Summary: Ms X complained about the Council’s Care Act assessment, the amount and inconsistency of care she received, and how it communicated with her and shared her information. We found fault and a service failure by the Council which meant Ms X did not receive all the care and support she was entitled to and experienced distress. The Council will apologise and make payment to acknowledge the injustice this caused her.

The complaint

1. The complainant, Ms X, complained about how Lincolnshire Partnership NHS Foundation Trust, acting on behalf of the Council, dealt with her Care Act assessment and provision of care and support from April to October 2023. She said it:
• failed to involve an advocate to support her when a needs assessment was carried out, and no reasonable adjustments were made for her communication and her mental and physical health;
• it found she was eligible for support under the Care Act but this was delayed and was not enough to meet her needs, and untrue statements were recorded in the assessment;
• failed to address a lack of consistency and handover between care teams which meant carers were not familiar with her and her needs;
• shared information and made referrals to other services without her consent;
• moved her to unsuitable housing, including hotel accommodations; and
• failed to respond properly to her complaint.
2. Ms X said, as a result, she became isolated, her mental and physical health was impacted, and she experienced distress and uncertainty.

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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 there was no fault in how the organisation made its decision, we cannot question the outcome. (Local Government Act 1974, section 34(3), as amended)
5. We investigate complaints about councils and certain other bodies. Where an individual, organisation or private company is providing services on behalf of a council, we can investigate complaints about the actions of these providers. (Local Government Act 1974, sections 24A(1)(A) and 25(7), as amended).
6. We cannot investigate late complaints unless we decide there are good reasons. Late complaints are when someone takes more than 12 months to complain to us about something a council has done. (Local Government Act 1974, sections 26B and 34D, as amended)
7. 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

8. I have investigated Ms X’s complaint from April 2023 when she moved to the Council’s area until November 2023 when it provided its complaint response. My investigation includes the Lincolnshire Partnership NHS Foundation Trust handling of her adult social care case on behalf of the Council through a Section 75 NHS Act 2006 arrangement. While her complaint was brought to our attention late, I found it was appropriate to exercise discretion as Ms X initially asked the Parliamentary and Health Service Ombudsman to consider her complaint which caused a delay.
9. I have not investigated Ms X’s complaint regarding:
• the suitability of her accommodations in hotels and her tenancy in a flat as the Council was not the body responsible for her homelessness case. This was the district Council’s duty. Any concerns about the suitability of the provision of housing should therefore be brought to the attention of the district Council.
• Any concerns Ms X may have about events which occurred after October 2023, including her move to the temporary accommodation flat. This is because this was not part of her initial complaint to the Council. Nor her complaint to the Ombudsman.

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How I considered this complaint

10. I considered evidence provided by Ms X and her representative, and the Council as well as relevant law, policy and guidance.
11. Ms X and the Council had an opportunity to comment on my draft decision. I considered any comments received before making a final decision.
12. Under our information sharing agreement, we will share this decision with the Care Quality Commission (CQC).

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What I found

Relevant law, guidance and policy

Care Act assessments and care plans

13. 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.
14. 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.
15. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). 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. When preparing a care and support plan the council must involve any carer the adult has. The support plan must include a personal budget, which is the money the council has worked out it will cost to arrange the necessary care and support for that person.

Care act transfer

16. Section 37 of the Care Act 2014 sets out the process which should be followed when an individual with a care and support plan moves into another council’s area. This includes notifications and sharing information to enable the transfer for care responsibility to the new council, which can help ensure the individuals care and support continues without unnecessary disruption.

Care homes and respite

17. A temporary resident is someone admitted to a care or nursing home where the agreed plan is for it to last for a limited period, such as respite care, or there is doubt a permanent admission is required. The person’s stay should be unlikely to exceed 52 weeks, or in exceptional circumstances, unlikely to substantially exceed 52 weeks. A decision to treat a person as a temporary resident must be agreed with the person and/or their representative and written into their care plan.
18. A council can choose whether to charge a person where it is arranging to meet their needs. In the case of a short-term resident in a care home, the council has discretion to assess and charge as if the person were having their needs met other than by providing accommodation in a care home. Once a council has decided to charge a person, and it has been agreed they are a temporary resident, it must complete the financial assessment in line with the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance.
19. Section 23 of the Care Act 2014 makes a distinction between housing duties and adult social care duties by councils. This means a council’s adult social care is not responsible for providing or meeting an individual’s general housing support or needs. This responsibility remains a housing duty in line with the Housing Act 1996 which may be held by the same council or a different council.

