Summary: Miss Y complains on behalf of her adult daughter, Miss W, about the Council’s decision not to provide direct payments to fund a Personal Assistant. There is some procedural fault in the Council’s support planning because Miss W’s support plan does not show how all her eligible needs will be met. The Council has agreed to apologise and review Miss W’s support plan.

The complaint

1. Miss Y complains the Council has failed to provide her daughter, Miss W, with social care support and a Disabled Facilities Grant (DFG) to meet her eligible needs. Miss Y says the Council initially told her that Miss W was eligible for funded support but then changed its mind some months later.
2. Miss Y says the Councils actions have caused her avoidable distress. She says Miss W has continued to experience isolation and her health has declined due to not receiving the support she needs.

Back to top

The Ombudsman’s role and powers

3. The law says we cannot normally investigate a complaint unless we are satisfied the organisation knows about the complaint and has had an opportunity to investigate and reply. However, we may decide to investigate if we consider it would be unreasonable to notify the organisation of the complaint and give it an opportunity to investigate and reply. (Local Government Act 1974, section 26(5), section 34(B)6)
4. 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)
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)

Back to top

What I have and have not investigated

6. I have investigated the Council’s actions in relation to the social care assessment and support planning for Miss W between January 2024, when Miss Y first approached the Council, and September 2024 when she complained to the Ombudsman.
7. I have not investigated any concerns about the DFG process because those concerns did not form part of the complaint made by Miss Y to the Council. I understand matters relating to the DFG have recently progressed and Miss Y may wish to submit a complaint about the process once she has received a decision about her application.

Back to top

How I considered this complaint

8. I considered evidence provided by Miss Y and the Council as well as relevant law, policy and guidance.
9. Miss Y and the Council had an opportunity to comment on my draft decision. I considered any comments before making a final decision.

Back to top

What I found

Assessment and support planning

10. 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.
11. Where a council is required to meet a person’s needs, Section 24 of the Care Act says it must:
1. prepare a care and support plan or a support plan for the adult concerned;
2. tell the adult which (if any) of the needs that it is going to meet may be met by direct payments; and
3. help the adult with deciding how to have the needs met.
12. Under Section 25 of the Care Act, councils must draw up care and support plans which:
1. specify the needs identified by the needs assessment or carer's assessment;
2. specify whether, and if so to what extent, the needs meet the eligibility criteria;
3. specify the needs that the local authority is going to meet and how it is going to meet them;
4. specify to which of the matters referred to in section 9(4) the provision of care and support could be relevant or to which of the matters referred to in section 10(5) and (6) the provision of support could be relevant;
5. include the personal budget for the adult concerned; and
6. include advice and information about—
1. what can be done to meet or reduce the needs in question;
2. what can be done to prevent or delay the development of needs for care and support or of needs for support in the future.

Reablement support

13. Reablement support services are time-limited and aim to help a person to preserve or regain the ability to live independently. The Care and Support Statutory Guidance says that councils can use reablement services as a way to discharge its duty to meet needs under Section 18 of the Care Act.
14. There are four types of intermediate care:

• crisis response – services providing short-term care (up to 48 hours);
• home-based intermediate care – services provided to people in their own homes by a team with different specialties but mainly health professionals such as nurses and therapists;
• bed-based intermediate care – services delivered away from home, for example in a community hospital; and
• reablement – services to help people live independently which are provided in the person’s own home by a team of mainly care and support professionals.

15. Reablement support can also be used to help inform the outcome of an assessment for longer-term care and support needs.
16. Regulations require intermediate care and reablement to be provided without charge for up to six weeks. This is for all adults, whether or not they have eligible needs for ongoing care and support. Councils may charge where services are provided beyond the first six weeks but should consider continuing providing them without charge because of the preventive benefits. (Reg 4, Care and Support (Preventing Needs for Care and Support) Regulations 2014)

Summary of key events relevant to the complaint

17. On 11 January 2024 Miss Y contacted the Council to request a social care assessment for her adult daughter, Miss W, who had some diagnosed mental health conditions and lived at home with Miss Y.
18. The Council arranged a meeting with Miss Y and Miss W on 29 January 2024 to begin a needs assessment. Before the meeting Miss W submitted a pre-written statement for the assessor to consider. Miss Y explained this was necessary due to the challenges Miss W sometimes experiences during social interactions.
19. Miss W had previously explored the idea of creating her own ‘studio’ living space at home, but this did not proceed. She explained this had been a barrier to her requesting support. Miss Y asked the assessor about applying for a DFG to make improvements to the living space for Miss W.
20. Following the assessment the Council recorded that: “without the studio being completed [Miss W] does not feel any other goals are achievable at present and does not wish to explore a personal assistant through a direct payment”. The Council concluded that: “[Miss W] has eligible care and support needs under the Care Act 2014 although declined formal support at this time”.
21. On 1 February 2024 the Council emailed Miss Y to relay the outcome of the assessment. The Council provided an information booklet about how to pursue a DFG and with the contact details for the relevant team. This was in response to Miss W’s request for her own kitchen in Miss Y’s house to enable her to prepare her own food. The Council also suggested the possibility of using an ‘Intensive Enablement’ service for 12 weeks to help Miss W work towards specific goals.
22. Miss Y expressed her disagreement with the outcome and clarified that Miss W had not refused services. On receipt of that information, the Council agreed that Miss W’s case should be allocated to a social worker and said it would contact Miss Y again soon The Council also reminded Miss Y to call the number in the DFG information booklet.
23. On 14 March 2024 the Council emailed Miss Y to say it had allocated a social worker who would need to speak directly with Miss W either in person or virtually. The Council says it attempted to contact Miss Y to arrange a visit at the end of March but did not receive a response.
24. The social worker discussed Miss W’s case with a manager and an Occupational Therapist (OT) on 2 April 2024. The Council decided it should explore other ways to increase Miss W’s independence and to consider a DFG only after trying those options.
25. Miss Y emailed the social worker to express her dissatisfaction with the suggestions made and said the Council had not fully understood Miss W’s needs.
26. On 28 April 2024 Miss W told the social worker she would like to consider PA (Personal Assistant) support. The Council decided to complete another assessment to fully understand Miss W’s needs and her short and long-term goals.
27. The assessment went ahead by telephone on 19 May 2024. In summary, the assessment considered the following key points:
• Miss W has declined the option of reablement support and would instead like direct payments to employ a family member as her PA. Miss W feels unable to accept support from anyone other than family.
• Miss W wants access to a separate sterile kitchen space.
• The reablement team could set up an area in Miss Y’s existing kitchen for Miss W to prepare food at home.
• The Council suggested a formal diagnosis might be helpful for Miss W.
• Miss W provided consent for the Council to access her GP records.
28. Miss W’s GP surgery responded to the Council to say it had requested Miss W’s medical records from her previous GP surgery but had not yet received them. The current GP surgery said their records showed possible diagnoses have been raised in the past including depression, anxiety, Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), eating disorders and Premenstrual Dysphoric Disorder (PMDD).
29. The GP confirmed that Miss W was waiting for an ASD assessment (Autistic Spectrum Disorder) and it was not actively treating her for any condition apart from anxiety.
30. The Council created a support plan dated 24 June 2024. This outlined Miss W’s eligible needs and how these should be met. In summary, it said:
• Managing and maintaining nutrition. Reablement suggested to explore whether Miss W can utilise current space to build on her independence with meal preparation.
• Maintaining personal hygiene. Miss W would like to continue meeting this need with support from her mother.
• Maintaining a habitable home environment. Reablement suggested to explore cleaning routines that Miss W could use in the kitchen to help build upon her independence.
• Accessing and engaging in work, training, education or volunteering. Miss W requested 16 hours direct payments to employ a family member as her PA to start building her confidence to go out.
• Making use of necessary facilities or services in the local community. Miss W requested 16 hours direct payments to employ a family member as her PA to start building her confidence go out.
31. On 8 July 2024 the Council wrote to Miss W and said reablement services could support her with meal preparation and to build her independence. The Council also reiterated the GP’s comments that Miss W was receiving active treatment for anxiety only.
32. The social worker ended their involvement with Miss W’s case on 9 August 2024.
33. Miss Y contacted the Council again to reiterate her request for support. On 11 December 2024 the Council agreed to send a copy of Miss W’s previous needs assessment for her to go through and identify any changes to Miss W’s needs.
34. Following this, the Council agreed to complete another assessment.
35. The assessment on 19 December 2024 identified that Miss W had eligible care and support needs and provisionally recommended that Miss W receive 21 hours of weekly support from a PA funded with direct payments.
36. Miss W received a diagnosis of ASD on 23 December 2024.
37. In January 2025 Miss Y told the Council that, in her view, Miss W needs 40 hours of support each week to encourage her with all aspects of daily living.
38. On 30 January 2025 the Council put the recommendation forward to its ‘Quality Assurance Meeting’ (QAM) for consideration. The outcome was to defer the support package and make a referral to Miss W’s GP for a sensory assessment. It also recommended a referral to an outreach and assessment service.
39. The Council requested an OT assessment on 6 March 2025. The purpose of which was to “… explore if DFG is able to support with creating a separate living space for [Miss W], including separate kitchen set-up”.
40. During a phone call with Miss Y on 10 March 2025, the OT confirmed they would need to visit Miss W at home. Miss Y initially said Miss W was too unwell to meet the OT. Despite this, the OT completed a home visit on 12 March 2025 and agreed to draft an assessment and submit a referral to the team responsible for making decisions for DFG funding. At the time of writing this statement the outcome of the DFG application is not known.

Was there fault in the Council’s actions causing injustice to Miss Y and Miss W?

41. Our role is not to ask whether an organisation could have done things better, or whether we agree or disagree with what it did. Instead, we look at whether there was fault in how it made its decisions. I have therefore considered the steps the Council took to assess Miss W’s care and support needs, and the information it took account of when making its decision.
42. In my view, there is some procedural fault in how the Council completed Miss W’s support plan. In completing the assessment process, the Council recognised it had a duty to meet Miss W’s eligible needs under Section 18 of the Care Act. The Council decided it could meet those needs with the provision of reablement services in the first instance. The Council had a duty to ensure Miss W’s support plan met the requirements of Section 25 of the Care Act to set out how reablement will meet her identified care and support needs.
43. Although we cannot take a view on whether the proposed reablement services are sufficient to meet Miss W’s needs, we expect the care and support plan to address how the service would do so. This includes how any wider eligible needs which fall outside the remit of reablement would be met. In Miss W’s case, the Council has outlined how reablement could help Miss W with managing nutrition and maintaining a habitable home environment. The support plan does not show how reablement services could met Miss W’s other eligible needs: accessing and engaging in work, training, education or volunteering and making use of necessary facilities or services in the local community. This is fault which the Council will remedy with a review of the support plan.
44. In our view, the Council will also need to schedule a review to consider Miss W’s progress after the completion of any reablement to decide whether she continues to have eligible long-term care and support needs and how those should be met.

Back to top

Action

45. Within four weeks of my final decision, the Council has agreed to:
• Apologise in writing to Miss Y and Miss W for the frustration caused by the errors in support planning. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council should consider this guidance when making the apology.
• Review Miss W’s support plan to ensure it is compliant with Section 25 of the Care Act. In particular, the Council should focus on demonstrating how all of Miss W’s needs can be met by the proposed reablement services, including accessing work or education and making use of facilities or services in the local community. The Council will also ensure that Miss W’s care and support needs are reviewed again following the provision of any short-term reablement services.

Back to top

Decision

46. In my view there is some procedural fault in the Council’s creation of Miss W’s support plan. The Council will apologise and review the plan to ensure it is compliant with the Care Act.

Investigator’s decision on behalf of the Ombudsman

Back to top

Investigator's decision on behalf of the Ombudsman