Summary: Mrs C complained that the Council had significantly reduced her care and support hours without adequate justification, which was causing her and her husband significant distress and inconvenience. We found some fault in the second assessment in October 2024. But we also found that Mrs C has not taken up offers of reablement care to provide more evidence of her care and support needs. The Council has agreed to offer Mrs C a period of reablement care followed by a review of the assessment from October 2024.

The complaint

1. Mrs C complained that Blackburn with Darwen Council (the Council) unreasonably reduced her care and support hours from 20 hours a week to six. It failed to take account of evidence from her GP that she could not manage to take medication unassisted and needed toileting assistance. It has also confused her need for support to access activities in the community for her wellbeing with her need to maintain social and family relationships. It has failed to properly consider the impact of this reduction on her husband, Mr C or how he can manage cleaning in addition to working and the increased care of Mrs C. Neither has it considered how he can access respite care when he cannot afford the charge. The reduction in care hours has significantly impacted on Mrs C’s mental health and caused both her and Mr C significant distress.

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The Ombudsman’s role and powers

2. We investigate complaints of injustice caused by ‘maladministration’ and ‘service failure’. I have used the word fault to refer to these. 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)
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(1), as amended)

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How I considered this complaint

4. I considered evidence provided by Mrs C and the Council as well as relevant law, policy and guidance.
5. Mrs C and the Council had an opportunity to comment on my draft decision. I considered any comments before making a 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.

Care Plan

7. The Care Act 2014 gives councils a legal responsibility to provide a care and support plan (or a support plan for a carer). 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. When preparing a care and support plan the council must involve any carer the adult has. 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.

Reviews

8. Section 27 of the Care Act 2014 says councils should keep care and support plans under review. Government Care and Support Statutory Guidance says councils should review plans at least every 12 months.

Direct payments

9. 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.

Carer’s budgets and respite

10. The Care Act 2014 says the council may meet the carer’s needs by providing a service directly to the adult needing care. The carer must still receive a support plan which covers their needs, and how the council will meet them. The carer’s personal budget must be an amount that enables the carer to meet their needs to continue to fulfil their caring role. It must also consider what the carer wishes to achieve in their day-to-day life. Part of the planning process should be to agree how the carer will use the personal budget to meet their needs. (Care and Support Statutory Guidance 2014)

Council’s respite care scheme

11. The Council charges a fixed amount for respite care which it provides either by vouchers or direct payments. The fixed charge for the current year is £143.04 per week. The Council says the carer is not expected to pay towards the respite care but the person being cared for is expected to make a financial contribution at the respite rate.

Eligibility criteria

12. The Care and Support Statutory Guidance 2014 lists ten outcomes which should be considered as part of the assessment process. These include:

g) developing and maintaining family or other personal relationships and

i) making use of necessary facilities or services in the local community including public transport and recreational facilities or services.

What happened

13. Mrs C has care and support needs. She had been receiving 20 hours of support by direct payments for several years, using a care provider and a personal assistant.

Assessment review 1

14. In January 2024 the Council started a review of her care needs assessment. The social worker (SW) obtained details of the support the care provider had been giving. SW was concerned that Mrs C was using the support for tasks not included in her care and support plan, such as dog walking, helping in the family café, cleaning the house and helping Mrs C with shopping and exercises.
15. SW met with Mrs C to discuss her needs. Mrs C explained that she needed her carers to give the morning medication to her as she could not use her hands to release the tablets from the blister pack when she woke up. She then needed to wait 10 to 20 minutes for the medication to work before she was ready to shower. SW suggested using a medication dispenser to promote independence and which Mr C could fill before he went to work.
16. Mrs C said she attended the family café most days, so she was not left alone unsupervised. Her father (to whom she provided care) came in most days. SW discussed what support Mrs C provided to her father (help with shopping and finances) and how this worked with her own care needs. Mrs C expressed interest in joining a book club at the café. SW said the staff running the book club and who she employed at the café could provide the support she might need. Mrs C disputes this would be possible.
17. Mrs C also said she wished to spend time away from her family such as going swimming which she found enjoyable but needed someone to help her get un/dressed.
18. SW said that Mrs C’s assessed needs were for personal care and toilet needs. Mrs C said she had not received a copy of her care plan for several years. In order to get a clearer picture of Mrs C’s needs SW suggested a period of assessment with reablement care. Mrs C declined this offer, due to previous bad experiences.
19. Mrs C said she needed to be supervised most of the time as she was prone to fainting episodes. SW said this problem had not been noted on her medical records since 2021. Mrs C said she had provided evidence of a recent episode at the dentist where an ambulance had been called. She said she only drove occasionally and never very far.
20. The SW concluded the assessment, reducing the care hours from 20 to 12: one hour per day with morning personal care for six days a week, 30 minutes a day for lunch preparation, five days a week, 30 minutes per week to attend medical appointments and three hours a week for social support. SW sent Mrs C copies of the previous two support plans and said a medication dispenser would be ordered.
21. Mrs C disputed the assessment. She felt SW had been unduly influenced by the information from the care provider’s records. Following a referral by the Council, she spoke to an advocate and met with a manager on 7 February 2024. She also met with SW on 21 February 2024 to discuss the assessment. Mrs C explained that one hour in the morning was not enough to carry out all the tasks because she needed to wait 10 to 30 minutes for her medication to work. She did not think she could use a dispenser and was worried what would happen if she dropped the medication on to the floor and there was no-one there to help her. SW suggested a cup could be used for the medication which she could tip. Mrs C said there was still the possibility she would drop the medication on to the floor.
22. They discussed the book club at the café and SW explained why they did not think she required extra support with this. They also discussed support with Mrs C’s exercises. SW had spoken to a community physiotherapist who said if Mrs C could not complete the exercises herself, she should be rereferred to look at alternatives. SW said it was a health need. She requested Mrs C’s consent to talk to her physiotherapist, but Mrs C declined.

Stage one complaint

23. On 22 February 2024 Mrs C made a formal complaint about the assessment process. SW contacted the physiotherapy service for information about Mrs C’s exercises. Mrs C had not seen a community physiotherapist since 2017. She tried to contact Mrs C’s GP but they would not give summaries of Mrs C’s records and said to request the information by email
24. The Council responded to her complaint on 26 March 2024. It said the assessment process was still ongoing. It repeated its offer of a period of reablement care to properly assess Mrs C’s needs. It apologised for not sending her the previous two support plans. It said it apologised if Mrs C had found the conversation with SW about the use of her direct payments distressing but it was necessary as the information obtained had indicated the payments were not being used correctly.
25. On 22 April 2024 the Council carried out a carer’s assessment of Mrs C in respect of the support she provided to her father. She asked for some respite as she spent a lot of time providing emotional and social support and providing his meals.

Crisis care

26. In May 2024 Mr and Mrs C and her advocate again met SW to discuss the assessment. They discussed the medication, and SW said it was difficult to properly assess her needs in this area when Mrs C had not actually tried the dispenser. SW had not ordered the dispenser at this point. During this period Mrs C agreed to have some crisis care as she could not source the care she needed temporarily with her direct payments.
27. SW then completed the support plan confirming a reduction in support hours from 20 to 12.
28. In early June 2024 Mrs C told the Council she was not managing with the reduced hours, and it was significantly affecting her mental health. She said she could not take the medication herself. SW said she had ordered the medication dispenser, Mrs C could use her disability benefits to pay for cleaning and given that she helped her father with shopping she could manage her own. SW said physiotherapy was a health need and was not arranged through either her GP or the hospital. Mrs C denied she regularly looked after her grandchildren and said it was dangerous for her to do domestic tasks. SW offered reablement care again. Mrs C said the safeguarding team was going to visit her and she requested an occupational therapy assessment.
29. The crisis team told SW that they were having problems with Mrs C’s medication and said they were unable to administer it, as it was not part of their duties but felt that Mrs C could manage it. They also queried the travel time to appointments as some were in a city some distance away. SW asked them to administer the medication until the dispenser arrived. Mrs C said she felt suicidal, and Mr C was expected to do all her care.
30. The safeguarding team visited Mr and Mrs C on 6 June 2024. They said they would recommend a review of the assessment.
31. On 10 June 2024 the Council visited to trial the medication dispenser. Mrs C was not happy with it and said she could not use it. The crisis team spoke to SW as there had been further problems administering Mrs C’s medication due to the loss of the medication chart. They said they had seen Mrs C take medication out of the blister packs the previous day and felt she could use the medication dispenser. She had not tried it the previous week. Mr C said she could not use the dispenser.

Stage two complaint

32. Mrs C requested a new social worker and said that the care staff had lied about her ability to take her medication. On 20 June 2024 her advocate made a further complaint about the completed assessment.
33. On 12 July 2024 an occupational therapist (OT) visited Mrs C to assess her. In respect of the medication, the OT noted Mrs C”s view that she could not take her own medication, even with a dispenser. The OT witnessed Mrs C’s personal assistant help her to take the medication but did not see Mrs C try to take the medication out of the blister pack. The OT said Mrs C needed help with personal care including washing, dressing, applying creams and taking medication.
34. The Council responded to Mrs C’s complaint on 19 July 2024 .It said it was satisfied it had met its statutory duties towards Mrs C in terms of the Care Act and the assessment review had been carried out appropriately and correctly. The Council had extended the review process to accommodate Mrs C’s views and get a full picture of her needs. It again said the offer of reablement care was available to further consider her needs. SW had taken account of her mental health needs when carrying out the assessment and fully discussed all the issues with her. It had not disproportionately concentrated on the alleged misuse of the direct payments but was focussed on getting an updated understanding of Mrs C’s needs. It said it would carry out a further review in 12 months time.

Assessment review 2

35. Mrs C continued to raise concerns about her situation with the reduced care and in September 2024 the Council offered to carry out a second review with a social worker from a different team (SW2). This took place in October 2024.
36. In the report of the assessment visit SW2 noted in respect of her dexterity that Mrs C held a milkshake in her hand for over ten minutes. Mrs C said she could not sit in the same position for long. SW2 said she sat for almost three hours, with slight re-positioning and two toilet trips. Mrs C said she felt an increase in her hours would have a positive effect on her mental health such as going out swimming or for a coffee and help with cleaning the house.
37. SW2 said it was understandable that Mrs C required formal support with personal care needs. She also said that if Mrs C could take her medication herself before the carer’s visit, then this would allow more time for her personal care needs. She said Mrs C would benefit from reablement input to assess how long and how often personal care support is required. SW2 concluded that Mr or Mrs C could tip her medication into a cup the night before so Mrs C could take them herself in the morning, thereby removing the need for extra time at the morning visit to allow the medication to work. Mrs C said during this visit that it took between 1.5 and 2.5 hours to deal with her personal care needs in the morning.
38. SW2 then justified a cut in the personal care hours by removing the lunch support saying that the carers could prepare a sandwich in the hourly morning visit.
39. SW2 also removed the three hours a week for social support, saying that Mrs C has a good family support network and was able to attend the café for social input, so she was not socially isolated and formal support was not required.
40. Finally, SW2 removed the support to attend appointments saying it was a health not a social care need. She said if Mrs C could not get to her appointments, she needed to discuss this with the GP to undertake home visits.
41. SW2 discussed Mrs C’s case at a manager’s meeting. SW2 recognised that she was recommending a significant cut in the personal care hours but felt that Mrs C’s attendance at the family café provided significant social support and community access. She considered there were no grounds for providing support with attending medical appointments as Mrs C could get to them independently. Mrs C had also refused reablement care. The meeting concluded that Mr and Mrs C should be allowed a short period to submit further information but if this did not change SW2’s view then the change in hours should be implemented.
42. Mrs C refused an offer of a visit from SW2 to discuss the assessment and said the café would be closing at Christmas. In November 2024 Mrs C provided a letter from her GP confirming that:
• she struggled to take her medication due to dexterity issues so needed help with this;
• she struggled with exercise and fulfilling her hobbies because she needed one to one support;
• she needed help to clean herself after using the toilet;
• due to issues with seizures and fainting she needed someone with her most of the time;
• Mrs C’s mental health was suffering and had sought help from the Mental Health Team; and
• Mr C was acting as her unpaid carer which was affecting his mental health and financial difficulties as he could not put as much time into his job.
43. Mrs C also provided details of a fainting fit she had experienced at the dentist in July 2024 for which an ambulance was called. She said she needed 1:1 support to attend community activities and could not manage the medication herself even with a cup or dispenser.
44. SW2 responded to Mrs C in December 2024 having considered the information she had provided. SW2 maintained her view that Mrs C could manage her medication if placed in a cup the night before. SW2 did not consider Mrs C was socially isolated and felt she could maintain social contacts and activities without additional support. She considered six hours a week of support was sufficient to meet her needs. She offered Mrs C a period of reablement to assess if it was sufficient. In respect of Mr C, he had a carer’s assessment in October and had been given cash-equivalent respite vouchers.

Stage two complaint

45. Mrs C continued to dispute the assessment. She attended a meeting at the Council on 14 January 2025 with senior managers. One of the managers said that taking medications alone was a health-related issue and would only be an issue for social care if it was ancillary to care needs. This need could be met by suggesting equipment or alternative management outside of formal paid care. They went on to say that the Council did not provide carers solely to dispense medication. They advised that SW2 could support Mrs C to attend a GP appointment to discuss alternatives medication for example a slow-releasing medication instead.
46. In respect of social support and accessing the community Mrs C explained that the interactions in the café did not support her social needs or her hobbies. She would like to go swimming but needs support with personal care and toilet needs. The Council said that in terms of accessing the community, Mrs C was currently maintaining relationships in a number of ways and still had access to the community and could maintain her social relationships. Mrs C explained that she does not enjoy the time in the café: it was a necessity to keep herself safe whereas she had a right to do some activities she enjoyed.
47. Following the meeting SW2 tried to contact a social prescriber without success. Mrs C confirmed that she had discussed a change in medication with her doctor, but no alternatives were available, and she could not use a medication dispenser.
48. The Council closed her case in February 2025 with a referral to an organisation who provided access to community activities. It noted Mrs C had again refused an offer of reablement care and a visit to her GP with SW2. Mrs C said because she had already discussed the matter with the GP herself. The Council’s final complaint response confirmed its position remained unchanged and directed Mrs C to complain to us.

Council response to my enquiries

49. In response to my enquiries the Council said in respect of the medication that Mrs C had requested carers to administer her medication, wait 30 to 40 minutes for the medication to take effect and then to deliver personal care. The Council did not consider the likelihood and frequency of Mrs C knocking over the cup was proportionate to the amount of daily care Mrs C was requesting. It said she had requested the morning visit be increased by an hour (this is not recorded in the minutes of the meeting). It noted she had refused an offer of reablement care to evidence whether she could manage the medication. It said it would be happy to revisit discussions regarding the medication dispenser as there were many models available, some of which do not require fine motor skills.
50. In respect of the social hours, it said the review assessment had not identified that Mrs C had any eligible needs in this area. It said it had noted Mrs C’s regular contacts with family members and the wider community during the time she spends in the family café. It also took account of her ability to engage in personal travel without support, that she was a carer for her father and helped him to access local community resources and that she cared for her grandchildren. In respect of wider community activities, the Council said it had made referrals to community connectors and social prescribers, but Mrs C did not wish to pursue any of the activities proposed. I have not seen evidence of the proposals or Mrs C‘s refusal.
51. In respect of toilet needs it acknowledged Mrs C’s concerns over this issue when she was out in the community. However, it noted that she was able to manage her needs during the day by using incontinence products and the special toilet fitted at her home. If Mrs C did not feel these were sufficient then it suggested she discuss the situation further with her GP.
52. In respect of the fainting episodes, the Council acknowledged the information Mrs C had submitted regarding these episodes. It said she had been provided with a telecare pendant since 2021 and there was a key-safe at the property. But it also noted this was not an active problem for Mrs C in her everyday life as she still drove her car, along with caring for her father and grandchildren.
53. It explained that the Council had carried out a carer’s assessment of Mr C in October 2024 and noted that his situation would improve if Mrs C’s received more formal support. A previous carer’s assessment had offered support to Mr C by a direct payment, but Mr and Mrs C declined this offer due to the financial contribution Mrs C would have to make. In respect of cleaning the Council has advised that cleaning is not included in personal care support, and they would need to employ a private cleaner.

Findings

54. The Council is entitled to assess Mrs C’s care needs based on the evidence obtained from all sources through the course of the assessment process. This may change from previous years if there is evidence that Mrs C’s needs have changed. In January 2024 SW identified that some of Mrs C’s direct payments were not being used in accordance with her care plan and so she had a legitimate reason to reassess the support Mrs C required. In October 2024 SW2 was carrying out a review of the January 2024 and reached a different view on the amount of support Mrs C required. It is not for me to say whether the amount of support is correct or not but to identify whether there was any fault in the way the decisions were reached.
55. The main points of contention in the assessment are administering morning medication, access to activities and services in the community, toilet needs and supervision needs. I will deal with these in turn below:

Medication

56. There is conflicting evidence over Mrs C’s needs in this area. She says she cannot take her medication unaided in the morning, either out of a cup or a dispenser. Her husband agrees with this. Her GP says she needs support to take her medication but does not give a view on whether she can use a dispenser or a cup. The OT said she did not witness Mrs C attempt to take her medication either out of a dispenser or a blister pack but said she needs assistance to take her medication.
57. On the other hand, the Council has two anecdotal accounts from carers that they believe Mrs C can take her medication from a dispenser and they have seen her take it from a blister pack. It also says it has not seen Mrs C trying to use the dispenser and she has not been willing to discuss if any other dispensers would be more appropriate. Mrs C has also consistently declined the offer of a period reablement care to further consider her needs in this area or allow SW2 to accompany her to a GP appointment to discuss dispensers or other alternatives.
58. On the basis of the information it has, the Council has concluded that Mrs C should be able to use a cup to take her medication and the likelihood of her dropping the medication is low. I consider this is a speculative view unsupported by evidence. I also consider there is conflicting about the amount of extra time Mrs C was requesting for the morning visit: the evidence I have seen suggests she was asking for between 10 and thirty minutes extra, not an hour. Given that the lunch preparation time has been consolidated into the morning visit, it seems possible to carry this out while the medication works, with the medication support still being ancillary to the other care tasks. The Council has taken its figure from Mrs C’s estimate that her personal care needs visit took between 1.5 to 2.5 hours.
59. However, I also note Mrs C has declined all other avenues to allow the Council to gather more independent evidence, either through reablement care or discussion with her GP. So, there is insufficient evidence to support either Mrs C’s position or the Council’s and I am unable to reach a conclusion that the Council is at fault.

Social support

60. SW2 concluded that Mrs C had no eligible needs in either
• developing and maintaining family or other personal relationships or
• making use of necessary facilities or services in the local community including public transport and recreational facilities or services.
61. The reasons given in the assessment report are because she attends the family café and has a good family support network. I accept the evidence supports the conclusion that her family and personal relationships criterion is met through daily attendance at the café. I do not consider the reasoning covers the second outcome and it does not mention at all her wish to do something away from her family and her caring responsibilities.
62. Neither does the assessment explain why SW2 considers Mrs C is able to access the community without support given her fainting episodes and toileting needs.
63. In response to my enquiries the Council has given much more detail to support the conclusions of the review assessment, saying Mrs C had regular contact with the wider community as well as family members during the time she spends in the family café, that it took account of her ability to engage in personal travel without support, that she was a carer for her father and helped him to access local community resources and that she cared for her grandchildren (disputed by Mrs C). These activities/abilities are not mentioned in the assessment report, are largely disputed by Mrs C and no explanation is given for how she can manage these activities given her stated supervision and toilet needs (supported by her GP). As I have said above, I have not seen evidence of any other community activities being put forward or considered, beyond swimming which the Council has refused to support.
64. Given the cut in social support hours was significant and contradicted SW’s view in the first assessment only nine months earlier (where Mrs C’s presenting needs were the same), I do not consider the Council has provided sufficient reasoning or evidence to Mrs C to substantiate its view that Mrs C’s needs in accessing the wider community are met by the café visits alone. This is fault which has caused some uncertainty to Mrs C

Travel to medical appointments

65. SW2 concluded that Mrs C did not need support to attend medical appointments as it was a health need. This again is a contradictory view to that expressed by SW nine months earlier when she considered Mrs C needed support. There is no explanation of the change of view or any reasoning as to why Mrs C can get herself there safely with no need of supervision. The suggestion that the GP can visit at home may not be viable and will not apply to hospital visits in a different city.
66. The Council’s response to my enquiries again gives more information establishing its view that Mrs C has a telecare pendant, this is sufficient to keep her safe when out in the community without support and that she can ask her GP for more assistance in managing her toilet needs when out in the community. These issues were not explained or substantiated in the assessment. Again, this is fault which means Mrs C was unclear why that support had been removed.

Summary

67. Overall, I do not consider the Council has given adequate justification for the significant cut in support hours between January and October 2024 when Mrs C’s presenting needs had not changed.
68. It is not for me to say how much support Mrs C needs, but I consider further assessment and evidence is needed to substantiate the Council’s current view. I recognise the Council has tried to achieve this by repeatedly offering Mrs C a period of reablement care and accompanying her on a visit to her GP, but Mrs C has consistently declined.

Carer’s assessment/respite care

69. The Council has carried out a carer’s assessment in respect of Mr C and offered him vouchers and direct payments towards respite care. As Mrs C will have to make a financial contribution towards the respite care they have declined to use the support. This is clearly a difficult choice to make but I have not found fault with the Council’s actions here.

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Action

70. I recommended the Council, within one month of the date of my final decision, offers Mrs C a period of reablement care followed by a review of the assessment done in October 2024 to reach a definitive view of Mrs C’s care needs including her ability to take medication with or without a dispenser, her ability to access the wider community including recreational activities outside of the café and her medical appointments without support.
71. If Mrs C does not wish to participate in the reablement care or the reassessment, the support plan following the October 2024 assessment remains valid.
72. The Council should provide us with evidence it has complied with the above actions.

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Decision

73. I find fault causing injustice. The Council has agreed actions to remedy injustice.

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Investigator's decision on behalf of the Ombudsman