Summary: Mr Y complains about the Council’s actions in relation to the care and support of his late mother, Mrs W. There was some delay in the Council’s assessment and support planning of Mrs W which caused Mr Y some distress. The Council will apologise and make a symbolic payment of £200 in recognition of the injustice caused by the fault. We do not find fault in other parts of Mr Y’s complaint.

The complaint

1. Mr Y complains about the Council’s actions in relation to the care and support of his elderly mother, Mrs W. In particular, he says:
1. When he approached the Council for support in May 2024, it did not properly consider his mother’s care and support needs and wrongly assumed that Mrs W’s elderly husband was able to help meet her needs.
2. The Council’s suggestion to allow Mrs W’s husband to provide care presented a safeguarding risk.
3. The Council has not communicated with Mr Y at key times during the care planning process. For example, it arranged an Occupational Therapy assessment for Mrs W in October 2024 but did not inform or invite Mr Y despite holding Lasting Power of Attorney (LPA). As a result, he says his mother was not properly represented because she lacks mental capacity.
4. The Council tried to ‘coerce’ the family into agreeing for Mrs W to return home after a period of respite care despite the family informing the Council that the house was not adequately adapted and that relatives could not provide care and support.
5. The Council has not provided information or advice about the financial assessment and charging process. Mr Y says the Council decided Mrs W’s weekly client contribution before completing a financial assessment.

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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. We consider whether there was fault in the way an organisation made its decision. 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)
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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What I have and have not investigated

5. I have investigated what happened between May 2024, when the Council first received a referral for Mrs W, and 27 September 2024 when Mr Y approached the LGSCO. I have not investigated what happened after September 2024 because the LGSCO’s Investigation Manual suggests that, where there are on-going issues, we should specify an end date beyond which we will not investigate. This should be no later than the date when the complaint was submitted to us and may well be earlier.
6. I have not investigated the complaints made by Mr Y concerning the OT’s involvement after September 2024 for the reasons explained in paragraph five. This includes parts of complaint c) and d).

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How I considered this complaint

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

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What I found

Care Act assessments

9. 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.
10. 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.
11. The Care and Support Statutory Guidance (2014) outlines the powers of councils to meet urgent needs where they have not completed an assessment:

“Where an individual with urgent needs approaches or is referred to the local authority, the local authority should provide an immediate response and meet the individual’s care and support needs. For example, where an individual’s condition deteriorates rapidly or they have an accident, they will need a swift response to ensure their needs are met. In some cases, the appropriate response may be that the local authority will meet the adult’s needs... Once the local authority has ensured these urgent needs are met, it can then consider details such as the person’s ordinary residence and finances”.

Financial assessments

12. Under the Care Act 2014, councils are required to assess an individual's care and support needs and, if eligible, provide a personal budget that reflects the cost of meeting those needs. While the full financial assessment determines the individual's contribution, the personal budget must be sufficient to meet the person's eligible needs.
13. The Care and Support Statutory Guidance (2014) says an indicative budget should be provided at the start of the care planning process. This allows the individual to plan effectively, knowing the resources available to meet their needs. The final personal budget is confirmed after the care and support planning process, but the indicative amount helps guide the planning from the outset.
14. The financial assessment process for adult social care differs depending on whether the care is domiciliary (care at home) or residential (care in a care home). These assessments are governed by the Care Act 2014 and associated regulations, with detailed guidance set out in the Care and Support (Charging and Assessment of Resources) Regulations 2014 and the Care and Support Statutory Guidance. The key differences between the two types of financial assessments:
15. For domiciliary Care (Non-Residential):
• the value of the person’s main home is disregarded when calculating capital.
• other capital assets (e.g. savings, investments) are considered.
• a person with capital over £23,250 will pay the full cost of their care.
• between £14,250 and £23,250: some contribution based on a sliding scale.
• under £14,250: capital is ignored and only income is assessed.
• a Minimum Income Guarantee (MIG) is applied, ensuring the person is left with a certain level of income after paying for care. The MIG varies depending on age, disability, and other circumstances.
• Disability-related expenses (DREs) can be deducted if the person receives disability benefits.
16. For residential care:
• the value of the main home is usually included in the financial assessment after 12 weeks (known as the 12-week property disregard). Exceptions apply if a qualifying relative (e.g., spouse, dependent child) still lives in the home.
• Same capital thresholds apply as in domiciliary care.
• a Personal Expenses Allowance (PEA) is applied instead of MIG. Most of the person’s income goes towards the cost of care, apart from the PEA.

Summary of key events relevant to the complaint

17. This section summarises the key events relevant to the complaint we are investigating. It is not intended to be a full chronology.
18. On 16 May 2024 the Council received a referral to assess Mrs W’s care and support needs. The referral said Mrs W had a diagnosis of dementia and needed support in her home which she shared with her elderly husband and two adult children.
19. Records provided by the Council show a call made to Mr Y’s sister, who I will call Ms Z. She also lives at home with Mrs W. Notes of the call show Ms Z described how Mrs W needed more support with personal care and daily activities. Ms Z said that showering Mrs W is challenging due to the shower being over the bath.
20. The Council agreed to assess Mrs W under the Care Act and to make a referral for mobility equipment.
21. An Occupational Therapist (OT) visited Mrs W at home on 24 June 2024. They noted that Mrs W was reluctant to accept and use equipment. Despite this, the OT agreed to order grab rails, a bed lever and raised toilet seat. The OT did not identify any other adaption needs because, in their professional view, Mrs W could walk up and down her stairs independently.
22. On 2 July 2024 the Council marked Mrs W’s case as priority due to reports that her needs had increased and because of the subsequent impact on her family.
23. The Council called Mr Y on 10 July 2024 to advise him that it scheduled a visit for 15 July to assess Mrs W’s care and support needs. The visit was later re-scheduled by the Council due to officer sickness.
24. On 18 July 2024 the OT called Ms Z to relay the decision to close the case for adaptations because Mrs W did not meet the criteria due to being able to mobilise up and down her stairs.
25. On 22 July 2024 a social worker completed a home visit to assess Mrs W’s eligibility for care and support under the Care Act. They noted that carer burnout was apparent, and that Mr Y expressed frustration with the time taken to arrange the assessment. Mrs W was asleep during the assessment and so the Council decided it needed to complete another assessment and a mental capacity assessment.
26. Mr Y emailed the Council on 8 August 2024 to confirm that his father was in hospital following stress induced seizures.
27. The Council completed a joint visit with a Community Psychiatric Nurse (CPN) on 15 August 2024. The records show Mrs W engaged well with the assessment. She was able to communicate but did not demonstrate a good understanding of her care and support needs. The social worker agreed they needed to present their findings for a decision about funding.
28. One week later the Council completed a carer’s assessment for Mr Y. The social worker also provided a copy of Mrs W’s assessment for him to review.
29. On 29 August 2024 the Council decided to arrange a respite placement at a residential home for Mrs W. In the meantime, Mr Y asked the Council for an update on his request for adaptations. The social worker relayed the OT’s view that Mrs W was able to climb the stairs and did not meet the criteria for adaptations.
30. The Council agreed funding for Mrs W’s package of care on 2 September 2024. The Council decided that Mrs W had eligible needs to be met by the provision of the following package of domiciliary care:
• 21 hours of care each week. This includes four 45-minute care calls per day.
• Six weeks of respite care each year in a residential care home.
31. On the same day, the allocated social worker wrote to Mr Y by email to confirm the following: “I have made a referral to the Financial Assessment and Benefits Team to complete a financial assessment as Adult Social Care support is means-tested. Please be aware that Mrs [W] will be self-funding if she is over the threshold amount of £23,250. Please find a link for Somerset Council's information leaflets and draw your particular attention to 'C - Money Matters.' Please have a read through particularly forms C5, C6 and C7. You will also find information within C2 and C3 about Direct Payments for future reference”
32. Following the agreement to arrange respite care, the chosen care home completed a pre-admission assessment on 6 September. The home confirmed it could meet Mrs W’s needs and offer a two-week respite placement from 23 September. This information was relayed to Mr Y.
33. The social worker emailed Mr Y on 19 September 2024 with a copy of the financial agreement for Mrs W’s upcoming respite stay. The social worker told Mr Y that Mrs W’s provisional weekly contribution was £188 but this would be confirmed upon completion of a financial assessment.
34. Mr Y expressed frustration that he had only four days to complete the financial assessment forms before the start of Mrs W’s placement. The social worker acknowledged his concerns but said that Mrs W may lose the bed provisionally allocated to her at the care home.
35. On 20 September 2024 the Council awarded a contract to a local care agency to deliver the four daily home calls from 7 October 2024 and after Mrs W’s return from the two-week respite placement.
36. Mrs W went into the home on 23 September 2024 as planned.

Complaints a) and b)

37. In the assessment completed on 15 August 2024, the allocated social worker noted: “Mrs [W’s] daughter [Ms Z] and son [Mr Y] have been her main carer, providing support with all aspects of daily living”. The social worker also noted that, “[Mrs W’s] husband is frail and suffers from Vaso Vagal Syncope with seizures, which is further exacerbated by stress in caring for his wife. [Mrs W] can be repetitive, walks around the home during the day and at night and can become agitated. This behaviour causes her husband significant stress and impacts on his own physical health causing collapse, seizures and hospital admissions”.
38. Whilst the Council acknowledged that Mrs W’s husband had previously provided unpaid care for his wife, the records do not show any suggestion by the Council that Mrs W’s husband should or would continue in this role. To the contrary, the social worker’s assessment acknowledged the significant impact on his health. The Council identified that Mrs W had eligible needs to be met by a package of care. Mrs W did not have an assessed need for 24 hour care at this time. The records do not show the Council decided that Mrs W’s needs would be partly or wholly met by her husband and so I do not uphold this part of the complaint.
39. With that said, the records show the Council marked Mrs W’s case as high priority due to the impact on her family and “carer breakdown”. Despite being marked as high priority, the first assessment did not take place until four weeks after the Council received a referral. Another three weeks passed before the Council completed the second visit to complete its assessment. I note preferred care home did not have a respite placement available for Mrs W before 23 September, which is not due to fault by the Council. However I have seen no evidence the Council offered any alternative placements or services as an interim measure. I consider this was not in accordance with the requirements set out in paragraph eight of this statement and caused unnecessary distress for Mr Y which the Council will acknowledge with an apology and a symbolic payment of £200.

Complaint c)

40. The records show regular communication between the Council and Mr Y between May and October 2024. The Council has also consulted Mr Y during the assessment and care planning process. Mr Y’s views form the basis of the Council’s assessment as he provided a voice on behalf of Mrs W at a time when she did not have the mental capacity to participate in decisions about her care and support. I do not uphold this part of Mr Y’s complaint.

Complaint d)

41. Mrs W’s move into the care home was initially for a period of two weeks to provide family respite and to allow Ms Z time to recover from a surgical procedure. The records show that Mr Y and Ms Z were aware of the temporary nature of the placement and the agreed end date. The records also show the Council informed Mr Y of the proposed care package of four home visits a day to commence the day after the Mrs W’s return from respite.
42. In the Council’s view at the time, Mrs W’s eligible needs could be met with 21 hours of home care support a week. Those calls would provide personal care, support with meal preparation, eating and supporting Mrs W into bed each evening. Mr Y says this proposed package of care was not sufficient.
43. Despite Mr Y’s concerns, there was no suggestion that Mrs W would return home without any formal support. I note Mr Y’s concerns about the suitability of the family home and problems with accessibility. Having reviewed the records, it is clear the OT made a professional judgement in July 2024 that Mrs W did not require any large-scale adaptations due to her ability to walk up and down the stairs. The records show the OT kept this under review. While I appreciate Mr Y disagrees with the OT’s conclusions, there is no evidence of procedural fault in the OT’s assessment which calls the outcome into question. I do not uphold complaint d).

Complaint e)

44. The records show Mrs W’s social worker wrote to Mr Y in early September to provide information about financial contributions. The social worker also reiterated on 19 September that the weekly contribution of £188 was provisional and subject to change, pending completion of the financial assessment. The Care Act allows for councils to provide an indicative budget.
45. I note there was further confusion when the Council later re-assessed Mrs W’s finances and amended the personal budget when she became a permanent care home resident. From that point, Mrs W was treated as a single person for means-tested benefits, such as Pension Credit. This meant Mrs W needed to apply for Pension Credit to help cover the cost of her care, specifically the standard weekly amount the Council expects someone to contribute (£188 per week).
46. When working out how much she could afford to pay, the Council counted Mrs W’s pensions, which together came to £124.85 per week. Out of this income, Mrs W was allowed to keep £30.15 each week for her PEA to spend on things like toiletries, clothes, or snacks. After subtracting that allowance, Mrs W had £94.70 per week of available income, which is the amount she was expected to pay toward her care costs. This approach is not fault.
47. In response to our enquiries, the Council has confirmed it applied a nil charge for the extended respite stay. Based on the information seen so far, I find no evidence of fault in the financial assessment. Although the Council provided two different figures, this was a result of the change in the type of Mrs W’s care package (from domiciliary to permanent residential).

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Action

48. Within four weeks of my final decision the Council has agreed to:
• Apologise and pay £200 to Mr Y for the avoidable distress caused by the failure to offer alternative services between June and September 2024 despite the Council agreeing that Mrs W’s case was urgent priority due to carer breakdown.
• We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The Council will consider this guidance in making the apology I have recommended in my findings.

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Decision

49. I find fault causing injustice in some parts of Mr Y’s complaint for the reasons explained in this statement. For those parts of the complaint, we recommend the Council completes the recommended actions in the section above to remedy the injustice caused by fault. The Council has agreed to those actions, and we have completed our investigation.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman