs Y could do herself, what her needs were, and the support she currently had from her carers and family. It then concluded Mrs Y had eligible needs in a number of areas, including “maintaining personal care” and “managing nutrition”. I have not seen significant concerns I would conclude as fault at these stages of the process. Whilst Mr X says the Council should not have considered the support of relatives in its assessment, the Care Act Statutory Guidance says this is a relevant consideration (referred to in Paragraph 13) for the care and support plan. The Council puts this together to outline what care can meet these eligible needs and does take into account support already in place. The second assessment noted Mr X’s sisters provided some help to Mrs Y and it would be for the Council to assess what other support was needed for any unmet outstanding needs. The Council’s consideration of family input for the care and support plan is not fault in itself.

Reduction in care

37. I understand Mr X’s concern with an alleged verbal comment made by Social Worker 3 to his sister about the Council’s financial constraints affecting care packages. Based on this, he said this unjustly contributed to the decision that Mrs Y could manage with a reduced number of visits. Without evidence, I am unable to take a view on this comment specifically. The issue is therefore whether the Council ensured it could demonstrate that care and support could meet Mrs Y’s assessed needs. I do not consider the Council sufficiently did at the second Forum.
38. The second assessment noted Mrs Y needed support with her meals and taking medication. The Council’s complaint response to Mr X only mentioned Mrs Y’s showering needs and getting her ready for bed but did not cover meals and medication. It did not directly address Mr X’s concerns about how two visits a day would be sufficient to meet both these needs three times a day. The Forum’s notes did not outline any discussions to show how it reached its decision on this matter. This is fault. This has caused uncertainty to Mr X as there has not been a sufficiently clear rationale provided for its decision, and this casts doubt that Mrs Y’s needs were properly considered. As the Council has already carried out another assessment of Mrs Y since Mr X complained to us, I do not consider it necessary to include this as a recommendation.
39. Mrs Y was not without care during this period as she continued to pay privately for her existing package. It appears the Council has agreed to backdate direct payments after the assessment in April 2023. This feeds into further matters raised by Mr X since (which he has raised as a new complaint) and I am not considering this further as stated in Paragraph 6. With this in mind for this complaint, I consider the injustice to Mrs Y is limited and the main injustice is to Mr X who dealt with most of the matter on her behalf. This is covered further below.

Delays and communication

40. There were delays in the care assessment process. The referral was made in March, and it took six months for a decision outcome on the support hours in September. This seems excessive and appeared avoidable. This is fault. There was an initial delay in allocating the case due to backlogs and staffing pressures. Then there was a change of social worker, so the assessment was not properly completed. It appeared there was a lack of oversight which allowed the case to drift until Mr X made contact. I cannot say if it had not been for this fault, a package of care agreed by both parties would have been put in place sooner. But there is uncertainty about whether it could have, which is injustice in itself. On balance, after Mrs Y’s case was picked up again in late July, the Council acted fairly swiftly on matters after this up to the Forum in September.
41. There is also evidence of poor communication by the Council with some confusing and contradictory messages. This included the relaying of information about the first assessment to Mr X. Later, the first July Forum said there was not enough information to make a decision. The Council has not fully explained why it considered the first assessment for four care calls was not sufficient. I cannot see the Council informed Mr X about the second July Forum which decided a reassessment was needed. At another point the Council mentioned it was because Mr X raised inaccuracies in the first assessment. There appeared to be a lack of clarity for the reasons given for the second assessment and on what basis, causing uncertainty to Mr X.
42. There was also an element of raised expectations for Mr X. I cannot see he was informed of the hours of care and support Social Worker 3 was presenting to the Forum and I can understand his confusion when only two care calls were agreed. There is also evidence the Council did not respond to Mr X’s concerns he raised in an email when it said it would. There was additional time and trouble for Mr X to try and chase up answers or clarification on matters. This caused injustice to Mr X with frustration, inconvenience, and distress.

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Agreed action

43. To remedy the injustice set out above, the Council has agreed to carry out the following actions:
44. Within one month of the final decision:
• Apologise to Mr X and Mrs Y for the delays in the care assessment process and for not properly explaining its rationale for reducing Mrs Y’s care calls; and
• Pay Mr X £250 as a symbolic payment to recognise the frustration, uncertainty, and distress caused by poor communication and unclear decision making in the assessment process, including delays.
45. Within two months of the final decision:
• Send written reminders to relevant staff to ensure decision making Forums clearly record discussions during meetings and to document rationale when deciding what care and support can meet an individual’s eligible assessed needs.
46. The Council should provide us with evidence it has complied with the above actions.

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Final decision

47. I found fault by the Council causing injustice to Mr X. The Council has agreed with my recommendations to remedy this, and I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman