Summary: Ms B complained about how the Council dealt with her concerns about her care and support plan. The Council addressed each of Ms B’s concerns and liaised with her and the care provider. It also reviewed her care and support plan and made sure it was sufficient to meet her needs. The Council took too long to complete the review however, and it did not handle the referral for advocacy properly. This caused Ms B uncertainty and put her to time and trouble. The Council will apologise to Ms B and make a symbolic payment. The Council will also remind staff of the process for making a referral for advocacy.

The complaint

1. Ms B complains about how the Council handled various aspects of her care. In particular, she says:
• The care provider could not send a female carer and Ms B cannot allow a male carer to provide personal care. Ms B has direct payments to find a second personal assistant but the agency managing the account is not working with her to progress this.
• The care and support plan is inadequate and not sufficiently flexible to meet her needs. The Council has not properly considered the evidenced recommendations of an Occupational Therapist’s report from 2021, and has not given full reasons for rejecting these.
• The care and support plan does not support Ms B’s nutrition as it does not allow the carers to cook her fresh food that takes account of her allergies, nor allow her the support she needs to shop for food.
• The plan does not give enough time for her to access the community and does not take account of her hospital visits, the lack of accessible transport, nor her need to visit her immediate family.
• The plan does not adequately reflect Ms B’s need for support with medication.
• The plan does not allow any contingency provision and holiday cover. The current personal assistant is owed 92 hours of holiday.
• The plan does not allow any support with household tasks so that Ms B can maintain a habitable home, with foot care, with pet care, and with correspondence.
• The Council did not arrange advocacy when she requested this.
• The Council failed to make sure that Ms B received the uplift to her direct payments in good time.
2. Ms B says that as a result of the Council’s shortcomings she is effectively housebound much of the time, she sometimes does not eat properly, and she does not always get a shower or full body wash. Ms B says she cannot fully engage with the care planning process without advocacy and without help to set up her laptop.

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The Ombudsman’s role and powers

3. 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)
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. 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 or care provider has done. (Local Government Act 1974, sections 26B and 34D, as amended)
6. The Council issued a care and support plan for Ms B in 2022, and her solicitor complained to the Council in July 2022 that it was not adequate and did not reflect the Occupational Therapist’s recommendations in their report from 2021.
7. The Council reassessed Ms B’s needs and issued a new care and support plan in April 2023. Ms B complained to the Council in September 2023 about the contents of the plan. However, she did not complain to us until October 2024. By this time, more than 12 months had passed since the decisions she was complaining about. Ms B is disabled and faces limitations, but she had legal representation and so could have complained sooner.
8. Ms B’s solicitor has asked me to consider extending the scope of my investigation to include the care planning in April 2023 and the Council’s decision not to implement the occupational therapist’s recommendations made in 2021. I have decided that I should not investigate these issues. This is because the Council reviewed the care plan in 2023 and 2024 and also had regular checks with the care provider. The Council has increased the care package and it is not clear that the current package is failing to meet Ms B’s needs. Rather that Ms B does not agree with how the care provider is implementing this. If there is no fault in the care planning since September 2023, then there is no merit in me investigating the earlier period where Ms B’s needs were broadly similar, because I am unlikely to find fault.
9. This means that I have not investigated decisions the Council made when it issued the 2022 or 2023 care and support plan, including its decision not to incorporate the recommendations of the Occupational Therapist’s report dated 2021.
10. This means that I have not investigated Ms B’s complaint that the care provider sent a male carer and her complaint that the direct payments agency did not help her find a personal assistant.
11. I have investigated the Council’s actions relating to the care planning and provision from October 2023 to October 2024. This includes the 2024 review process and subsequent plan, and any delay in paying the direct payment uplift.

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How I considered this complaint

12. I considered evidence provided by Ms B’s solicitor and the Council as well as relevant law, policy and guidance.
13. Ms B’s solicitor 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

The law and guidance

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. 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.
15. 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. Councils should consider a light touch review six to eight weeks after agreeing and signing off the plan and personal budget. They should carry out reviews as quickly as is reasonably practicable in a timely manner proportionate to the needs to be met. Councils must also conduct a review if an adult or a person acting on the adult’s behalf makes a reasonable request for one.
16. 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. The council must ensure people have relevant and timely information about direct payments so they can decide whether to request them. If they do so, the council should support them to use and manage the payment properly.

What happened

17. Ms B’s disabilities affect her mobility and cause her chronic pain. Her condition fluctuates and she cannot always know how much care she will need or what she will be able to do, even with support, on any given day. Ms B is also autistic.
18. Ms B has a care plan that was completed in April 2023 and updated at the end of July. The plan was for a total of 25 hours care and support per week. 11 hours of this was delivered by Ms B’s personal assistant and funded via a direct payment. This is 9 hours of personal care tasks and 2 hours for social inclusion. The Council commissions a care provider to deliver the remaining 14 hours. This is 12 hours of personal care and meal preparation, and 2 hours of social inclusion.
19. In September 2023, Ms B complained to the Council that:
• The care plan did not have enough hours to deliver the care she needed, and was inadequate in that there was no personal assistant cover, support with hospital appointments and medication, support with her choosing food, support with accessing all parts of her home, and contingency planning.
• The care plan did not have enough hours to help her access the community.
• There was no provision for holiday pay for her personal assistant.
• It had not arranged advocacy for her.
• She was having difficulties with the agency supporting her direct payments.
20. In October 2023, the Council, Ms B, her solicitor and the care provider met to discuss her concerns. They discussed Ms B’s concerns as outlined above. She said the care plan did not allow her to have a shower frequently enough.
21. The provider said that the Ms B wanted the carers to apply creams but these were an out-of-date prescription and so they could not do this. Ms B says the creams were in date, and the carers did not check the packaging properly. The provider also explained that it could support her in the community but Ms B needed to give it more notice to arrange this type of support.
22. The Council asked the provider for the care records so it could decide whether the package was meeting Ms B’s assessed needs, specifically in terms of her personal care, and what meals she was being offered. The care provider gave the Council notice that it would no longer be supporting Ms B.
23. The new care provider started in December 2023. At this time, the Council increased the care package by one hour per week to allow for help with showering, and a further hour to allow more time for Ms B to access the community. It said this was temporary and it would review how this new plan was working in February 2024.
24. Ms B asked the Council and the provider for help getting to a hospital appointment. The case notes show that the Council raised this with the care provider but also said that Ms B could use hospital transport or her direct payment to cover this. The care provider arranged Ms B’s transport to the appointment.
25. The Council formally responded to Ms B’s complaint in January 2024. It said:
• It acknowledged that her current care plan sets out that the impact of Ms B’s disability is different each day. It had increased the care plan hours to support Ms B with showering.
• It is for Ms B to organise cover for her personal assistant as this is delivered via direct payments. However, if Ms B cannot do this, as a last resort, the Council will try to provide cover. The direct payments also include the personal assistant’s holiday pay.
• The Council arranged a charitable grant to pay for a new laptop to help Ms B manage her direct payment account.
• Ms B should resolve problems with transport to hospital appointments with health services. If it is not possible to arrange suitable transport, Ms B can discuss this with the Council and it will review the situation.
• Health services should also help to support Ms B with administration relating to her medication.
• An OT had assessed Ms B’s access to her kitchen in January 2023 and found that the home did not need adaptations.
• It had not assessed her access to work and it will do this when it reviews the current plan in February 2024.
• The care provider should support Ms B with meals and offer a choice. If this is not happening Ms B should tell the Council who will liaise with the provider. The Council will also ensure that this is addressed when the plan is reviewed.
• The Council has increased the time for support to access the community by one hour per week.
• The Council had, in the past, arranged advocacy for Ms B, but she can refer herself for further advocacy.
• Ms B had raised a number of issues about the agency that supports her to manage the direct payments account. The Council set out the agency’s response to these issues and said it would also review how the arrangements could be improved.
• It can discuss additional support for when Ms B wants to go on holiday if the direct payments are not enough.
• Ms B could complain to the Ombudsman if she remained dissatisfied with the Council’s response.
26. At the end of January 2024, the Council met with Ms B and the care provider to discuss how the care was meeting her needs. The notes of the meetings say that there had been problems with the preferred carers being available at the weekends when Ms B needs support with socialising, but the care provider is hoping to provide more weekend cover. It will give Ms B a rota of carers so she knows who is coming.
27. They also discussed Ms B’s preferences for her care. The Council acknowledged that Ms B’s needs can fluctuate and the provider said that if Ms B tells it in the morning that she can manage a shower, it will add extra time to the evening call to manage this. The care provider said it would remind all carers how Ms B wants her meals prepared.
28. In February, the Council told Ms B it needed to review her care needs and her support. It referred Ms B for advocacy but the service said she did not meet its criteria because she does not have substantial difficulties in understanding the review process. Ms B asked the Council for a paper copy of her current care plan and assessment so she could consult her solicitor about this.
29. Mrs B chased the Council four times in March for a paper copy of the care plan and assessment. The Council also told Ms B that the advocacy service had said she was not eligible for advocacy. The Council gave Ms B the advocacy service’s details so she could contact it direct.
30. In April, Ms B told the Council that her direct payments had been increased in November 2023, but the uplift had not been added to her account. The agency handling the direct payments on the Council’s behalf advised that the uplift would be added and the arrears paid up.
31. In June 2024, the Council visited Ms B and completed an assessment of her care needs. At the visit, Ms B raised concerns with the Council about difficulties she had directing the carers with personal care and arranging a care call for support with a shower.
32. The Council arranged to visit Ms B again with the care provider to resolve this. The Council agreed with the care provider that it would offer a shower on the same two days per week and these could be rearranged as needed. The care provider said it would give Ms B a rota of the carers although this might sometimes change. The provider will offer a full body wash twice a day but it explained that staff need to ask her consent as to the parts she wants washing. The provider said they need as much notice as possible to arrange cover to take Ms B out.
33. In July, Ms B’s solicitor started to chase the Council for the updated care and support plan. The Council did not send Ms B the new plan until September 2024. Ms B’s solicitor wrote to the Council setting out her comments on the new plan. Some of these comments had already been raised by Ms B and addressed by the Council as part of the complaint made in 2023. The Council responded to outstanding comments in January 2025.
34. This is a summary of the issues raised by Ms B’s representatives and the Council’s position.
• Ms B says the care plan still does not meet her care needs as there are not enough hours of support. The Council said that the hours had been increased in December 2023 following her complaint to it and the more recent review does not support further changes.
• The Council had not arranged advocacy. The Council reminded Ms B that it had referred her but the advocacy service said she did not meet the criteria for Care Act advocacy. The Council invited Ms B and her solicitor to take this up with the advocacy service.
• Ms B complained that there was no support to manage her medication. The Council again said that this is not an eligible need for social care.
• Ms B asked for support to cover her personal assistant’s holiday or sick time. The Council reminded her that the cover was part of the direct payment package. The Council said that Ms B should try to organise cover, and if she could not then it would try to arrange support for her.
• Ms B said she needed a working laptop. The Council explained that this is not an eligible need but the Council had arranged for a grant towards the cost of this. Ms B says she still had to pay for half of this.
• Ms B said she cannot access all parts of her house. The Council explained that an OT had assessed Ms B’s access to her kitchen in January 2023 and found that the home did not need adaptations.
• Ms B reported problems with transport to hospital appointments. The Council said Ms B should resolve problems with the health service. If it is not possible to arrange suitable transport, Ms B can discuss this with the Council and it will review the situation. Ms B said she needs support while she is at hospital and other health appointments. The Council said this need can be met by a chaperone service at the site of the appointment, or Ms B can use her direct payment and social inclusion hours to attend appointments.
• Ms B had requested support to visit family and friends and for help to take holidays but this had not been recorded on the plan. The Council explained that Ms B could use her current package on holiday. It also said that if this was insufficient it could consider whether more support was needed on holiday.

Findings

Ms B has direct payments to find a second personal assistant but the agency managing the account is not working with her to progress this.

35. The Council raised the issues with the agency and the Council has told Ms B that if she cannot organise contingency care, then it will provide cover. There was no fault by the Council in this regard.

That the care and support plan is inadequate and not sufficiently flexible to meet Ms B’s needs

36. Ms B asked for more support with showering and with accessing the community. The Council increased her package of care by one hour to help with showering, but in January 2024, Ms B told the Council that this was not working and she was still not getting a shower. The Council met with Ms B and the care provider in January 2024, and reviewed the care and support assessment in June 2024. Having spoken to Ms B and to the care provider, the Council decided, that there were sufficient hours. It is for the Council to assess Ms B’s needs and how to meet these. There was no fault in how it reached its decisions and so there is no basis for me to criticise the assessment.

That the care and support plan does not support Ms B’s nutrition

37. Ms B raised with the Council that the meal preparation was not good enough. The Council discussed this with Ms B and the care provider and also took into account a consultant’s report on Ms B’s nutritional needs. The Council offered solutions such as better advanced meal preparation, using a cool bag to make it more accessible, and using ready prepared vegetables so as not to rely on ready meals. Ms B explained to the Council why she did not want to take up these suggestions and it was open to her to decline them. However, the Council has considered her needs and how it can meet these. It has made sure that there are sufficient hours in the plan for Ms B’s meal preparation and it has tried to resolve issues. As such there is no fault by the Council.

That the care and support plan does not give enough time for access to the community and does not take account of hospital visits, the lack of accessible transport, nor the need to visit family.

38. The Council met with Ms B and the care provider to discuss her concerns. The care provider is clear that it can support her to access the community (and this is also included in part of the direct payments). However, the care provider explained it needed more notice to do this.
39. Overall, the Council identified Ms B’s need to access the community and the support needed to meet this. However, it is for the Council to decide how to meet the need having taken into account Ms B’s views. It has raised her concerns that there was not sufficient time to access the community, and the care provider explained that it was trying to work as flexibly as possible but would need more notice to support Ms B. She can also arrange social inclusion support by her personal assistant paid via direct payments.
40. The Council has also explained that Ms B can arrange transport to health appointments via the health service or use her direct payments. It has also considered the help she may need while at these appointments.
41. The Council has told Ms B that she can have the same care package while away visiting family or on holiday and if this is not enough it can consider what more support she will need.
42. Again, there is no clear fault by the Council because it has considered Ms B’s care needs.

The plan does not adequately reflect Ms B’s need for support with medication

43. Ms B is concerned that the plan does not allow support for her medication. However, my understanding is that this referred to the help with applying creams and as the creams are not a prescribed medicine, the Council decided that it could not include this in the plan.

The plan does not allow any contingency provision and holiday cover. The current personal assistant is owed 92 hours of holiday.

44. The Council has discussed this issue with Ms B several times. There are funds for contingency care if Ms B’s personal assistant needs to take leave or is ill. The Council has also said that if Ms B cannot arrange a second personal assistant to cover this, the Council will arrange contingency care and support for her.

The plan does not allow any support with household tasks so that Ms B can maintain a habitable home, with foot care, with pet care, and with correspondence.

45. The Council has reviewed the care assessment and liaised with Ms B and the care provider. It has a good understanding of how the care is being delivered and Ms B’s concerns. There was no fault in how it completed the review and so it is for the Council to decide on what support Ms B needs.

The Council did not arrange advocacy when she requested this.

46. The law says the council must arrange for an independent advocate to assist a person to be involved in their assessment if they have a substantial difficulty and there is no one available to support them and represent their wishes.
47. The Council contracts with an agency to provide independent advocacy. The Council decides whether the person has substantial difficulty and needs the service to engage with the assessment process. The Council made a referral to the agency for advocacy. It said that Ms B had substantial difficulty. The agency told the Council that it had provided advocacy for Ms B in the past and it did not agree that she had substantial difficulty engaging with the assessment.
48. The Council has acknowledged that it should have ensured that the service went ahead with the advocacy or it should have decided that Ms B did not need it. The Council has also acknowledged that it should not have told Ms B that she could refer herself to the advocacy service. If it had decided that she was not eligible for advocacy, then the Council should have directed Ms B to the complaints process. This was fault by the Council.
49. I cannot decide even on the balance of probabilities whether Ms B would have been eligible for advocacy. This is because the service has raised doubts about her eligibility. I also cannot say if this would have altered the outcome of the assessment, and this is the issue at the heart of Ms B’s complaint to us. However, the Council’s mishandling of this caused Ms B uncertainty and frustration.
50. The Council has explained that the advocacy service was new at that time and it was getting used to the processes and its role. I am satisfied that the Council understands it remains responsible for deciding who is eligible for advocacy. It will also remind staff of the correct process and how a person can challenge a refusal of advocacy. It will also ensure that it monitors the service in regular meetings with it. The Council offered to refer Ms B to the advocacy service again.

The Council failed to make sure that Ms B received the uplift to her direct payments in good time.

51. Periodically, the Council will change the rates of direct payments to reflect inflation, the market, and the cost of living. These changes are not regular eg, annually, but can be agreed at any time, and the changes applied in retrospect.
52. I have only looked at uplifts agreed during the scope of this investigation, from October 2023 to October 2024. The Council changed the rates of the direct payment for home care in November 2023 and in June 2024. The Council has explained how it paid these uplifts to Ms B. These were paid in the November and June as they were applied and so the Council did not delay bringing the payments up to date.
53. In addition to these uplifts applied to all direct payments involving home care, the Council increased Ms B’s care package and this meant her direct payment for her personal assistants also increased. The Council increased Ms B’s package of care in December 2023, but it did not instruct its finance service to make the payment until May 2024. This was fault by the Council.
54. However, the injustice this caused Ms B is limited because she had sufficient funds in the direct payment account to cover the increased package until the Council paid the increase into the direct payment account.

Other matters

55. The Council could have handled the review process better. Ms B asked for a paper copy of the care and support plan to discuss with her solicitor prior to the review in February 2024. The Council did not send this to Ms B until April and the review, that was supposed to happen in February, did not happen until June. The Council then did not send the amended care and support plan to Ms B until September.
56. Ms B did not miss out on care during this time, but the Council’s shortcomings put her time and trouble in pursuing it.

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Action

57. The Council will within one month of the date of this decision:
• Apologise to Ms B for mishandling the advocacy referral and for taking too long to increase the direct payment when it increased her care package. We publish guidance on remedies which sets out our expectations for how organisations should apologise effectively to remedy injustice. The organisation should consider this guidance in making the apology I have recommended in my findings.
• Pay Ms B £150 in recognition of the uncertainty it caused and trouble it put her to when it took too long to arrange the review and send her the care and support plan, and when it mishandled the referral to the advocacy service.
• Share this decision with the relevant staff, and remind staff that make referrals to the advocacy service that it is for the Council to decide the person’s eligibility, and that they should refer a person who wishes to challenge this decision to the Council’s complaints process.
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 has agreed actions to remedy injustice.

Investigator’s decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman