Summary: Mrs B complained about the Council’s poor communication, a delay in taking actions and a failure to carry out a continuing healthcare checklist. We have found fault in the Council’s actions and the Council has agreed to apologise, pay a financial remedy and carry out the checklist.

The complaint

1. Mrs B complains on behalf of her daughter, Miss C. Mrs B says the Council failed to review Miss C’s needs for care and support, failed to appoint an advocate for Miss C and failed to carry out a continuing healthcare checklist. She says the Council did not respond to her requests to take action and she says Miss C lives in accommodation that does not meet her needs.

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The Ombudsman’s role and powers

2. 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)
3. 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

4. I have spoken to Mrs B. I have considered the evidence that she and the Council have sent, both sides’ comments on the draft decision and the relevant law guidance and policies.

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What I found

Law, guidance and policies

5. The Care Act 2014, the Care and Support Statutory Guidance 2014 set out the Council’s duties towards adults who require care and support and its powers to charge. The Council also has its own policies.

Assessment

6. The Council has a duty to assess adults who have a need for care and support. If the needs assessment identifies eligible needs, the Council will provide a support plan.
7. The threshold for eligibility is based on identifying how a person’s needs affect their ability to achieve relevant outcomes, and how this impacts on their wellbeing. Council must consider whether:
• The adult’s needs arise from a physical or mental impairment or illness.
• As a result of the adult’s needs the adult is unable to achieve 2 or more of the specified outcomes.
• As a consequence of being unable to achieve these outcomes there is a significant impact on the adult’s wellbeing.
8. The outcomes are:
• Managing and maintaining nutrition
• Maintaining personal hygiene
• Managing toilet needs
• Being appropriately clothed
• Being able to make use of the home safely
• Maintaining a habitable home environment
• Developing and maintaining family or other personal relationships
• Accessing and engaging in work, training, education or
• Making use of necessary facilities or services in the local community
• Carrying out caring responsibilities for a child.

Agreeing the care plan

9. The local authority must take all reasonable steps to agree with the person how the person’s needs will be met in the care plan, before the authority signs off the plan.
10. If the plan cannot be agreed with the person, or any other person involved, the local authority should state the reasons for this and the steps which must be taken to ensure that the plan is signed-off. If a dispute still remains, and the local authority feels that it has taken all reasonable steps to address the situation, it should direct the person to the local complaints procedure. 
11. If a person has substantial difficulty in being involved in the assessment process, and if there is nobody else to support the person, then the Council should appoint an independent advocate to support the person in the process.

Review of the care plan

12. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. The CASS Guidance says councils should review plans at least every 12 months. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.

Continuing healthcare (CHC)

13. CHC is a package of ongoing care that is arranged and funded by the NHS where a person has been assessed as having a ‘primary health need’. For most people who may be eligible for CHC, the first step in assessment is for a health or social care professional to complete a CHC Checklist. The threshold for meeting the CHC Checklist is set low.
14. If the completed CHC Checklist indicates the person may be eligible for CHC, the next step is a full multidisciplinary assessment. If the outcome of the Checklist is not to carry out a full assessment, the ICB should write to the person and tell them they have a right to ask the ICB to reconsider it. If they disagree with the outcome once the ICB has reconsidered the decision, they can complain to the ICB. There is no further right of appeal.
15. Complaints about NHS CHC are dealt with by the Parliamentary and Health Service Ombudsman.

What happened

16. Miss C is an adult woman who has a physical disability, mental health conditions and a neurodevelopmental condition.

Assessment of needs – May 2023

17. The social worker carried out an assessment of Miss C’s needs for care and support on 3 May 2023 and said Miss C needed support in managing her home, personal care and nutrition.
18. The assessment noted that Miss C was non-weight baring and spent most of her day in bed. She was unable to transfer from her bed to the wheelchair independently because of the layout of her flat. The flat was not wheelchair accessible because of the hallway and the tight corners.
19. The plan is slightly confusing as the narrative refers to Miss C receiving four visits a day, but the hours set out at the end of the plan are as follows:
• One hour support in the morning.
• Two 45-minute visits at lunchtime and late afternoon.
• Miss C received a further two 2-hour visits a week to support with paperwork, email, telephone calls and so on.

Admission to hospital – June 2023

20. Miss C was admitted to hospital on 24 June 2023 and was due for discharge on 31July 2023. The hospital’s clinical coordinator made a request to increase the care package for Miss C but also said in the email that they did not know what the current care package for Miss C was.
21. The ‘discharge to assess’ referral form said the morning visit should be increased to 1 hour as Miss C was living in her bedroom. Care workers should assist with Miss C washing, dressing, transfer to commode and breakfast. The lunch time visit should be one hour and the evening visit 30 minutes. The form noted that Miss C would be seen by a neuro physiotherapist on discharge and would receive further physiotherapist support so that she could become more mobile in the future and the care package decreased.

Care plan review – August 2023

22. The social worker reviewed the care plan on 18 August 2023. It said Miss C was only able to walk a few metres. It said she used a wheelchair outside of the property. The care plan was as follows:
• One 30-minute visit each morning
• Two 1-hour visits at lunchtime and late afternoon.
• The further two 2-hour visits per week were unchanged.
23. There is a note to say that the plan would be reviewed within one week of the occupational therapist’s home visit.

Mrs B’s email – August 2023

24. Mrs B sent an email to the Council’s duty team on 29 August 2023 and said:
• She requested a review of Miss C’s needs as she said there had been a substantial change in the needs.
• Miss C also needed an OT housing assessment as there had been a change in her mobility, mental health needs, medical needs and neurodevelopmental condition.
• Miss C needed a referral to a psychologist to support her with her neurodevelopmental conditions.

Home visit – September 2023

25. The Council’s manager visited Miss C on 26 September 2023. The purpose of the visit was to update the Care Act assessment of Miss C’s needs and to update the information Miss C had to provide for her financial assessment. Miss C then said in an email before the visit that she would not be able to obtain the information for the financial assessment as this would take some time.
26. There are no minutes of the meeting but the outcome is recorded as follows:
• Referral to be made to advocacy.
• Application to be made to a supported housing living development. A particular development had been identified which was aimed at people with learning disabilities and/or autism.
• Contact to be made to the wheelchair clinic about a referral.
• CHC checklist meeting to be arranged.

Mrs B’s complaint – November 2023

27. Mrs B complained on 9 November and said:
• There had been a lack of communication from the Council and the Council had not replied to her requests.
• Miss C was living in unsuitable accommodation and her physical and mental health needs were not met.
• Miss C had asked for an assessment of her needs under the Care Act, a continuing health care (CHC) assessment and an advocate, but these had not been provided.
• Miss C also needed a referral to a psychologist.

Assessment of needs – March 2024

28. The social worker carried out an assessment of Miss C’s needs on 7 March 2024. The social worker said Miss C was cared for in bed as Miss C could not weight bear enough to use a wheelchair.
29. The assessment does not say whether the care plan was changed.

Council’s response – April 2024

30. The Council responded to Mrs B’s complaint on 15 April 2024 and said:
• It apologised for the lateness of its response.
• The social worker ‘did not recall’ the request for an assessment of Miss C’s needs. Miss C already had a care plan so this would be reviewed annually unless there had been a substantial change in Miss C’s needs.
• A CHC checklist had been requested when Miss C was discharged from hospital, but was not completed. An error was also made in the request for an advocate but an advocate had now been requested.
• The Council agreed that Miss C’s current accommodation was not suitable and the social worker had written a letter of support to the housing department to provide an update on Miss C’s health needs.
• The Council upheld Mrs B’s complaint that there had been a lack of action and a lack of communication.

Agency’s care plan

31. The Council has sent me the care plan which the agency that supports Miss C uses. This care plan says that Miss C is supported four times a day.

Further developments after the complaint

32. I have set out some of the further developments after the complaint ended, only to establish injustice.
33. The supported housing development that had been suggested for Miss C does not accept pets and was therefore not suitable for Miss C as she has pets.
34. Miss C’s social worker contacted the Council’s housing department in May 2024 and asked them what further evidence Miss C needed to provide to be considered for a higher priority band as Miss C’s current accommodation did not meet her needs. Miss C had been assessed as ‘band C – medium welfare’.
35. The housing department said Miss C should provide evidence to show how her current housing had a detrimental effect of her welfare needs. The evidence could be provided by her GP, OT, social worker, health visitor or any other independent source.
36. The social worker sent emails in May and June 2024 trying to set up a visit to Miss C to gather the evidence for the application for an increase in banding.
37. An advocate was appointed for Miss C. The date is not clear but the advocate was available from May 2024 onwards. In May 2024 the social worker sent emails to the advocate and Miss C to try to find a date for the visit to carry out the CHC checklist. There were further attempts in the following months to organise a visit, but it was difficult to find a date which everybody could attend and there was also a decline in Miss C’s mental health.
38. The Council awarded Miss C ‘band B – high housing need’ on 21 August 2024.
39. The Council reviewed Miss C’s care plan on 29 October 2024 and the care plan remained unchanged:
• One 30-minute visit each morning
• Two 1-hour visits at lunchtime and late afternoon.
• Two 2-hour visits per week.
40. Miss C was referred to a psychologist. The psychologist assessed Miss C but said she did not qualify for a psychologist’s assistance.

Analysis

41. The Council has already upheld Mrs B’s complaint that there was a lack of action and poor communication and I agree there was fault.
42. The Council had received a referral to re-assess Miss C once she was discharged from hospital in July 2023. I note that there was a review of the care plan in August 2023 so I accept the Council reviewed the plan.
43. Mrs B then sent an email in August 2023 asking for the Council to take several actions, including a review of the Care Act assessment as she said Miss C’s needs had changed, as well as a referral to a psychologist. The Council did not respond to this email and this was fault. I note that the Council says there was no need to do a review, but the Council should, at least have responded to Mrs B to explain this. And it should have responded and acted upon the other requests that Mrs B made in her email.
44. The Council’s manager visited Miss C in September 2023 and several actions were agreed but these were not followed up at all, as far as I can see. This was further fault.
45. Mrs B then complained in November 2023 but there was then a further delay by the Council as it did not respond to the complaint until April 2024, some six months later and the Council did not start to take any of the actions it was meant to take until after April 2024. This was fault.
46. So overall there was poor communication and a substantial delay in progressing the agreed actions.

Injustice and remedy

47. I have considered what injustice Miss C has suffered because of the delay and I will consider the different actions the Council was meant to take, separately.
48. It is difficult to say whether the delay in responding to the request of a re-assessment of needs / review of the care plan caused a significant injustice to Miss C. I note that, when the care plan was reviewed, most recently in October 2024, the plan remained unchanged. Miss C has not complained about the care plan itself so it is difficult to say whether she disagrees with the care plan.
49. There was a delay in the Council’s adult social care / mental health team providing Miss C with support in her housing application. I note that, once the social worker became involved in May 2023, the housing department agreed an increase in banding in August 2023. Therefore, it is possible that, if this support had been provided earlier, the increase in the banding may have happened sooner so the injustice is uncertainty whether this would have happened.
50. I am working on the assumption that Miss C is satisfied with the banding which has now been allocated. If Miss C does not agree with the banding, she has the right to ask for a review of the decision / make a complaint to the housing department. I have only investigated the actions of the adult social care team in supporting Miss C in her housing application, not the actions of the housing department.
51. The delay in appointing an advocate has also caused an injustice as Miss C needed this advocate to support her in the assessment process. The injustice is the uncertainty whether an earlier appointment of an advocate would have resulted in a different outcome.
52. The delay in the referral to the psychologist was fault but, as the psychologist said Miss C was not eligible for a service, I cannot say Miss C suffered a significant injustice resulting from this.
53. In terms of the delay in the CHC checklist it is my understanding that the checklist has not been done yet. I accept that this is partly outside of the Council’s control, but I would have expected this to have been completed by now.
54. In terms of remedy, our remedy aims to put the complainant into the position they would have been if the fault had not occurred. When the injustice is mostly distress or uncertainty, which is the case here, then we can sometimes recommend a small symbolic sum as a financial remedy. The Council has agreed to pay Miss C £300 for the substantial delay in responding to her request for a re-assessment, providing her with an advocate, completing her CHC checklist and supporting her in her housing application.

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Action

55. The Council has agreed to take the following actions within one month of the final decision. It will:
• Apologise in writing to Miss C and Mrs B for the fault.
• Pay Miss C £300.
• Complete Miss C’s CHC checklist.

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Decision

56. I have completed my investigation and found fault by the Council. The Council has agreed the remedy to address the injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman