Summary: Miss X complains that the Council delayed in providing a care package for her. The Council is at fault as it delayed in carrying out a Care Act assessment for Miss X which in turn delayed the provision of a care package. The Council also delayed in carrying out an occupational therapy assessment for Miss X. These faults caused distress to Miss X and meant she had to pay privately for care for longer than necessary. The Council has agreed to remedy this injustice by making a symbolic payment of £200 to Miss X and reimburse her for the cost of the care she paid privately for.

The complaint

1. Miss X complains that the Council delayed in providing a care package following her request for care and support in December 2022. As a result, Miss X considers she was without adequate care and support for longer than necessary which also caused her to incur costs.
2. Miss X also complains that the Council wrongly considered she had made threats of self harm and commenced a safeguarding investigation and a social worker asked intrusive questions. This caused distress to her.

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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 significant injustice, or that could cause injustice to others in the future 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)

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How I considered this complaint

5. I have:

• considered the complaint and the information provided by Miss X;
• discussed the issues with Miss X;
• made enquiries of the Council and considered the information provided;
• invited Miss X and the Council to comment on the draft decision. I considered the comments received before making a final decision.

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What I found

Law and guidance

6. Section 2 of the Care Act 2014 requires councils to provide or arrange services, facilities or other resources which it considers will actively promote wellbeing and independence. Care and support systems should intervene early to support individuals and prevent need or deterioration wherever possible.
7. 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.
8. 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.

What happened

9. Miss X has physical health conditions. Until early 2021, Miss X received a care package funded by direct payments. Miss X terminated the care package as she was unhappy with the standard of care. She privately arranged and paid for her own care.
10. In December 2022, Miss X contacted the Council about another matter. The Council’s records note Miss X said she was struggling and asked the Council to look at getting support in place as her needs had increased. During one of the calls an officer considered Miss X had referred to harming herself. Miss X disputes she said this.
11. A social worker contacted Miss X for a wellbeing conversation. The Council’s records note the social worker considered Miss X may be able to manage with a referral to an agency which offered low level preventative services. She also referred Miss X for an occupational therapy assessment.
12. The Council has said it amended Miss X’s wellbeing conversation of December 2022 to a Care Act assessment in March 2023. The Council considered Miss X had eligible needs.
13. Miss X made a complaint to the Council about a number of matters. This included that the Council had not provided a care package, an officer had raised concerns about Miss X’s welfare and a social worker had asked intrusive questions.
14. The Council responded to Miss X in April 2023. It said:

• Local Authorities have a duty to prevent, reduce and delay need. So, the Council was correct to consider whether appropriate unfunded, community provision could meet a customer’s needs before considering a funded care package.
• Officers had rightly considered if concerns about Miss X’s welfare needed to be considered under the Council’s safeguarding processes.
• Social workers may need to ask sensitive questions when completing assessments.

15. The Council also said that a social worker would contact Miss X to find out whether the preventative referrals had had an impact and offer a Care Act assessment.
16. In May 2023, a social worker visited Miss X. The Council’s records note the purpose of the visit was to go through the previous assessment and make any necessary amendments. The record also notes the social worker discussed with Miss X the support she needed. It was felt Miss X required 9 hours of care per week to meet her needs to be provided by a care provider.
17. Miss X’s care package commenced on 10 July 2023. Correspondence between the Council and care provider show the delay in commencing the care package was due to Miss X’s holiday and other commitments.
18. In August 2023 the Council carried out an occupational therapy assessment. Miss X has said the assessment found that she did not require any aids or adaptations.
19. I asked the Council why it did not carry out a Care Act assessment for Miss X in December 2022. The Council has said it is not fully clear why this decision was made. The wellbeing conversation applied the principles of section 2 of the Care Act 2014 with referrals to occupational therapy and another organisation to reduce or delay the appearance of need.

Analysis

Delay in providing care package

20. The Council cannot explain why it did not carry out a Care Act assessment for Miss X in December 2022. I therefore cannot be satisfied the Council gave proper consideration to whether it should carry out a Care Act assessment at that time. Miss X had previously received a care package from the Council up until 2021. She requested support as she considered her needs were increasing. So, it is reasonable to conclude Miss X would have had the appearance of needs for care and support. I therefore consider the Council would have carried out a Care Act assessment for Miss X had it properly considered its duty under section 9 of the Care Act. I am mindful the Council can consider prevention services for all adults, including those with care and support needs. But this should not preclude it from carrying out a Care Act assessment for those adults with an appearance of care and support needs.
21. The Council’s process for the Care Act assessment lacked transparency. The Council amended the wellbeing conversation to a Care Act assessment in March 2023 and decided Miss X had eligible needs. But there is no evidence to show the Council notified Miss X of this decision. It is also not clear why the Council did not explain it considered Miss X had eligible needs in response to her complaint. However, the Council visited Miss X in May 2022 to update its wellbeing conversation/ assessment so I am satisfied the social worker was in a position to understand Miss X’s needs and the support she required.
22. The Council’s delay in carrying out a Care Act assessment for Miss X meant she did not receive her care package for longer than necessary. I consider this delay amounts to five months. This takes into account that the Council would require approximately a month to carry out support planning and arrange the care package. Miss X’s care package was also delayed as she was on holiday and had other commitments.
23. I understand Miss X was paying privately for carers to meet her care needs. So, she had to pay for her own care for five months longer than necessary. The Council should therefore reimburse Miss X for the fees she paid for her private care package. The Council should deduct the client contribution from the reimbursement as Miss X would have had to pay this if the Council had not delayed in arranging the care package.
24. The Council referred Miss X for an occupational therapy assessment in December 2022. But it did not carry out the assessment until August 2023 which is a delay of eight months. The Council has said this is within the expected waiting times. This is an excessive amount of time for people to wait for an assessment to establish their needs and will further delay provision of support. I understand Miss X did not require any aids or adaptations but the delay will have caused some uncertainty to her. I have also recommended the Council take action to address the excessive waiting times.

Safeguarding referral and intrusive questions

25. Miss X has raised concerns about the Council raising a safeguarding concern as she disputes she referred to harming herself during a telephone conversation. I will not investigate this matter further as I cannot achieve anything for Miss X by doing so. I cannot know what Miss X said to the officer. Even if there was fault by the Council, it would not have caused significant injustice to Miss X as the Council did not carry out a safeguarding enquiry.
26. Miss X has also complained about a social worker asking intrusive questions. I will not pursue this matter further as I cannot establish what questions were asked by the social worker to know if they were necessary or intrusive.

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Agreed action

27. That the Council will:
1. send a written apology to Miss X for the distress and uncertainty caused by the delay in carrying out a Care Act assessment, arranging a care package for her and delay in carrying out an occupational therapy assessment. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
2. make a symbolic payment of £200 to acknowledge the distress and uncertainty caused to Miss X;
3. reimburse the cost of Miss X’s privately commissioned care for the period of five month minus the client contribution Miss X would have paid.
4. by training or other means, remind staff of the provisions of section 9 of the Care Act 2014 requiring the Council to carry out a Care Act assessment for a person who has the appearance of care and support needs.
5. draw up an action plan to reduce the excessive waiting times for occupational therapy assessments.
28. The Council should take the action at a) to c) within one month and the action at d) and e) within three months of my final decision.
29. The Council should provide us with evidence it has complied with the above actions.

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Final decision

30. Fault causing injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman