Summary: Ms C complained on behalf of her mother, Mrs D that the Council had delayed in carrying out an assessment of her care needs, failed to properly include Ms C in the process or provide explanations for its decisions. It also delayed in providing information about a housing needs report and in responding to Ms C’s complaint about the issues. We found some fault in the Council’s actions. The Council has agreed to pay £300 to Ms C, £400 to Mrs D and improve its procedures for the future.

The complaint

1. Ms C complained on behalf of her mother Mrs D, that West Northamptonshire Council (the Council):
• delayed from November 2021 until December 2022 in completing a care act assessment and arranging a care package for Mrs D;
• failed to safeguard Mrs D from neglect by leaving her in an unsafe situation;
• failed to acknowledge Ms C’s role as her advocate, held meetings without her and unfairly claimed she was restricting Mrs D’s independence;
• failed to support Mrs D to move to Hampshire to be nearer to Ms C;
• delayed in responding to Ms C’s complaints about the issues; and
• failed to explain how Mrs D’s financial contribution has been assessed.
2. Ms C said Mrs D has been left at risk of harm and caused significant distress by the Council’s actions. Ms C has been caused significant distress, inconvenience and time and trouble.

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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 documents provided by the complainant, made enquiries of the Council and considered the comments and documents the Council provided. Ms C 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

Adult social care assessments

6. 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, including when they are discharged from hospital. 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.
7. 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.
8. If medically fit and appropriate a person can be discharged from hospital to a different care setting or to their home to be assessed.

Reablement

9. Intermediate care and reablement support services are for people usually after they have left hospital or when they are at risk of having to go into hospital. They are time-limited and aim to help a person to preserve or regain the ability to live independently.

Ordinary Residence

10. Sometimes councils have to decide between themselves which organisation has to meet someone’s eligible care needs under the Care Act 2014. They do this by deciding where the person is ‘ordinarily resident’. There is no definition of ordinary residence in the Care Act, therefore, the term should be given its ordinary and natural meaning.

Charging for care

11. A council can choose to charge for non-residential care following a person’s needs assessment. It must carry out a financial assessment to decide what a person can afford to pay. It must then give the person a written record of the completed assessment.
12. People receiving care and support other than in a care home need to keep a certain level of income to cover their living costs. Councils’ financial assessments can take a person’s income and capital into consideration, but not the value of their home. After charging, a person’s income must not reduce below a weekly amount known as the minimum income guarantee. This is set by national government and reviewed each year.

Disability Related Expenditure

13. Councils can take disability-related benefits into account when calculating how much someone should pay towards the cost of their care. When doing so, a council should make an assessment to allow the person to keep enough benefit to pay for necessary disability-related expenditure (DRE) to meet any needs it is not meeting. The Care and Support Statutory Guidance sets out a list of examples of such expenditure. It says any reasonable additional costs directly related to a person's disability should be included.

What happened

14. Mrs D has lived in a housing association bungalow in the Northamptonshire area for many years. The housing provide is an arms-length organisation of the Council. Mrs D is elderly with a number of chronic health conditions including visual and hearing impairments. Her daughter, Ms C, lives in Hampshire but visits regularly.
15. In November 2021 Mrs D was discharged from hospital to her home with a package of reablement care in place involving twice daily visits. After several weeks the package was reviewed and the reablement team felt Mrs D was able to manage personal care tasks independently. Ms C disagreed and said Mrs D found lots of different people coming in difficult because of her sensory impairments, but she still required help with personal care tasks, cleaning, shopping and getting out into the community.
16. In early December 2021 Ms C requested a financial assessment for Mrs D. the Council said it needed to complete a care act assessment first. Ms C arranged care from a private agency to help Mrs D with cleaning, shopping and going out for a coffee. They came twice a week for three hours and cost around £700 a month. Ms C said Mrs D was much happier and less lonely.
17. On 24 January 2022 social worker visited Mrs D at home, with Ms C present, to carry out a care act assessment. The information provided by the Council is a record of the conversation with the social worker rather than a completed assessment. This said the social worker took the case to a panel the following day and direct payments were agreed but it is not clear what for, or for how many hours.
18. The next record says that the social worker visited Mrs D again on 2 March 2022 with a colleague, without Ms C present. They talked in detail about how Mrs D managed. Mrs D says the care agency was very expensive and she felt she could do most things herself. She admitted she struggled to shower but was too embarrassed to ask the carers for help. She said she managed with food and continence issues. She made hot drinks for herself throughout the day and was able to put away the shopping when it was delivered (her daughter ordered it). She missed going out on her mobility scooter. The social worker suggested she could go out with a carer to supervise her. Mrs D felt she didn’t need someone to go with her to all her appointments as she could manage on her own. The social worker suggested a referral to the visual impairment team to see if they could make suggestions to make some tasks such as showering easier and find some cheaper cleaners. Mrs D said she wanted to talk to Ms C before making any decisions.
19. Following this meeting the social worker informed Mrs D in a telephone call that she was not eligible for funded support from the Council. Mrs D was unhappy with this and did not understand why. The social worker said she could employ cheaper cleaners and had to take into account the information Mrs D had told her during their meeting. Mrs D withdrew her consent for any further input from the Council and told the social worker to ring Ms C.
20. The social worker rang the care agency supporting Mrs D. They said she could complete most tasks herself and they mainly helped with cleaning and taking her to appointments. She confirmed Mrs D would not let them help with showering, but she showered while they were there. The social worker also spoke to Ms C who agreed with Mrs D to stop the assessment process.
21. The visual impairment team assessed Mrs D, but she already had most of the recommended items.
22. On 19 April 2022 Ms C requested that the care act assessment continue for Mrs D. The Council added her back to the allocation list.
23. On 27 May 2022 Ms C asked for an update and also requested a letter from occupational health detailing Mrs D’s housing needs so she could give this to the housing team in Hampshire to consider Mrs D’s housing options nearer to Ms C. The Council advised her to contact Mrs D’s housing provider to get a housing needs statement.
24. On 1 June 2022 the Council confirmed a home visit appointment on 10 June 2022 to carry out the assessment with Ms C present. Ms C asked again for a housing needs assessment.
25. The Council said the home visit and assessment were completed on 10 June 2022, but it has provided no notes of the visit, outcome or assessment.
26. On 23 June 2022 Ms C contacted the Council to say she and Mrs D felt she needed 9 hours of support per week. She also requested the housing needs assessment again. The social worker contacted the community occupational therapy team who declined and so she contacted Mrs D’s housing provider requesting a report. On 30 June 2022 Ms C requested contact details for occupational therapy so she could get the report.
27. After further email communication the Council’s housing team confirmed on 13 July 2022 that it did provide occupational therapy housing needs reports and made an appointment for 27 July 2022. The social worker referred Mrs D back to the reablement team as she had previously been independent with tasks. The private care agency confirmed that they helped Mrs D with showering, meal preparation and shopping. They said she was at risk of falling, struggled to access the toilet and move around the house.
28. On 25 July 2022 Mrs D fell at home and was admitted to hospital. She was discharged home on 28 July 2022. Ms C arranged for private care until 5 August 2022 and declined reablement care given Mrs D’s previous experiences. The reablement team had said Mrs D did not have sufficient need for their service as she only needed help with nutrition.
29. On 14 August 2022 Ms C complained to the Council about the lack of social care provision for her mother. She said the Council had been wrong to visit her without Ms C present as she has communication difficulties and was a very proud woman who did not like to ask for help. She also said Mrs D remembered things from a long time ago as if they were current, such as drinking 14 cups of coffee a day. She requested 9 hours of care a week.
30. The Council started another care act assessment on 17 August 2022. On 27 August 2022 the panel agreed to eight hours a week via direct payments @ £18 per hour. The assessment was completed on 13 September 2022 and the support plan drawn up on 28 September 2022 detailed eight hours of support per week for help with shopping, attending health appointments, personal care and meal preparation.
31. On 11 October 2022 the Council completed a financial assessment and concluded Mrs D’s contribution should be £126 per week. The direct payment contract was set up on 11 November 2022. The social worker visited Mrs D on 14 November 2022 and she was happy with the conclusion but the hours had not started yet.
32. Mrs D then went stay with her daughter in Hampshire. Ms C applied for extra care housing for Mrs D in Hampshire at the beginning of December. On 21 December 2022 the Council agreed to Ms C’s request for an extra hour per week of care. But Ms C had not returned the direct payment contract because she did not agree with Mrs D’s contribution. The Council informed Ms C that it would not be funding an extra care placement in Hampshire because Mrs D was choosing to move. It would transfer responsibility to Hampshire County Council.
33. Mrs D then fell while in Hampshire and broke her leg. She was admitted to hospital. Ms C returned the signed direct payment contract in early January 2023. The Council discovered that Mrs D was in hospital in Hampshire.
34. In February 2023 Mrs D was discharged to a nursing home for assessment. On 23 February 2023 the Council asked Ms C where Mrs D was planning to live. Ms C did not respond at this point. Mrs D was in a community hospital as Ms C had removed her from the nursing home. At the end of March 2023 Ms C requested the Council carry out an assessment because Mrs D was fit for discharge. The Council refused as Mrs D was not living in the county. But as Mrs D’s long-term residence was unclear it would leave her care package open.
35. In April 2023 Ms C escalated her complaint to stage two of the Council’s complaints process.
36. In May 2023 Ms C ended Mrs D’s tenancy in Northamptonshire. She confirmed Mrs D had been on the housing list in Hampshire since February 2023 for extra care housing. Hampshire carried out a care act assessment in preparation for her discharge from hospital and said the Council was responsible for the care as Mrs D was ordinarily resident in Northamptonshire. In June 2023 the Council concluded that it was not responsible for Mrs D’s care and support needs as she had chosen to move to and live in Hampshire.
37. Ms C complained to us in June 2023. We asked the Council to respond to her complaint.
38. In August 2023 the Council responded to Ms C’s complaint. It said it could not see a note in its records where Ms C had requested to be present at meetings with Mrs D. It apologised if this was an oversight. It confirmed that a care act assessment was completed on 13 September 2022 and was in place by 24 October 2022. It apologised if there was a delay in starting the assessment which was due to the demand for its services.
39. The Council said that it had worked with Ms C to find suitable support for Mrs D in Hampshire since she had moved there to live with Ms C. But she moved before the Council could fully explore the extra care housing and then went into hospital. As she had given up her tenancy in Northamptonshire, Hampshire was now responsible for her care and support needs.
40. It again apologised for any delay in completing the assessment.
41. We then decided to investigate the complaint.

Analysis

November 2021 to March 2022

42. Mrs D’s reablement care finished at the end of November 2021 and the reablement team’s view was that Mrs D was independent with personal care tasks. Ms C disagreed and said Mrs D, due to her sensory impairments became easily overwhelmed by lots of different people visiting and did not like to admit she needed help. After agreeing to carry out a care assessment the Council visited within about eight weeks. Given this included the Christmas and New Year period I do not consider this was an excessive period of time.
43. However, there is no formal record of the conclusion of the visit, no explanation of what was presented to the Ideal Outcome Meeting or what was agreed or why the social worker visited Mrs D on her own six weeks’ later. This was fault which left Mrs D and Ms C without a clear understanding of whether the Council was going to provide any care.
44. There was a conflict of evidence from the reablement team, Ms C and Mrs D’s view of Mrs D’s care and support needs which added to the uncertainty. But there is no evidence the Council properly balanced the different sources of evidence given between December 2021 and March 2022 or tested their veracity. This was fault which meant neither Ms C or Mrs D understood why Mrs D was not eligible for support.
45. I have not found fault with the decision by the Council to visit Mrs D alone. It was not unreasonable to talk to her about her needs to add to the evidence it had from other sources. But I consider it should then have discussed the information with Ms C to allow her to give her view as it appears Mrs D was not always accurate in her recall and often downplayed her difficulties. The failure to seek Ms C’s view meant the decision not to provide care was not adequately justified or explained to either Mrs D or Ms C.
46. The decision not to provide care was given over the telephone to Mrs D. This was rushed and inadequate, the Council failed to provide proper reasons and gave Mrs D nothing in writing. This caused Mrs D to lose trust in the Council and withdraw consent for any further intervention. Neither did it explain the decision to Ms C. This was fault which meant the process was delayed for a further two months and no formal assessment was completed.

April 2022 to July 2022

47. Ms C requested the assessment process restart on 19 April 2022. The Council visited Mrs D on 10 June 2022 almost two months later. Given the same social worker was involved I consider this was a long time, but I can see that the date of the visit was dictated by Ms C’s availability when she was visiting Mrs D, so I do not find fault here.
48. However, I have not seen any notes or conclusions from the home visit and note nothing had been completed or progressed by the time Mrs D fell on 25 July 2022 and was admitted to hospital. This was fault. According to the care agency Mrs D’s care needs had increased since the agency was asked in March 2022, but the Council had still not completed a proper assessment of those needs. If this process had been done more quickly, it is possible care could have been put in place much sooner.
49. During this period Ms C requested a housing needs assessment report by an occupational therapist. The Council said that it could not provide such a report and directed Ms C to Mrs D’s housing provider. But the housing provider took two months to confirm it could provide the report. However, Mrs D then missed the assessment visit as she was back in hospital. The Council agrees it has its own OT service that generally provides reports for people living in their own homes and it could have acted sooner to ensure the report was done for Mrs D, rather than delegating the matter to Mrs D’s housing provider. This may have assisted Mrs D to find alternative housing in Hampshire much sooner.

August – December 2022

50. When Mrs D was discharged from hospital at the end of July 2022 Ms C declined reablement care and arranged for the private care to restart. She complained to the Council in August 2022 about the failure to provide any care or support to Mrs D. I have not seen a formal complaint response at this stage, but the Council restarted the assessment process on 17 August 2022 and completed the assessment within a month, recommending eight hours a week of support via direct payments. It drew up the support plan explaining what the hours should be used for, completed a financial assessment and drew up the direct payment contract by mid-November 2022. The process was completed within three months and I cannot identify any delay here.
51. Ms C delayed the start of the direct payments because she did not return the signed direct payments contract until early January by which time Mrs D had moved to Hampshire to live with Ms C, fallen and been admitted to hospital again.

January to May 2023

52. Mrs D was not fit for discharge until at least February 2023. Between then and May 2023 the Council tried to establish her long-term residency intentions, but Ms C was not clear and as Mrs D had not lived in its area since November 2022 it declined to do any further assessments. By May 2023 Mrs D had given up her tenancy in Northamptonshire and Hampshire had completed a care act assessment. I do not find fault with the way it made its decision that Mrs D was not ordinarily resident in Hampshire.

Complaint response

53. The Council did not respond to Ms C’s stage one complaint at all and took four months to reply to her stage two complaint. This was fault which caused Ms C significant frustration and time and trouble. The response was very brief and did not cover all the events that had happened. It failed to acknowledge or analyse the period from November 2021 to August 2022 or consider whether it had been responsible for the delay in completing the assessment. This was also fault which exacerbated the injustice to Ms C.

Financial assessment

54. Each Council operates its own charging policy. I have not identified fault in the way the Council reached its view that Mrs D should pay £126 a week as a contribution to the cost of her care. Hampshire’s assessment was only slightly less, and this would appear to be due to a different treatment of Mrs D’s DRE. Ms C could have raised her concerns with the Council as a complaint and asked it to reconsider the DRE it had included.

Injustice

55. I accept that Mrs D’s admissions to hospital delayed the assessment process, along with the logistics of including Ms C for the assessment visits. However, I consider the Council contributed to the delay by starting the process from scratch each time, failing to weigh the conflicting evidence, include Ms C at crucial points or provide reasons for its decisions.
56. I understand Mrs D had some care during this period which she paid for at a cost of around £175 per week. If the Council had put care in place sooner, it is possible Mrs C would have had to pay less (her contribution was assessed at £126 per week). It is difficult to reach a definitive view on this point because the Council-funded care never started due to Mrs D moving to Hampshire and it is not clear whether Mrs D would have retained some of the existing private care. But it is likely Mrs D missed out on some Council funding during the period of delay.
57. I also consider Ms C has been caused significant distress, frustration and time and trouble in trying to arrange appropriate care for her mother.

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Agreed action

58. In recognition of the injustice caused to Ms C and Mrs D, I recommended the Council within one month of the date of my final decision:
• apologises to them both;
• pays Ms C £300 for her distress and time and trouble in pursuing the Council for over a year; and
• pays Mrs D £400 for loss of council -funded care and the uncertainty that the situation may have been different if the assessment had been completed sooner.
59. 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.
60. In addition I recommended the Council, within three months of the date of my final decision, reviews its assessment process to:
• consider whether it can streamline the process where repeat visits and requests are made by the same person;
• ensure family members and carers are adequately consulted and their views properly balanced where conflicting evidence is given; and
• ensure that decisions are given to service-users and their family members/carers in writing with reasons and that full records are kept of the decision-making process.
61. I also recommended that the Council, within three months, reviews its complaints process and considers introducing a checking mechanism to ensure thorough responses are provided within a reasonable timescale.
62. The Council has agreed to my recommendations and should provide us with evidence it has complied with the above actions.

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Final decision

63. I consider this is a proportionate way of putting right the injustice caused to Ms C and Mrs D and I have completed my investigation on this basis.

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Investigator's decision on behalf of the Ombudsman