Safeguarding

20. A council must make enquiries if it thinks a person may be at risk of abuse or neglect and has care and support needs which mean the person cannot protect themselves. An enquiry is the action taken by a council in response to a concern about abuse or neglect. An enquiry could range from a conversation with the person who is the subject of the concern, to a more formal multi-agency arrangement. A council must also decide whether it or another person or agency should take any action to protect the person from abuse. (section 42, Care Act 2014)

The Council’s Adult Social Care complaints policy

21. When the Council receives complaints about its adult social care services, it will:
• initially attempt early resolution and provide a response within 10 working days; and
• if a matter is not resolved and a complainant asks for the matter to be escalated, a senior manager will review and consider the request. When a request is accepted and the points of complaint are confirmed, it will provide its response within 20 working days.

What happened

22. Below are the key events which occurred. This is not intended to be a detailed summary of everything that happened.
23. In early 2023 Ms X lived in another local authority area. She had a tenancy but was due to be evicted. She also had a care and support plan which set out her needs. Support was in place to meet her needs, although she felt this was not adequate to meet her needs.
24. In April 2023 Ms X came to the County Council’s (the Council) area with the support of a friend. She approached the local district Council as homeless and requested support. The district Council provided Ms X with interim accommodation in a hotel.
25. The district Council and Ms X’s friend asked the Council to provide her with adult social care support. However, a Care Act transfer could not be completed for Ms X as she had refused for her previous local authority to share information about her, including its adult social care records and support arrangements. The Council explained it could not put any support in place until her needs and wishes had been assessed.
26. The Council arranged a meeting with Ms X for the following week. It told her this would be two social workers in line with its process and a family member would be supporting Ms X. The meeting did not go ahead as Ms X felt two officers’ presence would cause her too much anxiety.
27. Following communication with Ms X’s previous advocate, a new meeting date was agreed. It also agreed she could record the meeting, and it made a referral for a care act advocate.
28. In May 2023 a meeting to start Ms X’s Care Act assessment took place in her family members home who also attended. No Care Act advocate was in place, and two Council officers attended. The notes show:
• Ms X shared her views on her needs and wishes. She said she wanted supported living and have freedom, rather than residential care or her own tenancy. She felt she needed support to check on her and 1:1 support with some needs in and out of her home. She shared concerns about consistency in carers and for carers to be familiar with her conditions and needs.
• Ms X shared two friends were currently in the process of obtaining power of attorney for her health & welfare and her finances. She would update the Council when this was completed.
• The Council found Ms X was currently low risk to herself and was independent in several areas, but had eligible needs. It had no concerns about her ability to manage the hotel accommodation. However, a further visit and more information was needed to complete the assessment.
• A financial assessment was started but more information was needed from Ms X.
• It provided some information and advice to her, arranged for GP registration to be made, and made a referral for a Transforming Care team to access other health services.
29. A week later the Council decided to reach a view on Ms X’s Care Act assessment to enable it to put interim support in place for her. It found she had several eligible needs and decided three hours of support each day would meet her needs. It also set out further long-term options to be explored and identified the risks to her and her communication preferences. A care provider (Care provider Y) was identified.
30. Over the following month the Council continued to communicate with Ms X to get Care provider Y in place and to complete her financial assessment. However, as Ms X had been clear she did not consent for her information to be shared without her express approval, it could not put the care provision in place.
31. The Council held a multi-disciplinary team meeting in which Ms X’s case was also considered.
32. An advocate was in place to support Ms X in late May 2023. The Council informed the advocate about the information the Council needed from Ms X, including her consent for Care provider Y to be able to provide support. The advocate suggested Ms X should be placed in respite care due to the impact the hotel accommodation had on her wellbeing and mental health.
33. A team around the adult meeting was held which included a housing support organisation who subsequently helped Ms X with her financial assessment and welfare benefits applications. It was also asked to explore supported living provision for her.
34. In June 2023 the Transforming Care team accepted the Council’s referral. It subsequently arranged to meet with Ms X to address her concerns about her specific support and training needs for carers. This meeting took place in July 2023, and training was arranged to carers from Care provider Y.
35. In July 2023, following Ms X’s consent, the Council shared Ms X’s care and support plan with Care provider Y. The provider met with her the following week and the three hours per day of care support started soon after.
36. In August 2023:
• the district Council identified a tenancy for Ms X. It discussed the suitability of this with the Council and what adaptations and support may be needed for Ms X.
• An incident occurred in Ms X’s hotel and the police was involved. She was placed in another hotel initially by the Police and subsequently by the district Council.
• A charity, Care provider Y and the hotel Ms X had stayed at, raised concerns about Ms X’s care package and housing situation. She was reported as being unsettled and her mental health was being impacted.
• Care provider Y requested emergency respite care for Ms X, but before this could be put in place she was admitted to hospital. The hospital also raised a safeguarding concern about Ms X.
• Ms X was subsequently placed in another hotel. Care Provider Y could not provide all her care support in weekends, or due to Ms X being placed in a hotel outside the area it was able to cover. The Council found an alternative care provider (Care provider Z) which started supporting Ms X.
• The Council considered the concerns, and a multi-disciplinary meeting was held. It found risks were managed, support was in place, and longer-term housing was being arranged. Support hours in Ms X’s care and support plan were increased to six hours per day.
• The district Council offered Ms X a temporary accommodation flat. The Council’s social worker arranged for support to put the tenancy in place and arrange the necessary adaptations relevant for her adult social care support. An occupational therapist assessment would also be arranged once the move was agreed.
• Ms X reluctantly agreed to the district Council’s final property offer, which was the tenancy with care support in place. She refused some support from Care provider Z, and was again admitted to hospital.
37. In September 2023:
• Ms X was discharged into a hotel, but refused to return to the hotel. She attended A&E and remained in hospital. She was subsequently discharged into the hotel but continued to refuse Care provider Z’s support.
• The Council’s social worker continued to liaise with the hospital, the hotel, housing and provide updates to the multi-disciplinary team. Care homes for respite placements were also considered but none were identified with availability, could not meet Ms X’s needs, or had previously declined her.
• Attempts to persuade Ms X to sign the tenancy for the offered flat continued and the support available to her was explained. This included support with the move, arranging an occupational therapist assessment, safety equipment and white goods in the flat, and support to manage the tenancy.
• A further incident occurred when Ms X was to be moved between hotels where she again refused support from Care provider Z, and the police was called.
38. In October Ms X was moved to the flat. A housing support organisation supported Ms X with the move. She continued to refuse Care provider Z’s support.
39. Ms X found the property unsuitable. The Council said she subsequently withdrew her consent for Care provider Z to be involved in her care. Further concerns about Ms X’s welfare were brought to the Council’s attention.
40. The Council agreed a Care Act reassessment was needed. It arranged a welfare visit but Ms X did not respond. It made a referral for advocacy support and assigned a social worker to complete the reassessment. Several respite placements were contacted but none could offer Ms X a placement.
41. A meeting between professionals took place. The Council told Ms X about her options regarding care providers, sought her GP’s input, and attempted to arrange the occupational therapist visit.
42. In November 2023 emergency services found Ms X in her flat in poor conditions. She expressed a willingness to consider respite care. The Council found a placement and she moved in soon after.

Ms X’s complaint

43. Ms X complained to the Council about its handling of her care assessment and support since moving into its area. Her complaint and the Council’s response were:
• It failed to involve an advocate to support her when a needs assessment was carried out, and no reasonable adjustments were made for her communication and her mental and physical health;

The Council did not agree it had failed to consider Ms X’s needs for reasonable adjustments. It explained how it had attempted to support her to be able to communicate through her preferred methods. It also arranged a sensory assessment which helped inform its Care Act assessment and support planning. However, it apologised no advocate was involved in her initial assessment. An advocate had subsequently been assigned, and it would ensure an advocate is available for her reassessment.

• it found she was eligible for support under the Care Act but this was delayed and was not enough to meet her needs, and untrue statements were recorded in the assessment;

The Council explained it had assessed Ms X and considered the information available to it. However, this was challenging as she had not consented to a Care Act transfer, and it required her consent for other information. It had therefore made an initial decision to put three hours of care support in place. This was later increased to six hours of support.

It acknowledged there were times where not all care support was provided or available to Ms X. This was when she had not agreed to share information, Care provider Y could not deliver support in another area, requested care support on short notice, or refused care support from Care provider Z.

• failed to address a lack of consistency and handover between care teams which meant carers were not familiar with her and her needs;

The Council found Care provider Z was experienced and the Transforming Care team offered support regarding Ms X’s needs to the provider. It explained when Ms X was placed in her flat Care provider Z had provided a timetable with two carers where one was known to her, which worked well until she withdrew her consent for the provider. It had subsequently informed her and her advocate this would mean she would not have any support until another provider was identified.

• it shared information and made referrals to other services without her consent;

The Council did not agree it had shared information with Ms X’s consent. It explained it had sought her consent to share information for care support, and Ms X had engaged with some other referrals it had made.

• it moved her to unsuitable housing, including hotel accommodations; and

It explained the district Council placed Ms X in accommodations under its homelessness duty. She was initially settled, and support was provided. It could not comment on the suitability of accommodations as this was for the district Council. Nor, the incident with a manager from a hotel as this was a police matter.

44. Ms X was not satisfied with the Council’s response to her complaint. In April 2024 she asked the Parliamentary and Health Service Ombudsman to consider her complaint. This included the suitability of homelessness accommodations and the decision to place her in the temporary accommodation in a flat in November 2023.
45. Due to the Council’s Section 75 agreement with the Lincolnshire Partnership NHS Foundation Trust, it became clear Ms X’s complaint was in relation to the Council’s duties under adult social care and not the NHS. The case was subsequently brought to our attention.

Analysis and findings

Care act assessment and care support

46. The Council started Ms X’s Care Act assessment soon after she moved into its area. However, as Ms X refused a Care Act transfer, it had to complete a new assessment and could not rely on any previously held information. It could therefore not put any care support in place until it had done so.
47. The Council apologised to Ms X for not having an advocate during the initial part of its Care Act assessment process. This was fault as this should have been offered and arranged for Ms X beforehand.
48. However, I have not found this was the reason for why a limited amount of care was set out in its initial care and support plan. Nor that the Council caused delays in putting the support in place. This is because:
• Ms X had not agreed for the Council to obtain information which was already available about her care and support needs;
• The Council obtained Ms X’s wishes and views, including what support had worked or not worked in the past;
• Ms X said she had friends who were in the process of obtaining power of attorney to support her with health & welfare and financial matters;
• Ms X had some support from her previous carer and her previous advocate, and the Council considered the information they provided. It also made a referral for an advocate who became involved in the end of May 2023; and
• The Council had made referrals to get Ms X registered with local services to provide her with further support; and
• The Council and Ms X identified Care provider Y to be appropriate, but it then had to ensure the provider were familiar with her reasonable adjustments, could meet her needs, and the care staff it allocated had the appropriate training. As part of this process, it had to obtain Ms X’s consent to share her information, Ms X wanted to have a visit from the provider, and it had arranged for training for the Care Provider Y.
49. Therefore, while I accept three hours of care support each day was not enough to meet Ms X’s needs. This was not known at the time based on the information available to the Council.
50. However, shortly after Care provider Y became involved with Ms X, it became clear through further safeguarding concerns, including from Care provider Y, that Ms X was struggling and the support in place was inadequate.
51. While the Council increased Ms X’s care and support to six hours per day, this did not happen until further safeguarding referrals were made and she was admitted to hospital. I found the Council caused a short delay in properly considering the challenges she was facing and put additional care and support in place.
52. In addition, although the Council increased her care and support hours to six hours per day, the evidence shows:
• this could not be provided as Care Provider Y was not able to do so in weekends; and
• Ms X was moved to another hotel in another area by the district council, which meant Care provider Y could no longer deliver the support; and
• The Council identified Care provider Z to provide Ms X’s care and support in weekends and for the six hours per day. However, Ms X had not consented to this provider.
53. I acknowledge the Council’s view that it was Ms X who refused Care provider Z’s care and support, and she did receive some support. However, I am not satisfied the Care provider Z had the same level of experience regarding Ms X’s specific needs, nor the training which care provider Y had received. I also understand there were a lack of consistency with carers which meant Ms X had to repeatedly try to get her carers to understand her specific needs. This was not fully addressed by the time Ms X had been moved to the flat in October 2023.
54. I also acknowledge it was challenging for the Council to provide adult social care support for Ms X due to her changing housing situation. The evidence is also clear that the Council’s allocated social worker used best endeavours in her attempts to provide Ms X with the support set out in her care and support plan. This included liaising with care providers, Ms X and her advocate, the district Council’s housing team, the hospital and others.
55. However, I found it was not unreasonable for Ms X to refuse some care and support and ask the Council to put in place support which better met or understood her needs. The Council’s failure to ensure Ms X received appropriate care support as set out in her care and support plan was therefore a service failure.
56. I acknowledge Ms X experienced distress and frustration, including an impact on her physical and mental health from April 2023 when she moved into the Council’s area. However, I can only remedy the injustice the Council was responsible for. I found this to be from late July 2023 to October 2023 when she was moved to her flat.

Reasonable adjustments

57. I have also considered whether the Council had proper regard to Ms X’s reasonable adjustment request in how it communicated with her and how it could effectively work with her to limit the impact of her health conditions.
58. I found it considered her needs and made efforts to communicate with her in the way she requested. I also found it attempted to strike a balance between making decisions to enable care support to be arrange, and to give Ms X time to have her views and wishes adhered to. In doing so it also took account of information it received from her advocate, care providers, and others involved with Ms X.
59. While I accept Ms X found the process and working with the Council challenging, I am therefore not satisfied this was because the Council failed to have proper regard to her reasonable adjustments.
60. If Ms X believes the Council breached her rights under the Equality Act 2010 in this regard, she has the right to bring a claim to court to have such concerns considered.

Respite placement

61. The Council had a duty to ensure its care and support was meeting Ms X’s needs as assessed in her care and support plan.
62. While I cannot consider Ms X’s concerns about the suitability of the hotel accommodations provided by the district council through its housing duties, I can consider whether the Council should have considered, or done more to ensure her care and support needs were appropriately met.
63. In this case, it is clear from the various safeguarding concerns raised by several professionals involved with Ms X that she was struggling significantly, even when she was receiving support from Care provider Y. This may have been due to a combination of the accommodations she was provided and the limited care support that was in place or was delivered.
64. Regardless, the Council had a duty to consider whether it should provide her care and support in a different way. This could be in a care home or through temporary respite care. The evidence shows the Council did consider this and sought placements for her, but it was unable to source any placement which had availability, could meet her needs, or had not already refused her.
65. I found the Council’s actions indicate it agreed it would have been appropriate to alleviate her struggles through some form of respite placement or a temporary care home. However, it caused a service failure by being unable to do so and give Ms X such a choice. This was therefore missed opportunities to limit the impact the lack of appropriate care and support had on Ms X.

Information sharing concerns

66. Ms X said the Council had wrongly shared her information with some services and Care provider Z.
67. Based on the information available, it is clear Ms X was reluctant for her information to be shared. However, she did agree for some health, care, or advocacy referrals. It is also clear any information the Council did share was with the aim of assessing Ms X’s needs and arranging care and support which could meet her needs.
68. I found this part of Ms X’s complaint relates to whether the Council breached her rights by wrongly sharing her information. The Information Commissioners Office is the body best placed to consider such issues. I will therefore not consider this part of her complaint further.

Complaints handling

69. I acknowledge Ms X was not happy with the Council’s response to her complaint. However, I found the Council had responded to her complaint as set out in its complaints policy.
70. In doing so, it continued to work with her to try and resolve her concerns, and it provided its response to the matters she complained about without unnecessary delay in the process.
71. It is clear Ms X does not agree with the Council’s findings, but this does not mean there was fault in how it handled her complaint. Nor would I expect the Council to address the injustice she said she experienced, if it found it had not been at fault or caused the injustice.

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Action

72. When a council commissions or arranges for another organisation to provide services, we treat actions taken by or on behalf of that organisation as actions taken on behalf of the council and in the exercise of the council’s functions. Where we find fault with the actions of the service provider, we can make recommendations to the council alone. Here we have found fault with the actions of the Lincolnshire Partnership NHS Foundation Trust and make the following recommendations to the Council.
73. To remedy the injustice the Council caused to Ms X, the Council should, within one month of the final decision:
1. apologise in writing to Ms X to acknowledge the distress and uncertainty she experienced as a result of the Council’s faults.

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. pay Ms X a symbolic payment of £500 to acknowledge the likely loss of care and support she experienced up to October 2023 as a result of the Council’s fault and service failure.
2. Within three months of the final decision the Council should also:
1.  
2.  
3. review whether it has adequate provision for domiciliary care support and respite placement throughout its area to enable it to meet needs of service users, including those with challenging needs and requirements for consistency in service and carers.
3. The Council should provide us with evidence it has complied with the above actions.

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Decision

76. I found fault and a service failure by the Council which caused Ms X an injustice. The Council has agreed to my recommendations to acknowledge the impact this caused her.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman