Summary: Miss X complained about how the Council managed her care needs after the previous arrangement broke down and it did not provide her with the support or hours she needed. We found the Council at fault for significant delays with a reassessment of her needs and how it decided her care hours. The Council has agreed to apologise to Miss X, make a symbolic payment, and take action to prevent recurrence of fault.

The complaint

1. Miss X complains the Council, in respect of her care needs, failed to:
1. Address problems experienced with care provided by personal assistants through direct payments, including resulting safeguarding referrals;
2. Ensure she receives 31.5 hours a week of care since the personal assistant arrangements broke down in August 2023;
3. Provide care for her night-time care needs; and
4. Liaise with mental health services in respect of her care needs.
2. This has caused her ongoing distress and frustration.

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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. 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)
5. 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

6. Miss X said issues about her care have been ongoing for a number of years. This is more than 12 months before complaining to us in August 2024 and is therefore late (see Paragraph 4). I am satisfied Miss X could have complained specifically about this period sooner. I have investigated from August 2023 (12 months before Miss X complained to us) up until April 2024 (when the Council issued its final response to her complaint).
7. I am not investigating part a) of the complaint about safeguarding concerns with personal assistants. This is because personal assistants employed by complainants are not within our powers and jurisdiction to investigate.
8. I am not investigating events from May 2024. We expect councils to have the opportunity to formally consider new or ongoing matters under its complaints procedure first before we investigate. Miss X is entitled to make a new complaint if she is dissatisfied with the Council’s actions after this point.

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How I considered this complaint

9. I considered Miss X’s written views of the complaint.
10. I made enquiries of the Council and considered its written responses and information it provided, including a sample of care records from the Care Agency.
11. Miss X 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

Law and administrative background

Assessment

12. 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. 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.
13. 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.
14. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan. 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. 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.

Refusal of assessment

15. An adult with possible care and support needs may choose to refuse an assessment. In these circumstances councils do not have to carry out an assessment.
16. But under Section 11 of the Care Act 2014, it cannot rely on this (and so must carry out a needs assessment), if:
1. the adult lacks capacity to refuse the assessment and the authority is satisfied that carrying out the assessment would be in the adult's best interests, or
2. the adult is experiencing, or is at risk of, abuse or neglect.

Background

17. Miss X has an autism diagnosis and a range of complex needs. She has a number of physical medical conditions which can put her at risk of harm, and mental health difficulties affecting her daily life.
18. In 2021, the Council carried out a care and support assessment with Miss X. Miss X included a request for nighttime support because of concerns with her health condition. The Council decided it did not identify this as a need. In 2022, the Council made amendments to the assessment at Miss X’s request.
19. The Council’s care plan (“Care Plan 1”) for Miss X from 2023 agreed a personal budget to meet 31.5 hours of personal assistant (“PA”) support. Miss X received this as direct payments used to employ PAs.
20. Miss X has a detailed care plan (“Care Plan 2”) written by her partner and previous PA’s. She says this accurately reflects her needs.
21. Person B (who worked under external mental health services) has previously worked closely with Miss X.

What happened – summary of key relevant events

22. In August 2023, Miss X’s PA package broke down due to safeguarding concerns. Miss X’s partner took over her support for a short period.
23. In September 2023, the Council contacted Miss X. It offered care agency support. It noted previous PAs completed large amounts of administration and gardening for her, but these were not social care needs. Miss X said the Council’s Care Plan 1 was old and incorrect. The Council offered to update it with Miss X’s input. Miss X declined.
24. In January 2024, Miss X told the Council she wanted care agency support. She wanted the Council to use Care Plan 2.
25. In February 2024, the Care Agency visited Miss X to assess what support it could provide. It emailed the Council as Miss X said she wanted its carers for high levels of cleaning or administration. It was not comfortable for its carers to do this every day for several hours. It was willing to offer 31.5 hours support in general. The Council noted these concerns with the tasks Miss X wanted as hours for these would not be classed as eligible care needs.
26. The Council contacted Person B with an update about Miss X. It said it needed to do an assessment to determine the care package, but Miss X refused. Person B sent Care Plan 2 for the Council’s reference.
27. A Senior Manager emailed the social worker to request they complete a section 9 care needs assessment under of 11(2)(b) in the Care Act 2014 (see Paragraphs 15-16), as this was a triggered by an open safeguarding enquiry. They could use information from Person B to complete it as Miss X refused to engage.
28. Case records at the time showed different discussions about the number of support hours for Miss X. Some agreed 31.5 hours. Another record said the Care Agency would start on 19.5 hours to start and build on that. The next day, the Care Agency started.
29. Miss X later contacted the Council. She said the Care Agency was providing the wrong hours, as she should be getting 31.5 hours. She wanted these back to cover her administration needs.
30. Between February and March 2024, case records showed the social worker discussed this with Miss X. They would need to complete a reassessment first to review her current needs, but said carers did not do extensive administration and signposted her to other organisations for this. Miss X also wanted a move to a different internal team at the Council to better suit her mental health needs.
31. Between March and April 2024, Miss X raised some concerns about the Care Agency. She said it was not meeting her needs. She only wanted a few select carers, not a number of different staff visiting her. She did not want a reassessment. She wanted nighttime care and for the Council to accept Care Plan 2. The Care Agency contacted the Council. It said Miss X mainly asked for cleaning and someone to be present for personal care, but other tasks she seemed able to support herself.
32. In April 2024, Miss X made a formal complaint to the Council. The Council did not uphold most of her complaint.
33. In August 2024, Miss X complained to us.
34. In mid-October 2024, the Care Agency emailed the Council. It said it could not meet Miss X’s requests about her care with the staff it had available. It ended its support.
35. In early 2025, the Council said it had carried out a reassessment discussion with Miss X. It was currently progressing with the reassessment and would decide which longer-term team she would move into.

The Council’s response to my enquiries

36. In response to my enquiries, the Council noted inconsistencies with information and evidence it provided to us about the number of hours it agreed for Miss X. It initially said she remained on 19.5 hours as she did not fully engage or utilise the hours of support provided at the time. It later said it appeared 19.5 hours was an interim arrangement. This was intended to provide time for the social worker to complete an updated assessment. But it accepted the hours were not increased or reviewed in a timely manner. It also did not have evidence of how it explained these hours to Miss X before it started.
37. The Council acknowledged it could have done the reassessment without Miss X’s explicit consent (I explain this later) to determine her longer-term care and support needs and apologised for the oversight.
38. The Council said it should not have reduced the hours allocated to Miss X from February 2024. This was an administrative error.
39. The Council said it identified fault as it stopped the direct payment to Miss X by mistake after the Care Agency withdrew its support in October 2024.
40. To remedy this, it made a backdated payment of around £11,000 to her in April 2025. It calculated this by totalling the monthly direct payment Miss X would have been entitled to receive. This covered from November 2024 to April 2025.

Analysis

41. I understand events have moved on since Miss X’s original complaint to the Council. Since my investigation, the Council has reviewed and found itself at fault for a number of points. I welcome the Council’s actions and honesty in recognising shortcomings in its service.

Number of hours and support provided

42. The Council accepted it gave inconsistent explanations to me about the Care Agency hours it agreed for Miss X. It also did not openly explain this to her at the time. This fault caused Miss X confusion and frustration.
43. It said it should not have reduced Miss X’s hours, and this fault was due to administrative error. I consider the injustice to Miss X. I have looked at a sample of care records from the period I am considering. The Care Agency made efforts to work and stay in contact with Miss X. Carers generally completed tasks led by Miss X’s requests such as food preparation, light cleaning, personal care, but she did not always engage.
44. Miss X regularly expressed frustration with the Care Agency’s support. She said it would not provide support such as administration, gardening, and attending appointments, but this was in Care Plan 2. The Council did not agree to these and wanted Miss X to do a reassessment before it considered these tasks further.
45. I recognise care may not have been delivered in the way she wanted, but the Care Agency had to work within its limitations. This is both with what the Council agreed should be provided and with the staff it had available. I am unable to say, on balance, had the full hours been in place, Miss X would have been able to use them with the extra specific tasks she wanted. This is based on the disagreements about her needs and circumstances at the time.
46. I also cannot say this meant she missed out on specific care needs. This has not been decided in a reassessment and is still incomplete. In my view, the key issues mainly stem from this and is at the heart of the matter. This is explored further below.

Care plan and reassessment

47. It is not my role to decide what care and support a person needs. That is the Council’s role. We look at the process the Council follows to make its decisions.
48. The Council’s own care assessment for Miss X is from 2022. Miss X requested nighttime care, but the Council decided she did not need this then. This is too far back in time to consider, and I cannot add further to this. This would need to be considered as part of a reassessment.
49. Miss X want the Council to follow Care Plan 2. The Council was not obliged to rely on this and was entitled to do its own assessment to decide her needs. Miss X refused a reassessment a number of times, but the Council accepted fault as it should have acted sooner.
50. Section 11(2)(b) of the Care Act 2014 says where a council identifies an adult who is at risk of abuse or neglect and they refuse an assessment, it must carry one out. This applied here. Miss X had an open safeguarding enquiry at the time (not part of my investigation). The Council recognised this requirement early on in February 2024 but has not completed this. It let it drift. It should have done one as far as practicable, taking into account the care plan she had and views of professionals (such as Person B) to inform this.
51. This fault has caused significant frustration and distress to Miss X. Her needs are complex, and she is vulnerable. This reassessment would have decided what her needs were much sooner, and the Council could have acted accordingly. I cannot say what the outcome would have been had it done earlier. But this creates a significant level of uncertainty for Miss X about what could have happened and if it could have made a difference to her situation at the time.
52. I recognise the Council has met challenges and various barriers with this. This includes the nature of some of Miss X’s contact, along with some challenging behaviour. This is likely to have impacted on progress as it needed to respond to these. However, the Council has not acted in line with its overriding duty to assess her care needs and decide how it would meet them. The injustice with the significantly delayed reassessment has been ongoing for over a year.

Backdated payment

53. The Council has since provided a remedy to Miss X for fault and injustice it found with itself. I appreciate this is positive action; however, this was for events since, and not part of, Miss X’s original complaint to us. It is outside the scope of my investigation, and I am not considering this further. If Miss X is dissatisfied with this, she is entitled to make a new complaint to the Council.

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Agreed Action

54. To remedy the injustice set out above, the Council has agreed to carry out the following actions:
55. Within one month of the final decision:
• Apologise to Miss X in writing for the injustice caused by the faults identified and pay her a symbolic payment of £500 to recognise this.
56. Within two months of the final decision:
• Complete its reassessment of Miss X and send a copy to her.
57. Within three months of the final decision:
• The Council should send written reminders to relevant staff about what exceptions apply if an adult with care and support needs refuses an assessment, in line with Section 11 of the Care Act 2014. If these apply, the Council must carry out an assessment as far as practicable and record this; and
• It should send written reminders to relevant staff to ensure that if the Council is arranging care support, and intends to change a service user’s documented support hours temporarily, it should communicate and explain the reasons to the service user first.
58. The Council should provide us with evidence it has complied with the above actions.

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Decision

59. I find fault causing injustice. The Council agreed to the recommendations to remedy the injustice, and I have completed my investigation.

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Investigator's decision on behalf of the Ombudsman