Summary: Ms Z, on behalf of her aunt Mrs X, complained the Council delayed completing a social care assessment; failed to consult professionals with relevant information and failed to provide a suitable level of care. The Council delayed in completing the assessment causing uncertainty. A payment to acknowledge this is agreed.

The complaint

1. Ms Z, on behalf of her aunt Mrs X, complains the Council delayed completing a social care assessment; failed to consult professionals with relevant information and failed to provide a suitable level of care.
2. Ms Z says this affected Mrs X’s mental health as well as impacting on other family members who had to provide care and support.

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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. As part of the investigation, I have:
• considered the complaint and the documents provided by the complainant as well as relevant law, policy and guidance;
• made enquiries of the Council and considered the comments and documents the Council provided;
• discussed the issues with the complainant;
• sent my draft decision to both the Council and the complainant and taken account of their comments in reaching my final decision.

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What I found

Assessment

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. 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.

Direct payments

8. Direct payments are monetary payments made to individuals who ask for them to meet some or all of their eligible care and support needs. They enable people to arrange their own care and support to meet those needs. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.
9. The gateway to receiving a direct payment must always be through the request from the person. Councils must not force someone to take a direct payment against their will. They should not place someone in a situation where a direct payment is the only way they can get personalised care and support.
10. Councils must tell people during the care planning stage which of their needs direct payments could meet. However, councils must consider requests for direct payments made at any time and have clear and quick procedures in place to respond to them.
11. After considering the suitability of the person requesting direct payments against the conditions in the Care Act 2014, the council must decide whether to provide a direct payment. In all cases, the council should consider the request as quickly as possible.
12. The council must provide interim arrangements to meet care and support needs to cover the period in question. Where accepted, the council should record the decision in the care or support plan. Where refused, the council should explain its decision in writing to the person who made the request. It should also tell the person how to appeal against the decision through the local complaints procedure. (Care and Support Statutory Guidance 2014)

Key facts

13. This section sets out the key events in this case and is not intended to be a detailed chronology.
14. In July 2023, Mrs X’s daughter contacted the Council requesting support with equipment for Mrs X following a stroke. She made a second contact a few days later requesting a care needs assessment. Between June and August 2023, Mrs X was receiving care through a reablement package. The Council says a social worker involved in the case was satisfied Mrs X’s needs were not urgent due to involvement through the reablement package.
15. An occupational therapist (OT) visited Mrs X in October and recommended equipment for Mrs X. The OT also noted that Mrs X required assistance with personal care needs as her daughter had been providing care but needed to return to work.
16. The Council says it carried out an initial assessment in November 2023 but that no immediate service was discussed. It is my understanding the care needs assessment took place on 19 January and that the case was discussed at a funding panel in February 2024. A recommendation for a package of care of 12.15 hours per week was made to the panel. This would be for three care calls each day using a direct payment so a carer with the correct language skills could be employed.
17. The panel asked the social worker to explore with the family weekend care needs as Mrs X lived with two adults who might be able to provide care at the weekends. The Council says the family agreed they could provide care at the weekend so the care plan was amended to 8.45 hours a week covering three calls a day on weekdays only.
18. The Council says the family only wanted to consider direct payments and refused a commissioned service, even as an interim measure. It says it sent out information and included a financial assessment form but this was never returned.
19. In March 2024 Ms Z began acting on behalf of her aunt, Mrs X. She was in contact with the Council about the assessment saying the care hours offered were not adequate. In May, Ms Z made a formal complaint. She requested a reassessment by a different social worker which would include consideration of medical reports and seek input from the OT. She also complained about the delay in completing the assessment and poor communication.
20. The Council accepted it had failed to action the request for a care needs assessment in July 2023. It said a new social worker had been allocated to the case and would make contact to arrange a re-assessment. It did not uphold the other complaints about poor communication.
21. In June, before the Council provided the response to Ms Z’s formal complaint, the new social worker contacted Ms Z who said she wanted to wait for the outcome of the complaint before arranging the reassessment. The complaint response was dated 4 July but there is nothing to suggest Ms Z contacted the Council after receiving it.
22. In August the social worker left messages saying she would visit on 27 August to complete the reassessment of Mrs X’s needs. Mrs X’s daughter explained there had been a family bereavement and they were away. It was agreed the family would contact the Council when they returned.
23. The social worker left further messages saying she would visit on 10 September. The family returned the messages saying it was difficult to carry out the reassessment on that date and the social worker told them to contact her when they were ready. Ms X sent a message to the social worker’s mobile phone on 20 September asking if she could visit the following week. There is nothing to suggest the social worker responded to the message.
24. Ms X sent a further text message on 26 September. She said she had been trying to call the social worker but was not able to reach her. She asked the social worker to let her know when she was able to visit to complete the reassessment.
25. The social worker Ms X messaged left her job on 25 September and her mobile phone would have been switched off. Therefore, the message sent on 26 September would not have been seen.
26. In October, due to a lack of contact from the family, the Council took the view it would take no further action.

Analysis

27. The family first contacted the Council in July 2023 requesting a care needs assessment. This was not completed until January 2024 approximately six months later. The Care and Support Statutory Guidance says that an assessment should be carried out over an appropriate and reasonable timescale. We expect councils to complete assessments in a timescale that is proportionate to the complexity of the issues and normally within 4-6 weeks.
28. The time taken in this case amounts to fault. The Council failed to forward the request to the appropriate team. The delay caused uncertainty and meant the family had to provide care for longer than would otherwise have been the case.
29. In reaching this view I have taken account of the Council’s comments that it completed an occupational therapy assessment in November and did not consider Mrs X’s needs were urgent. While this is a matter of professional judgment, the time taken to complete the needs assessment was too long and did result in care needs being identified.
30. From June 2024 onwards, the new social worker made attempts to visit Mrs X and complete the reassessment of her care needs. While this has still not taken place, this is not due to fault by the Council. The family suffered a bereavement and so delayed the reassessment for a period of time. The Council failed to respond to a message on 20 September which is fault. The social worker then left her job so the next message was not received.
31. While the failure of the Council to respond to the message on 20 September was fault, I am not persuaded this caused a significant injustice. The family did not actively pursue the reassessment and actually later decided to wait until their complaint to the Ombudsman was investigated. I am satisfied the Council was prepared to complete the reassessment from June 2024 and that the failure to do this was not due to fault by the Council
32. When discussing the complaint with Ms Z she indicated the family is willing to now arrange new care needs assessment with a new social worker. The Council agrees to contact the family and complete the reassessment without further delay.
33. It is not the Ombudsman’s role to determine the amount of care that is appropriate. This is a professional judgement for the Council. In this case, the Council took the view the family could provide care at the weekends and it appears Mrs X’s daughter accepted this when first told. When challenged by Ms Z, the Council agreed to reassess Mrs X’s needs. I find no fault in respect of the amount of care offered.
34. Ms Z says the Council should have consulted other professionals when determining the applicable amount of care. While I understand this is what the family would have liked, I cannot say it was fault the Council didn’t do this. There is no statutory requirement for the Council to consult with specific professionals but it can use its professional judgement to determine if this is necessary. I therefore find no fault but this is something the family can discuss with the Council during the reassessment.

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Action

35. To remedy the injustice suffered by Mrs X as a result of the fault identified above the Council will, within one month of my final decision, take the following action:
• Apologise to Mrs X;
• Make Mrs X a symbolic payment of £250 to recognise the uncertainty caused by the delay in completing the care needs assessment.
36. In the complaint response to Mrs X dated 4 July 2024, the Council explained the referral system has changed and is now managed electronically meaning a similar problem should not reoccur. Therefore, I have not made any service recommendations as suitable action has already been taken.
37. The Council should provide us with evidence it has complied with the above actions.

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Decision

38. I have completed my investigation with a finding of fault for the reasons explained in this statement. The Council has agreed to implement the actions I have recommended. These appropriately remedy any injustice caused by fault.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman